摘要:

The efficacy of pneumococcal vaccine given after splenectomy lacks experimental validation. Adult CD-1 male mice that received type III pneumococcal capsular polysaccharide vaccine 1 μg IP, 48 hours postsplenectomy and 7 days before challenge with aerosolized type IIIStreptococcus pneumoniaehad a significantly higher mortality (96%) compared to immunized controls (64%) (p< 0.002). The vaccine protected immunized sham-operated mice compared to unimmunized controls (p< 0.015). Mice immunized 7 days before splenectomy were equally protected when compared to immunized sham-operated mice (p= NS). All deaths were secondary to culture-proven pneumococcal infection. These findings corroborate previous experimental and clinical studies demonstrating an impaired immunologic response and increased susceptibility to infection in asplenic individuals. Pneumococcal vaccines should be given before nonemergent splenectomy. Alternatives to splenectomy should be considered for patients with traumatized spleens where possible.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The effect of splenectomy on the ability of alveolar macrophages of young and adult rats to phagocytize Pneumococci, Types 3 and 14, andPseudomonas aeruginosawas studied. Young animals showed a significant (15%) decrease in the phagocytosis of pneumococci type 14, 4 weeks after splenectomy. This depression increased to 30% in 6 weeks' time. Such depression was also noted when young splenectomized rat alveolar macrophages were challenged withPseudomonas aeruginosabut not with type 3 pneumococci 6 weeks postsplenectomy. Three months following splenectomy in young animals, the rats were grown and they seemed to regain their normal phagocytic activity against pneumococci type 14. Adult rats also showed no alteration in their phagocytic activity against type 3 pneumococci. Autoimplantation of the spleen had a protective effect on the phagocytosis of type 14 pneumococci, and a nonsignificant effect on that of type 3. The present study postulates a modulatory role of the spleen on alveolar macrophage function. Splenectomy may cause the impairment of local lower respiratory immune function, making lungs vulnerable to specific bacterial invasion. Such splenic modulatory effect on alveolar macrophage phagocytic function seems to be age and antigen specific.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The possible value of albumin in a rabbit model of the acid aspiration syndrome was studied. Hydrochloric acid was instilled into the respiratory tracts of three groups of rabbits: Group A received a high intravenous dose of human albumin (1.5 gm/kg body weight); Group B (control) was given Hartmann's solution, and Group C a low dose of albumin (0.25 gm/kg body weight). The total amount of intravenous fluids was identical in all groups. Serum and pulmonary edema fluid (PEF) concentrations of total protein were highest in Group A. Simultaneous concentration gradients between serum and PEF for total protein, human and rabbit albumin, and globulin fractions were not statistically different in the three groups. In Group A, PEF appeared first and PaO2, static compliance, and hematocrit decreased significantly more than those of the two other groups. Survival of animals in Group C was highest. An additional Group (D) of rabbits received the same high dose of albumin without acid aspiration. In Group D hematocrit decreased while serum total protein and pulmonary function remained unchanged.It seems that a high dose of albumin causes a further deterioration of lung function following acid aspiration because of extravasation into the interstitial space. The administration of low doses of albumin was not different than Hartmann's solution, but led to the best survival in our model.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Neutropenia often accompanies septicemia in burned patients. This paradox suggests a defect in the regulation of granulopoiesis. Colony stimulating factor (CSF) produced by the monocyte-macrophage system is an important regulator of granulocyte production. We followed serial serum CSF levels and peripheral blood leukocyte differential counts in 22 patients with >30% burns. Six patients (mean burn, 58%) developed Gram-negative septicemia and died (Group I). Sixteen patients (mean burn, 38%) had no fatal septicemias (Group II). Nonsurvivors had initially low levels of CSF and developed persistent monocytopenia. Survivors, in contrast, had prompt rises in CSF and developed monocytosis. The presence of monocytopenia and low CSF levels in Group I suggests an abnormality in the stimulatory arm regulating granulopoiesis. Such a defect may play a role in the development of fatal septicemia following severe thermal injury.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A double-blind prospective study was done to assess the benefit of delaying closure of the wounds associated with open fractures. An additional doubleblind study compared the effectiveness of clindamycin versus cefazolin for prophylactic antibiotic coverage. Quantitative cultures of the wounds were accomplished at the time of debridement and again at the time of closure if the wound was not closed initially.Almost half of the wounds were contaminated (46%) at the time of debridement, although the incidence of wound infection was low (6.5%).Gram-negative organisms resistant to the prophylactic antibiotic were recovered initially only eight times, but four of these (50%) became infected. The contaminating organisms in each case were present in high concentration (greater than 105CFU/gm of tissue) at initial culture. The time of wound closure, cefazolin versus clindamycin, and internal fixation of the fracture were not followed by significant differences in the development of clinical infection in this series.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Intraoperative autotransfusions for selected patients can ease demands on blood banks. In 33 cases (trauma, elective vascular, and cardiac procedures), we saved 80.7 L of blood with a cell washer blood recovery system (Cell Saver®). In eight trauma cases, including three with intestinal perforation, cell washing salvaged 31.5 L of shed blood as a lifesaving emergency procedure. This stimulated interest in defining the limits of the instrumentation in cleansing blood of bacteria. In 18 in vitro experiments, discarded banked blood was inoculated withEscherichia colito simulate light, moderate, or heavy bacterial contamination. Volumes of blood (500 ml) containing a total of 6.3 × 105, 4.8 × 107, or 3.2 × 1010bacteria were processed. The original blood, filtered blood, plasma supernate, effluent wash solution, and final washed packed red cells were cultured quantitatively in each experiment. The mean total number ofE. coliretained in the final washed packed red cells was 1.4 × 105, 6.3 × 106, or 1.6 × 102bacteria, or 23%, 13%, and 5% of each original inoculum. Additional washing with 10 L of saline did not remove significantly more bacteria (p> 0.20). Although emergency autotransfusion of blood contaminated with intestinal contents was lifesaving, we recommend caution since these results show that cell washing does not remove all bacteria. Further laboratory and clinical studies are needed to determine the levels of bacterial contamination of autotransfused blood that can be tolerated, and to determine adjunctive means of rendering contaminated or potentially contaminated blood safe for autotransfusion.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Three hundred eighty-seven cases of isolated fractures of the radial head are reviewed, that were treated over a 20-year period by the authors without operative intervention. Mason types I, II, and III were all included in this group. Excellent and good results were usually obtained. Seventeen radial head fractures were excised during the same 20 years because of severely displaced and/or loose fracture fragments. Roentgenographic and physical examination were the criteria for surgery rather than any specific classifications. The cooperation of the patient with early range of motion exercises was the major factor in obtaining excellent or good results with this injury.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

If the elbow is filmed in flexion in a pubertal age child, the proximal radial epiphyseal line may be projected through the articular surface of the radial head on standard or oblique AP views. This can theoretically mimic a fissure or chisel-type fracture. Fractures involving the articular surface of the radial head, however, are extremely rare in children and the true fissure fractures that occur in the adult are notably different in specific radiographic features.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

One hundred thirty-six patients with penetrating injuries of the neck over a 4-year period were studied prospectively. Seventy-two patients (52.9%) had no major physical signs on admission, 56 were observed without complications, and 16 had a negative exploration. Injuries below the level of the cricoid cartilage were associated with a very high mortality (12.12%). We recommend a policy of selective conservatism in the management of penetrating neck injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In the treatment of unstable pelvic fractures, external fixators provide the advantages of substantial pain relief, easier nursing care, early mobilization, decreased hospital stay, and direct access to open wounds. Urethral catheter drainage alone for ruptured bladders obviates the need for open surgical repair in a critically injured patient and reduces morbidity and pain. Three cases are reported with bladder complications arising from these recently advocated methods of management; two with external fixators and one with urethral catheter drainage. In one patient with an external fixator, stretching of the bladder over a bone fragment resulted in transient hematuria with activity. In a second patient, the protruding bladder wall was caught between opposing pubic rami. In an extraperitoneal bladder rupture with pubic rami fractures, urethral catheter drainage alone resulted in a pseudodiverticulum of the bladder with a bone fragment projecting through the hole in the bladder cavity. These cases illustrate some complications with these recently advocated methods of management of unstable pelvic fracture and ruptured bladder.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID