摘要:

We reviewed the charts of 21 patients on the Trauma Service who were operated on for intestinal obstruction for the years 1983 through 1985. Six (28.6%) of the 21 patients had intussusception as the cause of their obstruction post-laparotomy for trauma. All were males ages 17 to 25 years. The mechanisms of injury were gunshot wounds in three, stab wounds in two, and blunt trauma in one.Five patients were hypotensive on admission with systolic BP <70, and two patients received uncrossmatched blood preoperatively. Injuries at exploration included liver laceration (six patients), gastric perforation (two patients), and diaphragmatic lacerations, splenic laceration, renal injury, and ventricular injury, one each. No patient suffered small intestinal injuries and we cannot explain the occurrence of intussusception.Intussusception occurred in the first 8 postoperative days in four patients and at 21 days, and 10 months, in the remaining two. The diagnosis was made twice by CT scan preoperatively.Jejunojejunal intussusception was common (five patients), jejunoileal in one and ileocolic in one (who also had a jejunojejunal intussusception). All patients were treated with manual reduction alone and none recurred. There were no postoperative complications and all patients were discharged by the eighth postoperative day.Our study suggests that early postoperative obstruction is caused by intussusception with unexpected frequency in trauma patients, and can be diagnosed by CT scan in some cases. Treatment with operative reduction has an excellent prognosis.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Few past studies have examined the long-term functional outcome of geriatric patients who survive trauma. To evaluate factors that determine the long-term potential for recovery in this population, we studied 63 survivors of blunt trauma over age 65 years between 9 and 38 months after hospital discharge. The overall level of injury was moderate, with a mean Injury Severity Score of 15.8 ± 1.1. Thirty-nine patients (62%) had two or more body regions injured. Forty-five patients (71%) had pre-existing cardiopulmonary disease. Surgery was required in half of the patients, one third experienced complications, and nine (14%) required ventilatory support for 5 or more days. Only two patients did not live independently before trauma. Immediately after discharge, 21 patients (33%) were independent, 23 (37%) were dependent but living at home, and 19 (30%) required nursing-home care (NH). NH patients were older, more severely injured, had more severe head and neck trauma, and required surgery more frequently after trauma than patients discharged directly home. Twelve of the 19 NH patients (63%) returned home 3.1 ± 0.9 months after discharge, and 13 of the 23 dependent patients (57%) became independent. Ultimately, 56 patients (89%) returned home after trauma. These patients were younger, had a shorter hospital stay, and experienced fewer complications than patients who required permanent NH care. Among 12 patients 80 years old and over, eight patients eventually returned home. Overall, 38 patients (57%) returned to independent living after trauma. Aggressive support of the elderly trauma victim appears justified, since few patients require permanent NH care and the majority return to independent living after trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The safety and effectiveness of continuous epidural fentanyl analgesia (CEFA) in the treatment of blunt chest injury was evaluated by reviewing its use in 40 patients with multiple rib fractures or flail chest. Ventilatory function tests were performed before and after the institution of CEFA and mean changes calculated.The use of CEFA was associated with significant improvement in vital capacity and maximum inspiratory pressure (p < 0.05). Minute ventilatory volumes and tidal volumes also showed slight improvement. There was no significant change in arterial CO2tension with the institution of CEFA, and 85% of patients had good pain relief with CEFA. None of these patients required any other narcotic administration. Documented complications associated with CEFA included pruritus, urinary retention, and transient hypotension. There were no major associated complications.The results suggest that CEFA is a safe, effective method of pain control that acts to improve ventilatory function in patients with blunt chest trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Waning of hyperglycemia has been shown to be closely associated with the deterioration of mechanisms supporting homeostasis during hemorrhagic shock. However, the mechanisms which link plasma glucose levels to maintenance of homeostasis during hemorrhagic shock are not clear. The goal of the present study was to evaluate the importance of glucose to maintenance of compensatory mechanisms. This was undertaken by maintaining plasma glucose levels through infusion of hypertonic glucose (2–3 M) starting at the onset of decompensation during persisting hypovolemia. Administration of glucose at a rate of between 60 and 80 μmoles/min x kg arrested the fall in glucose concentration and significantly slowed or arrested the decompensatory phase. All of the saline infused control animals (n = 6) died within 3 hours after reaching their maximum shed blood volume, averaging 145 ± 25 minutes, while two of the eight animals in the glucose infusion group died less than 4 hours after reaching the maximum shed blood volume. The remaining six animals were sacrificed between 270 and 397 minutes (average, 340 ± 22 minutes) after reaching the maximum shed blood volume since decompensation was arrested. Compared to the saline-infused control group, animals receiving glucose infusion exhibited a more moderate acidosis, and the hemoconcentration which normally accompanies decompensation was also prevented. Since the increase in plasma osmolality and the fraction of the total osmolality change accounted for by glucose was less in the glucose-infused animals, these results suggest that the effect is not mediated through a glucose-related maintenance of a transcapillary osmotic gradient. The results are consistent with a role for glucose as an energy substrate for organs which are critical to maintenance of homeostasis (e.g., heart, brain, or vascular smooth muscle).

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The management of vascular injury to the internal carotid artery (ICA) is controversial. We undertook a retrospective review of 14 patients with blunt injuries to the ICA and found three types of ICA injury, often presenting with delayed symptomatology. Six patients had intraluminal arterial stenosis or obstruction and were treated with anticoagulants. Five patients had pseudoaneurysms. Three of these were treated with balloon occlusion of the ICA above and below the orifice of the aneurysm, one with aneurysmorrhaphy, and one with resection and interposition vein graft. Three patients sustained a carotid cavernous fistula and were treated by balloon occlusion of the fistula while patency of the ICA was maintained. Treatment rendered all patients either asymptomatic or with residual deficits only.Angiography is essential to anatomically delineate the injury. The vascular surgeon, the neurosurgeon, and the interventional radiologist all make important contributions to the successful treatment of patients with blunt ICA injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Traumatic tissue injury or infection provokes a systemic inflammatory response, termed the acute-phase response, which is accompanied by hepatic synthesis of certain plasma proteins. Increased levels of serum amyloid A (SAA), C-reactive protein (CRP), and fibrinogen have been observed during the acute-phase response. One possible mediator of the acute-phase response is interleukin-1, a pro-inflammatory monokine released in response to traumatic tissue injury or infection. There is evidence that partially purified macrophage supernatants containing interleukin-1 activity stimulate hepatocyte secretion of SAA, CRP, and fibrinogen.The effect of interleukin-1 on mouse liver serum amyloid A mRNA levels was investigated. The acute-phase response was induced in mice by intraperitoneal injection of interleukin-1 obtained from cloned murine recombinant DNA. We monitored SAA mRNA levels using DNA/RNA dot blot hybridization. Interleukin-1 stimulated a dose-dependent increase in SAA mRNA levels compared to unstimulated controls. In contrast, mRNA levels for apolipoprotein E (a constitutive hepatic protein not produced as part of the acute-phase response) were unchanged under identical conditions. Interleukin-1 also induced SAA mRNA in an endotoxin-resistant strain of mice (C3H/HeJ), indicating that this stimulation was not due to endotoxin contamination since endotoxin alone was unable to induce SAA mRNA in these mice. These results indicate that recombinant interleukin-1, when injected intraperitoneally into mice, induced specific production of SAA mRNA and hence one phase of the acute-phase response.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

By 1995 population aging will decrease the size of the high-injury-risk age cohort (14–34 years) by 7.0 million (-8.2%). The reduction in the high-injury-risk age cohort should reduce the overall volume of penetrating and blunt injury nationally despite a population increase of 21 million. However, the number of, and the proportion of, elderly victims of injury will increase as there will be an additional 5.3 million (+18.5%) people age 65 years or older. Yet payments based on Medicare diagnosis-related groups (DRG's) do not provide adequate reimbursement for any, let alone the elderly, victims of injury. Moreover, Medicare and Medicaid reimbursements for the long-term care so frequently needed by the elderly victims of injury is inadequate. As our population ages, the adverse financial impact of these circumstances resultant from population aging will increasingly strain the financial resources of our trauma centers.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

One justification for expanding the indications for primary repair of colonic injuries is the high morbidity classically associated with colostomy closure. Our impression that this morbidity is overstated prompted us to review our experience with closure of colostomies constructed for treatment of colon trauma for the 5-year period 1979–1984.During this period 75 colostomies created for treatment of colorectal injuries were closed. Complications were frequent after colostomy creation, but few could be attributed to the colostomy. Following colostomy closure, however, complications were infrequent (5%) and generally minor. If morbidity of colostomy closure is cited as a factor justifying expanded indications for primary repair of colon injuries, current morbidity rates should be borne in mind.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The management of severe adult respiratory distress syndrome in critically injured patients requires the frequent measurement of arterial blood gases for adjustment of cardiovascular and ventilatory support. Since these require blood withdrawal and laboratory determinations, a noninvasive method of assessment of arterial gas tensions would permit more frequent assessment of the patient as well as permitting rapid changes in the patient's ventilatory status to be detected earlier in the clinical course. The role of transcutaneous O2and CO2tension in providing these measurements was evaluated in 92 studies in 38 critically ill patients with ARDS due to trauma and/or sepsis. All patients were normodynamic or hyperdynamic at the time of study (cardiac index 2.5 to 7.6 L/min/m2) and were intubated and on increased inspired oxygen fractions (FIO2= 30 to 100%) delivered by mechanical ventilation, had a range of body temperature from 35.0 to 39.5°C and pH from 7.29 to 7.57. The data from a transcutaneous O2and CO2sensor applied to the skin of the anterior thorax were analyzed by multiple regression analysis of variances. Prediction of the arterial oxygen tension (PaO2) from 52 to 253 torr was possible from regression-corrected measurements of the transcutaneous O2(TcO2):[PaO2=1.1 (TcO2) – 0.28 (FIO2) + 45.5]. The arterial carbon dioxide tension (PaCO2) from 26 to 57 torr was predicted from the transcutaneous CO2(TcCO2):[PaCO2= 0.76 (TcCO2) + 0.06 (FIO2) + 0.035 (TcO2) + 4.1]. With these corrections, a noninvasive Respiratory Index was computed for assessing ARDS severity, and dynamic changes in arterial gases could be followed in response to postural changes, ventilatory alterations, or cardiovascular perturbations. These data suggest that a reasonable estimate of the arterial blood gases can be obtained from a regression-corrected measurement of the transcutaneous O2and CO2tensions in critically injured normodynamic or hyperdynamic ARDS patients.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The present study was performed to determine the effects of pretreatment with purified human plasma fibronectin (FN) on survival in rats challenged withSalmonella typhimuriumperitonitis or E.coliendotoxemia. The effects on survival of combining FN with immunoglobulin G (IgG) or antithrombin-III (AT-III) were also determined duringS. typhimuriumperitonitis and E.coliendotoxemia. Permanent survival was increased 15% in the peritonitis group (p< 0.05) and 15% in the endotoxemic group (p > 0.05). There was no enhancement in survival by combining FN with a subprotective dose of IgG preparation. AT-III alone increased survival by 50% over survival in the control group. Combining FN with AT-III increased survival 10% greater than with AT-III alone, which is suggestive of an additive effect. Results from this study suggest that FN provides modest protection during Gram-negative peritonitis or endotoxemia in the rat. Combining FN with AT-III may augment in an additive manner the marked increase in survival observed with AT-III alone in this and previous studies.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID