摘要:

Burn injury produces acute gastrointestinal (Gl) derangements that may predispose the burn victim to bacterial translocation (BT). We studied the effects of heparin on gastrointestinal (Gl) anatomic alterations and BT after 25% and 32% total body surface area (TBSA), full-thickness murine burn injuries. Heparin (100 U/kg) was administered with 1 mL of normal saline (NS) resuscitation solution immediately postburn and 4 hours and 18 hours postburn in volumes of 0.5 mL NS. Mice with 25% TBSA burns treated with heparin maintained small intestine weight, measured 24 hours postburn, and ileal mucosal height was preserved, whereas burned, untreated mice lost organ weight and mucosal height. Bacterial translocation was decreased in mice with 25% TBSA burn injuries treated with heparin (35.0% vs. 10.7%,p< 0.025). After 32% TBSA burn injuries, BT was also decreased in heparin-treated animals (64.3% vs. 31.6%;p< 0.025). Analysis of mixed venous blood gases showed that heparin did not affect the severe metabolic acidosis that follows burn injury in this animal model, indicating that general tissue perfusion was not improved. Heparin administered in the acute postburn period ameliorates Gl structural and functional damage in this murine burn model and decreases BT.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The efficacy of hyperbaric oxygen (HBO) alone and in combination with several antimicrobial agents was evaluated in a lethal model of gas gangrene in mice. Intraperitoneal administration of penicillin, imipenem, clindamycin, or metronidazole immediately followed inoculation of >109CFU ofClostridium perfringenstype A in mice. Mice treated with hyperbaric oxygen were exposed twice a day to 100% oxygen at 303 kilopascals (kPa) pressure for 90 minutes. The total exposure time to HBO for surviving animals was 9 hours. Control (saline-injected) mice treated with HBO alone did not have an enhanced survival rate when compared with mice exposed to air at ambient pressure. Survival of infected mice treated with either clindamycin or metronidazole was significantly longer than that of groups treated with penicillin or imipenem (p<0.05). Hyperbaric oxygen alone or in combination with the four antimicrobial agents evaluated did not statistically improve survival of mice infected with a lethal dose of C.perfringens.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Prehospital fluid resuscitation of traumatic injury is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. We addressed these limitations in 14 anesthetized swine by evaluating a highly efficient volume expander, a near-saturated salt-dextran solution (SSD) administered through a new device, which gains vascular access via intraosseous (IO) infusion into the sternal bone marrow. After a steady-state baseline was achieved, all animals were hemorrhaged to 45 mm Hg for one hour. Half of the hemorrhaged animals were infused intraosseously with either normal saline (NS) or SSD until cardiac output was restored to the baseline value. No further infusion was given and animals were monitored for 2 hours. Both regimens were able to restore cardiac output to the baseline value, but only 1.3 pM 0.1 mL/kg of SSD was required vs. 31.6 pM 6.3 mL/kg for NS. In addition, cardiac output was better sustained after 2 hours with SSD than with NS. No deleterious effects of IO infusion of SSD were observed. From the improvement in cardiovascular variables and the lack of significant sternal or pulmonary pathologic perturbations, these data suggest that IO infusion of SSD can effectively treat hypovolemia and may allow field treatment when logistic considerations make conventional resuscitation impractical.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A prospective, randomized study was conducted to determine if prophylactic antifungal agents prevented yeast colonization (YC) or yeast sepsis (YS), or if they diminished mortality in 292 critically ill adult (nontransplant/nonburned) surgical and trauma patients admitted to the SICU for 48 hours or longer. Patients were randomized to receive (group I) no therapy, (group II) clotrimazole 10 mg three times a day, (group III) ketoconazole 200 mg per day, or (group IV) nystatin 2 million units every 6 hours. For comparison patients were stratified by the criteria of Slotman and Burchard into high risk (3 risk factors) and low risk (<3 risk factors). Fifty patients (17%) had yeast colonization, nine (3.1%) had yeast sepsis, and 41 (14%) died. Stepwise logistic regression analysis of yeast colonization and sepsis using the variables APACHE II scores>10, need for ventilator support >48 hours, and 14 risk factors (Slotman and Burchard) showed that treatment with three or more antibiotics, APACHE ll>10, and ventilatory support >48 hours were the only three variables that were significant predictors of yeast colonization and sepsis. There was no significant difference between the four groups with regard to YC (23%, 18%, 12%, and 15%, respectively), YS (3%, 1%, 2%, and 7%, respectively), or mortality (15%, 14%, 6%, and 20%, respectively). In the 165 high-risk (3 risk factors) patients, although no difference was seen between the groups, a lower incidence of yeast colonization (21% vs. 41%, p<0.05) but not yeast sepsis (5.5% vs. 5.1%) was observed when all the prophylactically treated patients (n=126) were compared with the controls (n=39). Prophylactic use of these agents in only the high-risk (3 risk factors) nontransplant/ nonbumed trauma/surgical patients is possibly effective and needs to be evaluated in a large multicenter study.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In a canine hind leg model, lymph flow (QL), lymph (CL), and plasma (CP) total protein concentrations, the reflection coefficient for total proteins (αd), and the filtration coefficient (K,) were determined before and for 6 hours after a 5-second 100C hind paw scald (3% total body surface area, TBSA). Before injury, hind leg venous pressure was elevated and maintained by outflow restriction until a minimal, steady state CL/CPratio was achieved. Albumin (5%) was infused 30 minutes after the scald at low (0.4 mL/kg/% TBSA) or high (2 mL/kg/% TBSA) doses. Scald uniformly increased QL, CL/CP, Kt, and paw weight gain (PWG). Whereas postburn infusion of low-dose albumin mildly attenuated increases in CL/CPand PWG noted in scald-alone animals, no differences were noted between the scald and scald/high-dose albumin groups.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A review of the literature identified a need for a prospective study of the complete range of craniofacial trauma. The aims of this study were to determine the incidence, etiology, and mechanisms of craniofacial and associated injuries, enabling a greater understanding of their range and magnitude. Nine hundred fifty consecutive patients seen at an urban university hospital with any degree of craniofacial trauma were prospectively investigated. Craniofacial trauma was found to be very common at all ages. The causes were directly related to age, sex, and alcohol consumption, and determine the type and severity of injury. The commonest cause of soft-tissue injury was falls, whereas that of fractures was interpersonal violence. Falls accounted for most of the injuries in children and the elderly, whereas interpersonal violence was mainly responsible for those occurring in patients aged 15 to 50 years. Interpersonal violence mostly involved young male adults: fights occurring mainly between strangers who had consumed excessive amounts of alcohol. Women were usually assaulted by assailants known to them, their partners. Pedestrians showed a propensity to sustain cranial fractures, whereas motor vehicle occupants tended to sustain midfacial fractures and bicyclists mandibular fractures. Pedestrians incurred the severest injuries of all road users, and a significant proportion of road user collisions involved bicyclists. Sports were responsible for a significant proportion of craniofacial injuries in youths and young adults. Craniofacial soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin, and a method for their classification is proposed. The commonest craniofacial fracture was that of the nasal bones (45%), followed by cranial bones (24%), mandible (13%), zygoma (13%), orbital blow-out (3%), and maxilla (2%). The incidence of craniofacial trauma can be greatly reduced by improvements in interior home design, school education in alcohol abuse and handling potentially hostile situations (especially for men), improvement in automotive safety devices and compliance by motor vehicle occupants, and utilization of full-face helmets by bicyclists and motorcyclists.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Mandibular fracture management has evolved over several decades, and controversies exist over ideal approaches for individual fractures. Treatment choices include closed versus open techniques, reduction methods and repair, and decision concerning intermaxillary fixation. Both the patient and the fracture characteristics have an impact on these choices. Patient factors include age, mandibular bone quality, dentition, patient reliability, and associated injuries. Fracture characteristics include favorability versus unfavorability, single versus multiple, location, and infection. This study was undertaken to develop and evaluate a management algorithm to determine the best treatment of mandible fractures. Sixty-seven patients were managed at the Grady Memorial Hospital otolaryngology service. Ages ranged from 3 to 68 years and included 55 male patients and 12 female patients. Forty-three patients had multiple fractures, while 24 had single fractures. Sixty-four patients were successfully managed and had normal function on follow-up examination. Eleven patients (16.4%) had complications. These included three infections, one malunion, two malocclusions, and five marginal nerve pareses. Multiple fractures did not have a higher incidence of complication. This protocol allows an orderly approach to the successful outcome of mandibular fractures.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Previous studies assessing the value of transthoracic echocardiography (TTE) in blunt chest trauma are limited because patients with severe chest wall injury often have suboptimal echocardiographic findings. Transesophageal echocardiography (TEE) can provide high quality images when the transthoracic image quality is poor. To provide complete echocardiographic assessment of cardiac structure and function we prospectively performed TTE in 105 patients with severe blunt chest trauma and TEE in 20 of the 105 patients (19%) whose TTE examination results were suboptimal. Myocardial contusion was diagnosed in 31 patients (30%), 22 by TTE and nine by TEE. Cardiac complications developed in 8 of 31 patients (26%) with myocardial contusion compared with 2 of 74 patients (3%) with normal echocardiographic findings (p= 0.001). Cardiac complications required treatment in only four patients. Echocardiography was of value in detecting severe right ventricular dysfunction as the cause of hypotension in two patients with suspected cardiac tamponade. Four patients with myocardial contusion died compared with two patients with normal echocardiographic findings (p= NS). No death was related to the cardiac status. In addition, TEE detected aortic injury in five patients, four with focal intimal tears and one with an aortic transection. We conclude that myocardial contusion is common following blunt chest trauma, rarely requires treatment, and is associated with a favorable prognosis. Only patients who develop cardiac complications benefit from echocardiography. Transesophageal echocardiography is of value when the TTE examination results are suboptimal and when aortic injury is suspected.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The aim of this study was to determine the value of bronchoscopy in the early diagnosis of inhalation injury. A total of 130 burn patients underwent bronchoscopy on admission to a specialized center. In order to validate the method and the bronchoscopist's conclusions, they underwent staged bronchial biopsies. Using the histologic findings as the “gold standard,” bronchoscopy proved to be sensitive (sensitivity, 0.79) and highly specific (specificity, 0.94) for the diagnosis of inhalation injury. In addition, it was more reliable than the circumstances of the injury, the clinical findings, and complementary tests. In a one-dimensional analysis, bronchoscopy-proven inhalation injury was one of the most strongly predictive variables for the onset of ARDS and death. The analysis of survival curves confirmed that inhalation injury portends a bad outcome in burn patients. It was used to predict the likelihood of ARDS and death at the time of admission with a view to early specific treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Introduction: The American College of Surgeons' (ACS) Committee on Trauma recommends drug and alcohol screening as “essential” for level I and II or “desirable” for level III trauma centers.Methods:Trauma centers were surveyed concerning alcohol and other drug testing policies and clinical practices during fiscal year 1989.Results:Surveys were returned from 125 level I, 153 level II, and 38 other centers (n = 316; 47 states and the District of Columbia). Resources to measure blood alcohol concentrations (BAC) and perform urine drug screens were available in 99.4% and 96.8% of centers, respectively. In 63.7% of level I and level II and 47.4% of other centers, BACs were “routinely” obtained. The 63.7% testing rate for level I and level II centers was not significantly higher than a 55.2% rate for such centers documented in a survey conducted 5 years earlier. In 40.0% of level I and level II and 26.3% of other centers, drug screens were obtained routinely. The higher overall BAC testing policy compared with that for other drugs was significant (p< 0.001). Substance abuse counselors were employed at 59.3% of the trauma centers, a rate significantly higher than the 31.8% rate identified in a previous survey (p< 0.001).Conclusion:Despite available resources and repeated ACS recommendations, measurements of BACs and drug screens are routine in only 63.7% of level I and 40.0% of level II trauma centers.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID