摘要:

Prior studies showed that albumin supplementation of the resuscitation for hypovolemic shock caused an increase in serum albumin but a fall in serum globulins; immunoglobulins were not measured. Using frozen sera, immunoglobulins (IgG, IgM, IgA, IgD) were measured in 184 severely injured patients including 40 patients prospectively randomized for supplemental steroid therapy and 46 patients prospectively randomized for supplemental albumin therapy. The remaining patients served as the control patients.Compared to normal, the control patients had a significant reduction in IgG, IgM, and IgA. This reduction was associated with a fall in total serum proteins and serum albumin concentrations. Supplemental albumin resulted in an increase in the serum albumin concentration but a reciprocal fall in the serum globulin fraction and in IgG, IgM, and IgA. The serum proteins and immunoglobulins in the steroid patients were significantly below normal but similar to that seen in the control patients. The reduction in serum proteins and immunoglobulins in the control and steroid patients paralleled the shock time (systolic pressure below 80 mm Hg) and the amount of plasma given during resuscitation. These correlations were not significant in the albumin-supplemented patients. These data indicate that albumin supplementation alters the normal immunoglobulin response to shock. These changes in the postinjury recovery period need further study.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Myoglobin is released in the circulation after burn trauma. There appears to be a correlation between burn depth and severity and level of myoglobinemia. Patients with marked myoglobinemia had an increased risk of early mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The use of prophylactic low-dose penicillin in acutely burned, hospitalized patients remains controversial. Fifty-one adult patients with burns of 1% to 91% total body surface area were prospectively studied to determine the efficacy of prophylactic penicillin in the prevention of wound cellulitis and burn wound sepsis, and to examine the influence of prophylactic penicillin on the emergence of antibiotic resistant microorganisms. In 25 patients given a 5-day course of penicillin prophylactically, 11 developed cellulitis and two had burn wound sepsis. A similar group of patients given placebo developed seven cases of cellulitis and three cases of burn wound sepsis (p= 0.340). No patient in either group developed gentamicin-resistant Gram-negative organisms, although the gastrointestinal tracts of two patients in the penicillin group showed new colonization by yeast. We conclude that the routine administration of prophylactic penicillin neither protects against cellulitis and burn wound sepsis, nor promotes selection of antibiotic-resistant bacteria in hospitalized patients with acute thermal injury.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Many problems require solving in treatment of avulsion injuries to children's feet, often involving tendons, bones, and joints. Few cases have satisfactory results because the soft-tissue defects are too extensive to reconstruct by conventional methods. Microvascular free flaps were utilized to cover such defects in seven children's feet and satisfactory results were obtained. The free groin flap is considered the most adequate donor flap for such injuries, since the donor scar is easy to conceal and donor site functional disabilities are minimal.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Biochemical and mechanical experiments were conducted to determine the effect of dietary thiamine on collagen maturation during wound repair. The breaking strength of excised wounds, the isometric shrink tension of skin, and the lysyl oxidase activity of normal and repairing skin were determined. Rats were divided into three dietary groups and fed either a thiamine-deficient diet (-B1), a thiamine-deficient diet supplemented with 1 mg thiamine-HCl (+B1) or a thiamine-deficient diet supplemented with 3 mg thiamine-HCl (+3B1). When -B1 rats were demonstrated to be deficient in urinary thiamine, all animals were wounded. Ten days after wounding the animals were killed and the tissues harvested. Significant differences were observed in lysyl oxidase activity between -B1 and +B1 in both wounded and unwounded tissue, and in isometric shrink tension between — B1, +B1, and breaking strength between all three dietary treatment groups. The changes observed in this study demonstrate a definite involvement of thiamine in wound repair and scar development.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Cranial computerized tomography (CT) has revolutionized the evaluation and management of patients with head injuries (7, 39, 58). CT is noninvasive and rapidly provides accurate information regarding the presence, extent, and nature of intracranial lesions resulting from trauma. Angiography is usually necessary only to define the integrity of vessels in penetrating injuries or suspected carotid cavernous fistulas. CT has proven indispensable in permitting noninvasive followup of these patients.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The clinical and computed tomographic (CT) features of three consecutive cases of temporal lobe contusion emphasize the presentation and frequent subsequent progressive neurological deterioration. The initial presentation was one of lethargy and combativeness with little or no focal neurological deficits. Thereafter all patients developed progressive neurological deterioration with decreasing levels of consciousness and lateralizing signs. Computed tomography (CT) which aided in making the initial diagnosis was repeated following clinical deterioration. Worsening in the patient's clinical condition correlated positively with changes within the contusion as visualized by CT.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

This study concerns the results of treatment of 39 patients with 40 tibial fractures which had progressed to nonunion and which subsequently were treated by autogenous bone grafting and cast immobilization. Thirty-one fractures were initially open and nine of these became infected nonunions. Thirty-four fractures united after bone grafting, four other patients finally required amputations, and two tibiae healed after subsequent internal fixation. The functional results, especially as related to the ankle and subtalar joints, the residual tibial deformities, shortening and cosmetic results, were less than optimal. The difficulty with correcting and maintaining correction of the initial deformity and long periods of joint immobilization contributed to these results. Each patient with a nonunion of the tibia should be assessed so that a recommendation as to the need for immobilization, its type, and the necessity for bone grafting or not can be made.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Tempered windshields commonly used in Europe have been shown to be related to the relatively high incidence of ocular injuries. Although windshields of the High Penetration Resistant (HPR) type in cars in North America are not at all significantly involved in ocular injuries, still about 50% of the injuries of the eye area are caused by glass. The HPR windshield probably is the main reason for the relatively low occurrence of ocular injuries in United States crashes compared to these injuries reported from countries with tempered windshields.No ocular injuries were observed among belted occupants in this study. It appears that the increased use of lap-shoulder belts would decrease the likelihood of occupant contact with the windshield, mirrors, roof support, steering wheel, and instrument panel—about two thirds of the occupant contacts related to ocular injury—and thus reduce the incidence of ocular injuries leading to decreased vision.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A retrospective study was done of 84 patients with osteochondritis dissecans of the capitellum who were seen during a 43-year period; followup of 57 patients could be obtained, nine of whom had involvement in both elbows. Most of the osteochondral lesions could be classified either as those still attached to the capitellum (type 1) or as loosened fragments lying free and floating within the joint (type 2): 24 were of type 1 and 37 were of type 2. Residual limitations were highest in the type 2 lesions that were treated either nonsurgically or surgically after a long delay. The best surgical results occurred with excision of the osteochondral defect and drilling or curettage of subchondral bone.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID