摘要:

The concentration of serum prolactin (PRL), plasma corticotropin (ACTH), serum follicle stimulating (FSH), and luteinizing (LH) hormones were measured in 28 adult burned patients (25 males and three females). Morning and night determinations were performed for each hormone. Serum PRL was elevated in males up to the fourth week after the thermal injury. Plasma ACTH increased significantly on the second day postburn and returned gradually to normal on the fifth; serum FSH and LH increased on day 1, then decreased significantly on day 2 and remained low for about 2 weeks.In females, while PRL increased significantly, the gonadotropins were slightly elevated and the ACTH remained within normal limits for the 3 days during which it was possible to study these patients. In all subjects the circadian rhythm of the four measured hormones showed significant variations from the normal pattern.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The Boston Emergency Medical Service system was studied to determine the effects of Advanced Life Support (ALS) prehospital trauma care compared to Basic Life Support (BLS) treatment. The severity of injury and clinical status of patients was defined and monitored using the Trauma Score (TS) described by Champion. The TS on arrival at the hospital increased significantly more for patients receiving field ALS care than for patients transported by BLS ambulances (p= 0.01). ALS resuscitation had most influence on patients with TS 4–13 and did not delay transport time. Furthermore, a positive change in prehospital TS was significantly related to an increased chance of long-term survival for any given severity of injury (p= 0.0002). From these data we conclude that the TS is useful for prehospital triage and that appropriate field ALS resuscitation results in more favorable outcomes following major trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The effect of sepsis in modifying post-surgical fuel utilization in critically ill patients was determined from 374 observations (246 septic [S] and 128 nonseptic [N] in 12 intubated ICU patients studied serially. Patients received TPN (values/24 hrs: Septic, N2, 9.1 ± 2.2 gm; glucose, 543 ± 211 kcal/m2, Nonseptic, N2, 8.3 ± 3.6 gm; glucose, 550 ± 346 kcal/m2). In some periods, intravenous lipid (L) was given to raise total caloric intake to 826 ± 223 kcal/24 hr/m2. The &OV0312;O2, &OV0312;CO2, respiratory rate, minute volume, and blood gas levels were measured, and respiratory quotient (RQ) and metabolic rate (MR) computed. Statistics were performed by 2-way ANOVA and analysis of covariance. Without lipid, mean &OV0312;CO2for S (126 ml/min/m2) and N (128 ml/ min/m2) were not significantly different, but &OV0312;O2 in S (146 ml/min/m2) and N (132 ml/min/m2), and the RQ values S (0.88) and N (0.97), were different (p< 0.0001). In 360 studies RQ was shown to be increased by the total caloric intake, but reduced in the presence of sepsis:RQ = 0.00014 (kcal/m2) - 0.09 (sepsis effect + 0.878N= 360;r2= 0.304; F2,357= 78;p< 0.0001; but both administered glucose and lipid calories contribute to the RQ in sepsis:RQ = 0.00017 (glucose kcal/m2) + 0.266 × 10−3(lipid kcal/m2) + 0.732n= 114;r2= 0.260; F2,111= 19.5;p0.0001. Sepsis increased &OV0312;O2with little change in &OV0312;CO2, thus RQ fell, suggesting increased use of lipid fuels for oxidation. During hypercaloric lipid infusion in septic patients (SL) &OV0312;O2and &OV0312;CO2increased but &OV0312;O2was still greater, so RQ remained low (SL RQ = 0.89). As sepsis worsened &OV0312;O2remained high but &OV0312;CO2fell producing RQ < 0.8, while plasma glucose levels were increased. These data suggest that septic patients are more dependent than nonseptics on lipid fuels for oxidative metabolism, and that IV lipids can be used to increase oxidative metabolism in sepsis at a time when glucose metabolism appears reduced.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

In a 3-year period of prospective study, 250 pediatric patients with multiple trauma (injury to at least two body areas) had injuries scored by a modification of the Injury Severity Scale (MISS). This scale uses the categories and rankings of the Abbreviated Injury Scale—1980 (AIS—80) except for neurologic injuries. Neurologic injuries are scored by using a combination of the Glasgow Coma Scale (GCS) and other neurologic findings (presence of surgical mass lesion, pupillary light response, and oculocephalic reflexes). The MISS is calculated as the sum of the squares of the three most severely injured body areas.The mean MISS score was 27.8, with 38% of MISS scores ≥25 and 62% <25. Among those with MISS scores ≥25 there was a 40% mortality and 30% disability, while there were no mortalities and 1% disability for those with MISS scores <25 (p< 0.001). Overall mortality was 15%, with 10% disability. Mean MISS scores for death and disability were 33.4 and 30.2, respectively.Neurologic injuries were present in 173 patients (69%); 128 patients had severe head injuries (coma >6 hours duration); 80% of all deaths were due to neurologic injury and all but two deaths had some degree of head injury; the remaining 20% of deaths were due to chest and abdominal injuries. Patients with MISS grade 5 injury (critical, survival uncertain) had 73% mortality, while those with grades 4 and 3 injury had 8% and 2% mortality, respectively.The MISS serves as an accurate predictor of morbidity and mortality in pediatric trauma. The best predictors of outcome were an MISS ≥25 and the degree of neurologic injury.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Effects of nonfragmenting solid brass bullets (5.56 mm, 3.1 gm, 1.9 cm long, machine-made at Letterman Army Institute of Research) and fragmenting soft-point bullets (5.56 mm, 3.2 gm, 1.7 cm long, commercially made by Hornady Manufacturing Co., Grand Island, NE) were compared when they were fired through soft tissue of the hind legs of five live swine (50 to 70 kg). The swine were anesthetized endotracheally (0.8% halothane) and placed in the supine position with the hind legs extended. Blocks of tissue simulant (10% gelatin at 4°C, molded in blocks 20 × 22 × 47 cm) were placed against the skin at the predicted point of bullet exit. All shots (a fragmenting bullet through one hind leg and a nonfragmenting bullet through the other hind leg of each swine) were fired at a range of 3 m from a rifle with a bullet tract at 90° to the long axis of the swine's body. Bullet velocities ranged from 930 to 990 m/s. Dissections of the bullet tract (through tissue and gelatin) revealed that tissue disruption from the fragmenting bullets was significantly greater (p< 0.001) than from nonfragmenting bullets. The recovered bullets were weighed. The results showed that the fragmenting bullet lost 59 to 77% of its original weight and the nonfragmenting bullet was the same weight as originally. Recognition of the amount of tissue disruption and identification of bullet fragments in the wounds resulting from the two different bullets should be a useful guide to operating surgeons in selecting the best approach for treatment of gunshot injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The characteristics of occurrence of head trauma were studied in north central Virginia. In 1978, 735 cases of head trauma were identified with documented head injuries occurring within the defined service area, and with a minimum overnight hospital stay. Overall occurrence was 208/100,000 population. The highest occurrence was found in the 15–19 age group (407/100,000). Nonwhites showed higher rates than whites. Motor vehicle crashes were the most frequent mechanism of injury (55% of patients) followed by falls (20%), and interpersonal violence (11%). Short-term time trends reveal unique daily, weekly, and seasonal patterns for motor vehicle crashes, falls, and interpersonal violence. Selected prevention strategies are discussed. The use of passive restraints in motor vehicles is recommended as one important means of reducing the occurrence and severity of head injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A prospective study of post-traumatic fat embolism among a group of Chinese patients suffering from fractures demonstrated an incidence of 8.75% in fracture patients with overt clinical features and a mortality rate of 2.5%. In a multiple-fracture group the incidence of fat embolism was 35%. The significant findings of 64% of the patients with a low arterial pO2 and 52% with positive cryostat tests for fat globules suggested a high incidence of subclinical presentation. The presence of large vacuoles in the cryostat sections is demonstrated and its significance discussed. The 'iceberg' phenomenon of fat emobolism syndrome should be well recognized, particularly in patients with multiple fractures.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Thirty-nine fractures with segmental bone loss and/or limb length discrepancy with defects of 1.8 to 12.0 cm were reviewed retrospectively. Most patients presented with an acute open fracture with segmental bone loss or a late reconstructive problem with a nonunion, frequently complicated by infection, segmental bone loss, and adjacent soft-tissue disruption. One hundred forty-two weeks was the average length of time of treatment before referral of a patient to us. Eighty-eight per cent of the patients received a bone graft that included either autologous cancellous bone, bank bone, a vascularized free iliac crest or fibular transplant, or some combination of these materials. Forty per cent of the patients required some type of soft-tissue coverage such as a split-thickness skin graft, myoplasty, or a free vascularized flap. Seventy-nine per cent of the cases achieved complete osseous and soft-tissue healing within an average of 49 weeks. One patient underwent an above-knee amputation. Almost 80% of all of the patients healed to within 85% or better of anatomic length. Based upon these results a protocol for the management of osseous and soft-tissue defects is outlined which includes debridement, rigid stabilization, and various types of soft-tissue and osseous reconstruction.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The entity of ureteral contusion with a gunshot wound has not been well described in the literature. The blast effect of the bullet, even one of low velocity, can cause contusion of the ureter manifested by hematuria, no extravasation on the IVP, and a normal appearing ureter or some bruising of the ureteral wall and periureteral tissues. The ureteral contusion may resolve or may progress to delayed necrosis of the ureteral wall with urine leakage. Twelve cases of ureteral contusion with gunshot wounds are reported. The ureter was found contused at exploration in two patients; one had excision of the contused area with end-to-end anastomosis and the other had a nephrostomy and ureteral splint. The ureter appeared normal in ten patients and no immediate treatment was performed to the ureter; eight had no postoperative evidence of urine leakage and two developed a urinary fistula.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Provided herein is a summary of findings by the authors and other investigators regarding the application of evoked potential studies to the assessment of neurologic function in severely head-injured patients in the acute and subacute stages postinjury. Multimodality Evoked Potentials (MEP's) are reportedly useful in three primary areas: 1) diagnosis; 2) prognosis; and 3) monitoring recovery. In diagnosis, the abnormalities in MEP's can be associated specifically with focal sensory/motor deficits such as hemiparesis and, generally, with the severity and extent of brain dysfunction. MEP abnormalities that are severe reflect irreversible damage while the mild abnormalities point to transient, reversible CNS dysfunction. Definition of the severity and extent of brain dysfunction by MEP's allows an accurate prediction of outcome, or the potential for recovery. Their accuracy is superior to many commonly used indices and MEP results add strength to clinical indicators of prognosis. Changes in MEP results obtained within a patient over time can be used to trace recovery and assess, for an individual, the functional consequences of secondary neurologic insult or medical complication. The authors conclude that MEP studies may serve a useful function as noninvasive indices of neurologic function in the management of severely head-injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID