摘要:

A retrospective study of 133 patients with documented head trauma is presented. Computed tomography (C.T.) has replaced cerebral angiography in the evaluation of these patients at our institution. C.T. provides a rapid noninvasive diagnosis, plus accurate localization of lesions; it also allows for the assessment of multiple lesions. The authors feel that C.T. should be the first neurologic mode of investigation after plain skull radiographs. It is important to obtain good quality scans, and intravenous sedation or general anaesthesia may be required.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The records of 82 patients with penetrating gunshot wounds of the head seen during a 2-year period (1973 through 1975) were reviewed. All patients had a thorough neurologic evaluation and diagnostic roentgenographic studies within 5 hours of injury. The state of consciousness, which could be assessed by simplified neurologic examination, emerged as the key parameter in prognosis; no patient seen within 5 hours after injury with decorticate or decerebrate posture survived. Anteroposterior, lateral, and the base view X-rays were of great help in differentiating between extra- and intracerebral location of the bullet. The best combination of diagnostic studies are the skull series and the CT scan. Surgery was performed on 45 patients, and 31 of these achieved functionally satisfactory results. The primary purpose of the surgery was for debridement and only in few cases for removal of a mass lesion. Antibiotic infection prevention was effective in all but two patients, who developed postoperative meningitis; none developed a brain abscess. The incidence of hematomas in surgical and autopsied patients was 10%. Simple grading criteria emerged that allow prognostication at admission of both survival and its quality. We conclude that less severely injured patients should be operated on within 3 to 8 hours and patients who are comatose and nonresponsive at admission should receive primarily supportive treatment, with surgery undertaken only if significant intracranial blood clot is seen on CT scan.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A simplified computer-based trauma registry system with well-defined limites of data caputre is presented. This registry was utilized to describe the profile of trauma at a university hospital. In 1 year there were 882 trauma victims hospitalized, with an overall mortality of 3.3%. The majority of the patients had relatively minor injuries, primarily involving soft tissue and bone. Severe multiple trauma was associated with a significant mortality. Intracranial or intra-abdominal injuries occurred in less than 10% of the patients. Transport accidents, falls, and assaults were the cause of injury in 70%. Key access to specific information about the trauma patient population demonstrated the potential of the registry system. The advantages and limitations of the registry are discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Eleven cases of deep puncture wounds of the foot and their complications are reviewed. More than half of the patients had foreign materials introducd at the time of the injury which was not completely removed initially. The morbidity with these “simple puncture wounds” may be quite prolonged. The authors conclude that attention to details when the patient is first seen in the emergency room or the physician's office and aggressive treatment of these wounds will prevent serious sequelae in many instances.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Fifty-two patients undergoing open reduction, internal fixation, or primary excsion for fracture of the olecranon are reviewed. Average age at time of fracture was 35.8 years: the most common modes of injury were falling, auto accidents, and altercations. Complications of fixation requiring reoperation occurred in 15% of cases. The Leinbach malleable screw was the fixation device used in 60% of the cases requiring reoperation. We feel that properly placed large intramedullary screws, Kirschner-wires, and 18-gauge figure-of-eight wires, or threaded Steinmann pins plus anatomic reduction, have led to satisfactory results.Radiographic union delayed beyond 8 weeks occurred in 20.5% of cases: however, those with sufficient followup went on to spontaenous radiographic union. Ulnar nerve neuropraxia, which resolved spontaneously, was noted in 2%, and significant heterotopic ossification in the olecranon fossa, prohibiting full extension, occurred in 5%. Range of motion at followup did not differ significantly between those undergoing excision or open reduction internal fixation; however, no objective comparisons between the two groups regarding triceps strength or mediolateral stability were obtained.We conlcude that immediate open reduction and internal fixation are indicated for all fractures where feasible; however, patients in which fixation was delayed for 7 days or more did well in this series.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Metabolic changes in 10 patients undergoing total hip replacement were studied. Metabolic expenditure postoperatively remained within 5–10% of preoperative values. Net nitrogen loss for the postoperative period was less than 35 gm for the first 4 postoperative days, well below changes seen in major nonsurgical trauma. Fluid balance was positive in all patients for the first 4 postoperative days. Patients not in negative fluid balance by the fourth postoperative day should be closely monitored for complications. Recognition of delayed fluid excretion is essential in order to avoid the complications of further fluid loading in the postoperative period. Muscle composition reveals predictable changes in extracellular water, sodium, and chloride composition following surgery.Our data showed that metabolic changes following total hip replacement are in the order of major general surgical procedures and well below that observed with major trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Blood cultures were obtained from 19 patients with thermal injury of from 7 to 73% (mean 38%) of the total body surface area before, during, and after manipulation of the burn wound. Procedures were separated into a group which required general anesthesia and those which did not, and extent of trauma associated with manipulation was noted. Simultaneous wound cultures were obtained. Two hundred sixty-three individual cultures were drawn in 63 sequential blood culture sets. The maximum rate of false positive blood cultures was 3.1%. Bacteria grew in one or more cultures in 19 out of the 63 sequential culture sets. Manipulation-induced bacteremia occurred in 13 cultues sets (20.6% of the procedures). Increased frequency of manipulation-induced cultures occurred with larger burn areas and with increased trauma to the burn wound during manipulation. The organisms most frequently isolated from blood cultures wereKlebsiellaandStaphylococcus aureus. Bacteremia which lasted longer than 15 minutes was identified in four cases. In two patients, organisms found during manipulation were later isolated from blood cultures during periods of sepsis. There was no direct evidence that manipulation-induced bacteremia caused clinical harm. However, these findings support the concept of gentle wound care.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Irreversible sepsis, in spite of advancements in topical therapy and antimicrobial agents, remains the leading cause of death in major thermal injury. A defect in intracellular bactericidal capacity in leukocytes from severely burned patients appears to correspond with increases in bacterial wound colonization and ultimate sepsis. This leukocyte defect has been demonstrated by abnormally low nitroblue tetrazolium reduction (NBT) and oxygen consumption of white cells in patients with major thermal injury. The subcellular mechanisms responsible for decreased bactericidal capacity were therefore investigated. Nicotinamide-adenine dinucleotide (NADH) and nicotinamide-adenine phosphodinucleotide (NADPH) oxidase activity was measured in patients with major burns, controls (normals), and in patients with nonburn stress or infection. NADH and NADPH oxidase levels in leukocytes from burn patients were not significantly different from those of normal non-challenged controls but were significantly lower than the leukocyte values found in the patients with nonburn infections or stress. This NADH and NADPH defect in the subcellular leukocyte fraction suggests that it may be a significant factor in the reduced bactericidal function of the intact leukocyte in thermally injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The phagocytic function of alveolar macrophages obtained from rabbits after they were given sublethal shock by tumbling in a modified Noble-Collip drum was studied. As compared to the phagocytic function of alveolar macrophages from normal rabbits, tumbling produced a statistically significant reduction in vitro bactericidal capacity for bothPseudomonas aeruginosaandEscherichia coli. However, there was no alteration in the ingestive phase. The reduced bactericidal capacity was evident within 15 minutes after the stress, but the batericidal capacity had returned to normal in rabbits that were allowed to recover for 24 hours before the studies were performed.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID