Showing papers in "Journal of Trauma-injury Infection and Critical Care in 1983"
TL;DR: A selective, individualized protocol is developed for the use of prophylactic pressure therapy in patients with spontaneously healing burn wounds based on results of a study performed to determine factors associated with an increased risk of the development of hypertrophic burn scars.
Abstract: A major problem in patients surviving thermal injury is the development of hypertrophic burn scars. The current study was performed to determine the factors associated with an increased risk of the development of hypertrophic burn scars. Fifty-nine children (mean age, 3 years; mean TBSA, 14%) and 41 adults (mean age, 37; mean TBSA, 21%) followed from 9 to 18 months formed the study group. The location as well as time required for the burns to heal were recorded in addition to the age and race of the patients. Sixty-three (26%) of the 245 burn areas, in these 100 patients, became hypertrophic. No correlation between patient age and the development of wound problems was found. Blacks had more wound problems than others, if the burn wound took longer than 10 to 14 days to heal. The most important indicator of whether wound problems would occur, in our series, was the time required for the burn to heal. If the burn wound healed between 14 and 21 days then one third of the anatomic sites became hypertrophic; if the burn wound healed after 21 days then 78% of the burn sites developed hypertrophic scars. Based upon these results we have developed a selective, individualized protocol for the use of prophylactic pressure therapy in patients with spontaneously healing burn wounds.
578Â citations
TL;DR: Earlier pulmonary and cardiovascular support beginning at the scene of the accident, and prevention and better treatment of head injury, respiratory failure, and sepsis are critical factors for increasing survival after injury.
Abstract: To determine limitations in survival and problems of single and multiple organ failure (SOF, MOF) following trauma in Bavaria, we reviewed 433 consecutive patients with multiple injuries treated at the Klinikum Grosshadern from 1978 through 1982. Most patients were young and were injured in traffic accidents. The overall mortality was 18% (78 deaths): 38 deaths were due to CNS injuries (49%), six from miscellaneous causes (7%), 15 associated with SOF (19%), and 19 associated with MOF (25%). There were 50 patients with SOF and 34 with MOF. Two MOF patterns were found: a rapid single-phase (15 patients) due to trauma and shock; and a delayed two-phase MOF (19 patients) due to trauma, shock, and sepsis. Mortality for the MOF group was 56%. The lung was the predominant organ to fail represented in all SOF and MOF cases. Cimetidine and pirenzipin prevented stress bleeding in all but four patients. Significant factors leading to MOF were shock, massive blood transfusions, sepsis, and errors in treatment. The temporal sequence of organ failure was lung, clotting system, kidney, and liver. Sepsis was ultimately the cause of death in eight MOF patients (42%). Earlier pulmonary and cardiovascular support beginning at the scene of the accident, and prevention and better treatment of head injury, respiratory failure, and sepsis are critical factors for increasing survival after injury.
467Â citations
TL;DR: It is concluded that in otherwise healthy patients with dermal burns of indeterminant depth less than 20% total body surface area, early excision and grafting is the preferred form of treatment.
Abstract: Compared to nonoperative treatment with silver sulfadiazine cream, early excision and grafting of 22 patients with indeterminant burns of less than 20% TBSA resulted in an average shorter hospitalization, lower cost, and less time away from work than 25 patients treated nonoperatively. While early excision and grafting resulted in increased use of blood products and operating room facilities, this did not result in increased patient morbidity. Long-term followup demonstrated no difference in need for reconstruction, incidence of blisters, incidence of loss of motion, or contour irregularities. Those patients treated nonoperatively required more late grafts for closure and demonstrated more hypertrophic scarring. Those treated by early excision demonstrated more mesh graft irregularity. We conclude that in otherwise healthy patients with dermal burns of indeterminant depth less than 20% total body surface area, early excision and grafting is the preferred form of treatment.
295Â citations
274Â citations
TL;DR: It was found that the Injury Severity Score was not predictive of survival in the elderly injured, but central nervous system injury and hypovolemic shock were predictive of Survival.
Abstract: Over a 2-year period, 100 consecutive patients more than 70 years of age with multiple injuries were evaluated at a metropolitan trauma center for injury patterns and factors that affected survival. The analysis incorporated mechanism of injury, body region affected, Injury Severity Score, shock, change from level of prehospital function, and mortality. The mortality for the group was 15%. It was found that the Injury Severity Score was not predictive of survival in the elderly injured. However, central nervous system injury (p less than 0.01) and hypovolemic shock (p less than 0.001) were predictive of survival. While 85% of the injured patients survived, 88% of these did not return to their previous level of independence.
230Â citations
TL;DR: Patients with pilon fractures were followed 24 to 96 months post-fracture and nonanatomic reduction, unstable fixation, infection, nonunion, and/or angulation were the usual causes of failure of this form of treatment.
Abstract: Forty-two patients with pilon fractures were followed 24 to 96 (mean, 53) months post-fracture. Fractures were classified as Type I (26%), Type II (29%), or Type III (45%) as defined by Ruedi and Allgower. Type I fractures were usually torsional in nature whereas Type II and III injuries were usually the result of a fall from a height or motor vehicle accident. Type I and II pilon fractures were amenable to anatomic open reduction and stable internal fixation and 80% or more had satisfactory results. Only 44% of Type III fractures treated by open reduction and internal fixation produced a satisfactory outcome. Nonanatomic reduction, unstable fixation, infection, nonunion, and/or angulation were the usual causes of failure of this form of treatment.
204Â citations
TL;DR: The patterns of injury seen in the casualties from four terrorist bombings are described to illustrate the types and severity of particular wounds.
Abstract: The physical factors responsible for injury following an explosion in a room or building are: direct exposure to overpressure; blast-induced whole body displacement; impact of blast-energized debris; burns from flash and hot gases. The patterns of injury seen in the casualties from four terrorist bombings are described to illustrate the types and severity of particular wounds. The most common fatal injury is brain damage; 'blast lung' is uncommon in civilian terrorist bombings; flash burns, fractures, serious soft-tissue damage, and eardrum injuries are seen in people close to the bomb, who usually require hospital admission; many others taken to hospital can be treated for injury by debris and released. The environment and its internal structure and the position of the occupants of the space can influence the type and severity of injuries.
203Â citations
TL;DR: In burned patients it was difficult to determine whether these impaired lymphocyte responses to T cell mitogens, circulating suppressor lymphocytes, and serum factors suppressive of lymphocyte activation were permanent or temporary.
Abstract: We have previously reported that severe burn injury was regularly accompanied by impaired lymphocyte responses to T cell mitogens, circulating suppressor lymphocytes, and serum factors suppressive of lymphocyte activation. However, in burned patients it was difficult to determine whether these manifestations of suppressed immunity were predictive of, or the result of, sepsis which was ubiquitous in this population. In an attempt to clarify this issue, we have studied 31 patients with multiple trauma (without burns) mean age, 31 years; average injury severity score, 22; range, 9-56; in whom sepsis was less common. Patients were tested for lymphocyte response to the T cell mitogens PHA and Con A, the percentage of circulating putative suppressor (OKT8) and helper (OKT4) T cells using monoclonal antibodies, circulating suppressor cell activity as revealed by functional assays, and serum suppression of lymphocyte activation. Patients were compared with ten normal volunteers (mean age, 32) studied simultaneously. Significant suppression (greater than 50% compared with controls) in lymphocyte responses to mitogens 1 to 5 days after injury was seen in 12 patients, was accompanied by a shift in the ratio of helper (OKT4) to suppressor (OKT8) T cells (patients, 0.96:1; normals, 1.82:1; p less than 0.01), and was followed by the appearance of significant (greater than 50%) serum suppressive activity in six of the 12 patients. Circulating suppressor cell activity as revealed by functional assays was also seen early after injury in three of 12 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
190Â citations
TL;DR: PTFE grafts inserted in proximal extremity veins are excellent temporary conduits which decrease hemorrhage in blast cavities and fasciotomy sites, but all grafts studied by venography at 7 to 14 days were either narrowed or occluded.
Abstract: From 1978 through 1983, 206 patients had 236 polytetrafluoroethylene (PTFE) grafts inserted in vascular wounds. More than 85% of injuries were due to gunshot wounds, shotgun wounds, or stab wounds. Arterial grafts were inserted into vessels of the upper extremity (38.8%), lower extremity (46.1%), neck and chest (8.8%), and abdomen (6.3%). Grafts were most commonly placed in the brachial or superficial femoral arteries. Venous grafts were more commonly inserted into vessels of the extremities (96.7%), with the majority located in the superficial femoral vein. PTFE was found to be an acceptable prosthesis for interposition grafting in arterial wounds, but long-term patency was less than that seen when interposed saphenous vein grafts are used. Early and late occlusions were a significant problem with 4-mm PTFE grafts in the brachial artery, and this size is not recommended in this location. Peripheral PTFE graft infection did not occur in the absence of exposure of the graft or of osteomyelitis. Exposed grafts did not fare well and early coverage is recommended, even with extensive soft-tissue wounds around the graft. PTFE grafts inserted in proximal extremity veins are excellent temporary conduits which decrease hemorrhage in blast cavities and fasciotomy sites, but all grafts studied by venography at 7 to 14 days were either narrowed or occluded.
189Â citations
TL;DR: It is suggested that acute thermal injury leads to systemic complement activation, neutrophil activation, and acute lung injury that is related to production of toxic oxygen products by activated blood neutrophils.
Abstract: Acute thermal injury (70 degrees C, 30 sec) to rat skin results in progressive consumptive depletion of the complement system. Individual complement components (C3, C4, C6) each show reductions in hemolytic activity. Crossed immunoelectrophoresis analysis of serum from thermally injured rats reveals conversion of C3 compatible with activation of the complement system. During the first hour following thermal injury, C5a-related chemotactic activity appears in the serum and is temporally related to the development of neutropenia. Lung injury, as revealed by increases in lung permeability, develops progressively during a 6-hour period and parallels changes in complement levels. Morphologically, lung changes include leukoaggregates within pulmonary capillaries and the presence of intra-alveolar hemorrhage. Protection from lung injury following remote thermal injury to skin is afforded by depleting animals of complement or neutrophils, or by systemic treatment of animals with a combination of catalase and superoxide dismutase. Antihistamine drugs have no protective effect. These data suggest that acute thermal injury leads to systemic complement activation, neutrophil activation, and acute lung injury that is related to production of toxic oxygen products by activated blood neutrophils.
171Â citations
TL;DR: Above all traditional signs, a high index of suspicion was an essential element in diagnosing heart injury; all such cases underwent thoracotomy without delay.
Abstract: This 2-year retrospective study of penetrating heart injury comprises 125 hospitalized patients (HP) (stab wounds) and 407 who died before arrival (DBA) (23 bullet, 384 stab wounds). The cardiac penetration sites were related approximately to the location of the entrance wound. The incidence of injury to respective intrapericardial structures related to their anatomic vulnerability; coronary artery transection was uncommon, however. Aortic lacerations caused rapid death (93% were DBA), followed by those breaching the left ventricle; atrial wounds comprised a greater proportion in HP than DBA series. Cardiac tamponade was more than twice as common in HP than DBA cases. Above all traditional signs, a high index of suspicion was an essential element in diagnosing heart injury; all such cases underwent thoracotomy without delay. Mortality results were: 14.4% for operating theater (OT) and 87.5% for emergency room (ER) thoracotomies. Prognosis amongst HP was worst for aortic (60% mortality) and best with right ventricular injury (7.5%). A 'salvage rate' of 17.1% overall, or 17.9% for stab wounds, was recorded.
TL;DR: Among blunt trauma patients, those with isolated head injury have the highest survival rate and emergency thoracotomy does not enhance the survival rate of trauma patients who were formerly declared 'dead on arrival'.
Abstract: In 5 years, 267 patients with cardiopulmonary arrest after trauma were treated at our institution. The long-term survival rate was 2.6%. Only 1.5% of the 267 patients were functional individuals. Overall, neither the mechanism of injury nor routine emergency thoracotomy influenced the salvage rate. Our results in the management of trauma victims without vital signs indicate that: 1) among blunt trauma patients, those with isolated head injury have the highest survival rate; 2) patients with blunt multisystem injuries involving the chest, abdomen, or truncal orthopedic structures are unsalvageable; 3) cardiopulmonary arrest with penetrating head or neck wounds is a lethal combination; and 4) with the exception of patients sustaining penetrating chest or heart injuries, emergency thoracotomy does not enhance the survival rate of trauma patients who were formerly declared 'dead on arrival.'
TL;DR: Analysis of pelvic fracture management based on the experience of 533 patients treated in a recent 5-year period is presented and overall mortality was 6.4%.
Abstract: Analysis of pelvic fracture management based on the experience of 533 patients treated in a recent 5-year period is presented. Overall mortality was 6.4%. Of 190 (36%) 'complicated' pelvic fractures based upon the nature of the pelvic fracture itself or more often the associated injuries, the mortal
TL;DR: The BDI was significantly more accurate than the clinical assessment in those predicted not to heal by the surgeons and maintained an accuracy of 79% in the wounds where the surgeons would not make a prediction.
Abstract: A Burn Depth Indicator, utilizing reflectance ratios of red, green, and infrared light, has been devised and clinically tested for 18 months at our Burn Center. Using the endpoint of wound healing in less than or more than 3 weeks, clinical assessment by two experienced surgeons of intermediate depth wounds was compared to readings from the BDI . In about one third of cases the surgeons were unwilling to commit themselves to a prediction. In the cases where the surgeons were willing to make a prediction, they were incorrect about 25% of the time. The BDI was significantly more accurate than the clinical assessment in those predicted not to heal by the surgeons and maintained an accuracy of 79% in the wounds where the surgeons would not make a prediction. The BDI is portable, noninvasive, and provides an immediate reading. It may have utility as a triage tool for emergency rooms or combat situations, and has utility at present in our Burn Center as a more accurate tool than our clinical judgment in predicting which wounds should be excised and grafted during the first few days after injury.
TL;DR: Despite improved awareness, earlier care of trauma victims, new antibiotics, and advanced monitoring techniques, histotoxic clostridia continue to cause loss of life and limb.
Abstract: Gas gangrene is not a disease of the past. Despite improved awareness, earlier care of trauma victims, new antibiotics, and advanced monitoring techniques, histotoxic clostridia continue to cause loss of life and limb. A 20-year literature review on gas gangrene (Part I) indicates that a combined th
TL;DR: This retrospectively reviewed operative trauma cases in which liver packing and planned reoperation were used as treatment options for liver lacerations, finding that control of hemorrhage remains the primary problem in lowering mortality from severe hepatic trauma.
Abstract: Liver lacerations are the most common intra-abdominal injury that leads to death, and control of hemorrhage remains the primary problem in lowering mortality from severe hepatic trauma. We retrospectively reviewed operative trauma cases in which liver packing and planned reoperation were used as temporizing measures in hemodynamically unstable patients. These cases were compared to patients closely matched for age, sex, type of trauma, and associated injuries but who did not undergo liver packing and planned reoperation. Preliminary data support our contention that liver packing and planned reoperation is a valuable adjunct for the management of hemorrhage from severe hepatic injury without incurring increased morbidity or mortality. This technique is useful for the experienced trauma surgeon to arrest hemorrhage and gain hemodynamic stability before attempting definitive care and for the community hospital surgeons who after gaining hemodynamic control would like to transfer the patient to a tertiary care facility.
TL;DR: Overall, the intoxicated group had a fourfold increased mortality rate and, although the ISS levels of those dying were similar in the two groups, the mortality following the critical head injury was twice as high among intoxicated patients.
Abstract: Previous reports have failed to demonstrate a statistically significant adverse effect of acute ethanol intoxication in the well-resuscitated trauma patient. In the present study the prevalence of acute alcohol intoxication and its effect on outcome was analyzed in a homogenous population of young, previously healthy motorcycle accident victims (N = 134). The incidence of intoxication was 25%. The intoxicated cyclists were at fault for the accident 50% more often than the nonintoxicated cyclists and were found to wear helmets one third as frequently. Furthermore, the protective effect of helmet use as seen in the nonintoxicated group was lost in the intoxicated group, who sustained head injuries twice as frequently. Only patients with critical head injuries died and, although the ISS levels of those dying were similar in the two groups, the mortality following the critical head injury was twice as high among intoxicated patients (80 vs. 43%). Overall, the intoxicated group had a fourfold increased mortality rate. Thus, although intoxicated motorcyclists comprised 25% of the total population, they represent a mere 9% of the helmet-wearing population, and, in contrast, 39% of the severely head-injured victims and a majority (57%) of the mortality rate.
TL;DR: Thirty-eight consecutive patients with frostbite injuries were treated at the University of Chicago's Burn Center in January 1982 with a protocol designed to decrease the production of thromboxane locally and prostaglandins systemically, and all patients recovered without significant tissue loss.
Abstract: The breakdown products of arachidonic acid have been implicated as mediators of progressive dermal ischemia in both cold and thermal injuries. Increased tissue survival can be demonstrated experimentally with the preservation of the dermal microcirculation by using antiprostaglandin agents and thromboxane inhibitors. Thirty-eight consecutive patients (28 males and 10 females aged 2 mo to 46 yr) with frostbite injuries were treated at the University of Chicago's Burn Center in January 1982 with a protocol designed to decrease the production of thromboxane locally and prostaglandins systemically. All patients recovered without significant tissue loss. The average hospital stay was 5.6 days for acute injuries and 6.9 days for subacute injuries.
TL;DR: Bicyclists with a relatively long time from injury to death tended to be older persons with survivable injuries and often died from complications (pneumonia, pulmonary embolus) rather than directly from their injuries.
Abstract: Among 173 fatally injured bicyclists, the head or neck was the region most seriously injured in 86%. The frequency of injury to the head and neck region and the frequency of nonsurvivable (AIS 6) injury were highest among the cases aged 16 years or less. Vertebral fractures occurred most often in the highest cervical vertebra (C1) and progressively less often in lower vertebrae. The relationship between vertebral position and fracture likelihood is approximately log linear. Bicyclists with a relatively long time from injury to death tended to be older persons with survivable injuries. They often died from complications (pneumonia, pulmonary embolus) rather than directly from their injuries.
TL;DR: Evaluating where in an EMS/Trauma system errors occur and then by correcting those errors, it should be possible to minimize the mortality rate in pediatric trauma.
Abstract: One hundred consecutive pediatric trauma deaths (0.01-18 yrs) were analyzed for their survival potential in an optimally functioning EMS/Trauma system in Mobile, Alabama (1980-1982). Thorough evaluation of all phases of care by paramedic run sheets, ER records, hospital records, and autopsy reports, revealed that 47/100 victims could have never survived due to the extreme nature of their injuries, and 53/100 victims had the potential of surviving if the EMS/Trauma system functioned optimally. Errors in care were identified in those cases deemed potentially salvageable. Identification phase errors were found in 79% of potentially salvageable victims. Field treatment errors occurred in 36%, transport errors in 23%, and definitive care errors in 17% of those considered to be potentially salvageable. By evaluating where in an EMS/Trauma system errors occur and then by correcting those errors, it should be possible to minimize the mortality rate in pediatric trauma.
TL;DR: A review of 62 consecutive patients who sustained flail chest after trauma from 1971 to 1982 was conducted to document the late effects of this injury.
Abstract: A review of 62 consecutive patients who sustained flail chest after trauma from 1971 to 1982 was conducted to document the late effects of this injury. The mechanism of injury was motor vehicle accident in 44 (71%), fall in nine (14.5%), and farming accident in nine (14.5%). Patients ranged in age from 7 to 87 years. Twenty-four (39%) patients arrived in shock and 54 (87%) had major extra-thoracic associated injuries. Thirty-seven (60%) patients were managed by intubation and mechanical ventilation and 25 (40%) by chest physiotherapy. Pulmonary complications developed in 60% of the total group. Eight patients (12.9%) died during the initial hospitalization. Five patients died 1 month to 9 years after discharge, and 17 were eventually lost to followup. Six-month to 12-year followup (mean, 5 years) was re-established for 32 patients. Twenty-one of these returned for comprehensive testing including physical examination, chest roentgenograms, spirometry, flow volume curves, diffusion testing, and calculation of dyspnea index. Of 32 patients questioned, only 12 had returned to full-time employment. Eight (25%) still had subjective chest tightness, 15 (49%) complained of thoracic cage pain, and 12 (38%) had experienced moderate or severe change in their overall level of activity. Using the British Medical Research Gradation for Dyspnea, three (9%) patients had moderate and six (19%) severe shortness of breath. Objective dyspnea index calculated from VEBTPS /MVV revealed mild dyspnea in 50% and moderate dyspnea in 20%. Formal carbon monoxide diffusion testing was normal in 90% of patients and revealed mild decrease in 10%.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma, particularly in patients seen during a 6-year period with cardiac rupture secondary to blunt trauma.
Abstract: Blunt injury to the heart ranges from contusion to disruption This report comprises 14 patients seen during a 6-year period with cardiac rupture secondary to blunt trauma Eight patients were injured in automobile accidents, two patients were injured in auto-pedestrian accidents, two were kicked in the chest by ungulates, and two sustained falls Cardiac tamponade was suspected in ten patients Five patients presented with prehospital cardiac arrest or arrested shortly after arrival All underwent emergency department thoracotomy without survival Two patients expired in the operating room during attempted cardiac repair; both had significant extracardiac injury Seven patients survived, three had right atrial injuries, three had right ventricular injuries, and one had a left atrial injury Cardiopulmonary bypass was not required for repair of the surviving patients There were no significant complications from the cardiac repair The history of significant force dispersed over a relatively small area of the precordium as in a kicking injury from an animal or steering wheel impact should alert the physician to possible cardiac rupture Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma
TL;DR: Early debridement, bowel and urinary diversion followed by penile skin grafting, thigh pouches to protect testicles, and scrotal reconstruction resulted in acceptable cosmetic and functional results in all cases of major skin loss.
Abstract: Major injuries to the testicles, penis, and genital skin from trauma and infection were seen in 62 patients over a 6-year period (1977 to 1983). Urethral injuries were excluded. In the past blunt testicle injuries were infrequently diagnosed and surgically ignored because of large surrounding hematomas. With the use of real-time ultrasound, 17 of 18 cases of testicle rupture were correctly diagnosed preoperatively. Surgical repair resulted in testicle salvage in 16 patients. Penetrating testicle injuries resulted in a high orchiectomy rate secondary to the infrequently described but recognized entity of self-emasculation in transsexuals. Penile rupture from blunt injuries (8) was successfully repaired and complete function was recovered. Penetrating penile injuries (4) were extensive and involved the urethra in two cases; full function returned after reconstruction. Major skin loss of the penis and/or scrotum (19) occurred from necrotizing fasciitis, burns, avulsion and penetrating injuries. Early debridement, bowel and urinary diversion followed by penile skin grafting, thigh pouches to protect testicles, and scrotal reconstruction resulted in acceptable cosmetic and functional results in all cases of major skin loss.
TL;DR: The time of wound closure, cefazolin versus clindamycin, and internal fixation of the fracture were not followed by significant differences in the development of clinical infection in this series.
Abstract: A double-blind prospective study was done to assess the benefit of delaying closure of the wounds associated with open fractures. An additional double-blind study compared the effectiveness of clindamycin versus cefazolin for prophylactic antibiotic coverage. Quantitative cultures of the wounds were accomplished at the time of debridement and again at the time of closure if the wound was not closed initially. Almost half of the wounds were contaminated (46%) at the time of debridement, although the incidence of wound infection was low (6.5%). Gram-negative organisms resistant to the prophylactic antibiotic were recovered initially only eight times, but four of these (50%) became infected. The contaminating organisms in each case were present in high concentration (greater than 10(5) CFU/gm of tissue) at initial culture. The time of wound closure, cefazolin versus clindamycin, and internal fixation of the fracture were not followed by significant differences in the development of clinical infection in this series.
TL;DR: It is concluded that hepatic blood flow is markedly reduced after injury and reduced HBF is correlated with liver dysfunction although normal splanchnic oxygen consumption is maintained.
Abstract: Hepatic dysfunction following injury is felt to be due to hepatic ischemia. To test this hypothesis we measured hepatic blood flow (HBF) and splanchnic oxygen delivery and consumption in nine multiply injured patients. HBF, measured by indocyanine green clearance, was 0.4 +/- 0.1 L/min/m2 12 hours after injury. It steadily increased to 1.3 +/- 0.1 L/min/m2 by 1 week after injury. Changes in cardiac output were similar and were due largely to changes in HBF. Hepatic hypoperfusion was correlated with subsequent increases in serum bilirubin. High oxygen consumption was associated with high HBF and oxygen delivery, and splanchnic oxygen consumption became a large fraction (range, 21-67%) of total body oxygen consumption. Although splanchnic oxygen delivery was diminished with low HBF, splanchnic oxygen consumption remained normal (37 +/- 2 ml/min/m2) due to increased oxygen extraction. We conclude that hepatic blood flow is markedly reduced after injury. Reduced HBF is correlated with liver dysfunction although normal splanchnic oxygen consumption is maintained.
TL;DR: Critical analysis of 53 cases of Malgaigne fracture of the pelvis was undertaken at Hennepin County Medical Center, Minneapolis, over a 10-year period (1968-1978) with particular emphasis to immediate and late complications.
Abstract: Critical analysis of 53 cases of Malgaigne fracture of the pelvis was undertaken at Hennepin County Medical Center, Minneapolis, over a 10-year period (1968-1978) with particular emphasis to immediate and late complications. Thirty patients were followed from 2 to 12 years after injury. Eleven patients were asymptomatic. Eleven had paresthesias of the lower extremity on the same side as the fracture. Nine had gait disturbance, eight had severe low back pain, four had groin pain, and two had fecal incontinence. Low back pain as a late sequela was related to sacral or sacroiliac injury. There appeared to be a correlation between the amount of displacement of the detached hemipelvis and the frequency of subsequent low back pain. Reduction of the upward displacement of the hemipelvis, by whatever means, to anatomic configuration can be of help in reducing late sequelae. In the later years of this study external fixation was successful.
TL;DR: The 185 consecutive cases of renal trauma requiring surgery at Parkland Memorial Hospital between 1976 and 1980 are reviewed and the importance of prompt and accurate radiographic assessment of injury with aggressive use of renal arteriography is stressed.
Abstract: Successful management of patients with renal trauma requires definition of the extent of injury and knowledge of the indications for exploration. The 185 consecutive cases of renal trauma requiring surgery at Parkland Memorial Hospital between 1976 and 1980 are reviewed. Injury was due to penetratin
TL;DR: It is suggested that calcium entry blockers can maintain regional cerebral cortical blood flow and may have a significant role in cerebral resuscitation following cardiac arrest.
Abstract: Recent studies on cerebral resuscitation following an ischemic anoxic insult suggest that both inadequate reperfusion and direct neuronal death are partially initiated by calcium entry into vascular smooth muscle and neurons. To investigate the effects of calcium blocking agents on cerebral resuscitation, a controlled perfusion arrest model with cardiopulmonary bypass was used. Post-resuscitation regional cerebral cortical blood flow (rCCBF) and intracranial pressures (ICP) were monitored in five control dogs and in 12 study dogs resuscitated after a prolonged (20-minute) cardiac arrest. The resuscitation included dexamethasone and three agents thought to be calcium entry antagonists and to offer potential cerebral protection after complete prolonged cerebral ischemic anoxia. Prearrest rCCBF measured by a thermal dilution method with a thermistor placed on the cerebral cortex was 2.0 +/- 0.6 (S.D.) ml/gm/min on bypass at 100 mm Hg mean arterial pressure. Twenty minutes after resuscitation was begun, the rCCBF in ml/min/gm were: controls 1.1 +/- 0.3; dexamethasone (2 mg/kg) 1.2 +/- 0.4; MgSO4 (100 mg/kg) 1.8 +/- 0.5; verapamil (0.15 mg/kg) 1.9 +/- 0.4; and lidoflazine (1 mg/kg) 1.5 +/- 0.3. Ninety minutes following the beginning of resuscitation the rCCBF were: controls 0.1 +/- 0.1; dexamethasone 0.1 +/- 0.1; MgSO4, 1.7 +/- 0.3; verapamil, 1.9 +/- 0.4; and lidoflazine, 1.5 +/- 0.3 ml/gm/min. Thus the Ca2+ entry antagonists maintained cerebral blood flow at 20 and 90 minutes following a prolonged ischemic anoxic insult. Dexamethasone was no better than control. These data suggest that calcium entry blockers can maintain rCCBF and may have a significant role in cerebral resuscitation following cardiac arrest.