J Trauma
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C1-C2 is the predominant level of cervical spine injuries in children and adolescents. Either a fracture of the dens or atlantoaxial dislocation (AAD) without fracture of the dens can occur. We present a number of cases to compare their clinical presentations and discuss the preferred method of treatment. ⋯ There is a higher incidence of atlantoaxial dislocation without fracture in children under 13 years of age and a higher incidence of dens fractures in those over 13 years of age. Those with fractures of the dens are more likely to present with evidence of neural injury while those with AAD are more likely to be neurologically intact; however, a correct diagnosis and proper management are mandatory to prevent chronic myelopathy. Halo-vest immobilization is sufficient for most fractures of the dens in children, with AAD usually requiring a fusion.
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Review Case Reports
Renal artery pseudoaneurysm after blunt abdominal trauma: case report and literature review.
Renal vascular injuries such as transection, thrombosis, dissection, and arteriovenous fistula formation are unusual but well-recognized consequences of blunt abdominal trauma. We discuss a rare case of renal artery pseudoaneurysm presenting 6 weeks after blunt abdominal trauma that was successfully treated with selective embolization.
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Colloids are used clinically to minimize edema yet may have detrimental consequences on glomerular filtration. The purpose of this study is to assess the renal and hormonal effects of colloid supplementation in the fluid resuscitation of burn victims. ⋯ These findings illustrate that despite substantially increasing plasma volume, colloid infusions reduce glomerular filtration and may limit any associated diuresis. Furthermore, this study demonstrates that hormonal regulation of blood volume remains intact after moderate burn injury.
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To determine the end result of patients who underwent delayed fasciotomy, i.e., more than 35 hours for an established lower limb compartment syndrome. ⋯ One patient died of multiorgan failure and septicemia. The remaining four patients required lower limb amputation, because of local infection and septicemia. The one late amputation was performed 6 months after the injury, because the patient was left with a functionless insensate foot. Where recognition of an established compartment syndrome is delayed for more than 8 to 10 hours, we propose that the traditional inevitable fasciotomy be reassessed.
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We hypothesize that during severe normothermic hemorrhagic shock (HS), induction of profound hypothermic circulatory arrest (PHCA) of 60 minutes to allow repair of otherwise lethal injuries in a bloodless field, can be survived without brain damage. In previous dog studies, normothermic HS with mean arterial pressure (MAP) of 40 mm Hg for 30 minutes, followed by PHCA of 2 hours at brain (tympanic membrane) temperature of 5 to 10 degrees C and core temperature of 10 degrees C, induced and reversed with cardiopulmonary bypass, resulted in survival with mild histopathologic brain damage. This study was designed to determine the severity of HS that can safely allow 1 hour of PHCA. In pilot studies with HS at MAP 30 mm Hg for 90 minutes with or without subsequent PHCA of 60 minutes there were no survivors. ⋯ The critical level of hypotension during 60 minutes normothermic HS that is compatible with survival in dogs is a MAP of between 30 and 40 mm Hg. After otherwise survivable severe normothermic HS of 60 minutes, PHCA of 60 minutes does not add brain damage or mortality, and may allow survival from injuries that would otherwise be irreparable.