J Trauma
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Comparative Study
Early patellofemoral osteoarthritis caused by an osteochondral defect after retrograde solid nailing of the femur in sheep.
Retrograde femoral nailing (RFN) is an increasingly used technique for internal fixation of femoral fractures. Geometrically and empirically, the nail entry zone is close to the center of the femoral groove, causing concern about the development of patellofemoral osteoarthritis. ⋯ RFN can cause patellofemoral osteoarthritis. Care should be exercised to use RFN in isolated supracondylar or shaft fractures of the femur in healthy young adults.
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Clinical Trial Controlled Clinical Trial
Microchimerism in transfused trauma patients is associated with diminished donor-specific lymphocyte response.
Blood transfusion can result in long-term survival of donor leukocyte subpopulations, or microchimerism, in the peripheral blood of injured patients. Neither injury severity nor the number of transfusions is associated with its occurrence. We sought to determine whether changes in general or antigen-specific lymphocyte activation may be associated with the subsequent development of microchimerism. ⋯ Transfusion-associated microchimerism is correlated with diminished response to mitogen challenge as well as to specific alloantigenic challenges. This microchimerism is predated by diminished lymphocyte response to a specific blood donor in many instances. The blood donor associated with this diminished alloantigenic lymphocyte response may be the source of microchimeric cells present in the recipient.
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To determine whether prehospital clinical assessments are associated with the survival of traumatic cardiopulmonary arrest (TCPA) patients and to test recently issued clinical guidelines for prehospital cessation of resuscitative efforts published by the National Association of Emergency Physicians and the American College of Surgeons Committee on Trauma. ⋯ +/- Prehospital clinical assessments are not reliable for the triage of TCPA patients. Patients should be transported to the ED for further evaluation and care. The guidelines should not adopted until more thorough studies are conducted.
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Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the diagnosis of SF. The purpose of this study was to determine whether SCT scan can be used as a stand-alone diagnostic modality in the evaluation of SF. ⋯ SCT of the spine identified 99.3% of all fractures of the cervical, thoracic, and lumbar spine, and those missed by SCT required minimal or no treatment. SCT is a sensitive diagnostic test for the identification of SF. Routine plain radiographs of the spine are not necessary in the evaluation of blunt trauma patients.
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Hemorrhagic shock leads to the appearance of substances in plasma that depress Na/K ATPase activity leading to a rise in plasma potassium. Recently, we reported that adenosine can stimulate Na/K ATPase activity, lower the plasma potassium back to control and prolong survival in shocked rats. However, adenosine also caused bradycardia. We therefore searched for adenosine analogs that stimulate Na/K ATPase without the side effects of bradycardia. ⋯ Purine nucleosides stimulate Na/K ATPase and prolong survival in hemorrhagic shock in rats, probably through an intracellular mechanism.