J Trauma
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Both high tidal volume (V(T)) ventilation and hemorrhage induce acute lung injury in adult rodents. It is not known whether injurious ventilation augments lung injury in infant rats exposed to severe hemorrhage. ⋯ High V(T) ventilation with low PEEP improves respiratory system mechanics without causing additional damage to healthy and hemorrhage-exposed infant rats after 4 hours of ventilation. This study highlights the tolerance to high V(T) ventilation in infant rats and underscores the need for age-specific animal models.
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To report our experience with the diagnosis and treatment of aortoiliac vascular injuries caused by misplaced orthopedic fixation screws. ⋯ Vascular injuries related to misplacement of fixation screws are relatively infrequent but potential life and limb-threatening complications that require early recognition with prompt repair of vascular lesions and screw reposition.
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The original Trauma and Injury Severity Score (TRISS) methodology from the Major Trauma Outcome Study (MTOS) is the most widely used outcome prediction model. The coefficients from the MTOS cohorts are still used in the Japan Trauma Data Bank for evaluating the quality of patient care. The purposes are to determine whether the database of this institution is well matched to the MTOS study and whether the original TRISS coefficients are accurate predictors of the patient outcome in Japan. ⋯ The trauma populations in this study differed significantly from the MTOS. The Modified TRISS coefficients should be adapted for outcome assessment based on the location of the injured population. This is the first report of an M-study from Japan to be published in the English literature.
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The performance of child restraint systems (CRS) in side impact motor vehicle crashes has been under study due to the injury and fatality burden of these events. Although previous research has quantified injury risk or described injured body regions, safety advances require an understanding of injury causation. Therefore, the objective was to delineate injury causation scenarios for CRS-restrained children in side impacts and document probable contact points in the vehicle interior. ⋯ Head injuries are the target for injury prevention for children in CRS in side impact crashes. Most of these injuries are due to the contact; for near-side occupants, contact with the CRS structure and the door interior, for far- or center-seated occupants, contact with the front seat back. These data are useful in developing both educational and technological interventions to reduce the burden of injury to these children.
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Intramedullary reaming and nailing increases intramedullary pressure. This may cause intravasation of bone marrow contents, leading to bone marrow embolization and altered cardiopulmonary function. Possible beneficial effects of attenuation of the intramedullary pressure increase by the use of a reamer-irrigator-aspirator (RIA) system were studied with the hypothesis that the RIA technique would cause lower numbers of pulmonary embolisms (PEs) and lesser cardiopulmonary affection than traditional reaming (TR). ⋯ The pattern of the procedure-related hemodynamic and pulmonary effects did not differ significantly between the RIA and the TR groups. The RIA group had lower numbers (ns) of embolisms per square centimeter lung area than the TR group. After reaming with the TR device, two animals died of PEs, the first postoperative day. The patients with femoral shaft fracture and additional cardiopulmonary injury or preexisting reduced cardiopulmonary function, however, need special attention, and the use of RIA may, in these cases, represent a better operative alternative with a lesser operative burden.