J Trauma
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A review of the records of 288 patients sustaining blunt cervical column and/or cord injuries revealed that twelve (4.2%) had significant intra-abdominal injuries, all occult, and all detected by peritoneal lavage. Three of 58 patients in shock (BP less than 100 mm Hg) with neurologic deficits were found to have intra-abdominal injuries. ⋯ An analysis of the mechanisms of injury and associated injuries indicated that those at risk of having significant intra-abdominal injury are those who have been injured in a vehicular crash and those who have other obvious major injuries that can cause shock. The data indicate that patients not at risk of having intra-abdominal injury can be selected for early attempts at anatomic cervical realignment in an effort to achieve return of neurologic function.
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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. ⋯ 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.
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This study reviews the recent experience with popliteal artery injuries at the Massachusetts General Hospital. Twenty-two patients suffered 24 injuries. The overall limb salvage was 83%. ⋯ Arterial repair includes thrombo-embolectomy in distal arteries. If necessary, reverse saphenous vein is grafted. When operation is unsuccessful, revision should be performed.
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Short-term storage of a patient's harvested skin is clinically desirable for numerous reasons. Previous experience in our center using a skin storage solution of saline with a high concentration of antibiotics resulted in poor graft viability and an unsatisfactory clinical outcome. This report defines an improved method of storage which allows longer storage time, yielding viable skin and results in subsequent graft acceptance on the patient. ⋯ In contrast 11/16 autografts which had been stored in the RPMI-1640 solution for 5 to 22 days (median, 11 days) were successful takes when regrafted to patients. Graft loss was observed in five cases due to the following reasons: inability to immobilize graft (one); poor vascular bed (two); and bacterial infections (two). These data are in agreement with results reported in a separate paper, demonstrating the effectiveness of RPMI-1640 as a storage medium for maintaining viable human skin grafts which were subsequently transplanted to athymic nude mice.(ABSTRACT TRUNCATED AT 250 WORDS)
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To appraise the ability of each to improve wound healing in zone-of-stasis burns (i.e., burns becoming progressively more ischemic early postburn), 1) an antithromboxane (dipyridamol PO immediately postburn), 2) burn-wound cooling, 3) their combination, or 4) no treatment was administered to burned guinea pigs half of which had burn blisters removed immediately postburn (PB). In all groups with blisters removed whole-thickness or very deep partial-thickness skin loss occurred. In all groups with blisters intact complete reversal of ischemia occurred without necrosis and, while dipyridamol and cooling each diminished stasis early PB, only cooled wounds showed any improved retention of hair follicles at 3 weeks PB. In this model, therefore: 1) blister removal eliminated any therapeutic effect of cooling or dipyridamol; 2) in burns with blisters intact, absorbed heat appeared at least as detrimental to healing as stasis, and 3) some of the beneficial effects of cooling appeared unrelated to prevention of stasis.