J Trauma
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Retrievable inferior vena cava filters (rIVCF) reduce the short-term risk of pulmonary embolism without the filter and inferior vena cava (IVC) thrombosis that have been reported with the use of permanent filters. Studies have shown that most rIVCFs are not removed, leaving patients at risk for thrombotic complications of rIVCF retention. We hypothesize that the application of a systematic follow-up for rIVCF will improve filter removal rates, providing patients short-term prophylaxis from pulmonary embolism whereas avoiding complications of permanent filter retention. ⋯ A dedicated system for following-up patients with rIVCFs markedly improves removal rates of retrievable filters.
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Comparative Study
Effects of fluid resuscitation with hypertonic saline dextrane or Ringer's acetate after nonhemorrhagic shock caused by pulmonary contusion.
Injured lungs are sensitive to fluid resuscitation after trauma. Such treatment can increase lung water content and lead to desaturation. Hypertonic saline with dextran (HSD) has hyperosmotic properties that promote plasma volume expansion, thus potentially reducing these side effects. The aim of this study was to (1) evaluate whether fluid treatment counteracts hypotension and improves survival after nonhemorrhagic shock caused by lung contusion and (2) analyze whether resuscitation with HSD is more efficient than treatment with Ringer's acetate (RA) in terms of blood oxygenation, the amount of lung water, circulatory effects, and inflammatory response. ⋯ Fluid treatment does not affect blood pressure or mortality in this model of nonhemorrhagic shock caused by lung contusion. However, our data indicate that HSD, when compared with RA, has advantages for the injured lung.
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Fractures of the talar neck are relatively uncommon. The reported rates of avascular necrosis in Hawkins type II fractures vary from 34% to 50%. Various strategies have been adapted to prevent the occurrence of avascular necrosis. ⋯ The use of a vascularized cuboid pedicle bone graft and combined internal and external fixation can effectively prevent avascular necrosis of the talus in preliminary study. Further randomized control research is necessary to clarify the effectiveness of this technique.
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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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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.