J Trauma
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The evaluation of various techniques to diagnose or exclude ventilator-associated bacterial pneumonia has been a focus of much research. One such technique involves elastin fiber detection. It has been inferred from previous work that 40% potassium hydroxide preparations of respiratory secretions that demonstrate elastin fibers have a 100% specificity in diagnosing bacterial pneumonia in intubated, mechanically ventilated patients without acute diffuse lung injury. The purpose of this investigation was to ascertain if elastin fibers might be detected in respiratory secretions in acute, diffuse lung injury in the absence of pneumonia (i.e., assess specificity). ⋯ We concluded that seeing these results, given a true specificity of 0.99 inferred from previous work, is highly improbable with a probability of 2.74 x 10(-7). Thus, elastin fiber analysis is likely to be highly nonspecific for diagnosing pneumonia in the setting of acute diffuse lung injury.
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Based on the findings in computed tomography scans, we defined a grading system that is well correlated to the changes of the brainstem and its perimesencephalic cistern during intracranial hypertension. ⋯ Our grading system is easy to use, and is well correlated to give an accurate prediction of outcome in cases with severe head injury based primarily on the results of an initial computed tomography scan, even without clinical information, and it should play a role in the classification of head injury.
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Review Case Reports
Brachial artery rupture associated with closed posterior elbow dislocation: a case report and review of the literature.
A case report of a closed posterior elbow dislocation with brachial artery rupture treated with a reversed saphenous vein graft, fasciotomy, and medical collateral ligament (anterior oblique component) repair is presented. A literature review of 21 other similar cases is discussed. ⋯ At final follow-up, 12 patients (55%) had a motor and/or sensory deficit, and 11 patients (50%) had restriction of elbow extension. Seven of these 11 patients had a loss of elbow extension of 5 to 15 degrees; the other four patients had a loss of 20 to 35 degrees.