J Trauma
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Serum levels of interleukin-6, interleukin-8, the soluble receptor for tumor necrosis factor (sTNFr), and the soluble receptor for intercellular adhesion molecule-1 (sICAM-1) were measured serially in a series of 13 severely injured trauma patients to determine if any of these elements of the inflammatory response are predictive of multiple organ failure (MOF). Six of the 13 patients developed MOF as determined by a MOF scoring system. ⋯ There was a significant correlation between the absolute level of sICAM-1 at the time of resuscitation and the severity of subsequent MOF. This finding suggests that leukocyte-endothelial cell interactions are upregulated immediately after injury and may be implicated in the end-organ injury that leads to MOF.
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The purpose of this study was to examine the financial impact of assault-related penetrating trauma. We specifically reviewed hospital charges and reimbursement data. Two hundred eleven patients were identified from our Trauma Registry in a 4-year period: 108 with firearm injuries and 103 with injuries related to cutting or piercing instruments. ⋯ Financial losses incurred by community hospitals from the care of penetrating injuries are substantial, and must be borne by cost shifting or other strategies. No evidence of "dumping" was found among this group of patients. The specter of injury caused by intentional violence extends beyond urban trauma centers, and has a serious negative financial impact on community trauma centers.
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Case Reports
T-tube intubation in the management of late traumatic esophageal perforations: case report.
Delayed diagnosis of esophageal perforations can lead to high mortality and morbidity and presents a surgical dilemma. A case report of a bullet wound of the esophagus that was diagnosed late is presented. Placement of a biliary T-tube and pleural decortication were carried out after the perforation was found at esophagoscopy. The patient had no fistula nor esophageal narrowing at discharge 31 days after injury.
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The annual number of major lower limb amputations in Denmark as a consequence of trauma was constant during the period 1978 through 1990, with about 70 (1.4 per 100,000 population) per year. The mean age of the amputation population was 49.4 years (males, 44.8 years; females, 58.8 years). Analysis of the age distribution shows characteristic differences between male and female patients. ⋯ The only systematic change during the period under study was the increase in the number of through-knee amputations. The in-hospital mortality was related to sex, level of amputation, and age. The relative number of amputations varied in the different counties of Denmark and a positive correlation between population density and rate of amputation was found.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective evaluation of epidural versus intrapleural catheters for analgesia in chest wall trauma.
Severe blunt chest trauma can produce multiple rib fractures, flail segments, and pulmonary contusions. All of these injuries produce pain and diminished pulmonary function. The effectiveness of intrapleural and epidural administration of bupivacaine was prospectively evaluated in 19 patients with severe chest trauma. ⋯ Vital capacity, FIO2, minute ventilation, and respiratory rate were not affected. Mild hypotension was a common complication with epidural catheters. We conclude that continuous epidural analgesia is superior to intrapleural block and significantly improves tidal volume and negative inspiratory pressure.