Annals of surgery
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The life expectancy of patients with aortic aneurysm is significantly prolonged by graft replacement therapy. Regardless, a significant predictor of late death is complications of either residual aortic aneurysmal disease or the development of additional aortic aneurysm. This paper reviews a personal experience in the treatment of 4170 patients with aneurysmal disease of either dissection or medial degenerative origin, indicating that multiple segment involvement was or became present in 1262 (30%) patients, 463 (67%) of 694 patients with dissection, and 799 (23%) of 3476 patients without dissection. ⋯ The 5-year survival rate from the time of first operation, including early death from operation was 75% in group 1, 65% in group 2, and 39% in group 3. The causes of death in group 3 patients were aneurysmal rupture and/or associated disease. It is concluded that initial total aortic study and regular postoperative monitoring with computed tomographic scanning is indicated to detect extensive disease or recurrence of disease and that aggressive replacement is indicated except in patients with associated disease that does not permit operation.
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The presence of transforming growth factor-beta (TGF-beta) at the site of acute injury, its ability to attract inflammatory and connective tissue cells, and its stimulatory effect on the deposition of connective tissue matrix combine to suggest that it may play a key role in the response to injury. The effect of exogenous TGF-beta form 2 on dermal wounds healing by secondary intent was investigated using a sponge composed of collagen and heparin as a delivery vehicle. Longitudinal lenticular-shaped wounds on the dorsum of adult guinea pigs were treated at the time of wounding with delivery vehicle containing 0.5, 1, or 5 micrograms of purified, bovine bone-derived TGF-beta 2, and were compared with wounds that received vehicle only or were untreated. ⋯ At day 8, but not at day 14, wounds treated with 1 or 5 micrograms of TGF-beta 2 contained a significantly higher proportion of connective tissue than did wounds treated with vehicle only, and they also exhibited higher wound strength. No effect on wound size or re-epithelialization was detected. The observations provide evidence that a single treatment with exogenous TGF-beta 2 delivered in collagen/heparin sponge vehicle can accelerate repair in guinea pig dermal wounds allowed to heal by secondary intent.
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Burn treatment requires large volumes of crystalloid, which may exacerbate burn-induced cardiopulmonary dysfunction. Small-volume hypertonic saline dextran (HSD) resuscitation has been used for effective treatment of several types of shock. In this study isolated coronary perfused guinea pig hearts were used to determine if HSD improved left ventricular contractile response to burn injuries. ⋯ However hearts from burned animals treated with HSD + 1 mL LR/kg/% burn had significantly higher LVP (79 +/- 4 vs. 68 +/- 4 mmHg, p = 0.01) and +/- dP/dt max (+dP/dt: 1387 +/- 60 vs. 1261 +/- 90 mmHg/sc, p = 0.01; -dP/dt: 1079 +/- 50 vs. 993 +/- 59 mmHg/sc, p = 0.01) than hearts from untreated burned animals and generated left ventricular function curves comparable to those calculated for hearts from control animals. Mortality 24 hours after burn was 29% for untreated burns was 0% for control animals, as well as for groups treated with the Parkland formula or HSD plus 1 or 2 mL/kg/% burn lactated Ringer's. The only deaths after treatment occurred in those animals given HSD plus 4 mL/kg/% burn, Parkland formula (17% mortality).(ABSTRACT TRUNCATED AT 400 WORDS)
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To evaluate the impact cirrhosis has on survival the records of 40 cirrhotic trauma victims from the registries of two Level 1 trauma centers were reviewed and probability of survival calculated using the TRISS methodology. Mechanism of injury, anatomic location, involvement of single or multiple sites, presence of ascites, elevations in serum glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase, serum bilirubin, prothrombin time (PT), and hypoalbuminemia were tabulated for each patient. Contingency tables were created for injury and hepatic parameters, as related to survival, and subjected to chi square analysis. ⋯ Loglinear analysis revealed that the presence of ascites, elevated PT, or bilirubin, further diminished the rate of survival for any individual injury characteristic. We concluded that survival among cirrhotic trauma victims was significantly lower than predicted. In addition the presence of hepatic insufficiency further diminishes survival, regardless of the injury sustained.
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The purpose of this study was to determine the effectiveness and associated problems of emergency intubation in 605 injured infants and children admitted to the Children's Hospital of Pittsburgh in 1987. We identified 63 patients (10.4%) undergoing endotracheal intubation at the scene of injury, at a referring hospital or in our emergency department. Injuries were to the head (90.5%), abdomen (12.7%), face (11.1%), chest (6.3%), neck (3.2%); or were orthopedic (19%) or multiple (39.7%). ⋯ Head injury with coma is the most common setting for emergency intubation. Airway complications are common, and are more frequent in treatment attempt at the scene. Despite endotracheal intubation, injured children in our series remain at high risk for hypoxemia, elevated arterial PCO2, and major airway complications, all of which contribute to secondary brain injury.