J Trauma
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An unusual case of abdominal impalement is presented. In such patients intra-abdominal injury must be suspected, and the impaling object must not be manipulated until the proper moment in the operating room. An approach involving various subspecialties, such as urology, neuro-, and vascular surgery, is often required.
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The role of late restitution of blood volume after hemorrhage in cardiovascular stabilization was examined in awake, splenectomized dogs. Cardiovascular variables were measured: at 2 hours after hemorrhage, changes were noted in cardiac output, mean arterial pressure, heart rate, stroke volume, arterial pressure, and CVP in three hemorrhage groups (p less than 0.05), and in total peripheral resistance for 15 ml/kg and 22.5 ml/kg hemorrhage groups (p less than 0.05). At 24 hours after hemorrhage, the degree of restitution of blood volume was correlated with cardiac output (p less than 0.01), stroke volume (p less than 0.02), and total peripheral resistance (p less than 0.01). ⋯ Blood volume restitution was correlated with degree of hemorrhage throughout the 24-hour period of investigation. Plasma protein content restitution and blood volume restitution were correlated with changes in osmolality. The results suggest thatcardiovascular stabilization after hemorrhage is a function of the degree of restitution of blood volume mediated through a shift of fluids to the interstitutium, mediated in turn by extracellular hyperosmolality.
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The rarity of triceps tendon avulsion is called into question by our series of 6 cases collected over a 5-year period in a small, isolated Israeli community. The even rarer occurrence of triceps avulsion accompanying fractures of the radial head is more obviously contradicted by the 3 or 4 instances of such combined injuries in our series. ⋯ Just as fractures of the proximal ulna oblige the clinician to look for dislocations of the radial head (Monteggia or Hume fractures) (6), so must falls on the outstretched arm bring to mind the possibility of triceps tendon tears. Seemingly trivial findings then become significant, and the clinical entity thus crystallizes into the diagnostic syndrome.