J Trauma
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Management of patients who have suffered traumatic hemipelvectomy is one of the most difficult challenges to confront a trauma surgeon. We present a case of a female survivor of traumatic hemipelvectomy and factors in the care of these patients that can lead to a successful outcome.
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Two multiple trauma patients with total rupture of the pericardium and luxation of the heart into the left pleural cavity after blunt trauma are presented. One of the patients also had rupture of the posterior wall of the left ventricle with abundant bleeding. ⋯ The pericardial injury in one patient was diagnosed and treated by immediate thoracolaparotomy, in the other by left thoracotomy within 1 hour after laparotomy: both patients recovered. Awareness of possible pericardial lesions in multiple trauma patients with symptoms of hemodynamic failure is stressed.
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During the 10-year period from 1975 to 1985 20 patients suffering from causalgia were treated. There were 15 men and five women. Ages ranged from 17 to 45 years (mean, 23). ⋯ The diagnosis of causalgia was based on the characteristic clinical picture and was confirmed by sympathetic blocks. All patients were treated by sympathectomy and all had complete dramatic relief in the immediate postoperative period. Followup ranged from 4 months to 10 years (mean, 5.3 yr).
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A patient with traumatic disruption of the thoracic duct resulting in a chylothorax and a 'chyloma' in the left supraclavicular region is described. Supradiaphragmatic ligation of the thoracic duct was necessary for treatment of the chyloma.
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Immobilization of the spine is of prime concern during transportation of trauma patients to prevent neurologic compromise. In an attempt to study certain techniques of prehospital thoracolumbar spine immobilization, we radiographically evaluated the motion of the thoracolumbar spine in a volunteer with a stable spine, a cadaver with an unstable thoracolumbar spine, and a patient with a T12-L1 fracture dislocation. Both the backboard and the Scoop stretcher offered adequate stabilization for thoracolumbar spine instability. The logroll maneuver presented the greatest possibility for movement of the spine at the unstable thoracolumbar segment.