J Trauma
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A 28-year-old male developed tension pneumopericardium following penetrating paraxiphoid injury to the pericardial space. We found no previous reports of this unique problem. Pneumopericardium associated with penetrating chest trauma warrants thorough exploratory surgery to rule out direct cardiac injury.
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The activities of a trauma service in a university hospital were analyzed to test the hypothesis that operative caseload alone does not adequately measure the trauma experience of a surgical resident. Over a 2-year period, 378 victims of major trauma (blunt in 79%) were admitted to the service. Only 41% of them required a major operation by the Trauma Service. ⋯ A trauma service in a university center manages significant numbers of patients with multisystem injuries who never undergo a general surgical procedure. This experience constitutes such an important component of surgical education in trauma that it should be recognized by agencies accrediting residents and training programs. Completion of surgical residency should also imply competence in critical care of surgical patients.
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In 1976 belt usage was made compulsory for front seat passengers in the Federal Republic of Germany. Since 1984, noncompliance incurs a fine of DM 40. In 1984 belt usage was also made compulsory for back seat passengers (noncompliance not being fined). ⋯ Approximately 15 to 20 percentage points of this change are probably due to this measure. Major injuries decreased noticeably as well, in particular injuries to the eyes. Belt usage on back seats is still unsatisfactory (20%), although here too, the effect on injuries of the belt is incontestable, taking into consideration occupant interaction.