J Trauma
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Large skeletal defects of the femur caused by infected nonunions remain a challenge to orthopedic surgeons. Conventional bone grafting may not succeed when the recipient bed is not ideal. Single fibular grafts were proven very useful in bridging this type of defect, yet were complicated by the high incidence of refracture and the need for protection of long duration. ⋯ All the fractures healed in an average of 7 months. By 1 year the grafts hypertrophied to the size of the femur. A follow-up of at least 2 years recommends this technique in the management of certain chronic osseous defects of the femur.
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Review
The 1991 Fraser Gurd Lecture: evolution of airway control in the management of injured patients.
The evolution of methods for airway control has been an important factor in improving overall trauma care. Many important advances have been made in technique, tubes, and timing. Current methods of airway control are listed in Table 2 and are categorized as emergency or elective. ⋯ The role of differential ventilators in the management of unilateral pulmonary parenchymal injury requires clinical validation. Intravascular membrane oxygenators have been proposed in advanced pulmonary insufficiency in a ventilated patient. Thus, while many important strides have been made in airway management following trauma, there remain great challenges in addressing the persistent problem of systemic hypoxemia after multiple injuries.
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Comparative Study
Immediate positive pressure ventilation with positive end-expiratory pressure (PEEP) improves survival in ovine smoke inhalation injury.
The purpose of this study was to compare the effects of immediate initiation of positive pressure ventilation (PPV) with positive end-expiratory pressure (PEEP) versus the initiation of PPV with PEEP only after hypoxemia ensued following severe smoke inhalation injury. ⋯ Immediate PPV + PEEP did not prevent the development of hypoxia and was associated with increased pleural fluid formation. Death within 96 hours in the delayed group was the result of respiratory failure aggravated by bronchial cast formation despite vigorous pulmonary toilet. Early positive pressure ventilation with PEEP, preferably initiated immediately after the inhalation insult, significantly increases short-term survival and is associated with decreased tracheobronchial cast formation in this ovine model of severe smoke inhalation injury.
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Case Reports
Spontaneous endobronchial erosion and expectoration of a retained intrathoracic bullet: case report.
In all four previously reported cases of endobronchial erosion from retained intrathoracic foreign objects, the object eventually required surgical removal. We report the case of a patient with a bullet in the left hemithorax who developed bronchial erosion and hemoptysis 3 months after the injury, with subsequent expectoration of the bullet. Although most foreign bodies within the thorax pose no special problems, migration of the object or the development of symptoms warrants investigation and possibly subsequent surgical removal of the object.
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Comparative Study
The effects of hypothermia and injury severity on blood loss during trauma laparotomy.
To assess the relationships between core temperature (T) and other factors relating to operating room (OR) blood loss and mortality following abdominal injury, the records of 122 patients undergoing laparotomy for trauma at Detroit Receiving Hospital over a 1-year period (1989) were reviewed. Most injuries were penetrating (86%) and the mortality rate was 8.2%. Overall, 57 of 122 (47%) had hypothermia (T < or = 35 degrees C) upon arrival in the OR. ⋯ Trauma scores and the presence of shock preoperatively correlate with the development of intraoperative hypothermia. Hypothermic patients with similar injury severity have greater blood loss. Prevention and rapid correction of hypothermia during resuscitation and surgery appear to be extremely important in reducing blood loss in this patient population.