J Trauma
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Comparative Study
Cultured epithelial autograft: five years of clinical experience with twenty-eight patients.
Cultured epithelial autograft (CEA) has been used as an adjunct in burn wound coverage at the Vancouver Hospital and Health Sciences Centre since 1988, and has been available to all patients admitted with significant burn injuries. During the 5-year period from 1988 to 1992 inclusive, 28 patients treated with CEA survived long enough for assessment. The mean age was 35.3 years with a mean total body surface area burn of 52.2% and a mean total full thickness injury of 42.4%. ⋯ The anterior trunk and thighs were the best recipient sites. Subjective differences between CEA and meshed autograft were noted. The results show that after 5 years of use, CEA engraftment continues to be unpredictable and inconsistent, and hence, it should be used as only a biologic dressing and experimental adjunct to conventional burn wound coverage with split thickness autograft.
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The availability of unreamed interlocked nails for fixation of tibia fractures has raised the issue of what effect reaming the intramedullary canal has on the clinical outcome after tibial nailing. A retrospective review was performed of all tibial fractures treated with interlocking nailing at the authors' institution over the past 5 years in order to compare reamed and unreamed nailing. Forty-five nailings were identified of which 38 had adequate follow-up information to be considered healed or non-united at 1 year. ⋯ Patellofemoral complications were more common in unreamed nailings. Although this study is limited by retrospective, nonrandom design, it raises questions about the routine use of unreamed nailing with regard to healing potential and other postoperative complications. Further study is warranted.
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Comparative Study
Outcome from critical care in the "oldest old" trauma patients.
This study evaluated the "oldest old" Intensive Care Unit (ICU) trauma patients, defined as patients of age 75 and over, to determine the relationships between age, injury magnitude, physiologic severity of illness, and outcome in this group, compared with younger trauma patients. Of 1,039 consecutive Surgical ICU (SICU) patients with complete data, 45 were in the Oldest group, 54 were in the Elderly group (ages 65 to 74), and 940 were in the Younger group (age < 65). Age, sex, and type of trauma (penetrating versus blunt) did not predict outcome. ⋯ When patients were stratified by ISS, there was a statistically significant difference in day 1 SAPS among age groups for most ISS categories, with higher SAPS associated with advancing age. The oldest old fare worse with trauma because their injury is more severe (higher ISS) and because their physiologic response to a given level of injury is exaggerated (higher SAPS). However, once the oldest old are stratified by SAPS, their outcome parallels that of their younger trauma cohorts.(ABSTRACT TRUNCATED AT 250 WORDS)
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The purpose of this study was to determine the frequency and significance of computed tomographic (CT) scan-detected pneumoperitoneum in blunt abdominal trauma. We retrospectively reviewed 118 consecutive CT scans of the abdomen in blunt abdominal trauma patients (mean Injury Severity Score 24), performed at our Regional Trauma Unit over a 12-month period. Seven (5.9%) patients had intra-abdominal extraluminal air. ⋯ In the setting of blunt abdominal trauma pneumoperitoneum does not necessarily indicate hollow viscus injury. It frequently is secondary to other etiologies, especially dissection of interstitial air from the chest, as suggested in this study. The decision for laparotomy should be based on a combination of the clinical findings, CT scan results, or other diagnostic tests such as peritoneal lavage.
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To determine the appropriate methods for the diagnosis and management of gunshot injuries to the external genitalia. ⋯ Successful management of genital GSWs is dependent upon prompt surgical exploration, conservative debridement, and primary repair.