J Trauma
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C1-C2 is the predominant level of cervical spine injuries in children and adolescents. Either a fracture of the dens or atlantoaxial dislocation (AAD) without fracture of the dens can occur. We present a number of cases to compare their clinical presentations and discuss the preferred method of treatment. ⋯ There is a higher incidence of atlantoaxial dislocation without fracture in children under 13 years of age and a higher incidence of dens fractures in those over 13 years of age. Those with fractures of the dens are more likely to present with evidence of neural injury while those with AAD are more likely to be neurologically intact; however, a correct diagnosis and proper management are mandatory to prevent chronic myelopathy. Halo-vest immobilization is sufficient for most fractures of the dens in children, with AAD usually requiring a fusion.
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To evaluate te feasibility of retrospectively creating a data base useful in trauma systems evaluations. ⋯ Linking records to create the study data base was arduous and could not be practically accomplished on a large scale or on a continuing basis. Because of the growing emphases on trauma system evaluations and outcomes beyond survival at acute care discharge, we recommend the routine inclusion of rehabilitation data in hospital-based trauma registries.
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The results of retrospective analysis in the treatment of 189 wounded with colorectal lesions treated at the Military Medical Academy from July 1991 to December 1993 were presented. Primary surgical management was performed in 33 (17.5%) wounded. The others were transported into this hospital for further treatment after primary surgical management in war hospitals in the combat zone. ⋯ Postoperative complications (colorectal cause) were found in 40 (21.2%) wounded. Reoperation was performed in 35 (18.5%) wounded. Total mortality rate was 10.1% (19 wounded).
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The authors describe an approach and a novel technique to solve a leaky endotracheal tube cuff problem in ventilator-dependent patients without immediately resorting to the potentially hazardous task of changing an endotracheal tube.
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Colloids are used clinically to minimize edema yet may have detrimental consequences on glomerular filtration. The purpose of this study is to assess the renal and hormonal effects of colloid supplementation in the fluid resuscitation of burn victims. ⋯ These findings illustrate that despite substantially increasing plasma volume, colloid infusions reduce glomerular filtration and may limit any associated diuresis. Furthermore, this study demonstrates that hormonal regulation of blood volume remains intact after moderate burn injury.