J Trauma
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Unilateral pulmonary contusion after blunt thoracic trauma can prove to be a devastating injury. Regional disturbances in blood flow and alveolar ventilation can significantly alter pulmonary function. We present a case report of unilateral pulmonary contusion that resulted in significant pulmonary dysfunction. ⋯ The effect of nitric oxide applied to the "normal" lung, the "injured" lung, and both lungs is described. The use of inhaled nitric oxide was associated with an increase in oxygenation when applied to the normal or both lungs. The use of nitric oxide in conjunction with differential lung ventilation appeared to offer benefit in this patient with severe unilateral pulmonary contusion.
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Tibial fractures with an associated vascular injury are a challenging management problem for the orthopedic and vascular surgeon. The effect of a concomitant vascular injury on fracture healing has not been specifically delineated previously. ⋯ Outcomes of tibial fractures with an associated vascular injury are poorest in older patients (who are at increased risk of amputation) and those with an injury to the posterior tibial artery (who are at increased risk of delayed union and nonunion).
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Comparative Study
Effect of chronic cocaine administration on the hemodynamic response to acute hemorrhage in awake and anesthetized sheep.
Although Cocaine use is common in trauma victims, little is known about how cocaine affects the cardiovascular response to trauma and associated blood loss. This study determined the effect of chronic cocaine use on the cardiovascular response to hemorrhage in awake and anesthetized sheep. ⋯ Chronic cocaine exposure did not have an important effect on the cardiovascular response to hemorrhage in awake sheep. However, in anesthetized sheep, chronic cocaine exposure diminished the compensatory cardiovascular response to graded hemorrhage.
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The prevalence of impairments and disabilities in activities of daily living (ADL), nonwork activities, and work were registered in a consecutive series (n = 69) of subjects with severe injuries. At follow-up 3 years after trauma, residual impairments prevailed in 80%. Only a few (6%) were ADL-dependent. ⋯ Although overall changes in social network quantity and quality were small, significantly more subjects with cognitive impairment or vocational disability experienced a decline in the quality and quantity of their social network after trauma. Furthermore, 25% of the subjects reported an increase in feelings of loneliness after trauma. We recommend the design of individualized, multidisciplinary rehabilitation plans before discharge from departments of surgery.