J Trauma
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Randomized Controlled Trial Clinical Trial
Low-dose vasopressin in the treatment of vasodilatory septic shock.
Despite appropriate therapy, refractory hypotension often occurs in septic shock. A double-blinded placebo controlled clinical trial was performed to assess the role of low-dose vasopressin (VP) as a pressor agent in septic shock. ⋯ A VP infusion improved arterial pressure and permitted the withdrawal of catecholamine vasopressors. VP is a useful agent in the treatment of refractory septic shock.
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Comparative Study
Below-knee amputations as a result of land-mine injuries: comparison of primary closure versus delayed primary closure.
Antipersonnel land mines are designed to maim by mutilating the lower extremities, and these injuries are at higher risk for infection than injuries from other weapon systems. ⋯ Our results reveal that primary closure may be done in traumatic below-knee amputations caused by land-mine injuries with an acceptable infection rate, if the evacuation time is less than 6 hours, and if there is meticulous debridement.
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Randomized Controlled Trial Comparative Study Clinical Trial
Internal fixation of distal radius fractures with dorsal dislocation: pi-plate or two 1/4 tube plates? A prospective randomized study.
Severely comminuted distal radius fractures can be treated by different methods. Our routine procedure in dorsal dislocated fractures is the dorsal stabilization with two 1/4 tube plates. The new pi-plate is an other device that matches optimally the anatomy of the distal radius and allows a near half-circumferential dorsal buttress of comminuted intraarticular and extra-articular radial fractures. ⋯ With open reduction, cancellous bone grafting, and internal plate fixation in comminuted distal radial fractures, excellent results can be achieved. In our experience, we cannot recommend the 7pi-plate in its current shape and prefer to stabilize distal radius fractures and dorsal fragment dislocations with two 1/4 tube plates.
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Improving the care of trauma patients in a rural environment requires that several important issues be addressed. First, a universal definition of what constitutes "rural" must be established. We propose that a combined effort of the Federal Government and the Committee on Trauma of the American College of Surgeons develop this definition. ⋯ Finally, increased public awareness of problems unique to rural trauma care is necessary. The rural trauma subcommittee of the ACSCOT should go from an ad hoc committee to a standing committee with the American College of Surgeons Committee on Trauma. We propose a national conference on rural trauma care hosted by the federal government for the purpose of addressing these issues and simultaneously increasing public awareness.