J Trauma
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In patients with unstable pelvic ring fractures, the factors related to poor outcome are still controversial. The purpose of our study was to evaluate the long-term functional outcome of patients with unstable pelvic ring fractures and correlate it with various other factors. ⋯ The long-term functional outcome after unstable pelvic ring fracture was not associated with Injury Severity Score, fracture location or fracture type. We discovered a close correlation between neurologic injury and functional outcome.
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Review Case Reports Comparative Study
Coagulopathic patients with traumatic intracranial bleeding: defining the role of recombinant factor VIIa.
The combination of coagulopathy and intracranial bleeding (ICB) is a well-recognized cause of morbidity and mortality in the neurosurgical patient because of the risk of hematoma expansion. Although recombinant factor VIIa (rFVIIa) has been shown to be useful in intracerebral hemorrhage, its use in other forms of ICB such as subdural hematomas (SDHs) has rarely been described. ⋯ rFVIIa is an inducer of hemostasis, which successfully controlled potentially devastating bleeding in all of 15 coagulopathic neurosurgical patients with ICB. The use of rFVIIa lowered the INR into the operable range in all patients, allowing surgery, and in some cases, obviated the need for surgery. Randomized, placebo-controlled clinical trials are needed to further assess the efficacy and cost-effectiveness of this approach in this setting.
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Major limb amputations are among the most debilitating wounds sustained by those who survive a combat injury and these injuries leave a lasting impression with the public. This article will review the history of major limb amputation in military trauma surgery. ⋯ Major limb amputation remains a fearsome outcome of limb injury. However, during the last 500 years, military trauma surgeons have solved the problems of bleeding, infection, and neurovascular repair after major limb injury such that amputation rates even during times of active military conflict are at historic lows.
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Controlled Clinical Trial
Continuous hemofiltration in hyperthermic septic shock patients.
Severe hyperthermia commonly accompanies septic shock. High body temperature in absence of infection activates the inflammatory response and is associated with a high mortality. Three years ago, our hypothesis that sustained fever is harmful in septic shock led us to the development of a protocol aiming at decreasing hyperthermia (>/=39.5 degrees C) by means of hemofiltration when the patients did not respond to antipyretics. We present a report of temperature and hemodynamic changes and the outcome of 19 consecutive hyperthermic septic shock patients with multiorgan system failure and compare them with a historical similar group of patients in whom hyperthermia was not treated with hemofiltration. ⋯ Continuous low-flow hemofiltration decreased body temperature and vasopressor requirements in hyperthermic septic shock patients. The mortality was unexpectedly low.