J Trauma
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Percutaneous tracheostomy is increasingly being used for patients needing prolonged ventilatory support. The purpose of this study was to assess the feasibility of widespread application of endoscopic guided percutaneous tracheostomy. Sixty-one consecutive ICU patients requiring prolonged mechanical ventilation underwent bedside endoscopic guided percutaneous tracheostomy. ⋯ There was a 50% reduction in cost when compared to operative tracheostomy. Percutaneous tracheostomy is a simple, safe, cost-effective bedside procedure for critically ill ventilator-dependent patients. Endoscopic guidance appears to increase the safety of this procedure and may prevent complications of pneumothorax, subcutaneous emphysema, and paratracheal false passage previously reported with blinded percutaneous methods.
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Ninety-two most severely injured patients--with injuries to at least four body regions with a mean ISS of 39--were examined at the outpatient clinic 5 to 20 years after the trauma. In addition, nine patients were interviewed by phone, thus 92.6% of the patients still alive were contacted. ⋯ Only seven patients needed constant medication because of their injuries. We conclude that the treatment of even the most severely injured patients with multiple injuries is certainly worth the effort.
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Case Reports
Management of blunt injuries of the axillary artery and the neck of the humerus: case report.
Axillary artery injury, a rare vascular complication of fracture of the humeral neck, is rendered unique by the concomitant subluxation of the humeral head. A coordinated vascular and orthopaedic surgical approach is necessary to reconstruct both the shoulder joint and the artery. The operative techniques chosen may determine long-term outcome.
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Case Reports
Tangential low-velocity missile wound of the head with acute subdural hematoma: case report.
Tangential missile wounds of the head without skull fracture are a known entity. Usually, references in the literature indicate that this type of injury results from a high-velocity missile impact. ⋯ This possibility should be brought to the attention of clinicians as an essential element in this pre-treatment clinical evaluation. We propose a pathomechanical explanation for the development of the clinical state.
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Pigs were used for studies of effects on the peripheral nervous tissue of pressure waves induced by impact and passage through the left thigh of high-energy missiles. The short-lasting pressure waves were demonstrated to move close to the speed of sound and to have a spectrum of high frequencies and large amplitudes. The sciatic nerve in the contralateral leg showed no hemorrhage or major deformation. ⋯ Similar changes, although less extensive, were noticed in the phrenic nerves as well as in unmyelinated axons in both sciatic and phrenic nerves. It is concluded that a high-energy missile hit in the thigh of a pig, caused structurally demonstrable dislocations of myelin sheaths, and disarrangement of cytoskeleton and endoplasmic reticulum in axons as well as other signs of damage. The changes may interfere with the normal functions of peripheral and autonomic nerves.