J Trauma
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Immunization with pneumococcal capsular polysaccharide vaccines is advocated after splenectomy; however, experimental and clinical data suggest an impaired antibody response in splenectomized individuals. This study examined the value of splenic autotransplantation at various sites in augmenting the antibody response to Type III pneumococcal capsular polysaccharide in mice immunized 3 months after operation. ⋯ Antibody responses were elevated only in mice autotransplanted with 50% or more of the original splenic mass. Since autotransplantation of splenic tissue augments the antibody response to pneumococcal capsular polysaccharides, the combination of splenic autotransplantation and pneumococcal vaccination may confer more protection than either modality alone in individuals who must undergo splenectomy.
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Comparative Study
Non-cavitary hemorrhage producing shock in trauma patients: incidence and severity.
Intraperitoneal and intrathoracic bleeding, cavitary hemorrhage (CH), are recognized as major causes of hypovolemic shock in trauma patients. Blood loss from fractures and lacerations, non-cavitary hemorrhage (NCH), is not considered a common cause of shock. ⋯ There was no significant difference in the resuscitative fluid requirements, morbidity, or mortality between patients presenting in hypovolemic shock due to CH and NCH. Blood loss from NCH must be recognized as a significant source of hypovolemic shock in trauma patients.
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Significant differences were identified between a group of elderly patients (65 years and older) and a nonelderly group both with blunt thoracic trauma. There was a lower incidence of elderly patients presenting in shock; however, cardiopulmonary arrest at arrival was more frequent in this group. ⋯ A high index of suspicion must be generated for an elderly patient who has sustained blunt chest trauma. An aggressive diagnostic and therapeutic approach may lead to a decrease in the high morbidity and mortality rates in the elderly.
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When operated carelessly, snowblowers can produce serious trauma to the hand. During a 3-year period, 13 cases were identified. The injuries occurred when the operators attempted to dislodge impacted snow from the snowblower chute. ⋯ Injuries were treated with debridement and primary repair. Operator carelessness is usually responsible for the injury. If the public is made aware of snowblower hazards at the time of heavy snowfall, injuries may be avoided.