J Trauma
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Five cases of firearm missile emboli are reported. Three were not unusual arterial bullet emboli. One, however, was a single shotgun pellet embolus which produced death from cerebral infarction. The fifth case appears to be the first known to embolize within the portal system and was associated with a 'wandering bullet' within the pericardial space.
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Comparative Study
The risk:benefit of autotransfusion--comparison to banked blood in a canine model.
Recent enthusiasm for intraoperative autotransfusion has overshadowed critical assessment of its potential risks. In this study, adult mongrel dogs underwent controlled intraperitoneal hemorrhage of twice their estimated blood volume over a 4-hour period. The blood was replaced by an equal volume of banked blood (Group I, n = 5), or collected and reinfused via the Sorenson System (Group II, n = 6), or the Haemonetics Cell Washing Device (Group III, n = 6). ⋯ T. lengthened, and levels of factors II, V, VIII, and fibrinogen fell. Autotransfusion clearly eliminates the infectious and incompatibility problems of banked homologous blood. Despite advances in technique, however, consumptive coagulopathy, fibrinolysis, and platelet dysfunction occur.(ABSTRACT TRUNCATED AT 250 WORDS)
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Since the opening of the Toronto Transit Commission Subway System in 1954, detailed records have been kept of person/train contact incidence. Until the end of 1980, 207 people committed suicide and 223 attempted suicide and have been unsuccessful. There have been 25 fatal accidents and 11 nonfatal accidents. ⋯ We studied in detail 119 City of Toronto coroner's reports to assess the causes of death, associated injuries, and psychiatric histories of suicide victims. This included 11 patients who arrived alive to hospital but subsequently died. A number of psychiatric papers suggest that 90% of patients who attempt suicide and are unsuccessful, will not die in the future as a result of suicide and 60 to 80% will not repeat their attempt.
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Previous reports on the use of the serum amylase level to assess pancreatic injury in patients with blunt abdominal trauma have been disappointing. The availability of methods to measure the serum isoamylases (P & NP) might be expected to improve the accuracy with which the serum amylase level is used. Sixty-one patients treated for a variety of blunt trauma injuries were studied. ⋯ Two patients with isolated head injury had substantial elevations of pancreatic isoamylase. The regulation of serum amylase is multifactorial and variable. The measurement of serum isoamylase levels does not offer great improvement over the serum amylase in evaluating patients with blunt abdominal trauma.
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Although shotgun and gunshot injuries are frequently grouped together, shotgun injuries are ballistically and clinically very different from gunshot wounds. Because of the differences between gunshot and shotgun injuries, the clinical records of 85 patients with 112 extremity shotgun wounds treated over a 6-year period were reviewed: 11% had Type I injuries; 30% and 59%, respectively, had Type II and Type III injuries. Overall, 59% had major soft-tissue injuries and 44% had bone or joint injuries, and nerve and vascular injuries were documented in 21% and 26%. ⋯ In contrast, neither skeletal nor vascular injuries resulted in long-term extremity disability. Thus, we recommend an aggressive operative approach towards early wound closure in these patients to decrease hospitalization time. Further, we believe that the operative determination of the presence or absence of anatomic damage of the nerves in patients with neural deficits is an important component in the long-term management of these patients.