J Trauma
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Stimuli involved in induction of alterations of the complement system and production of circulating inhibitor(s) of phagocytic function of polymorphonuclear neutrophils following burn injury were investigated using a guinea pig model of scald burn injury. The activity of C1-C9, assessed by measurement of total hemolytic complement, was found to increase primarily in response to burn injury per se, whereas reduction in the activity of the alternative complement pathway was shown to develop in association with natural colonization and local burn wound infection with bacterial pathogens. Invasive burn wound infection induced experimentally with Staphylococcus aureus, Pseudomonas aeruginosa, or Candida albicans exacerbated this latter abnormality, caused consumption of C1-C9 activity, and was associated with appearance of serum factors that depressed phagocytosis of Escherichia coli 075 by peritoneal polymorphonuclear neutrophils. Thus injury and coexistent infection both play important roles in induction of humoral alterations of host defense associated with burn injury.
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Case Reports
Combined subclavian artery and brachial plexus injuries from blunt upper-extremity trauma.
Four cases of blunt upper extremity trauma producing subclavian artery and brachial plexus injuries are presented. In each case the patient was hemodynamically stable and arteriography demonstrated the subclavian lesion. Arterial reconstruction was successfully accomplished in three cases, but no use of the injured limb was regained by any patient. Early arterial repair may still be indicated to allow later above-elbow amputation for the purpose of functional rehabilitation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prolonged tracheal intubation in the trauma patient.
Over a 15-month period, 74 trauma patients who were expected to require extended intubation were studied prospectively to evaluate the appropriateness of tracheostomy. Patients were randomized to receive either early (34) or late (40) tracheostomies. ⋯ Significantly more complications occurred in rigid-posture, head-injured patients than in any other trauma grouping, but there was no significant difference in the complication incidence between the two tracheostomy groups within that classification. We conclude that patients can undergo translaryngeal intubation for up to 2 weeks without significantly increasing complications relative to transtracheal intubation.
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Blunt chest trauma resulting in azygous vein injury with associated mediastinal widening is described. Emergency operative intervention was required, and subsequent arteriography revealed initial transection of the subclavian artery requiring repair. The potential significance of mediastinal venous bleeding and the importance of arteriography in diagnosing occult arterial injury in this setting are emphasized.
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During a 10 1/2 year interval ending in June 1980, 47 patients with penetrating cardiac trauma were managed at The University of Alabama Medical Center. Thirty-nine patients (83%) were male. Mean age was 31 years (range, 13 to 69). ⋯ Mortality was 16% for the patients with both shock and cardiac tamponade. Thirteen per cent of the patients in normal sinus rhythm died, while 87% of the patients with idioventricular rhythm or asystole died (p less than 0.0001). Mortality in penetrating cardiac trauma remains high, particularly in patients with GSW and in those patients presenting with an idioventricular rhythm or asystole.