J Trauma
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A period of aggressive surgical treatment of early identification of fungal infection of the burn wound was compared with the previous 5 years' experience with patients suffering from fungal infection of burn wounds. The portion of those patients with Candida infections diagnosed and treated premortem increased from 48.0% to 63.6% and of patients with noncandidal infections from 40.8% to 67.0% in the more recent period. ⋯ Local surgical control of the infected portion of burn wounds is an effective way of improving the survival in noncandidal burn wound infections. Surgical excision of burn wounds does not alter the poor prognosis of patients with Candida invasion of the burn wound.
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Even though metal refineries require workers to wear safety boots, molten metal splash causes serious burns to the feet and ankles of these employees. Twenty cases are reported which illustrate the need for safety boot top protection. In analyzing these cases, it was found that these molten aluminum and brass alloy burns were not full-thickness, and dermis could be preserved. The technique of dermabrasion-debridement was found to be a valuable tool for accurate debridement of such wounds in this location.
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In two cases of bullet embolization to the pulmonary artery the bullets were left in place. Removal of the bullet was felt to be an unnecessary surgical risk. A two-year and six-year follow-up revealed no complications. In both instances the patients received adequate blood replacement for resuscitation and levels of antibiotics considered high enough to eradicate any possible infection from the contaminated missile.
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Between 1968 and 1978, 32 patients were seen with nonunion of distal humerus fractures in close proximity to the elbow: 25 were treated with open reduction and fixation of the nonunion, and seven patients were treated with excision of the distal fragments and total elbow arthroplasty. Of the 25 patients treated with open reduction and fixation, 22 had union at an average of 7.74 months. However, six of these patients needed secondary procedures for repeat bone grafting or revision of the fixation device. Two of the seven patients with total elbow arthroplasty needed reoperation for loose humeral components.
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Post-trauma patients have an oxygen consumption which is proportional to oxygen delivery, suggesting that tissue oxygen consumption is limited by diffusion. Transfusion of packed red blood cells (RBC), which increases the oxygen-carrying capacity of blood, would be expected to increase mixed venous PO2, thereby improving tissue oxygenation. However, the low P50 of stored blood may increase the affinity of hemoglobin for oxygen and reduce oxygen consumption. ⋯ Standard P50 decreased by 4.2 +/- 2.4 Torr following transfusion of two units of RBC (p less than 0.05). Red blood cell transfusion thus failed to increase oxygen consumption in these patients, despite an increase in oxygen content. Thus, RBC transfusion may not improve tissue oxygenation.