J Trauma
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In 34 cases of cervical spine facet dislocation treated between 1975 and 1979, the dislocations were reduced by closed methods and immobilized in the halo thoracic brace. If closed reduction was unsuccessful, open reduction and fusion were performed. ⋯ Patients with facet dislocations and minimal neurologic injury are at risk of late instability following halo thoracic brace immobilization, and therefore open reduction and posterior cervical fusion may be advisable for them. However, surgical fusion carries a high incidence of long-term neck pain and stiffness, and is indicated only in patients at risk of developing late instability.
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Between 1972 and 1981 40 victims of near-drowning were admitted to the Santa Clara Valley Medical Center. Hospital records were reviewed with regard to: 1) the circumstances of submersion and rescue; 2) the patient's condition upon arrival at the emergency room; 3) treatment, hospital course, and ultimate outcome. There were ten hospital deaths, 23 patients recovered completely, and seven were discharged with incapacitating neurologic disability. ⋯ The use of hypothermia, steroids, and barbiturate coma was not randomized, but did not appear to influence ultimate outcome. Intracranial pressure was monitored in five patients and was never elevated during the first 24 hours. The complete recovery of nearly 20% of apparently lifeless individuals justifies aggressive resuscitation and support of all victims of near-drowning.
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Clinical research on burns has developed substantially in China since 1958. Having the rich inheritance of our traditional medicine the study of burn treatment in our country has developed in a way somewhat different from that in Western countries. ⋯ In the field of estimation of the surface area and depth classification, immunology and its clinical practice of skin graft, burn wound sapremia and burn septicemia, much clinical and laboratory research work was studied by the Chinese surgeons in the past 10 years. Also, prevention of scar overgrowth and deformity following its burn contracture by prophylactic management is discussed.
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Open pelvic fracture is a devastating injury with a reported 50% mortality rate from massive bleeding and pelvic sepsis. Utilizing a graded approach to management of hemorrhage that included wound packing, anti-shock trousers, angiographic embolization, and hemipelvectomy, we controlled bleeding in all but one of the 35 patients in this series. Patients lost an average of 15 units of blood. ⋯ Prevention of invasive infection by a diverting colostomy in patients with buttock wounds or perineal wounds was stressed, while anterior soft-tissue wound were managed selectively. Debridement and frequent dressing changes under anesthesia were necessary to prevent and/or treat soft-tissue infection. Associated injuries occur commonly with genitourinary and peripheral nerve trauma and account for the majority of the long-term morbidity.
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The pathogenesis, pathology, classification, clinical features and prognosis of pulmonary burn injury have been studied recently by Chinese surgeons. New methods to treat electrical contact burns and chemical burns are introduced in this paper. The initial attempt to use microvascular surgical technic for repairing the post-burned tissue defect has developed successfully in China.