J Trauma
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The amputated hindquarters of adult female rats were infused with solutions of lactated Ringer's, Collins hypertonic renal perfusate, and dextran-dextrose on a washout and continuous basis. The perfusate was analyzed for energy compounds and breakdown products and the muscle tissue examined histologically. Intermittent perfusion or injection under pressure led to marked edema in a 4-hour period and was abandoned in favor of a system that perfused the part at 120 to 150 cm H2O. ⋯ The release of ATP and hypoxanthine with lactated Ringer's suggests that it is the most damaging of the perfusates. These findings support the results of the pressure graphs and histologic studies. A potential for replantation of amputated limbs that contain muscle when the cold ischemia time may exceed 6 hours is suggested by the data presented.
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The results of the selective management of 300 abdominal stab wound victims have been reviewed for a 5-year period. Initially the need for laparotomy was evaluated by sinography, later physical examination, and most recently by local wound exploration combined with peritoneal lavage. The use of sinography resulted in an unnecessary laparotomy rate of 38%. ⋯ In all other cass with intact peritoneum are discharged from the Emergency Department. If peritoneal violation is evident peri toneal lavage is performed. If the lavage is positive laparotomy is undertaken, and if negative the patient is hospitalized for an additional 24 hours of observation.
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Twenty-three patients with total complete brachial plexus injuries were reviewed an average of 5.5 years from the time of injury. Three different treatment approaches were used; no surgery (four), above-elbow amputation alone (14), and shoulder arthrodesis combined with above-elbow amputation (five). Return to gainful employment and prosthetic wearing habits were best achieved with early (within the first year) above-elbow amputation alone. There seemed little to recommend arthrodesis of the shoulder combined with above elbow amputation.
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Comparative Study
Influence of fibrinogen levels in dogs on mortality from hemorrhagic and traumatic shock.
1) Fibrinogen levels appear related to the outcome of hemorrhagic shock in dogs. 2) Fibrinogen levels can vary with different animals based on location, disease, stress, nutrition, or other factors. 3) Any experiments in hemorrhagic shock (or anything else) should utilize simultaneous and paired controls of animals from the same source or they may be subject to major error.