J Trauma
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Therapies to lower intracranial pressure (ICP) after traumatic brain injury (TBI) include hyperventilation (HV), intravenous mannitol (IM), and cerebrospinal fluid drainage from a ventriculostomy (DV). To determine the effects of these therapies on cerebral blood flow (CBF), fiberoptic oximetry was used to measure jugular venous O2 saturation (SjvO2) as an index of the CBF to cerebral metabolic rate for O2 (CMRO2) ratio after IM (25 g IV for more than 5 min), DV (3 min), or HV (increase respiratory rate by 4) therapy for elevated ICP. Assuming CMRO2 is constant, changes in SjvO2 reflect changes in CBF. ⋯ Therapy was initiated a total of 196 times when ICP was > 15 mm Hg for > 5 minutes, and measurements made at 20 minutes after treatment were compared with those made just before. After DV, ICP fell in 90% of the observations by 8.6 +/- 0.7 mm Hg (mean +/- SEM, n = 119); after IM, ICP fell in 90% of the observations by 7.4 +/- 0.7 mm Hg (n = 43); and after HV, ICP fell in 88% of the observations by 6.3 +/- 1.2 mm Hg (n = 14). In patients where ICP fell, SjvO2 increased by 2.49 +/- 0.7% saturation (from 68.0 +/- 1.3%) with IM, but only by 0.39 +/- 0.4% saturation (from 67.2 +/- 0.9%) with DV.(ABSTRACT TRUNCATED AT 250 WORDS)
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Traumatic ventricular septal defect with valvular injury is an uncommon blunt trauma. It may develop either immediately or be delayed, but it should be corrected electively. ⋯ Two-dimensional echocardiography and Doppler color flow mapping are very important for rapid detection in patients who are critically injured. This is a case report of the successful repair of ventricular septal defect and posterior leaflet disruption of mitral valve right after blunt trauma.
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Penoscrotal avulsion injuries are rare surgical emergencies. The best treatment for penile avulsions is split skin graft, although late results of split-grafted scrotal avulsions are not superior. Scrotal skin avulsions require additional judgment for the treatment, because there are several available treatment options. Scrotal skin remnants must be used to cover whenever possible.
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Case Reports
Management of thoracic duct injury associated with fracture-dislocation of the spine following blunt trauma.
Thoracic duct injuries accompanying blunt thoracic trauma are rare. A significant number of these lesions, however, are associated with fracture-dislocation of the spine. In this report, we discuss the surgical management of chylothorax in this setting.
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A retrospective review of 145 patients with thoracic or lumbar spine fractures from blunt trauma was conducted to identify the clinical presentation of these patients. The presence of back pain or tenderness (BPT), neurologic injury, altered sensorium from head injury or alcohol intoxication, and concomitant major injury were determined. Any delayed or missed diagnoses were analyzed. ⋯ Of the 27 (19%) patients with a negative finding of BPT, all (100%) had an altered sensorium, concomitant major injury, or neurologic deficit. There were no asymptomatic thoracic or lumbar spine fractures in neurologically intact patients with clear sensoriums and no concomitant major injuries. These patients do not need routine thoracolumbar radiography.