J Trauma
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Fluid and sodium restriction have been advocated after brain injury as a means of controlling intracranial pressure (ICP). Recent clinical data showing no significant relationships between the amount of fluid infused or sodium administered (Na) and ICP question this practice. ⋯ These data suggest that both the volume of fluid infused and the fluid balance do affect the ICP, but the amount of Na infused does not. The lack of a significant correlation between any of the independent variables and CWC suggests that their effect on ICP is not related to cerebral edema formation. These findings, combined with the observed significant positive correlation between free H2O infused and ICP, and the significant negative correlation between serum osmolarity and ICP, suggest that HSL resuscitation increases intracranial compliance after brain injury while LR decreases it. The data also suggest that free water restriction is warranted in patients with head injuries.
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Penetrating thoracoabdominal trauma presents a difficult diagnostic dilemma. Violation of the diaphragm may be very difficult to establish. Conventional diagnostic procedures such as chest radiography, computed tomography, and diagnostic peritoneal lavage have been shown to be unreliable. ⋯ There were no procedure-related complications. Thoracoscopy is a safe, accurate, reliable diagnostic technique for evaluating thoracoabdominal penetrating trauma. It is less invasive than celiotomy and has the added benefit of diagnosis and therapy of the intrathoracic injuries.
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This study was designed to document the reasons hospitals have been unsuccessfully peer reviewed as potential trauma centers. ⋯ A limited but critical set of criteria enable a hospital to function as a trauma center. Trauma quality improvement is a poorly understood but a correctable issue. Surgical and hospital commitment are essential for verification. Prior consultation may be of benefit.
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A recent retrospective analysis of femur fractures concluded that early surgical fixation in patients who have sustained blunt thoracic trauma (AIS score for Thorax > or = 2) was a risk factor for postoperative pulmonary failure. We conducted a review of all femur fractures admitted to a level I trauma center from November, 1988 to May, 1993. Inclusion criteria were ISS > or = 18, mid-shaft femur fractures treated with reamed intramedullary fixation, and no mortalities secondary to head trauma or hemorrhagic shock. ⋯ Mortality rate, length of stay (LOS), LOS in the TICU, and duration of mechanical ventilation tended to be greater in patients with delayed fracture fixation, however, this was not statistically significant. The N2 patients had a pneumonia rate of 38% compared with 10% in group N1 (p = 0.07). The T2 patients had a pneumonia rate of 48% compared with 14% in group T1 (p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)
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Retraction Of Publication
Retraction of papers published in The Journal of Trauma.