J Trauma
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Serum levels of interleukin-6, interleukin-8, the soluble receptor for tumor necrosis factor (sTNFr), and the soluble receptor for intercellular adhesion molecule-1 (sICAM-1) were measured serially in a series of 13 severely injured trauma patients to determine if any of these elements of the inflammatory response are predictive of multiple organ failure (MOF). Six of the 13 patients developed MOF as determined by a MOF scoring system. ⋯ There was a significant correlation between the absolute level of sICAM-1 at the time of resuscitation and the severity of subsequent MOF. This finding suggests that leukocyte-endothelial cell interactions are upregulated immediately after injury and may be implicated in the end-organ injury that leads to MOF.
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Case Reports
Transcutaneous balloon catheter tamponade for definitive control of subclavian venous injuries: case reports.
Two cases are presented in which transcutaneous balloon catheter tamponade of exsanguinating infraclavicular injuries was performed in the trauma admitting area. Angiography and venography demonstrated isolated injuries of the subclavian vein tamponaded by the balloon catheter. Balloon catheter tamponade provided emergency control of bleeding in the admitting area and ultimately definitive treatment of the venous injury.
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Injuries of the inferior vena cava (IVC) require prompt and definitive action. To evaluate our current management strategy, we reviewed 38 patients with IVC trauma treated from 1983 through 1990. Sixteen were injured by gunshots, eight by stabs, and 14 by blunt mechanisms. ⋯ We conclude that inferior vena caval injury remains a highly lethal injury. Successful outcome depends on prompt volume restoration, a stratified selective management approach, and avoidance of hypothermia. Prosthetic vena caval reconstruction represents an acceptable alternative.
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To determine whether being overweight is a predisposing factor for some common fracture types caused by stumbling, slipping, and low-energy falls, the body mass index (BMI) of 4012 adult patients with acute extremity fractures requiring surgical treatment was compared with the age-specific and sex-specific BMI values obtained from a general population sample. The cross-sectional study included 317 patients with displaced fractures of the elbow joint (distal humerus, olecranon, or radial head) and 3695 patients with displaced malleolar fractures of the ankle. ⋯ Major contrasts emerged in middle-aged men with ankle fractures, the 95% CI for the mean BMI in the age group 50-59 years being 27.4-28.2 kg/m2 versus 25.7-26.3 kg/m2 in the general population. The conclusion of the study was that an increased body mass index was descriptive of patients with displaced fractures at the elbow and the ankle, and that overweight and obesity can be regarded as predisposing factors to these injuries.
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Review Case Reports
Extracorporeal membrane oxygenation in the successful treatment of traumatic adult respiratory distress syndrome: case report and review.
We present the case of a 25-year-old, 28-week pregnant woman with two gunshot wounds to the chest. Extracorporeal membrane oxygenation (ECMO) was begun within 12 hours, despite poor results in prior studies and the need for anticoagulation postoperatively, since oxygenation was rapidly deteriorating despite aggressive treatment. The patient ultimately made a full recovery.