J Trauma
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We present an uncommon case of traumatic atlantoaxial distractive instability which manifested itself clinically in a respirator-dependent quadriplegic. The initial radiographic finding was anterior atlantoaxial dislocation. The patient was managed initially by halo traction and, 8 weeks later, demonstrated occipitocervical fusion with gratifying results.
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It has been suggested that the adult respiratory distress syndrome (ARDS) is a manifestation of a generalized vascular permeability defect. Low-level urinary albumin excretion reflects changes in systemic vascular permeability in a variety of acute inflammatory conditions including trauma. To test the hypothesis that impaired pulmonary function is associated with increased systemic vascular permeability, 44 trauma patients with Injury Severity Scores (ISS) ranging from 9 to 75 were studied over 3 days. ⋯ During the first posttrauma period the log ACR and the PO2/FIO2 ratio were inversely related (r = -0.712; p < 0.001), and the log ACR predicted PO2/FIO2 independent of ISS (p = 0.001). The log mean ACR (SD) for groups I and III were 34.0 (5.6) and 8.7 (2.9) mg/mmol, respectively (Mann Whitney p = 0.013). Following trauma, pulmonary dysfunction is associated with increased vascular permeability in remote organs.
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The purpose of this study is to describe our experience with thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest trauma. ⋯ Thoracoscopic drainage and decortication offers an alternative to thoracotomy for definitive therapy of empyema thoracis developing after penetrating chest trauma.
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Case Reports
Acute bleeding caused by rupture of the thyroid gland following blunt neck trauma: case report.
We describe a case of blunt neck trauma that resulted in extensive rupture of a normal thyroid gland. Our experience shows that lesions of the thyroid gland must be taken into diagnostic consideration after blunt neck trauma, even in the absence of obvious signs of injury.
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Comparative Study
Blood transfusions: for the thermally injured or for the doctor?
Because of the inherent risks of blood transfusions, including the transmission of viral and other infectious diseases, it is important to re-evaluate blood transfusion policies. ⋯ Routinely transfused patients, on average, received over 5 units more blood than the selective group without any apparent clinical benefit. Thus, the results of this pilot study support a policy of selective blood transfusions in burn patients.