J Trauma
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The involvement of cytokines in trauma still has not been satisfactorily elucidated. The development of multiorgan failure, the very serious complication of multiple trauma with high mortality, should also be controlled by cytokines, endotoxin, and other mediators. We therefore prospectively studied 42 consecutive patients with multiple trauma admitted from June to December 1992 to the Research Institute for Traumatology and Surgery in Brno. ⋯ In conclusion, the IL-6 and TNF-alpha levels seem to play a significant role in multiple trauma and their late elevation in patients with MOF conveyed a poor prognosis. A significant correlation between initial IL-6 levels and ISS was observed. Other cytokines did not show dynamic changes during the study.
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Recent years have seen a renewed interest in the use of hypertonic-hyperoncotic solutions as plasma volume expanders for the treatment of hemorrhagic hypotension. In particular, a number of studies in experimental animals have addressed the efficacy and safety of small-volume infusions of 7.5% NaCl/6% dextran 70 (HSD). ⋯ In the few human field trials completed to date, HSD has been shown to be potentially beneficial in hypotensive trauma patients who require surgery or have concomitant head injury. Extensive toxicologic evaluations and lack of reports of adverse effects in the human trials indicate that, at the proposed therapeutic dose of 4 mL/kg, HSD should present little risk.
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The quality of a trauma system can be assessed by the rate of preventable deaths. A random selected sample of 110 trauma patients was examined using both clinical and autopsy data. ⋯ The main failures of treatment were identified as errors and delays during the first phases of in-hospital assessment and care. An improvement in the pre-hospital phase will be almost useless if the quality of the definitive in-hospital management is not addressed.
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Seventy adult and pediatric patients with blunt splenic injury were managed nonsurgically using previously published clinical criteria without regard to the appearance of the spleen on computed tomographic (CT) scans. Seven patients (10%) who underwent delayed surgery were considered failures of nonsurgical therapy; all recovered after total splenectomy. Two radiologists, blinded to patient outcome, retrospectively reviewed the admission CT scans of all 70 patients and graded them according to three published scoring systems. ⋯ No failures occurred in patients under age 17 years. Our data support the hypothesis that properly selected patients can be safely observed regardless of the magnitude of splenic injury on CT scans. A decision to undergo early exploration should be based on clinical criteria, including the patient's age and associated injuries.
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Case Reports
Thoracic aortic dissection with renal artery involvement following blunt thoracic trauma: case report.
Blunt thoracic aortic injury most often occurs beyond the left subclavian artery with subsequent transection and exsanguination. We present a case of an unrestrained driver involved in a high-speed motor vehicle crash who had a traumatic mid-thoracic aortic dissection involving the orifices of both renal arteries, resulting in anuria. This diagnosis should be considered in the presence of anuria following chest trauma.