Canadian Medical Association journal
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Although continuous positive-pressure ventilation (internal pneumatic fixation) was a great advance in the treatment of flail chest and is now the standard treatment of this condition, early and late complications related to tracheostomy and long-term ventilation are associated with this method. These complications can be avoided by use of three recently adopted techniques--expectant therapy, intermittent mandatory ventilation with positive end-expiratory pressure, and early surgical stabilization of fractures. All patients should continue to be treated in intensive care units so that impending respiratory failure can be identified and treated. These newer forms of therapy not only have the advantages of avoiding complications inherent in tracheostomy and prolonged ventilation, but also decrease the length of hospital stay and expense of treatment.
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In seven infants with DiGeorge syndrome the major clinical manifestation was cardiac failure in the 1st week of life. All had severe congenital heart disease: five had interruption of the aortic arch and associated lesions, one had a ventricular septal defect and a cervical aorta, and one had truncus arteriosus. All but one died by 2 weeks of age. Necropsy data lent support to the hypothesis of a relation between the cardiovascular anomalies and defective development of structures derived from the third and fourth pharyngeal pouches.
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Increased intracranial pressure is a frequent complication of head injuries. Direct measurement of intracranial pressure is now possible; it is a useful guide to therapy and allows detection of pressure under circumstances where clinical examination is unreliable or when increased intracranial pressure is unexpected. It is also useful in monitoring the efficacy of treatment by such agents as mannitol. Measurements of cerebral blood flow are still at an investigative stage but the accumulating valuable data have influenced the treatment of head injuries.