Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Jun 1975
ReviewRe-evaluation of the biomechanics of blunt impact injury of the head.
With blunt impacts, there may be bruising or tearing of scalp, elastic deformation of the skull with or without linear fracture, mass motions or relative movements of the brain mass--inertial stress propagation--as well as pressure gradients. Mass motions of the brain may cause concussion, vascular tears with extravasation and contusions of the cerebral surface as well as lesions in the deeper portions of the cerebral mass. Coup contusion is caused by the inbending bone at the impact site striking the immobile head. ⋯ During impact if the head is on a solid stand, such as the metal table, a contrecoup lesion is seen at the opposite end from the impact site. This contrecoup lesion is produced by the brain impacting the skull, as well as the flattening of the skull against the brain at the antipole, from the presence of the solid table. Intermediate contusions develop between the impact site and the antipole in the brain interior as a result of inertial stress propagation.
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Fifteen critically ill patients with sepsis, 12 of whom had significant pulmonary dysfunction develop, were investigated with regard to changes in pulmonary capillary pressure, in serum oncotic pressure and on roentgenograms of the chest. It could not be shown that the pulmonary edema, which is a major characteristic of the septic lung lesion, was due to changes only in oncotic and hydrostatic pressures. ⋯ A significant relationship was found which consisted of increasing severity of the lung lesion, decreasing serum oncotic pressure and increasing pulmonary pressure. When patients with sepsis require resuscitation with fluids, the administration of moderate amounts of albumin along with monitoring of pulmonary capillary pressure appears to be a rational approach to therapy.
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Surg Gynecol Obstet · Jun 1975
Associated diagnoses which complicate rehabilitation of the patient with bilateral lower extremity amputations.
Cardiopulmonary problems were the most common limiting factor in the rehabilitation of 42 bilateral lower limb amputees. Diabetes mellitus and local stump problems, most common in below knee amputees, delayed rehabilitation but, subsequently, obtained the highest goals. Thirty of the 42 amputees finally were self sufficient; the average time required was 30 weeks to maximum benefit.