Acta chirurgica Scandinavica
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Intrathoracic tracheal rupture following closed chest trauma is a potentially lethal injury which can be successfully repaired if the diagnosis is made early. Dyspnoea, mediastinal emphysema and pneumothorax which do not respond to intercostal tube drainage should alert the clinician to the possibility of intrathoracic tracheal rupture. A case is described. ⋯ The diagnosis was delayed because of coexisting head injury. The tracheal lacerations were successfully repaired via a right thoracotomy. The principles of management in such injuries are reviewed.
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Clinical Trial
Air-flow meter assessment of the effect of intercostal nerve blockade on respiratory function in rib fractures.
The respiratory effect of intercostal nerve block for pain from fractured ribs was evaluated in a prospective study of ten hospitalized patients. The respiratory function, evaluated with a Glaxo AirFloMeter, showed significant improvement one hour after induction of blockade, but after six hours the effect had subsided.
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Comparative Study
Acute traumatic intracranial haematoma and skull fracture.
The value of plain skull radiographs in acute head injury has been much debated. A prospective study is presented of the isolated predictive value of skull fracture, in addition to the level of consciousness on admission after trauma, for acute intracranial haematoma. ⋯ The association was found at all levels of consciousness and was most pronounced in patients with minor or no diminution of consciousness on admission. Fractures crossing a vascular groove had additional predictive significance.
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Comparative Study
Lysine-vasopressin in excisional treatment of burns in pigs. Decreased blood loss and earlier circulatory recovery.
The hemodynamics were monitored during 24 hours in piglets anesthetized with Pentothal-N2O/O2, submitted to 33% full-thickness skin burn and resuscitated with 2.4 ml/kg/% burn of 100 mmol NaCl in 2.5% glucose. Three groups were studied: (I) standardized burn, (II) standardized burn and excision after 5 hours, (III) standardized burn, excision and lysine-vasopressin (LVP) given as intravenous infusion in a vasopressor dose. All groups showed similar decrease of cardiac output (CO), which was about 30% 4 hours after burn. ⋯ LVP led to higher CO fraction and greater blood flow to hepatic artery, reduced flow to proximal gastrointestinal tract and skin and unchanged flow to heart, kidneys and other organs 24 hours after burn. The mean blood loss during and after burn excision was greatly reduced in group III (50 g/25 kg) compared with group II (146 g/25 kg). The therapeutic implications of LVP in excisional burn treatment are discussed.