Occult pneumothorax in patients with abdominal trauma: CT studies.

Abdominal CT, which routinely includes the lower thorax, is an important adjunct to supine chest radiography in detecting chest injury in patients with blunt abdominal trauma. In 1,086 consecutive patients with blunt abdominal trauma, 223 of whom had both supine chest radiography and abdominal CT, 49 patients examined with both techniques had pneumothoraces, 28 of them occult (seen only on CT). To help guide management, we established three categories of occult pneumothorax, based on size and location: (a) minuscule (< 1 cm in greatest thickness, seen on four or fewer images); (b) anterior (> 1 cm in greatest thickness, but not extending beyond the midcoronal line); (c) anterolateral (extending beyond the midcoronal line).

Computed tomography and diagnostic peritoneal lavage. Complementary roles in blunt trauma.

Viewpoints regarding the use of computed tomography (CT) and diagnostic peritoneal lavage (DPL) in the evaluation of stable blunt abdominal trauma patients remain polarized and their respective roles are ill-defined. To further clarify their independent and combined value, the authors report the results of a prospective study of their use in adult patients satisfying the entry criteria of major blunt torso trauma, hemodynamic stability, equivocal and unreliable abdominal examination, and absence of both before abdominal surgery and unstable pelvic fractures. The 116 patients admitted to the study over an 11-month period were first submitted to a CT scan using a 9800 series GE scanner (General Electric Medical Systems; Milwaukee, WI).

Monodelphis domesticus: a model for early developmental wound healing.

Fetuses heal significantly differently than adults; amniotic fluid and the fetal environment have profound effects on the fetus' response to excisional wounding. The Brazilian gray short-tailed opossum (Monodelphis domesticus) is presented as a new model for early developmental wound healing. This is a small, docile, pouchless marsupial whose young, at birth, are equivalent to an 8-week gestational age human, which allows investigations of early developmental wound healing exclusive of the amniotic environment.

The effects of partial and total amniotic fluid exclusion on excisional fetal rabbit wounds.

Previous studies have consistently demonstrated that fetal rabbit excisional wounds exposed to amniotic fluid do not heal in utero. This study examines fetal wounds covered to exclude amniotic fluid. Full-thickness excisional wounds were created on fetal rabbits on day 25 of gestation.

Transforming growth factor-beta stimulates wound healing and modulates extracellular matrix gene expression in pig skin: incisional wound model.

Enhanced wound healing is elicited by exogenous administration of transforming growth factor- beta 1 (TGF- beta 1) in split-thickness, excisional wounds in the pig (Quaglino, Lab Invest 63:307-319, 1990). A study was designed to investigate if the selective and localized effects of TGF-beta 1 found in the previous model were dependent upon the type of wound or could be considered a more general effect of the cytokine. Transdermal, sutured incisions in the pig were evaluated by conventional histology and by in situ hybridization to reveal locally affected gene expression of collagen, elastin, fibronectin, stromelysin, TGF- beta 1, and basic fibroblast growth factor.

Cellular inflammation of fetal excisional wounds: effects of amniotic fluid exclusion.

The development of an cellular inflammatory response secondary to mechanical wounding has not been observed previously in the fetus. The effect of amniotic fluid exclusion on the inflammatory response in fetal rabbits subjected to full-thickness dorsal excisional wounds on day 25 of gestation (term = 31-32) was examined. The fetuses were either returned immediately to the uterus; a silicone cover was sutured over the wound; or a silicone cover with a centrally located hole was sutured over the wound.

Visceral protein levels in trauma patients are greater with peptide diet than with intact protein diet.

Early enteral nutrition may preserve gut function and prevent bacterial translocation after trauma. Standard enteral nutrition uses products which contain intact protein and require digestion for absorption. Peptide-based enteral nutritional products are better absorbed and stimulate the release of gut trophic hormones.

Management of renovascular hypertension in the elderly population.

This article summarizes our experience with the operative management of renovascular hypertension in a contemporary population of elderly patients. During a recent 18-month period 35 of 74 patients (47%) undergoing an operation for renovascular hypertension at our center were in their seventh (21 patients) or eighth (14 patients) decade of life (mean age, 68 years). There were 17 men and 18 women with blood pressures ranging from 176/90 mm Hg to 280/215 mm Hg (mean, 213/121 mm Hg).

Fatal and disastrous complications following percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) has become the preferred method of nutritional support in virtually every patient in whom this procedure is technically feasible because of its apparent technical facility, cost containment, and bedside insertion. PEG can, however, be associated with serious complications and death. This is a report of three patients who developed life-threatening abdominal wall abscesses and four patients who died after PEG insertion.

Renal artery aneurysm: selective treatment for hypertension and prevention of rupture.

Thirty-nine patients with renal artery aneurysm (RAA) were seen over a period of 15 years. Among 20 women and 19 men, 31 were found to have solitary aneurysms, and eight had multiple RAA. Thirty-three patients had diastolic hypertension; nine of them proved to be of renovascular origin.

The diabetic rat as an impaired wound healing model: stimulatory effects of transforming growth factor-beta and basic fibroblast growth factor.

Two models of wound repair compared the effect of defined, recombinant growth factors on the rate of wound repair in both normal and streptozotocin-induced diabetic rats: subcutaneous implantation of polyvinyl alcohol sponges and incisional wounding. Transverse incisional wounds were made on the dorsal surface of rats and closed with steel sutures. Three days postwounding the rats received a single injection of either transforming growth factor-beta or vehicle alone directly into the wound site.

Growth factors bFGF and TGB beta accelerate the rate of wound repair in normal and in diabetic rats.

The effects of basic fibroblast growth factor (bFGF) and transforming growth factor beta (TGF beta) on the rate of wound repair in both normal and streptozotocin-induced diabetic rats were investigated using two model systems of wound repair, namely incisional wounding and subcutaneous implantation of polyvinyl alcohol (PVA) sponges. Both models showed the expected wound-healing defects of the diabetic rats. Granulation tissue collected from the implanted PVA sponges showed that the diabetic rats had reduced amounts of collagen, DNA and protein present at the wound site at two time points tested (7 and 9 days post-implantation).

Short-term v long-term quality of life in children following repair of high imperforate anus.

In children with high imperforate anus, their quality of life (QOL) is directly related to their success or failure in attaining fecal continence (FC). At the Children's Hospital of Philadelphia, 120 patients were treated for high imperforate anus. Sixty-one patients were available for long-term follow-up ranging from 2.

High imperforate anus--quantitative results of long-term fecal continence.

In a 22-year period, 120 patients were admitted for treatment of a high imperforate anus. Sixty-one patients were available for long-term assessment following a pull-through procedure. These patients were evaluated by written questionnaire and personal interview.