Hemodynamic effects of external cardiac massage in trauma shock.

The effectiveness of closed chest cardiopulmonary resuscitation (CCCPR) in maintaining cardiac output has been well studied in cardiac arrest. Trauma surgeons most often encounter shock secondary to hypovolemia or cardiac tamponade, and the effectiveness of CCCPR in that setting has not been established. To determine the hemodynamic effects of external massage in profound shock, hypotension was induced in baboons.

The sensitivity of vital signs in identifying major thoracoabdominal hemorrhage.

Prehospital and emergency room recordings of hemodynamic vital signs frequently play a major role in the evaluation and treatment of trauma victims. Guidelines for resuscitation and treatment are affected by absolute cutoffs in hemodynamic parameters. To determine the sensitivity of various strata of systolic blood pressure and heart rate in identifying patients with major thoracoabdominal hemorrhage, a 1-year retrospective review was conducted.

Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma.

The vast majority of thoracic trauma victims require only observation or tube thoracostomy for definitive treatment of their thoracic injury. Although tube thoracostomy is generally considered a limited intervention, 2 to 25 percent of patients who undergo this procedure develop infectious complications. To determine the incidence and risk factors for the development of empyema thoracis after tube thoracostomy, a retrospective study was undertaken.

A twelve-year survey of cervicothoracic vascular injuries.

This study of a large series of victims of trauma to the cervicothoracic great vessels confirms the lethal potential of these injuries: more than half of victims of such injuries died. The optimal management of patients potentially harboring such vascular damage appears to include skilled prehospital resuscitation and rapid transport to a trauma center, a high index of diagnostic suspicion, a low threshold for the performance of contrast arteriography, aggressive surveillance for associated neurologic and aerodigestive tract injuries, and timely technical repair, including liberal indications for sternotomy or thoracotomy to assure vascular control.

Drug use in trauma victims.

We examined the prevalence and characteristics of drug use in a large sample of fatally and nonfatally injured trauma victims. Routinely collected urine specimens from 452 emergency room patients and 160 persons autopsied at the Medical Examiner's Office (MEO) were analyzed for the presence of marijuana, cocaine, opiates and benzodiazepines using EMIT enzyme immunoassays. Blood alcohol levels were also measured.

Evaluation of potentially preventable deaths among pedestrian and bicyclist fatalities.

The prehospital, emergency department, and in-hospital care of 84 patients who died following a pedestrian- or bicycle-motor vehicle collision in a four-county area was retrospectively reviewed using a systematic, detailed scoring system. The purpose of the study was to examine the effectiveness of an advanced paramedic-regionalized trauma care system and to examine the usefulness of a systematic evaluation tool in identifying preventable and possibly preventable deaths. Among the 84 deaths, one was judged to be preventable and 18 possibly preventable.

Risk factors for urethral injuries in men with traumatic pelvic fractures.

Urethral injuries are commonly associated with pelvic fractures. The prompt recognition and appropriate management of these injuries may significantly impact subsequent morbidity, yet few studies have addressed the identification of the risk factors for urethral injury in men with pelvic fractures. We reviewed retrospectively the records of 405 men with pelvic fractures seen at our medical center, including 21 (5 per cent) with urethral injuries.

The medical and social impact of nonaccidental injury.

To determine the medical and economic impact of nonaccidental trauma at a regional trauma and emergency care facility, a prospective patient database was used to follow up all victims of intentional injury admitted during one year. Specific patient data were combined with financial data to determine the medical outcome, expenditure, and hospital reimbursement. We found that 17% of the 2451 trauma patients admitted to our facility were victims of nonaccidental injury.

Air transport following surgical stabilization: an extension of regionalized trauma care.

A 30-month retrospective review was performed of all trauma patients initially evaluated and operatively stabilized at Level III hospitals, with subsequent specialized air transport within 48 hours of injury to the regional Level I trauma center in Seattle. Nineteen patients were identified, with a mean ISS of 44 (range, 20-66). Mean transport time and distance were 2.

Traumatic pneumoperitoneum following combined abdominal and thoracic injury.

Pneumoperitoneum following blunt abdominal trauma in the absence of other signs of severe intraabdominal injury is a rare finding. Although the vast majority of all cases of pneumoperitoneum are due to a ruptured intraabdominal hollow viscus, free abdominal air may result from significant barotrauma to the thorax. This type of secondary pneumoperitoneum can occur in the absence of chest x-ray evidence of a pneumothorax or pneumomediastinum.

Incidence and effect of hypothermia in seriously injured patients.

Hypothermia is a well recognized consequence of severe injury, even in temperate climates, and the physiologic consequences of hypothermia are known to be detrimental. To analyze the frequency and risk factors for hypothermia and its effect on patient outcome, we prospectively studied 94 intubated injured patients at a regional trauma center during a 16-month period. Esophageal temperature probes were placed in the field or ER and core temperatures (T) were followed for 24 hours or until rewarming.

Nonoperative observation therapy for splenic injuries: a safe therapeutic option?

Combining these reported and estimated incidences of mortality from overwhelming postsplenectomy infection, splenic salvage with nonoperative observation therapy and operative therapy, and the incidence of posttransfusion hepatitis and related mortality provides a conditional probability estimation of the risks of death with nonoperative observation therapy and operative therapy (Figure 4). The combined mortality rates for nonoperative observation and operative therapies are based on the following measured and estimated statistics: The post-transfusion hepatitis death rate per unit of blood transfused is 0.14 percent.

An unusual complication of rubber band ligation of hemorrhoids.

Rubber band ligation of hemorrhoids has had a low incidence of complications until recently, when five deaths resulted from bacterial septicemia or toxemia. The case presented describes a severe soft-tissue infection following banding successfully treated with antibiotics, surgical debridement, and hyperbaric oxygen.

Hospital stay following biliary tract surgery. A comparison of two community hospitals.

An apparent difference in length of postoperative hospitalization following biliary tract surgery at two university-affiliated community hospitals led to a retrospective review of 200 consecutive patients at each hospital. Patient characteristics and surgical practices that potentially affected hospital stay were compared. A highly significant difference was identified in the length of hospitalization between the two institutions.

[Functional properties and possible uses of a hydrolysate of pepitona (Arca zebra) in the preparation of foods].

The present study revealed that the drum-drying and spray-drying procedures used on the pepitona (Arca zebra) hydrolysate, as well as the storage time, exert a deteriorative significant effect on the functional properties of both hydrolysates. The greatest and more significant losses of the majority of such properties occur during the first two months of storage period. Thus, in the case of foaming capacity, losses ranging from 17% to 34% were detected in the drum-dried hydrolysate, and of 38% to 49% in the hydrolysate dehydrated using a spray drier, during the first two months of storage.

[Determination of processing conditions for obtaining a pepitona (Arca zebra) hydrolysate for human consumption].

For the purpose of obtaining two protein hydrolysates from peptiona (Arca zebra), to be used as nutritional ingredients in accepted food items destined for human consumption, the enzymes bromelain and papain were studied. The effect of adding each of these proteases, on the rate of hydrolysis and conversion extent of insoluble pepitona protein to soluble nitrogen, were examined. Distilled water was added to the raw material to give a 2:1 ratio of solvent to pepitona, and mixed to produce a slurry at a pH of 6.

[Preparation and nutritional characteristics of a hydrolysate from pepitona (Arca zebra)].

Two soluble products resulting from the hydrolysis of pepitona (Arca zebra) were prepared as flour. Papain at its optimum hydrolysis conditions, previously established, was the enzyme used (40 degrees C for two hours at a pH of 7 in the proportion of 0.3% weight/enzyme/100 g meat).

Hepatocellular carcinoma. A 5 year institutional experience.

Liver cancer is the most common of all malignancies worldwide, its incidence reaching almost epidemic proportions in some countries. However, its significance in North America has generally been underemphasized. In a 5 year period, hepatocellular carcinoma was diagnosed in 35 adult patients in our institution.

The influence of ethanol intoxication on outcome of injured motorcyclists.

Previous reports have failed to demonstrate a statistically significant adverse effect of acute ethanol intoxication in the well-resuscitated trauma patient. In the present study the prevalence of acute alcohol intoxication and its effect on outcome was analyzed in a homogenous population of young, previously healthy motorcycle accident victims (N = 134). The incidence of intoxication was 25%.

Re-evaluation of the role of spermatozoa as inducers of protein synthesis by the rabbit endometrium.

The effect of spermatozoa as inducers of protein synthesis by the rabbit endometrium was studied. The presence of spermatozoa increased the leucine incorporation into proteins from 15.6 +/- 1.