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At least 1,225 records · Page 68Linked to original sources
PubMed1992

Surgical repair of traumatic tricuspid insufficiency: report of three cases.

Traumatic tricuspid insufficiency (TTI) is a rare lesion but is classically encountered as a "steering-wheel injury" in nonbelted car divers. This lesion is often not diagnosed because of its subtle clinical manifestations at first and the presence of associated injuries in multiple trauma. The majority of patients reported were treated with valve replacement but, more recently, successful repair of the native valve has made the latter the treatment of choice. Three patients were referred to us with a delayed diagnosis of TTI 2, 4, and 8 years after being involved in motor vehicle crashes (MVCs). Surgery was required and consisted of resuspension of the valvular leaflet with autogenous pericardium and ring annuloplasty. Two-dimensional echocardiography confirmed tricupid valve competence and the patients remained symptom free at a mean follow-up of 25 months.

Accidents, Traffic↗
PubMed1989

[Indications and results of interlocking nailing of the femur].

Since the introduction of an interlocking nail in 1972, different systems have been developed for the management of unstable femoral fractures. At the Clinic for Traumatology at the University Hospital of Zürich, the system of Grosse and Kempf was utilized until 1986, after which the AO universal nail system has been and still is used. Between 1981 and 1987, 63 femoral fractures in 62 patients have been treated with interlocking nails. The fractures were produced by a variety of mechanisms of injury, of which 75% were caused by traffic accidents. Associated injuries to other organ systems were sustained by 73% of the patients, overall there were 33% considered to have multiple trauma. 25% of the fractures were open. 44% (n = 28) required stable fixation, 15 were dynamized. The remaining 35 fractures were treated with dynamic nailings, 8 proximal and 27 distal. 15% were open nailings. Following dynamic stabilization full weight bearing was obtained after 56 and stable fixation after 120 days. A bridging callus was observed after an average of 8 weeks, and cortical bridging at 26 weeks following nailing. Complications included displacement of transversal screws in 3, local infections around the distal or proximal transversal screws in 3 and osteomyelitis at the fracture site in 3 cases.

Adolescent↗
PubMed1992

[Vascular injuries--management in a non-university central hospital].

In a retrospective study the surgically treated vascular injuries (n = 35) of the last 10 years were evaluated. One third of the patients had multiple trauma and in 57% of the cases vascular injury was accompanied by a fracture. All patients (n = 28) except those who underwent delayed amputation (amputation rate 14%) have been followed personally for an average of 5.1 years. 90% of these patients showed an excellent or acceptable longtime result in regard to vascularity, nobody complained of claudication. Diagnosis of a vascular injury was mostly confirmed by direct surgical exploration, only one third of the lesions were diagnosed by arteriogram. A positive signal in Doppler examination does not exclude vascular injury and therefore cannot replace arteriography or exact clinical evaluation.

Adult↗
PubMed1989

Measured energy expenditure in pediatric intensive care patients.

Few data are available on energy requirements of mechanically ventilated, critically ill children. We measured the resting energy expenditure in 18 mechanically ventilated patients between ages 2 and 18 years, using indirect calorimetry. All patients had fractional inspired oxygen concentration less than 0.6, no spontaneous respirations, hemodynamic stability, and no fever or active infection, and were receiving 5% dextrose. All subjects were hypermetabolic, since the measured resting energy expenditure divided by the predicted basal energy expenditure from the Harris-Benedict equations was 1.48 +/- 0.09 (mean +/- SEM). The energy requirements calculated using "injury factors" and "activity factors" adapted for adults is 1.62 times basal energy expenditure. The injury factor for the pediatric multiple trauma patients should be 1.25 compared with 1.35 in adults. In these pediatric intensive care patients 33% +/- 8% of the energy is derived from carbohydrates, 53% +/- 8% from fat, and 14% +/- 2% from protein oxidation. In individual critically ill pediatric patients, energy requirements should be estimated by measuring their resting energy expenditure whenever possible and adding 5% for their activity. In the absence of the actual measurement of resting energy expenditure, the recommended energy requirement is 1.5 times basal energy expenditure. In this acute phase of injury, the daily nitrogen requirement is 250 mg per kilogram of body weight.

Adolescent↗
PubMed1987

Pediatric polytrauma: orthopaedic care and hospital course.

Seventy-eight children with multiple trauma who had sustained one major musculoskeletal injury and at least one other major injury were studied. Injury severity was classified by the Modified Injury Severity Scale. There were 137 musculoskeletal injuries; 47 complications occurred in 27 patients. Early osteosynthesis tended to shorten the hospital stay, intensive care unit stay, and length of time ventilatory support was needed. Those patients undergoing immediate surgical stabilization of fractures had fewer complications than those undergoing surgical stabilization after 72 h. Those children with fractures treated by prolonged bed rest and who also had both neural and thoracoabdominal injuries had a higher rate of complications related to immobilization.

Accidents, Traffic↗
PubMed1994

[An algorithm for management of shock in polytrauma].

The initial management of patients with multiple trauma requires a well-defined plan of action for immediate and adequate therapy, that ensures fast recognition of life-threatening conditions and injuries. While treatment protocols for specific situations and injuries are fairly well defined, there are few such concepts for the overall management process. Therefore, we designed a comprehensive algorithm for in-hospital trauma care to give priority-based guidelines to the trauma room physician. The full management plan (diagnostic and therapeutic interventions in sequence) is implemented in seven flow charts. The first algorithm starts with the initial assessment of immediate life-threatening disorders of A (airways), B (breathing) and C (circulation) and is followed by the early stabilization and maintenance of vital functions. It is followed by six interrelated flow charts, based on disturbed physiological functions (respiration, circulation) and anatomical injuries (thorax, abdomen, head/brain, spine/pelvic girdle/extremities), which are worked up simultaneously and repeatedly. This algorithm is not only intended as an overall guideline for use the management of severely injured patients, but is also indispensable for quality assurance.

Algorithms↗
PubMedDate not supplied

Biliary leakage due to a rapidly growing post-traumatic hepatic artery pseudoaneurysm: a case report.

Post-traumatic hepatic pseudoaneurysms are rare. We report a very unusual case of bile duct injury complicated with an asymptomatic post-traumatic hepatic pseudoaneurysm. A previously healthy 17-year-old man sustained multiple traumas after a motorcycle accident. Post-traumatic hepatic pseudoaneurysms were detected after blunt liver injury. The rapid growth of the pseudoaneurysms in the hepatic hilus compressed the common hepatic bile duct and caused extrahepatic bile leakage at the lateral lobe. At first, the hepatic arterial pseudoaneurysms were embolized and bile leakage at the left lobe was treated conservatively. Finally, however, segment 2 and 3 partial liver resection should have been performed to stop the bile leakage. Post-traumatic pseudoaneurysm should be ruled out, in addition to the presence of biliary tract injury, if the intraperitoneal bile leakage appears after liver injury.

Accidents, Traffic↗
PubMed1995

Severe skiing injuries: a retrospective analysis of 361 patients including mechanism of trauma, severity of injury, and mortality.

All ski accident patients requiring an inhospital treatment at our institute from 1984 to 1992 (n = 2,053) were analyzed retrospectively. The incidence, pattern, and severity of the injuries, as well as the 30-day mortality comparing two time slots (1984 to 1988 and 1989 to 1992) were analyzed for the 361 cases classified as "serious" injuries according to the following definitions and groupings: group 1, multiple trauma (Injury Severity Score > or = 18) and patients with multiple fractures (n = 179; group 2, abdominal or thoracic single trauma (Abbreviated Injury Scale (AIS) score > or = 2, n = 58); and group 3, isolated head injuries (AIS score > or = 2, n = 124). Serious injuries were observed in 19% in the first period compared to 16% in the second period (not significant). Two hundred thirty-eight of 361 patients injured themselves by just falling, while 117 collided with some sort of obstacle like other skiers (45), trees or rocks (27), posts, pylons, barriers (20), and moving objects (25) such as piste machines, ski lifts, automobiles, and in one case a helicopter. Six skiers were caught on the ski run by an avalanche. Comparing the two time periods, trauma circumstances did not change significantly. The number of most severe head injuries (AIS score > or = 4) increased from 11.6 to 19.3% (p < 0.05). The overall mortality increased from 2 to 7% (p < 0.05). Group 2 had the best prognosis with no mortality, while group 3 was rated worst with 8%. Skiing remains a major source of serious trauma in winter resort areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Disseminated polyneuropathy after coma].

An acute polyneuropathy developed during intensive-care treatment of three young men who had sustained severe multiple traumas and of one woman with bacterial meningoencephalitis. In the first case there was a predominantly distal paraparesis of the legs; in the second, flaccid neurological deficits occurred particularly in the areas of the left ulnar, peroneal and tibial nerves combined with paralysis of cranial nerves IX, X and XII. A symmetrical sensorimotor polyneuropathy with tetraplegia and cranial nerve deficits occurred in the third case, and an asymmetrical sensorimotor polyneuropathy in the female patient. In all four patients electrophysiological tests demonstrated the pattern of neurogenic damage. All patients had respiratory failure, malnutrition, septic fevers and acute renal failure requiring haemodialysis for two to five weeks. It is assumed that the polyneuropathy was of multifactorial genesis.

Adult↗
PubMed1991

[Epidemiology of liver injuries in 14 district, urban, regional and canton hospitals in Switzerland].

224 patients with liver injuries treated in 14 District and Regional Hospitals over a 10-year period were retrospectively evaluated. The results were compared to those obtained in 175 patients referred to the Central University Clinic "Inselspital", Berne/Switzerland. In all cases the degree of multiple trauma was assessed by the Injury Severity Score (ISS) and the severity of the liver injury by a Liver Injury Score (modified after MOORE). Blunt injury to the abdomen as a result of road traffic accidents, accidents at work or sporting misadventures were responsible for about 80% of all liver injuries. Peritoneal lavage was the main special investigation and was reliable in the diagnosis of haemoperitoneum. Abdominal ultrasonography proved of additional value. It allowed in experienced hands not only the diagnosis of liver injury but also some assessment of the severity of injury. Additional injuries to other abdominal organs can be assessed. By utilizing abdominal ultrasonography (or computed-tomography) liver trauma were managed conservatively in selected stable patients with minor injuries. The overall mortality was 17% in the 224 patients and compares well with the international figures. The results of treatment revealed a low mortality for liver injuries Grades I to III, whether managed in a District or Regional Hospital or in the Central University Clinic. For more severe injuries (Grades IV or V) the prognosis was worse in the District or Regional Hospitals than in the Central University Clinic. 20% of patients with liver injury Grades I to III in stable circulatory condition could be treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Severe dextran-induced anaphylactic/anaphylactoid reaction despite preventive hapten administration].

Dextran-60 is widely used as a colloid volume substitute and for thromboprophylaxis. In order to avoid the most dangerous complication associated with dextran, the dextran-induced anaphylactic/anaphylactoid reaction (DIAR), hapten dextran is infused before starting the first application of dextran. We report of a 60-year-old man with multiple trauma, who received a dextran infusion for thromboprophylaxis because of high risk for thrombosis due to a severe thrombocytosis developing in the late postoperative period. Despite prophylaxis with monovalent hapten dextran, an anaphylactic reaction occurred. Although a serum sample drawn prior to the reaction is lacking, the causal relationship to dextran can be classified as likely, due to the close time relationship to the dextran-60 infusion. In addition, there were high titers of dextran-reactive antibodies in the blood drawn immediately after the reaction occurred. It is concluded that even after correct application of monovalent hapten dextran, dextran infusions carry the risk of severe anaphylactic reactions. They should therefore only be administered if clinical observation of the patient and the possibility of resuscitation are guaranteed.

Anaphylaxis↗
PubMed1996

[Pathophysiology of polytrauma].

Sequential organ failure after multiple trauma emerges from a whole-body inflammatory process which develops as a complex host defense response to hypovolemic shock/resuscitation and traumatic tissue injury. Successful prevention and treatment involves exact assessment of inflicted damage and profound knowledge of the different stages of posttraumatic immune alterations. Local release of potent inflammatory mediators (cytokines, complement, arachidonic acid derivatives, reactive oxygen metabolites) primarily induces a repair process. However, massive soft tissue and bone injury, follow-up surgery, infections and blood transfusions trigger a systemic spill over of these mediators orchestrating a generalized inflammatory response (Systemic Inflammatory Response Syndrome, SIRS). Diffuse capillary leakage and microcirculatory disorder prepare cellular dysfunction. Secondary severe immune defects support septic complications which maintain an autodestructive process. Therapeutical advances depend on the analysis of local and time-dependent expression of relevant inflammatory mediators and cellular signalling systems.

Arachidonic Acid↗
PubMed1992

Acute cholecystitis: a complication in severely injured intensive care patients.

Acute cholecystitis is an often unrecognized and potentially life-threatening complication seen among ICU patients with multiple injury. To investigate the epidemiology of this entity and to evaluate significant etiologic precursors, a prospective clinical and sonographic study was performed in 45 consecutive patients (mean age, 29 years) treated for multiple trauma (mean ISS, 27) in the ICU. Eight of 45 patients developed a cholecystitis during intensive care treatment (18%). Six patients recovered with conservative therapy; in two instances a cholecystectomy was necessary. There was no mortality as a result of cholecystitis. A significant relationship between the severity of the initial trauma (p less than 0.05), the number of blood transfusions (p less than 0.01), and the incidence of acute cholecystitis was found. Other factors such as prolonged shock, respiratory failure, or parenteral alimentation were less prevalent and were not temporally related to the onset of the disease. All patients had large amounts of narcotics administered over a prolonged period, so that narcotic-induced biliary stasis appeared to be another eminent factor involved in the genesis of posttraumatic cholecystitis. Our results lead to the conclusion that acute cholecystitis occurs with an unexpectedly high incidence and that a high remission rate can be expected following conservative treatment provided that appropriate serial ultrasound examinations are performed.

Acute Disease↗
PubMed1994

Use of antithrombin III in critical patients.

OBJECTIVE: To evaluate the effect of the AT III concentrates upon the clinical evolution and hemostatic parameters. DESIGN: Prospective, open, randomized trial. PATIENTS AND PARTICIPANTS: Septic and multiple trauma patients admitted to our Intensive Care Unit. SETTING: Levels of AT III below 70% were used as criteria to choose 36 patients, 20 of whom received treatment with AT III and 16 did not. INTERVENTIONS: AT III concentrates were administered at an initial dose of 60 U/kg followed by 10 U/kg every six hours. RESULTS: The administration of AT III neither contributes to alterations in haemostasis, nor the clinical evolution (evaluated according to Apache II score). CONCLUSIONS: The results suggest that the administration of AT III concentrates to critical patients with acquired low levels, but without manifest DIC, may not be justified; although further studies on a larger population are required to establish definite conclusions.

APACHE↗
PubMed1992

Successful treatment of fungal right atrial thrombosis complicating central venous catheterization in a critically ill child.

A 9-year-old boy was admitted to our pediatric intensive care unit after multiple trauma. On the 17th day post trauma, he developed catheter-related sepsis with candidemia. After removal of the catheter and 6 days of unsuccessful intravenous antifungal therapy, conventional and transesophageal two-dimensional echocardiography was performed revealing a large right atrial thrombus. Surgical thrombectomy under cardiopulmonary bypass was performed and the patient recovered within a few days. Fungal right atrial thrombus is a rare, life-threatening complication of central venous catheterization. Two-dimensional echocardiography is a simple and effective diagnostic technique that should be performed when candidemia is detected. The proper therapeutic response depends on the findings of this examination. For a symptomatic patient with a large, mobile thrombus, we strongly recommend thrombectomy. Surgery not only allows removal of the mass and thus elimination of the mechanical complication but is also a key to management of infection.

Candidiasis↗
PubMed1989

[Plate osteosynthesis in femoral shaft fractures].

Between 1979 and 1988, 119 children with 123 femur shaft fractures were treated in the Department of Traumatology of the university-hospital of Freiburg. Traffic accidents were the reason in half of the cases. 19 children had multiple trauma and serious cranio-cervical traumata. In the case of 14 further children, additional limb fractures could be diagnosed, four of which were contralateral femur shaft fractures. More than half of the children with femur shaft fractures were treated by internal fixation. Only internal fixation by plate was employed. 32 children were operated upon at the day of the accident (49%). Children with solitary injuries could be treated as outpatients after 13 days. The implanted material could be removed after an average of 8.4 months. At the moment a reexamination of 31 operated cases (altogether 65 children with 69 fractures are operated) is performed. 30 children have excellent (18 patients) or good (12 patients) results. The healing process was complicated by delayed healing of the fracture (1 patient), plate fracture after 2 months (1 patient) and subcutaneous haematoma (2 patients). Osteitis did not occur.

Bone Plates↗
PubMed1991

Limitations of radiography and computed tomography in the diagnosis of transverse sacral fracture from a high fall. A case report.

Transverse sacral fractures with sacral canal compression and neurologic deficit are rare sequelae of high falls. Nevertheless, a high index of suspicion is necessary as such an injury may present significant complications and may be missed on standard anteroposterior pelvic roentgenograms and pelvic computed tomography (CT) examinations obtained during the evaluation of multiple traumas. The saddle anesthesia, loss of bladder and sphincter function, and sexual dysfunction may be masked or unrecognized during the acute phase of polytrauma. Special attention must be directed to obtaining a lateral profile view of the sacrum, as this deformity may not be seen in any other view. Sagittal reconstruction images of the sacrum can be obtained during a pelvic CT examination if the initial lateral roentgenograms are technically inadequate because of the patient's obesity or limitations of portable radiographic equipment in the emergency department. The CT scoutview itself may show the acute sacral angulation if sufficient technique factors are employed. The roentgenographic suspicions can be confirmed with lateral multidirectional tomography or even with sagittal magnetic resonance imaging (MRI). Because this transverse sacral fracture is unstable in flexion, additional neurologic injury may result if the spine or hips are unwittingly manipulated in flexion.

Accidental Falls↗
PubMed1988

[Diagnosis and treatment of atlanto-occipital ruptures].

Atlantooccipital rupture is a rare ligamentous injury, which is usually accompanied by multiple trauma. Literature and personal communications report of 30 patients with such an injury. Long term survival is known in 18 cases, but there were severe neurological deficits in two cases. Reports of five of our own patients are presented. Death occurred after a few hours in three cases. One patient survived for four weeks, and one girl fully recovered after timely atlantooccipital fusion. In seven of 18 cases who have survived for a long time, the diagnosis was made only at a late stage. This underscores the necessity of including the occipitocervical transition in the diagnosis of the cervical spine. This applies in particular to unconscious accident casualties. Standard X-rays of the upper cervical spine (supplemented if necessary by cautious radiographic control under mild head extension) verify the diagnosis. In treatment, an early fusion of the cervicooccipital transition is to be given preference. Only in this way can stable healing and thus the most important precondition for neurological restitution be fulfilled.

Adolescent↗