Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Multiple Trauma”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,495 records · Page 83Linked to original sources
PubMed1982

Traumatic avulsion of the innominate and left carotid arteries: successful repair.

Traumatic rupture of the aorta or the arch vessels is a rare and frequently fatal injury. This lesion should be considered in all cases of severe chest trauma. Early aortography is essential for accurate diagnosis. Nineteen cases of avulsion of the innominate artery have been previously reported. In only two of them a second aortic arch branch had an associated injury. The case presented here is the first successful repair of a combined avulsion of both the innominate and the carotid arteries from the aortic arch. Cerebral circulation was maintained during the operation with a heparin-coated shunt from the ascending aorta to the right common carotid artery. Reconstruction was accomplished by inserting a bifurcated Dacron prosthesis from the aorta to the innominate and left carotid arteries. The use of a heparin-bonded shunt maintained cerebral perfusion, and greatly simplified the operation and avoided the risk of extracorporeal circulation and systemic anticoagulation in a patient with multiple trauma.

Adult↗
PubMed2004

Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation.

CONTEXT: The 1994 genocide in Rwanda led to the loss of at least 10% of the country's 7.7 million inhabitants, the destruction of much of the country's infrastructure, and the displacement of nearly 4 million people. In seeking to rebuild societies such as Rwanda, it is important to understand how traumatic experience may shape the ability of individuals and groups to respond to judicial and other reconciliation initiatives. OBJECTIVES: To assess the level of trauma exposure and the prevalence of posttraumatic stress disorder (PTSD) symptoms and their predictors among Rwandans and to determine how trauma exposure and PTSD symptoms are associated with Rwandans' attitudes toward justice and reconciliation. DESIGN, SETTING, AND PARTICIPANTS: Multistage, stratified cluster random survey of 2091 eligible adults in selected households in 4 communes in Rwanda in February 2002. MAIN OUTCOME MEASURES: Rates of exposure to trauma and symptom criteria for PTSD using the PTSD Checklist-Civilian Version; attitudes toward judicial responses (Rwandan national and gacaca local trials and International Criminal Tribunal for Rwanda [ICTR]) and reconciliation (belief in community, nonviolence, social justice, and interdependence with other ethnic groups). RESULTS: Of 2074 respondents with data on exposure to trauma, 1563 (75.4%) were forced to flee their homes, 1526 (73.0%) had a close member of their family killed, and 1472 (70.9%) had property destroyed or lost. Among the 2091 total participants, 518 (24.8%) met symptom criteria for PTSD. The adjusted odds ratio (OR) of meeting PTSD symptom criteria for each additional traumatic event was 1.43 (95% CI, 1.33-1.55). More respondents supported the local judicial responses (90.8% supported gacaca trials and 67.8% the Rwanda national trials) than the ICTR (42.1% in support). Respondents who met PTSD symptom criteria were less likely to have positive attitudes toward the Rwandan national trials (OR, 0.77; 95% CI, 0.61-0.98), belief in community (OR, 0.76; 95% CI, 0.60-0.97), and interdependence with other ethnic groups (OR, 0.71; 95% CI, 0.56-0.90). Respondents with exposure to multiple trauma events were more likely to have positive attitudes toward the ICTR (OR, 1.10; 95% CI, 1.04-1.17) and less likely to support the Rwandan national trials (OR, 0.90; 95% CI, 0.84-0.96), the local gacaca trials (OR, 0.80; 95% CI, 0.72-0.89), and 3 factors of openness to reconciliation: belief in nonviolence (OR, 0.92; 95% CI, 0.87-0.97), belief in community (OR, 0.92; 95% CI, 0.87-0.98), and interdependence with other ethnic groups (OR, 0.86; 95% CI, 0.81-0.92). Other variables that were associated with attitudes toward judicial processes and openness to reconciliation were educational level, ethnicity, perception of change in poverty level and access to security compared with 1994, and ethnic distance. CONCLUSIONS: This study demonstrates that traumatic exposure, PTSD symptoms, and other factors are associated with attitudes toward justice and reconciliation. Societal interventions following mass violence should consider the effects of trauma if reconciliation is to be realized.

Adult↗
PubMed1991

[Cranial trauma: the predictability of the presentation symptoms as a screening for radiologic study].

A prospective study was performed on 4,262 consecutive patients who had had skull examinations for recent head trauma. Clinical signs and symptoms and patient history were correlated with skull fractures and intracranial sequelae as identified on CT studies, in order to evaluate the predictive value of each clinical finding and to identify high-yield referral criteria. Ninety-seven skull fractures (3%) and 32 intracranial sequelae (0.7%) were observed. All the intracranial complications were observed in patients with fractures and with altered consciousness of some degrees (Glasgow Coma Scale score less than 13). Most patients were asymptomatic (41%) or showed "low risk" symptoms (29%): among them, neither fractures nor complications were observed. High-risk clinical signs, mainly expressing basilar fractures (as rhinorrhea, otorrhea, focal neurologic signs, retroauricular hematoma) demonstrated high predictive value (100%) for intracranial sequelae. Other "moderate risk" findings for intracranial injury--i.e. loss of consciousness at any time, antegrade or retrograde amnesia, multiple trauma, and possible skull penetration--showed a high correlation with skull fractures and a slightly lower one with intracranial sequelae. The most predictive finding for brain injury was the depressed level of consciousness: brain injuries were never observed in fully conscious patients; in altered consciousness with GCS 15-13 we observed 4% of skull fractures with no sequelae; at GCS values 12-9, 61% of skull fractures and 20% of sequelae were present, whereas at GCS less than 8, 100% of complicated fracture were observed. The finding of skull fracture showed 33% of predictivity for brain damage, which was, however, always associated with "high or moderate risk" clinical signs. Therefore, the authors suggest some guidelines for the management of patients with recent head trauma, including referral criteria for X-rays or CT studies, based on signs and symptoms with high, intermediate and low risk of developing intracranial sequelae.

Adult↗
PubMed2001

CT angiography of the carotid arteries in trauma to the neck.

OBJECTIVES: serious vascular injuries to the neck may be asymptomatic or masked by other life-threatening conditions. Angiography, the "gold standard" vascular imaging modality, is an invasive procedure. Moreover, it is time-consuming and thus may delay a needed vascular intervention. The results of screening angiography are negative in more than 80% of cases. Therefore other less invasive and faster screening tests, such as the Doppler ultrasound and magnetic resonance angiography, have been tested. This retrospective study was done to evaluate the use of CT angiography (CTA) in suspected vascular injuries of the neck. METHODS: from 1995 to 1998, 16 patients with suspected traumatic carotid artery injury underwent CTA. Twelve of these patients had penetrating injuries and four had blunt injuries to the neck. CTAs were obtained by Elscint Twin Flash Spiral Scanner, while MIP reconstructions were carried out on an Omnipro, Elscint (Indy, Silicon Graphics) work station and interpreted by a radiologist. RESULTS: all the CTAs were diagnostic. Positive findings included one complete tear of the right common carotid artery (confirmed by surgery) due to a penetrating injury and one bilateral internal carotid artery thrombosis after blunt injury to the neck. In addition, three patients with multiple trauma were operated on, due to either proximity only or questionable neurological findings. Surgical exploration confirmed the negative findings seen on CTA. CONCLUSION: CT angiography of the carotid arteries in cervical trauma may be used as an accurate decisive tool for a needed surgical intervention. More studies with larger number of patients and comparison with angiography are needed.

Adolescent↗
PubMed2006

A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms.

OBJECTIVE: To ascertain whether the differential responses that previously have been found between trauma-focused, cognitive-behavioral therapy (TF-CBT), and child-centered therapy (CCT) for treating posttraumatic stress disorder (PTSD) and related problems in children who had been sexually abused would persist following treatment and to examine potential predictors of treatment outcome. METHOD: A total of 183 children 8 to 14 years old and their primary caregivers were assessed 6 and 12 months after their posttreatment evaluations. RESULTS: Mixed-model repeated analyses of covariance found that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were positively related to the total number of PTSD symptoms at posttreatment for children assigned to the CCT condition only. CONCLUSIONS: Children and caregivers assigned to TF-CBT continued to have fewer symptoms of PTSD, feelings of shame, and abuse-specific parental distress at 6- and 12-month assessments as compared to participants assigned to CCT.

Caregivers↗
PubMed1996

[Comparison between of TRISS and ASCOT methods--in Tainan area. Trauma and Injury Severity Score. A Severity Characterization of Trauma].

In this study, we compare the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT) models by using NCKUH trauma registry to assess the performance of correct prediction in terms of sensitivity, specificity and misclassification rate. The database has accumulated to 5,672 cases, NCKUH 2,490; Chi-Mei 3,182 respectively. Blunt trauma mechanism was composed of 4, 892 (86.2%) while 552 (9.7%) were pertinent to penetrating. The male/female ratio is 2.4:1. Traffic accident is the major cause of injury (3, 472-(61.2%)), followed by work injury (723-(12.7%)); fall (702-(12.4%)) and burn injuries (160-(2.8%)). The category of traffic accident is comprised of motorcycle-related, (1,257-(69.14%)), followed by automobile-related was (301-(16.56%)) and bicycle injuries (123-(6.8%)). The category of working injury comprised by machine crushed cases (332-(45.92%)) followed by cutting (148-(20.47%)) and impacts (69-(9.5%)). The overall mortality rate in our registry was 8.3%. ASCOT and TRISS were compared using sensitivity, specificity and misclassification rates. Each method had disadvantages in predicting outcomes of particular subgroups of patients. ASCOT tends to underestimate the probability of survival among patients with head/spinal injuries; while TRISS had a similar effect on multiple trauma victims. In conclusion, ASCOT is superior to TRISS in correctly predicting severe head trauma cases. However, both methods have their limitations in terms of accurate prediction. It is our hope to develop a mixed, revised model to better predict patients survival probability. Therefore, it is feasible to adopt ASCOT methodology in prediction of trauma patients in Taiwan. Expanded database and better methodology need to be developed in further study.

Adult↗
PubMed1986

Blunt liver injury in childhood: evolution of therapy and current perspective.

One hundred eighty-eight consecutive children with serious blunt abdominal or multisystem trauma were evaluated between August 1981 and July 1985. Of the 188 patients, 53 (28%) were found to have hepatic parenchymal injuries and are the basis of this report. Four of the 53 (8%) underwent emergency laparotomy for exsanguinating hemorrhage; two patients died, both of hepatic vein lacerations, and two are alive and well after right hepatic lobectomy. Forty-nine (92%) of the children with liver injuries did not require operation for hemorrhage. Four of these 49 patients developed serious complications; hemobilia occurred in one patient and bile peritonitis occurred in three. The one case of hemobilia was resolved without surgery. One child underwent a delayed operative biliary tract reconstruction that was successful. The other two children required a combination of debridement and drainage procedures. Fifty-one of the 53 children (96%) are currently alive without morbidity related to their liver injuries. Both children who died had multiple trauma including central nervous system injuries and had exsanguinating hemorrhage that required emergency laparotomy at initial evaluation. There were no children with "late" hemorrhage and none who developed septic complications. Nonoperative management of most childhood blunt abdominal trauma is possible. Widespread use of abdominal computerized tomography scanning has made this approach practical. This large series of consecutive liver injuries from a large pediatric trauma center illustrates the advantages and the risks of a selective but primarily nonoperative approach to liver trauma in children.

Alanine Transaminase↗
PubMed2002

An epidemiological study and determination of causes of traffic accident-related deaths in Tehran, Iran (during 2000-2001).

Traffic accidents are an important cause of traumatic death particularly in developing countries such as Iran. One of the most principal steps in prevention and control of traffic accident-related trauma and its deaths is having information about demographic characters of its victims and their cause of deaths. Our cross sectional study deals with all of the cases of traffic accident-related deaths which were referred to the Tehran Legal Medicine Organization. This survey covers one year from March 20th, 2000 to March 24th, 2001. All the victims' files were studied. Number of traffic accident-related deaths were 2128 (25% of all of cases which were referred to this centre for determination of cause of death). Male to female ratio was 4.1 to 1. Most of deaths have been between 21 and 30 years old (22.1%). Mean age was 39.4 year (SD: 21.9 yr). Seasonal variation was not seen. Twenty-seven percent of cases were died at the scene and 72.7% in hospital. The most common cause of death was head injury (49.8%), the other causes were multiple trauma (35%), internal bleeding and visceral laceration(11.1%), cervical spinal cord injury (1.9%), complications of trauma (1.6%) and others (0.6%), respectively. These findings were compared with other surveys and authors recommend some suggestions such as public education of traffic rules, obligatory use of seat-belts, wearing of crash-helmet, attention to preventable causes of death, etc.

Journal Article↗
PubMed1995

[A case of HLA-DR2, DQw1 negative post-traumatic narcolepsy].

We reported a case of a 24-year-old man who had frequent sleep attacks beginning 4 years after a head trauma. He showed frequent episodes of excessive daytime sleepiness and cataplexy which were triggered by emotional excitement. He also complained of sleep paralysis and hypnagogic hallucination. An overnight polysomnography revealed the sleep onset REM stage as typically observed in narcoleptic patients. The HLA typing was negative for DR2 and DQw1. He was diagnosed as having HLA-DR2 and DQw1 negative-post-traumatic narcolepsy. Peroral pemoline suppressed excessive daytime sleepiness, sleep paralysis and hypnagogic hallucination with dramatic relief of cataplectic attacks by the addition of imipramine. It has been reported that more than 90% of narcoleptic patients are HLA-DR2 and-DQw1 positive. About 10% of the narcolepsy patients were regarded as symptomatic due to brain tumors, cerebrovascular disorders, head trauma, multiple sclerosis, encephalitis and so on, which mainly affect the brainstem or diencephalon. Thus far, narcolepsy is considered to develop depending on both the genetic background including HLA types, and exogenous factors. According to reported cases with narcolepsy, sporadic cases were HLA-DR2 positive even more frequently than familial cases. To date, however, there have been only three previous reports of a symptomatic narcolepsy patient without association of HLA-DR2 and DQw1. In conclusion, the present report suggests that typical symptomatic narcolepsy could be HLA-DR2 or DQw1 negative.

Adult↗
PubMed1975

[Energy and protein needs of surgical patients].

Energy and protein requirements following operation, are those levels which permit the best possible use of fatty and protein body reserves, without the resistance to trauma becoming diminished. The fatty reserves in a 70 kg man, correspond to 72 000 calories and require, to be used without danger of acidosis, 100 or, preferably, 200 g of glucose daily. Energy expenditure may be about 1 200 calories, thus much less than one would think. Fat does not have the antiketosis effects, nor the nitrogen sparing effects of glucose and their interest in raising calory intake has not been demonstrated. There is a level of nitrogen intake of about 20 to 30 g of protein, below which, nitrogen balance becomes rapidly negative and one then has to increase considerably the protein intake to 80 or 90 g to restore nitrogen balance. 200 g of carbohydrate, then 20 to 30 g of amino-acid, provide a calory intake of 900, easily administrable by the parenteral route, without the danger of bacteremia with more hypertonic solutions in infected operated patients. Higher calory intakes are only indicated in multiple trauma and burns.

Adult↗
PubMed2005

De Quervain disease in volleyball players.

BACKGROUND: Chronic inflammatory tendon diseases in athletes are frequent, and they often result from modifications in normal kinematics of a tendon associated with a patient's anatomical determinants. De Quervain stenosing tenosynovitis is an inflammatory disease of tendons of the first dorsal compartment of the wrist. There is no literature about this disease concerning professional volleyball players. HYPOTHESIS: Limited, multiple trauma on the dorsal radial portion of the wrist, associated with long training times, can be involved in the pathogenetic process of de Quervain disease in professional volleyball players. STUDY DESIGN: Case series; Level of evidence, 4. MATERIALS AND METHODS: The authors studied 45 consecutively enrolled volleyball players (27 professional, 18 nonprofessional) satisfying clinical criteria for the diagnosis of de Quervain stenosing tenosynovitis. All patients were evaluated by questionnaire and physical examination. They were divided into group A (mild) and group B (severe) based on the severity of the symptoms and physical findings; they were followed for a mean of 37 months. RESULTS: Total training quantity (mean weekly training time multiplied by mean sports activity duration) in group A was 74, whereas it was 155 in group B (P < .01). No neuropathies were found in group A, whereas they were found in 3 patients in group B. Fifty percent of surgical patients had a longitudinal fibrous septum, whereas 54% showed multiple tendon sheaths making up the abductor pollicis longus tendon. CONCLUSIONS: This study shows that increased training time and consequent microtrauma associated with professional volleyball activity can increase the likelihood of de Quervain disease.

Adolescent↗
PubMed1995

Open tibia fractures in the splenectomized trauma patient: results of treatment with locking, intramedullary fixation.

OBJECTIVE: To confirm our clinical impression that patients with traumatic splenectomy had more complications in the treatment of open tibia fractures, we retrospectively reviewed the records of patients with open tibia fractures treated between 1989 and 1992. MATERIALS AND METHODS: Eight patients with open tibia fractures and traumatic splenectomies were compared to 43 patients with open tibia fractures and intact spleens. The latter group typically underwent either exploratory laparotomy or peritoneal lavage. The two groups were similar with respect to age, mechanism of injury, fracture wound classification, and injury severity score (22.4 in the splenectomized patients, 18.6 in the control). All tibia fractures were treated with a nonreamed, cross-locked, titanium intramedullary nail, and all patients were treated according to the same protocol of antibiotic therapy. Patients were followed for two years or until roentgenographic and clinical union. RESULTS: The splenectomized patients had a significantly higher incidence of chronic osteomyelitis (25% vs. 4.6%), and the need for additional tibial surgeries to achieve union (75% vs. 16%). Time to union averaged 11.3 months in the splenectomized group and 7.6 months in the patients with intact spleens. CONCLUSIONS: The increased risk for chronic osteomyelitis and other complications of tibial fracture in the splenectomized patients should be taken as an argument favoring splenic, repair, when possible, rather than splenectomy in victims of blunt multiple trauma.

Adolescent↗
PubMed1980

Blunt abdominal trauma: exploratory laparotomy or peritoneal lavage?

In contrast to other series purporting advantages of routine lavage [20], our data support the position that, in patients with blunt abdominal trauma, certain criteria eliminate the need for peritoneal lavage and make this procedure an unwise investment of valuable time on a routine basis. Criteria such as evidence of hollow organ rupture on radiologic studies, gross abdominal wall defects (excluding simple lacerations), rapidly increasing abdominal distention, uncorrectable hypotension and isolated rigidity on abdominal examination in an otherwise intact and cooperative patient, should be considered indications for laparotomy. In a stable patient with associated injuries or altered central nervous system status, abdominal examination should be viewed as suspect and peritoneal lavage considered mandatory. However, in over one fourth of cases, positive lavage may fail to correlate with intraabdominal injury of a degree that necessitates operative repair. In patients admitted for observation of abdominal injuries with concurrent alterations in central nervous system status or associated injuries that hinder accurate abdominal examination when no urgency exists, we support the opinion that selective use of peritoneal lavage will save unnecessary delay in diagnosis and operative treatment. The highly lethal nature of multiple injuries and central nervous system damage is confirmed by our data, veryfying reports by Davis et al [6] of a 70 percent or greater mortality rate among comatose patients hospitalized with multiple trauma.

Abdominal Injuries↗
PubMed2002

Innovative minimally invasive pediatric surgery is of therapeutic value for splenic injury.

BACKGROUND/PURPOSE: Until now, minimally invasive surgery (MIS) has not had any therapeutic status for operable splenic trauma, because reliable sealing of larger defects is not possible with general techniques. METHODS: Fleece-bound sealing allows rapid, large-area sealing of erosions and defects, so that with the aid of an MIS applicator system (AMISA), this method of tissue management can be transferred to MIS. RESULTS: An in vitro evaluation showed that liquid fibrin sealing (FS) exhibits incomplete selective leak closure and low adhesive strength (4.1 hPa) and is not suitable for challenging surfaces. Fleece-bound sealing (ready-to-use v. prepare-to-use) showed reliable sealing and higher adhesive strength for collagen fleeces that are ready coated with fibrinogen-based sealant (TachoComb H; Nycomed, Linz, Austria) compared with various carrier systems that had to be impregnated on the spot (prepare-to-use; 50.2 v 23 hPa; P <.0001). Between October 1993 and October 2001, 19 of 87 children with splenic rupture were treated with the AMISA system (AMISA + TachoComb H) (21.8%), and 3 of these children had multiple trauma. The operation was indicated because of circulatory instability despite adequate volume replacement therapy. Splenic repair always was possible with the AMISA system, a changeover and splenectomy was not necessary, and the postoperative course was complication free. The mean stay in the hospital was 9.2 days. CONCLUSIONS: The AMISA system efficiently expands the indications for emergency laparoscopy and can be used successfully in emergency laparoscopy for splenic rupture management.

Adolescent↗
PubMed2004

[Percutaneous management of hemorrhages in pelvic fractures].

PURPOSE: To report our experience in the control of haemorrhage with the transcatheter embolisation technique. MATERIALS AND METHODS: Between 1999-2001, we treated 56 patients with important pelvic trauma. Forty-two were victims of car accidents and 14 of falls from great altitudes. Twenty presented acute symptoms due to blunt pelvic trauma, with massive bleeding, not treatable by drugs and blood transfusion. Diagnosis of pelvic haemorrhage was made with CT. When high-flow haemorrhage was found, the patient was referred for angiography. Embolisation was achieved after a diagnostic arteriography, with bilateral transfemoral approach and selective catheterisation of the internal iliac arteries. RESULTS: Technical success was achieved in 100% of cases: all the haemorragic sites were found and embolised. In only one patient with severe shock was it impossible to locate the site of contrast material extravasation on the first day; the patient was successfully treated on the second day with improvement of the clinical conditions. The obturator artery was involved in five cases, the gluteal artery in eleven. In eighteen patients, use of an angiographic catheter was sufficient to treat the haemorragic sites. Percutaneous control of the haemorrhage was obtained by using Gelfoam, Ivalon and coils. CONCLUSIONS: Percutaneous haemorrhage control is safe and effective, and not as costly or dangerous as the surgical option. We regard it as the treatment of choice in multiple trauma patients with important and high-flow pelvic haemorrhage.

Adolescent↗
PubMed1996

Ingredients of organ dysfunction or failure.

The simultaneous dysfunction of several organs (MODS, or multiple organ dysfunction) represents the most challenging task for the intensivist. In recent years more and more patients have been diagnosed as suffering from MODS due to several causes, including better immediate treatment of injuries that only a few years ago would have been considered incompatible with life or with consequent reduced organ reserve. Even if initially MODS has been associated with infections and sepsis, because of its similarity with a generalized inflammatory reaction mediated by a wide array of mediators, it is now clear that noninfectious insults, such as multiple trauma, acute pancreatitis, and retroperitoneal bleeding, can start a chain reaction ultimately leading to the onset of MODS. A specific trigger factor has not yet been identified, but experimental and clinical evidence suggests that the gut, endothelium, and immune system interact to produce the altered metabolic and cardiorespiratory patterns commonly observed in patients with MODS. It is thus possible that a target-oriented approach, including rapid correction of intestinal underperfusion, supply of specific nutrients, and down-regulation of the inflammatory cascade, can act as either a preventive measure for subjects at risk or as a main treatment for patients with full-blown MODS.

Bacterial Translocation↗
PubMed1993

[Results of dorsal pelvic ring stabilization].

Complete disruptions of the posterior pelvic ring are rotationally and vertically unstable [type C according to the Tile/AO (ASIF) classification (1991)]. Usually operative treatment is required. The data on 24 patients over a 5-year period were analyzed. Thirteen patients were female (54.2%) and 11 male (45.8%); the average age was 32.8 years. Multiple trauma was present in 20 patients (83.3%). In most cases operative stabilization of the posterior pelvic ring was performed by lag screws from the ilium into the body of the sacrum. The mortality in this series was 16.7% (4 patients). One patient had a thrombosis of the femoral and pelvic veins. In 2 patients we had to perform a second operative procedure because of lag screws that had not been precisely placed or had dislocated. Two incisions healed secondarily. On the postoperative radiographs in 3 patients a slight deformity of the pelvic ring was visible; in another patient the reduction of the injured hemipelvis was not sufficient. The 20 survivors had a clinical and radiological examination on average 27.5 months after their injury. Eleven patients were without pain, while 9 complained of low back pain. Gait disturbances were found in 8 patients; in 2 of them this was due to associated injuries. Five patients were unable to work. Eight patients had neurological deficits, some of them minor. Additional complications were impotence (3 patients), urinary (2 patients) or fecal incontinence (1 patient), and dystocia requiring a cesarean section (1 woman) [multiple entries].(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Accelerated nitrogen loss after traumatic injury is not attenuated by achievement of energy balance.

BACKGROUND: We wanted to determine if achievement of energy balance decreases myofibrillar protein catabolism and nitrogen loss during posttraumatic catabolic illness. METHODS: Surgical intensive care unit of a level I trauma center in a university medical center. Trauma patients expected to be mechanically ventilated for at least 4 days were randomly assigned to one of three parenteral feeding groups: (1) nonprotein calorie group: dextrose and lipid intake equal to measured energy expenditure; (2) total calorie group: dextrose, lipid, and protein intake equal to measured energy expenditure; and (3) hypocaloric group: dextrose and lipid intake equal to 50% of measured energy expenditure. Target protein intake for all groups was 1.7 g/kg body wt. On day 4 of nutrition support, a 24-hour balance study was conducted. Urine urea and total nitrogen production, 3-methylhistidine excretion, energy expenditure, and substrate utilization were measured. RESULTS: Despite significant differences in nonprotein and total calorie balance among the groups, nitrogen loss, nitrogen balance, and catabolic rate were not significantly different. Nitrogen loss correlated with catabolic rate but not with energy expenditure or energy balance. Catabolic rate was associated with energy expenditure but not with energy balance. Nitrogen loss was positively correlated with the percentage of nonprotein energy expenditure met by nonprotein calorie intake. CONCLUSIONS: Achievement of energy balance (nonprotein or total energy) failed to decrease catabolic rate or nitrogen loss acutely in multiple trauma patients. Provision of caloric intake equal to energy expenditure does not seem necessary during the acute phase of posttraumatic catabolic illness.

Adult↗