Clinical experience of the management for the most severely head—injured patients with GCS score of 3

ＴＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ,ＣｈａｎｇｚｈｅｎｇＨｏｓｐｉｔａｌ,ＳｅｃｏｎｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ,Ｓｈａｎｇｈａｉ２００００３,Ｃｈｉｎａ（ＪｉａｎｇＪＹ,ＤｏｎｇＪＲ,ＹｕＭＫ,ＺｈｕＣ）ｈｅｐｒｏｇｎｏｓｉｓｏｆｍｏｓｔｓｅｖｅｒｅｌｙｈｅａｄｉｎｊｕｒｅｄｐａｔｉｅｎｔｓｗｉｔｈＧｌａｓｇｏｗＣｏｍａＳｃａｌｅ（ＧＣＳ）ｏｆ３ｐｏｉｎｔｓｉｓｓｔｉｌｌｄｉｓｃｏｕｒａｇｉｎｇ,ｂｅｃａｕｓｅｔｈｅｉｒｍｏｒｔａｌｉｔｙｉｓａｌｍｏｓ…     

Beneficial effects of fructose 1,6 diphosphate on hemorrhagic shock in rats

ＩＤｅｐａｒｔｍｅｎｔｏｆＣｌｉｎｉｃａｌＰｈａｒｍａｃｏｌｏｇｙ,ＦｉｒｓｔＡｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌ,ＣｈｏｎｇｑｉｎｇＵｎｉｖｅｒｓｉｔｙｏｆＭｅｄｉｃａｌＳｃｉｅｎｃｅｓ,Ｃｈｏｎｇｑｉｎｇ４０００１６,Ｃｈｉｎａ（ＺｈｏｕＹＤ,Ｗ...     

Changes of evoked potentials and evaluation of mild hypothermia for treatment of severe brain injury

ＣＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ,ＴｈｅＦｉｒｓｔＡｆｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌｏｆＣｈｏｎｇｑｉｎｇＵｎｉｖｅｒｓｉｔｙｏｆＭｅｄｉｃａｌＳｃｉｅｎｃｅｓ,Ｃｈｏｎｇｑｉｎｇ400016,Ｃｈｉｎａ(ＹａｎＹａｎｄＴａｎｇＷＹ)ｅｒｅｂｒａｌｉｓｃｈｅｍｉａｉｎｐａｔｉｅｎｔｓｗｉｔｈａｃｕｔｅｓｅｖｅｒｅｂｒａｉｎｉｎｊｕｒｙｉｓｔｈｅｍａｊｏｒｃａｕｓｅｏｆｓｅｃｏｎｄａｒｙｂｒａｉｎｄａｍａｇｅ.1Ｍｉｌｄｈｙｐｏｔｈｅｒｍｉａｍａｙｌｉｍｉｔｉｓｃｈｅｍｉｃｄａｍａｇｅｂｙ…     

Significance of runaway calcium homeostasis in cultured cardiomyocytes in development of hypoxia,burnt serum—induced injury

ＴＢｕｒｎＲｅｓｅａｒｃｈＩｎｓｔｉｔｕｔｅ，ＳｏｕｔｈｗｅｓｔｅｒｎＨｏｓｐｉｔａｌ，ＴｈｉｒｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＣｏｌｅｇｅ，Ｃｈｏｎｇｑｉｎｇ４０００３８，Ｃｈｉｎａ（ＣｈｉＬＸ，ＹａｎｇＺＣ，ＷａｎｇＸａｎｄＬｉＡ）Ｔｈｉｓｓｔ...     

Thinking on trauma research

ＴＲｅｓｅａｒｃｈＩｎｓｔｉｔｕｔｅｏｆＳｕｒｇｅｒｙ/ＤａｐｉｎｇＨｏｓｐｉｔａｌ,ＴｈｉｒｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ,Ｃｈｏｎｇｑｉｎｇ400042,Ｃｈｉｎａ(ＷａｎｇＺＧ)ｈｅ20ｔｈｃｅｎｔｕｒｙｉｓａｃｅｎｔｕｒｙｉｎｗｈｉｃｈｈｕｍａｎｍａｔｅｒｉａｌｃｉｖｉｌｉｚａｔｉｏｎａｎｄｍｅｄｉｃｉｎｅｄｅｖｅｌｏｐｅｄｔｈｅｍｏｓｔｒａｐｉｄｌｙ,ｍａｎｙｃａｕｓｅｓｏｆｄｉｓｅａｓｅｓｕｎｋｎｏｗｎｂｅｆｏｒｅｗｅｒｅｆｏｕｎｄｍｏｌｅｃｕｌａｒｌｙ,ｍａｎｙｄｉｓｅａｓｅ…     

The dynamic response of heart and its injury involving chest impact

ＣＲｅｓｅａｒｃｈＩｎｓｔｉｔｕｔｅｏｆＳｕｒｇｅｒｙ，ＤａｐｉｎｇＨｏｓｐｉｔａｌ，ＴｈｉｒｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ，Ｃｈｏｎｇｑｉｎｇ４０００４２，Ｃｈｉｎａ（ＬｉｕＢＳ，ＷａｎｇＺＧ，ＷｅｎｇＧＷ，ＹａｎｇＺＨ，Ｌ...     

Effect of bactericidal／permeability—increasing protein on sepsis induced by intra—abdominal infection in rats

ＡＲｅｓｅａｒｃｈＩｎｓｔｉｔｕｔｅｏｆＳｕｒｇｅｒｙ,ＤａｐｉｎｇＨｏｓｐｉｔａｌ,ＴｈｉｒｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ,Ｃｈｏｎｇｑｉｎｇ４０００４２,Ｃｈｉｎａ（ＪｉａｎｇＪＸ,ＸｉｅＧＱ,ＬｉｕＤＷ,ＺｈｕＰＦ,ＷａｎｇＺＧ,ＨｅＹＮ,ＺｈｏｕＪＨａｎｄＸｕＨ）ＴｈｉｓｓｔｕｄｙｗａｓｓｕｐｐｏｒｔｅｄｂｙｔｈｅＮａｔｉｏｎａｌＮａｔｕｒａｌＳｃｉｅｎｃｅＦｏｕｎｄａｔｉｏｎｏｆＣｈｉｎａ（Ｎｏ．３９４７０６７８）．ｌｔｈｏｕｇｈｇｒｅａｔａｔｔｅｎｔｉｏｎｈａｓ…     

Analysis of the unexpected damage in children Wilm○s tumor

Ｒ　ＤｅｐａｒｔｍｅｎｔｏｆＳｕｒｇｅｒｙ,ＬｕｏｈｕＨｏｓｐｉｔａｌ,Ｓｈｅｎｚｈｅｎ５１８００１,Ｃｈｉｎａ（ＣａｉＺＭ）ＤｅｐａｒｔｍｅｎｔｏｆＳｕｒｇｅｒｙ,ＦｉｒｓｔＡｆｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌ,ＳｕｎＹａｔｓｅｎＵｎｉｖｅｒｓｉｔｙｏｆＭｅｄｉｃａｌＳｃｉｅｎｃｅ,Ｇｕａｎｇｚｈｏｕ５１００８０,Ｃｈｉｎａ（ＬｉｕＴＢ）ｅｃｅｎｔｌｙ,ｍｕｃｈａｔｔｅｎｔｉｏｎｈａｓｂｅｅｎｐａｉｄｏｎｔｈｅｕｎｅｘｐｅｃｔｅｄｄａｍａｇｅ．ＣｈｉｌｄｒｅｎＷｉｌｍ○ｓＴｕｍｏｒ（ＷＴ）ｉｓ…     

Free flap transfer bridged by antegrade and retrograde posterior tibial vessel flaps temporally borrowed from the healthy leg

ＳＤｅｐａｒｔｍｅｎｔｏｆＯｒｔｈｏｐａｅｄｉｃｓａｎｄＴｒａｕｍａｔｏｌｏｇｙ,ＮａｎｆａｎｇＨｏｓｐｉｔａｌ,ＦｉｒｓｔＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ,Ｇｕａｎｇｚｈｏｕ５１０５１５,Ｃｈｉｎａ（ＰｅｉＧＸ,ＺｈａｏＤＳ,ＷａｎｇＱ）ＩｎｓｔｉｔｕｔｅｏｆＣｌｉｎｉｃａｌＡｎａｔｏｍｙ,ＦｉｒｓｔＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ,Ｇｕａｎｇｚｈｏｕ５１０５１５,Ｃｈｉｎａ（ＺｈｏｎｇＳＺ）ｉｎｃｅ１９７９,ｂｒｉｄｇｅｄｔｉｓｓｕｅｔｒａｎｓｆｅｒ,ｗｈ…     

Effects of nimodipine on changes of endothelin after head injury in rabbits

ＩＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ ,ＤａｐｉｎｇＨｏｓｐｉｔａｌ ,ＴｈｉｒｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｃｈｏｎｇｑｉｎｇ 40 0 0 42 ,Ｃｈｉｎａ (ＳｈｅｎＧＪ ,ＺｈｏｕＹＷ ,ＸｕＭＨ ,ＬｉｕＢＳａｎｄＸｕＹＱ)ｔｉｓｒｅｐｏｒｔｅｄｔｈａｔｅｎｄｏｔｈｅｌｉｎｉｓｉｎｖｏｌｖｅｄｉｎｔｈｅｐａｔｈｏｌｏｇｉｃａｌｐｒｏｃｅｓｓｏｆｂｒａｉｎｄａｍａｇｅａｆｔｅｒｈｅａｄｉｎｊｕｒｙ .Ｔｏｓｅａｒｃｈｆｏｒｔｈｅｐｒａｃｔｉｃａｌｅｎｄｏｔｈｅｌｉｎａｎｔａ…     

Penetrating Cardiac Wounds: Principles for Surgical Management

Stab wounds are the main type of penetrating cardiac injury in China and they have a fairly good prognosis when the patient receives expeditious and appropriate management. The objective of this study is to present the experience of managing the patients with penetrating cardiac injuries. A retrospective study involving 82 cases with penetrating wounds of the heart in the past 16 years was carried out. Stab wounds accounted for 86.58% of this series (71 of 82 patients). All 82 cases were treated operatively. The amount of preoperative infusion as fluid resuscitation for shock was less than 1,000 ml in 65.85% of the present study. Only in three patients was preoperative pericardiocentesis performed, yielding a false-negative result in one. Six patients sustaining cardiac arrest soon after arrival were subjected to emergency room thoracotomy (ERT), and five of them surviced. The overall survival rate was 96.34%. One patient died of exsanguination due to injury of multiple chambers; of the remaining 2 deaths after operation 1 was associated with abdominal injuries and the other with failure of cerebral resuscitation. From the experience reported in this study, early establishment of diagnosis and prompt thoracotomy against time are the fundamental factors affecting the outcome of penetrating cardiac injuries. Preoperative massive transfusion and pericardiocentesis are not advocated.     

穿透性心脏损伤56例手术救治分析

目的　总结心脏穿透伤处理体会 ,以改善治疗效果。　方法　复习 11年间收治的 5 6例病历资料 ,对治疗方法和结果作回顾性分析。　结果　本组戮刺伤占 89%。 5 6例均行剖胸术。其中 6 8%术前输液量 <10 0 0ml。仅 2例作术前心包穿刺 ,1例假阴性。 4例术前心跳停搏 ,经紧急剖胸后 3例获救。术后死亡 2例 ,分别因腹部合并伤及脑复苏失败。总生存率 96 4%。　结论　及时诊断并分秒必争地紧急剖胸和准确操作是穿透性心脏损伤获救的关键。不提倡术前大量扩容及心包穿刺。     

Penetrating chest injuries--an indication for early thoracotomy

Indication for thoracotomy is undisputed in cases of gaping wounds with massive haemorrhage. However, discrete stab and gunshot wounds may quite often conceal imminent pericardial tamponade. Three quarters of all penetrating thorax injuries are located in or close to the cardiac silhouette. When it comes to patients with circulatory conditions of good stability, management of superficial wounds may cost valuable time and cause delay to thorough revision of the cardiac injury which usually would be possible without extracorporeal circulation. Success of that revision may then be limited due to tamponade-related impairment of cerebral perfusion and subsequent ischaemic brain damage. The risk implied in early exploratory thoracotomy was found to be low, as compared to the risk emanating from pericardial tamponade in cases of stab wounds in the cardiac region. Hence, early thoracotomy is generally indicated and should be generously decided to handle penetrating wounds of the chest. Superiority of early thoracotomy in handling penetrating thorax injuries is demonstrated in this paper by six of the authors' own patients. While relief of cardiac tamponade is possible by pericardiocentesis, immediate and safe restoration of blood volume through a central vein or the right atrium, control of haemorrhage, and definite repair of the cardiac defect can be achieved only by thoracotomy.     

Penetrating cardiac injuries

Our objective was to determine the influence of several clinical factors on the survival of patients with penetrating wounds to the heart. A retrospective review of 80 consecutive penetrating cardiac injuries treated in a Level II urban trauma center from 1980 through 1994 were examined. Thirty-six patients (45%) had gunshot wounds (including 1 shotgun wound), and 44 (55%) had stab wounds. Intervention consisted of emergency room (ER) or operating room thoracotomy. We measured the effect of several clinical factors on morbidity and patient survival. Survival rate was 17 of 36 (47%) in gunshot injuries and 35 of 44 (80%) in stab injuries, with an overall survival rate of 52 of 80 patients (65%). The average age was 24 years (range, 9-53), and there were 3 female patients. Twelve patients (15%) had multiple cardiac injuries, and 63 (79%) had other associated injuries. Fourteen patients (17%) presented with no blood pressure, and 55 (69%) were hypotensive on admission. ER thoracotomy was performed on 7 of 52 survivors (13%) and 24 of 28 nonsurvivors (86%). Survival after ER thoracotomy was 7 of 31 patients (22%). A selective approach is recommended, because ER thoracotomy has a limited role in penetrating cardiac injury. A high index of suspicion, prompt resuscitation, and immediate definitive surgical management resulted in a high survival rate for these frequently lethal injuries.     

Penetrating chest wounds: 24 years experience

Thoracic and thoracoabdominal penetrating wounds are frequently encountered in urban medical centers in the United States. This study was undertaken to determine the clinical characteristics and in hospital outcome of these injuries. This was a longitudinal, nonblinded study using the established standard of care of patients with penetrating chest trauma. It consists of an analysis of a consecutive series of 3049 patients treated at one trauma center between April 1972 and March 1996. There were 1347 stab wounds and 1702 gunshot wounds. Antibiotic prophylaxis was administered to patients who underwent laparotomy or thoracotomy or who had lung contusion with hemoptysis (41.6%, 1296/3049). Of 3049 patients, 196 had cardiac injuries. All of them underwent thoracotomy, and the mortality was 21.9%. In contrast, among 2853 patients without cardiac injuries, only 257 (9%) required thoracotomy; the mortality in this group was 1.5%. Patients with thoracoabdominal injuries (899/3049) had a mortality of 4.3% compared to 2.1% among those who had isolated chest injuries. The overall mortality was 2.8%. Of 1702 patients with gunshot wounds, 85 (5%) sustained transaxial injuries, with an overall mortality of 36.5%. The complication rate among the survivors was 6% with only 2.5% being infectious. We conclude that the mortality for noncardiac penetrating injuries of the chest is low. The presence of associated abdominal injuries increases the mortality twofold. More than one-third of the patients with transaxial wounds die. Gunshot wounds of the heart result in higher mortality than stab wounds to the heart. The infection rate is low.     

The use of Gore-Tex graft reinforced with external rings in pediatric cardiac surgery

The case records of 200 patients who had emergency thoracotomy for penetrating trauma were reviewed. The mortality was 47% (93/200) for the entire series, 27% (21/79) for stab wounds and 60% (72/121) for gunshot wounds.Of 55 patients who underwent thoracotomy in the emergency department, 8 (15%) survived. Twelve patients “dead” at the scene could not be resuscitated. Nineteen patients sustained cardiac arrest in the ambulance, 3 (16%) of whom survived. Of 19 who had cardiac arrest in the emergency department, 5 (26%) survived.Of 38 patients who had cardiac arrest in the ambulance or emergency department, 14 with stab wounds had a 43% survival and 24 with gunshot wounds had a survival of only 8%.Patients who underwent thoracotomy in the operating room (OR) had a higher survival, 68% (99/145). For those with thoracic, extremity, or neck injuries, survival was 81% (93/115). For those who had an OR thoracotomy for aortic cross-clamping because of abdominal injuries, survival was only 17% (5/30).Early thoracotomy has a place in the management of patients who have cardiac arrest in the ambulance or emergency department because of penetrating chest, neck, or extremity injuries, especially if caused by stab wounds. Cross-clamping of the thoracic aorta for massive abdominal bleeding should be applied selectively.     

Cardiac tamponade following penetrating mediastinal injuries: improved survival with early pericardiocentesis.

Cardiac tamponade was diagnosed in 197 patients admitted over 20 years (1955-1974) to the Charity Hospital of New Orleans, for emergency treatment of pentrating mediastinal injuries. Of the 197, 174 definitively treated patients followed one of three patterns of management: 96 had OR thoracotomy, 68% were unstable, and preoperative pericardiocentesis reduced mortality from 25 to 11% (p less than 0.01); 44 had emergency thoracotomy, 91% were unstable, and prethoractomy pericardiocentesis decreased mortality from 94 to 63% (p less than 0.05); 34 patients primarily with isolated stab wounds, were treated nonsurgically with pericardiocentesis and observation, only 50% were unstable and there was 15% mortality. Recurrent tamponade did not significantly increase overall or operative mortality in patients with pericardiocentesis. Recommendations: early, even presumptive, diagnosis of tamponade; immediate pericardial decompression via pericardiocentesis; and rapid transfer to OR for thoracotomy or sternotomy and cardiorrhaphy with continous pericardial decompression via intrapericardial catheter.     

Penetrating chest wounds: a 10-year review

From January 1975 to December 1984, 93 patients with penetrating chest wounds were admitted to three hospitals in Regina. Sixty-three percent of the wounds were caused by knives and 34% by firearms. Sixty-three patients were treated conservatively, 18 patients had thoracotomy and 12 others underwent laparotomy. Of the 18 patients, 16 had wounds between the nipples; 8 of the 16 had injuries to the heart or great vessels. Whereas the majority of penetrating wounds to the chest may be treated by observation or thoracostomy alone, a surgical approach is recommended when penetrating injuries are thought to have traversed the mediastinum, because of the high incidence of associated cardiac injuries. In doubtful cases the decision should favour early thoracotomy.     

Unusually low mortality of penetrating wounds of the chest. Twelve years' experience

Within a 12-year period ending in March 1984, 1109 patients with penetrating thoracic injuries were treated at King-Drew Medical Center located in south central Los Angeles. The average age of the patients was 28.1 years. There were 607 stab wounds and 502 gunshot wounds. Antibiotic prophylaxis was prescribed only for the 428 patients who had laparotomy, thoracotomy, and pulmonary contusion with hemoptysis. Of the 1109 patients, 105 had cardiac injuries. All patients with cardiac trauma underwent thoracotomy, and the mortality rate was 18.1%. Specifically, the mortality rate of gunshot wound of the heart 24.5% and that of stab wound of the heart, 11.5%. In contrast, of the 1004 patients without cardiac injuries, only 115 required thoracotomy and the mortality rate in this group was 0.8% (8/1004). The mortality rate was 69.6% in patients who had a thoracotomy in the emergency room but only 2.8% in patients who had a thoracotomy in the operating room within the first 24 hours after admission. In the 242 patients who had associated abdominal injuries, the mortality rate was 2.1% (5/242), as compared with 2.5% (22/867) for those who had isolated chest injuries. In the entire group, the incidence of complications was 5.1%, of which 1.8% were infectious complications. The presence of associated abdominal injuries did not influence the outcome. The mortality rate in noncardiac thoracic injuries is very low compared with that of cardiac injury. Because of the complexity of the injury, gunshot wound of the heart has the highest mortality rate.     

Penetrating cardiac injuries

One hundred nine penetrating cardiac injuries were reviewed: 49 gunshot wounds and 60 stab wounds. They were classified into four groups: group 1 (lifeless), 38; group 2 (agonal), 16; group 3 (shock), 33; and group 4 (stable), 22. Thirty-six patients in group 1 (94%) and 8 of 16 patients in group 2 (50%) underwent emergency room thoracotomy; 24 of 33 in group 3 (73%) and 20 of 22 (90%) underwent thoracotomy in the operating room. Twenty-one (38%) of 55 patients undergoing emergency room thoracotomy survived, whereas 47 (87%) of 54 patients undergoing operating room thoracotomy survived. Survival was 12 of 38 (31%) in group 1, 11 of 16 (69%) in group 2, 26 of 33 (79%) in group 3, and 18 of 22 (82%) in group 4 with an overall survival of 67 of 109 (61%). Gunshot wounds of the heart portend a worse prognosis than stab wounds. Survival of gunshot wounds was 20 of 49 (40%) compared with 47 survivors of 60 stab wounds (78%). Aggressive treatment, including emergency room thoracotomy, is justified for lifeless and deteriorating cardiac injury victims.