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1.
We report the use of a Foley catheter, placed through the wound, to provide balloon tamponade of major bleeding from the neck and supraclavicular fossae. In 10 consecutive explorations for exsanguinating injury in these regions balloon tamponade was used eight times, and was judged to be fully effective in four patients, partly effective in one, and ineffective in three patients 相似文献
2.
D Demetriades D Charalambides D Pantanowitz 《Annals of the Royal College of Surgeons of England》1992,74(6):381-384
This is a prospective study of 100 patients with bullet injuries of the colon. Primary repair was performed except in cases of severe colonic damage requiring colectomy or in the presence of disseminated gross peritoneal contamination. Primary repair was performed in 76% with an incidence of abdominal sepsis of 11.8%. The remaining 24% of the patients had a colostomy and the incidence of abdominal sepsis was 29.2% (P < 0.05). Left-sided colonic injuries, multiple colonic perforations, shock on admission, delay > 6 h, more than two associated intra-abdominal injuries, high Injury Severity Score (ISS), and high Penetrating Abdominal Trauma Index (PATI), are not in themselves contraindications for primary repair. 相似文献
3.
We report a patient who developed tension pneumopericardium following penetrating trauma to the chest. Lung adhering to the pleura due to previous infection prevented the lung from collapsing and resulted in diversion of the air leak into the anterior mediastinum and from there through a breach into the pericardium. 相似文献
4.
5.
Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen 总被引:5,自引:0,他引:5
Velmahos GC Demetriades D Chahwan S Gomez H Hanks SE Murray JA Asensio JA Berne TV 《American journal of surgery》1999,178(5):367-373
BACKGROUND: Angiographic embolization is an effective technique to control bleeding after blunt trauma to the liver or pelvis. Its role in penetrating trauma to the abdomen has not been studied. METHODS: From January 1992 to May 1998, 40 patients underwent angiography for bleeding resulting from intra-abdominal penetrating injuries (33 gunshot wounds, 7 stab wounds). Angiographic embolization of intraperitoneal or retroperitoneal vessels was performed by standard angiographic techniques with gelatin sponge and/or coils. Data were extracted from medical records, radiology data bank, trauma registry, and morbidity/mortality records, and compared by Student's t test and chi-square test. The main outcome measures were failure of angiographic embolization to control bleeding and complications of angiographic embolization. RESULTS: Angiography was performed during a course of nonoperative management in 6 patients (group A), because of failure to control bleeding surgically in 23 (group B), and because of late vascular complications after an initially successful operation in 11 more (group C). In 32 patients, angiography revealed active bleeding; 29 (91 %) underwent successful angiographic embolization. Of the remaining 3 patients, 2 were successfully managed surgically (1 each from groups A and B) and 1 died despite multiple surgical maneuvers (group B). One patient who developed postoperatively a large, bleeding superior mesenteric artery pseudoaneurysm, suffered extensive bowel necrosis after angiographic embolization. No other significant complication was related to angiographic embolization. CONCLUSIONS: Angiographic embolization after penetrating injuries to the abdomen is safe and effective for a small number of selected patients. It is a valuable tool for bleeding control when surgery has failed. It may be ideal for control of late vascular complications when reoperation is not desirable. It may prove to be a useful adjunct in the nonoperative treatment of selected injuries. 相似文献
6.
George C. Velmahos William C. Shoemaker Charles C.J. Wo Demetrios Demetriades 《World journal of surgery》1999,23(1):54-58
RID=" ID=" <E5>Correspondence to:</E5> G.C. Velmahos, M.D.,
Ph.D. 相似文献
7.
Peep Algvere 《Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie》1976,201(2):123-134
Summary By means of a micro-surgical technique, the central retinal artery of the owl monkey (Aotus trivirgatus) was embolized with spheric plastic beads (7–25 in diameter). Beads (4–15 ) were also injected into choroidal capillaries through a supero-temporal vortex vein.Choroidal ischemia induced proliferation or degeneration of the pigment epithelium, frequently accompanied by photoreceptor degeneration and circumscribed retinal detachment. Occlusion of retinal vessels resulted in posterior vitreous detachment and micro-cystoid degeneration in inner retinal layers, followed by retinal schisis. In combined retinal and choroidal ischemia long-lasting retinal detachments regularly developed.Supported by U.S. Public Health Service Fogarty International Fellowship IFO5 TWO1799-01 and the Swedish Medical Research Council (Project B72-60R-3655) 相似文献
8.
Velmahos GC Chahwan S Falabella A Hanks SE Demetriades D 《World journal of surgery》2000,24(5):539-545
Angiographic embolization (AE) has been used extensively for bleeding control after injuries to the face and neck. Its role
in abdominal trauma requires further exploration. We reviewed the medical records of 137 consecutive patients who underwent
angiography with the intent to embolize bleeding sites within the abdomen. Of them, 97 (71%) had blunt and 40 (29%) had penetrating
trauma. AE was performed for hemorrhage associated with pelvic fractures (97 patients), liver lacerations (n= 26), renal lacerations (n= 12), splenic lacerations (n= 5), other injuries (n= 9), and multiple injuries (n= 12). On angiography, 102 patients were found to have bleeding sites and underwent AE, with angiographic and clinical bleeding
control in 93 (91%). The rate of successful hemostasis by AE was identical in blunt and penetrating trauma patients. There
was no major morbidity after AE. No factors predicted patients with a high likelihood to have a positive angiogram. Patients
who had AE before or after a period of attempted hemodynamic stabilization in the intensive care unit were no different with
respect to hemodynamic parameters immediately before AE or effectiveness of AE for bleeding control. AE is a safe and effective
method for controlling bleeding after blunt and penetrating intra- and retroperitoneal injuries. Early AE may be used in selected
patients as a front-line therapeutic intervention that offers expeditious hemostasis and prevents delays in definitive bleeding
control. 相似文献
9.
10.
Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially
when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients
with PDT. The mean intensive care unit (ICU) stay before PDT was 12 days. One surgeon performed PDT alone (5 cases) or assisted
residents (95 cases) in all operations; 84 were performed at the ICU bedside. Only the first six patients were taken to the
operating room solely for tracheostomy. A modified technique was used: (1) the endotracheal tube was left in place during
sequential dilations; (2) dilators were inserted in a 60-degree cephalad orientation to the skin and directed caudally after
penetration of the anterior tracheal wall; (3) a digit was inserted through the tracheal opening to guide withdrawal of the
endotracheal tube to the level of the vocal cords; and (4) size 8 tracheostomy cannulas were inserted over 28F dilators. The
average time from skin incision to insertion of the tracheostomy tube was 12 minutes (< 10 minutes, 41 patients; 10 to 15
minutes, 37 patients; > 15 minutes, 22 patients). Sixty-five percent had unfavorable anatomic conditions due to spinal precautions
or diffuse neck edema. Postoperative complications occurred in four patients; surgical emphysema after tracheal lacerations
in three, cannula dislodgment in one. All complications were successfully managed without an operation by tube exchange (n= 3) or observation (n= 1); there was no procedure-related mortality. Forty patients were available for long-term follow-up (6–18 months after tracheostomy)
by telephone; one had persistent hoarseness without respiratory difficulty. We concluded that bedside PDT is safe and easy
to teach when performed with a technique that ensures correct instrumentation. 相似文献