bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of open fractures in the multiple trauma patient
Authors: Allgöwer Martin , Border John R. 
Published: May 2005

AbstractThe management of open fractures in the multiple trauma patient is discussed. It is concluded that operative stabilization of the open fracture both enhances the survival of these patients and reduces the complications of the fracture while enhancing extremity function. This procedure must be conducted so as to avoid devascularization of more tissue and especially bone fragments and so that adequate stability is provided. In general, all open fractures are left open with the degree of openness depending upon the magnitude of the soft tissue trauma. In grade I and II open fractures, stabilization can usually be achieved by internal fixation or by a combination of minimal internal fixation (usually lag screws) and external fixation. In grade III open fractures, stabilization is usually best achieved by external fixation. However, the external fixation must be carefully designed to allow the subsequent soft tissue coverage operations which are usually required in third degree open fractures. In general, the external fixator should be viewed as a device to gain sufficient stability for patient mobilization and soft tissue management and not as definitive fracture care. For this reason, in the tibia unilateral frames are usually best and bilateral or trilateral frames should be reserved for segmental defects and severe zonal comminution. Definitive fracture care is then administered after soft tissue healing by cast or internal fixation.
The metabolic response to trauma and sepsis
Authors: Hassett J. , Border J. R. 
Published: May 2005

AbstractThe metabolic response of the body to trauma and sepsis is the summed response of the organs. Net catabolism of the muscles of ambulation is particularly important in providing the other organs with a source of amino acids for protein synthesis and, therefore, anabolism. This net catabolism of muscle is based upon decreased physical activity, the net effects of the neuroendocrine system, and the consequences of local amino acid concentration changes within muscle, particularly of leucine. Secondary to these changes, previously healthy humans sustaining acute short‐term trauma of fairly major degree do not require exogenous supplies of amino acid even though the patient has a short‐term negative nitrogen balance.In contrast, the septic patient has, in addition to the preceding changes, activation of phagocytosis with release of phagocytic factors that mobilize white cells, increase body temperature, and further modulate the metabolism of muscle and probably all other organs. Since these changes are induced by phagocytosis, which may be activated by retained dead tissues of all kinds, the basic attributes of the septic state may be activated in the absence of bacteria. The retained dead tissue makes bacterial growth much more likely. The septic state, therefore, has as its hallmark all of the changes of the trauma state, plus a prolonged enhanced catabolism of all amino acids, which leads to protein malnutrition with its overt manifestation of multiple systems organ failure. These patients require calories only 10 to 50% in excess of the requirement of normal humans, but a great increase in amino acid intake (up to 2.5% to 3 g/kg per day). This support will purchase more time in which to treat the underlying sepsis.
Nutritional support of the multiple trauma patient
Authors: Schmitz J. ‐E. , Ahnefeld F. W. , Burri C. 
Published: May 2005

AbstractThis report presents a brief review of currently relevant aspects of the parenteral nutritional support of the multiple trauma patient in intensive care. The decisive factors governing selection and application of an individually devised program of parenteral nutrition are the multiple trauma patient's energy turnover and nitrogen losses on the one hand, and the tolerance limits and viability of the traumatized organism on the other. It is possible nowadays to provide situation‐adapted nutritional support corresponding to the individual requirements of a seriously injured patient. However, further detailed studies are still necessary to come up with more definite answers to questions regarding requirement levels, turnover, and tolerance of the substrates applied in critical metabolic situations. This aside, adequate nutritional therapy at present represents without a doubt an integral feature of any long‐term post‐trauma therapeutic program.
Evaluation and management of the polytraumatized patient in various centers
Authors: Olerud S. , Allgöwer M. 
Published: May 2005

AbstractA questionnaire was sent to the following 6 trauma centers: University Hospital for Accident Surgery, Hannover, Federal Republic of Germany (Prof. H. Tscherne); University of Munich, Department of Surgery, Klinikum Grosshadern, Munich, Federal Republic of Germany (Prof. G. Heberer); Akademiska Sjukhuset Uppsala, Sweden (Prof. S. Olerud); University Hospital, Department of Surgery, Basel, Switzerland (Prof. M. Allgöwer); Hôpital de la Pitié, Paris, France (Prof. R. Roy‐Camille); and University of Texas Southwestern Medical School, Dallas, Texas, U.S.A. (Prof. B. Claudi). Their answers have been summarized in a few short paragraphs where tabulation was not possible, and then mainly in tabular form for convenient comparison among the various centers. There seems to be considerable international agreement on the main points of early aggressive cardiopulmonary management to prevent multiple organ failure and also, surprisingly, on the advantages of early internal fixation of major fractures.
Comprehensive regional trauma/Emergency Medical Services (EMS) delivery systems: The United States experience
Authors: Boyd David R. , Cowley R. Adams 
Published: May 2005

AbstractThe early 1970's, as an outgrowth of the American military experience, several pioneer regional trauma/EMS programs showed the way for better planning, organization, and resource deployment for trauma/EMS systems in the civilian community. The experience of the mid and late 1970's has brought an even wider implementation and modeling of trauma/EMS care systems with identification of specific patient problems, designation of trauma service centers, development of protocols, and professional teams on a regionwide basis. Currently, the acceptance of regionalized systems of care for trauma makes it a potentially manageable disease with greater prospect for developing even better systems of trauma care and control in the 1980's. The progressive impact on improving trauma care for this nation will in large part be due to the continued planning and development of regional trauma/EMS systems which have as a key focus the designation of an appropriate limited number of trauma service centers for geographic regions and the nation.There should be little question today that hospitals having extensive experience with injured patients offer better care to these patients than hospitals receiving only an occasional trauma patient. Mortality and morbidity rates are lower in more experienced hospitals where interdisciplinary teams provide coordinated resuscitation, evaluation, and definitive operative management. The skills and teamwork employed in this complex task are improved by practice and repetition, which come only with a large volume of injured patients.
Prevention and management of infection in trauma
Authors: Molnar Joseph A. , Burke John F. 
Published: May 2005

AbstractExamination of the causes of late mortality in multiple trauma patients reveals that as much as 78% of all deaths may be attributed to septic complications, suggesting the value of understanding the prevention and treatment of traumatic sepsis. In penetrating trauma, the protective features of the skin are eliminated, and systemic mechanisms of host defense are compromised. These changes in the host defense mechanism and the risk of infection influence the choice and technical features of wound closure and the use of antibiotics. Early diagnosis is imperative, but difficult.
Progress in the treatment of polytrauma over the past twenty years
Authors: Walt Alexander 
Published: May 2005

AbstractSignificant advances have been made over the past 20 years in the treatment of multiple trauma patients. An organized, preplanned, and intelligent network of people, transport, and facilities has been developed. Surgeons have come to appreciate the urgency of establishing the appropriate therapeutic priorities, both immediate and long term. The place of antibiotics in combatting sepsis in polytrauma has gradually been put into perspective. Technological developments and refinements in surgical skill as a result of experience and improved training are enabling more patients to survive post‐trauma emergency surgery. In addition, the care given in surgical intensive care units has improved as physicians become trained to view the patient as a series of integrated organ systems, the function of which may be observed and tracked in physiological terms.
Progress in the care of the victim of multiple injuries
Authors: London P. S. 
Published: May 2005

AbstractProgress over the past 20 years in the care of victims of multiple injuries has been largely technical. These technological advances, which have made it possible to study both the structural and functional effects of injury on all organ systems, have also brought difficulties—increased septicemia from invasive measures, changes that result from the treatment that may themselves prove fatal, and life prolonged beyond any meaningful existence.Progress, however, has also been made in therapy, in the understanding of the pathophysiology, and in the training and equipping of emergency room staff. It is these individuals who have played a large part in the progress in this field.
Progress in care and treatment of multiple trauma patients during the last twenty years
Authors: Sander E. 
Published: May 2005

AbstractDuring the last 20 years, the increase in polytrauma has stimulated scientific development and brought about new activities in the field of patient can, Of these new activities, the early treatment of shock by first aid measures and intensive therapy are of greatest importance.In the operative approach, the atraumatic method of operation with the help of new technical devices, instruments, and implants has stood the test of time. A remarkable development arose in the operative treatment of fractures, which plays a decisive role in polytrauma on account of the high rate of bone injuries as well as for reasons of general patient support. The operative treatment of abdominal, craniocerebral, and thoracic injuries was improved not so much by changing operative technics, but rather by vigorous treatment of shock and intensive medical support which have decisively changed the magnitude and timing of the surgery that can be performed to aid the patient. By this means, as well as by newly developed diagnostic possibilities, the necessary conditions for an effective operative treatment have been greatly improved. Thus, at present, more complete primary care of the injured may be carried out successfully in a large percentage of trauma victims.
Our experience with the changes in the care of the multiple trauma patient over the past twenty years
Authors: Rehn J. , Müller‐Färber J. 
Published: May 2005

AbstractThe experience of the Bergmannsheil in West Germany in treating multiple trauma patients is long and has reflected many of the advances in trauma care that have occurred, especially over the past 20 years. Constant confrontation with diagnosis and therapy of multiple trauma patients has resulted in an organizational regimen that reduces the time to commencement of effective treatment. Modern diagnostic equipment and procedures, prompt treatment, and a sequence of priorities for the medical care of multiple fractures and other injuries have all contributed to improved care for the multiple trauma patient.
Differentiated carcinoma of the thyroid gland
Authors: Ozaki Osamu , Notsu Takeshi , Hirai Keisuke , Mori Tohru 
Published: May 2005

AbstractLocal recurrence at the stump of resection was examined with regard to stage of disease and extent of resection in patients with papillary and follicular carcinoma of the thyroid treated during the 23‐year period from 1956 to 1979.The overall recurrence rate was 8.3% in both papillary and follicular carcinoma. In papillary carcinoma, total lobectomy is indicated for tumors<2 cm in diameter and subtotal thyroidectomy for pT‐3 tumor stage, whereas total thyroidectomy should be performed for tumors ≧ 5 cm in diameter and for pT‐4 tumor stage. On the other hand, in follicular carcinoma, total lobectomy is performed for tumors<2 cm in diameter, but subtotal thyroidectomy is the treatment of choice for those ≧ 2 cm in diameter and for pT‐2 or more advanced tumor stage. Total thyroidectomy is not indicated for most patients with follicular carcinoma.
Hyperparathyroidism with hypercalciuria and urolithiasis: Long‐term effects of parathyroid surgery and postoperative thiazide therapy
Authors: Elomaa Inkeri , Sivula Arto , Kahri Arvi , Puutula‐Räsänen Liisa , Pelkonen Risto 
Published: May 2005

AbstractEleven hypercalciuric patients (10 women and 1 man) with hyperparathyroidism and recurrent renal stones are described. In 6 patients normal calcium metabolism was restored after the removal of a single adenoma. No new stones were passed during the follow‐up period of 5 years. In 2 patients with more than 1 abnormal parathyroid gland, the hypercalciuria continued for 8–12 months after the parathyroid surgery. New stones developed in both of them. Subsequent thiazide therapy abolished the hypercalciuria and no additional renal stones were seen during a follow‐up period of 4 years. In 3 patients hypercalcemia reappeared 2–12 years after parathyroid surgery. Treatment with thiazide decreased serum calcium and parathyroid hormone levels for at least 9–36 months. No new stones developed.Hypercalciuria and recurrent hypercalcemia appearing after parathyroid surgery for hyperparathyroidism and the responses to thiazide therapy are thought to be evidence for renal hypercalciuria. Thiazides are recommended as therapy in such patients to prevent the formation of new renal stones, and probably also the recurrence of hyperparathyroidism.
Changes in thyroid surgery during iodine prophylaxis of endemic goiter
Authors: Riccabona G. , Ladurner D. , Steiner E. 
Published: May 2005

AbstractThe present report is based on 13,778 patients who had thyroid surgery between 1952 and 1980. Until 1971, western Austria was considered an endemic goiter area (school children goiter incidence 50% in 1963), but with the advent of iodized salt in 1963, the goiter incidence has decreased to 13% in preadolescents in recent years. This change in thyroid pathology was accompanied by a decrease in weight of removed thyroids (mean, 125 g→95 g) with a relative increase of hyperthyroid goiters (8.6%→43.6%) and of thyroid cancer in the surgical series (2.6%→6.8%), while the overall rate of interventions decreased only slightly. Surgery for recurrent goiters is rare now (6.2%) while it was considered a problem in previous years (16%). Histological patterns of thyroid cancer have shown a shift to more differentiated, and therefore more treatable, cancer types. The TNM classification has changed also, with 39.1% T2N1M0 cases now versus only 29% in this prognostically better group before 1971. In conclusion, this study indicates that during iodine prophylaxis for endemic goiter, thyroid surgery will retain its significance in the treatment of thyroid disease but that a different therapeutic approach becomes necessary as a result of significant changes in thyroid pathology. Nodular goiters developing under adequate iodine supply require a much more aggressive therapy than those observed in iodine deficient areas.
Unilateral versus bilateral adrenalectomy in multiple endocrine neoplasia IIA
Authors: Tibblin Sten , Dymling John ‐Fredrik , Ingemansson Stig , Telenius‐Berg Margareta 
Published: May 2005

AbstractFactors influencing the result of various forms of surgical treatment for pheochromocytoma were studied in patients with multiple endocrine neoplasia IIA (MEN IIA) syndrome. The material consisted of 18 patients belonging to 4 non‐related families operated on during 1966–1981 with a mean follow‐up time of 7.4 years. Twenty‐seven adrenals were removed at 22 operations. In all adrenals, multiple pheochromocytomas and/or medullary hyperplasia were present. In 13 patients the first operation was a unilateral adrenalectomy. Four of these had to be reoperated on because of recurring or persisting symptoms. Five patients were operated on bilaterally at the first instance. In 4 of these, the reason was bilateral macroscopic tumor involvement. Various pre‐ and intraoperative findings were evaluated with respect to the surgical result. The maximum diameter of the largest tumor was the only factor relating positively to surgical success with unilateral operation. Of 9 patients who remained asymptomatic following unilateral adrenalectomy, 8 had tumors less than 5 cm in diameter. The 4 patients who had to be reoperated on with a contralateral adrenalectomy all had a maximum tumor diameter exceeding 5 cm. A pragmatic approach to the problem of timing and extent of adrenal surgery in MEN IIA is advocated. Clinical, biochemical, histopathological, genetic, and social dimensions of the disease should be taken into consideration when choosing the surgical procedure.
Adrenal radiography: Problems and pitfalls in adrenal localization
Authors: Geelhoed Glenn W. , Druy Edward M. 
Published: May 2005

AbstractThe traditional preoperative localization of adrenal tumors has employed one or more of the following radiographic techniques: plain abdominal films, intravenous urography, adrenal venography and venous sampling, arteriography, ultrasonography, computed tomographic scanning, and scintiscanning. These localization techniques may be divided into invasive or noninvasive types with each technique having different degrees of sensitivity and specificity for the establishment of adrenal disease. The diagnostic accuracy of these radiographic techniques is reviewed for a 5‐year series in a university hospital with special emphasis on false‐positive localization. The techniques employed in localization and their sequence vary and depend on whether adrenal medullary or adrenal cortical disease was suspected, and whether or not the patient was protected by pharmacologic preparation.
Analysis of preoperative combined bleomycin and radiation therapy for esophageal carcinoma
Authors: Soga Jun , Fujimaki Masao , Tanaka Otsuo , Sasaki Koichi , Kawaguchi Masaki , Muto Terukazu 
Published: May 2005

AbstractEvaluation of the preoperative combined bleomycin (BLM) and radiation therapy for esophageal carcinoma was undertaken. Of 206 patients with esophageal carcinomas resected and histologically examined, 109 were treated with BLM and radiation (BR group) and compared with the other groups consisting of group R which was treated with radiation alone, group B with BLM alone, and group N with no preoperative treatment.The combined BLM and radiation therapy in comparison particularly with simple radiation therapy was considered to have better histological effectiveness on carcinoma cells, particularly in remote lymph nodes, and better prognostic results represented by the 5‐year survival rates: 32.2% for the group treated with the former therapy and 16.3% for the group with the latter (average, 26.2%). The ideal total dosage of BLM may be 75 mg (intramuscular, 7.5 mg × 10 days) and that of radiation 3,000 rads (200 rads × 15 days), both in 3 weeks, and the operation may be performed 1 or 2 weeks after completion of this treatment. BLM may be replaced by other chemotherapeutic agents that are believed effective in squamous cell carcinomaf.
The incidence of gastric stump cancer
Authors: Clark Charles G. , Ward Michael W. N. , McDonald Alexander M. , Tovey Frank I. 
Published: May 2005

AbstractA prospective study, consisting of annual interview, has been carried out on 225 patients who had a partial gastrectomy between 1955 and 1960, a follow‐up of between 22 and 27 years. Seventy‐seven patients have died during followup, with an accurate cause of death known in 71. One patient died of gastric stump cancer 17 years after a Polya gastrectomy for duodenal ulcer, representing the only stomach cancer in this series. This is an incidence of 0.44% as compared to an incidence of 0.1% for the general population of similar age.We have reviewed the literature with regard to the incidence of gastric stump cancer. This review and our own data suggest that the incidence is sufficiently low to make annual endoscopy of asymptomatic post‐gastrectomy patients unjustified. This conclusion may well need qualification if it becomes possible to define premalignant changes in gastric mucosa from endoscopic biopsy, so that a high‐risk subpopulation can be identified.
Pancreatic endocrine function in patients with intrathoracic replacement after esophagectomy
Authors: Sudo Takaaki , Shiraha Sei , Ishiyama Kenji , Takemoto Masahiko , Kawamura Masao , Umemura Hiroya , Kuyama Takeshi 
Published: May 2005

AbstractThe majority of patients with esophageal carcinoma are elderly and have disturbances of carbohydrate metabolism to a greater or lesser extent. Surgery for esophageal carcinoma and change in the route of the digestive tract by reconstructive surgery are considered to have an effect on carbohydrate metabolism, especially on insulin and glucagon secretion.Since the opening of Kinki University School of Medicine in 1976, the present authors have performed reconstructive surgery by the retrosternal route after total esophagectomy from the chest. In the present study, we carried out oral glucose (50 g) tolerance tests (O‐GTT) before and 1 month after esophageal reconstruction, gave intravenous glucose (0.5 g/kg) tolerance tests in controls and 1 month after esophageal surgery, and examined the influence of esophageal reconstruction on carbohydrate metabolism by determining blood sugar, insulin, and glucagon levels.Consequently, the insulin response to O‐GTT was attenuated in the group of patients with esophageal carcinoma as compared with the control group. However, after esophageal operation, it was enhanced in the early phase and was weakened in the late phase. The glucagon secretion was significantly increased in the patients after esophagectomy. This suggested that hyperglucagonemia relates to disorders of carbohydrate metabolism after surgical treatment of esophageal carcinoma.The insulin response to intravenous glucose suggests an impairment in the first phase of insulin secretion in the surgically treated group, demonstrating a role for the vagus in insulin secretion.
Treatment of retained common bile duct stones: A prospective controlled study comparing monooctanoin and heparin
Authors: Velasco Nicolás , Braghetto Italo , Csendes Attila 
Published: May 2005

AbstractA prospective controlled trial comparing the efficacy of heparin and monooctanoin as solvents of retained common bile duct stones through the T‐tube is presented. The results were compared to those obtained by the saline washout technique which was used as a retrospective comparison group. After treatment, 33% and 65% of the patients treated with heparinized saline solution and monooctanoin, respectively, showed absence of stones on cholangiograms (p<0.01). In patients submitted to the washout technique, 20% of 54 patients who completed the treatment showed disappearance of stones. Side effects during infusion were more serious in the monooctanoin group and 1 patient developed sepsis in this group. The results of the present study strongly suggest that monooctanoin may be a reasonable alternative treatment for those patients who show residual common bile duct stones after surgery.