ICU management of blunt chest trauma: our experience.

Blunt chest tramma is a major cause of mortality and morbidity following road side accident. An understanding of the factors affecting the mortality and morbidity will help in formulating better management strategies. The records of 40 consecutive patients presenting with blunt chest trauma (BCT) requiring ICU care from 1994-1996 were reviewed. Flail chest was the most common chest injury seen in 35 patients (87.5%). Isolated flail chest was seen in 22 patients, isolated pulmonary contusion in 2 patients and a combined injury in 13 patients. Ventilatory assistance was required in 34 patients (85%) for an average duration of 16 days (range 2-43 days). All patients with anterior flail required assisted ventilation in contrast to 75% and 88% of patients with unilateral and bilateral flail respectively. Presence of pulmonary contusion with or without flail was also associated with a high incidence of ventilatory support requirement. Chest infection (pneumonia) was the most common complication seen (65%). Adverse outcome occurred in 12 patients (30%). The main contributing factors for increased morbidity and mortality were: associated pulmonary contusion, associated extrathoracic injuries and preexisting medical illness. Statistical significance was observed only with pulmonary contusion.

Effects of hypothyroidism on pregnancy of rats.

Adult female rats of approximately same age and weight were grouped and thyroidectomized before pregnancy and at different stages of gestation. While studying their pregnancy performances, it was observed that there was a significant (P less than 0.05) increase in the length of gestation in thyroidectomized animals as compared to intact controls. This is possibly due to the smaller litter size. The litter size and foetal weights were significantly (P less than 0.01) lower than the controls and were inversely proportional to the duration of the hypothyroidism during pregnancy. Hypothyroidism did not affect the implantation. The mammary gland growth was significantly (P less than 0.01) reduced in all the experimental groups. Hypothyroidism during pregnancy hardly affected the adrenal weight but significantly (P less than 0.01) decreased the ovarian weight possibly due to the disturbance in hypophysialgonadal axis.

Effect of pregnancy and thyroidectomy on the rat spleen.

Pregnancy caused a significant increase (P less than 0.001) in the ascorbic acid and cholesterol concentrations in the spleen as compared to the controls, indicating a rise in its metabolic functions. When thyroid gland was removed either from the non-pregnant animals or at different stages of gestation from pregnant animals, there were significant (P less than 0.001) fall in the levels of these biochemical parameters as compared to the corresponding intact groups. These findings indicated that splenic functions undergo certain changes during pregnancy and the thyroid hormones significantly influence them.