Facial trauma in motor vehicle accidents: etiological factors.

The effects of seat belts and the use of alcohol and drugs have been studied as etiological factors in facial trauma to occupants of motor vehicle accidents (MVAs). During a 15-month period, 461 patients were admitted to a regional trauma center as a result of injuries sustained in MVAs. Two hundred thirty-seven (51%) of these patients had facial trauma. Facial trauma was the single most common injury in these patients. One hundred eighty-five patients (78%) had major soft tissue injury, and 52 patients (22%) had facial bone fractures. Forty-two of 237 patients (18%) with facial trauma were wearing seat belts compared with 74 of 224 patients (33%) without facial trauma who were wearing seat belts at the time of the accident. Large numbers of patients who were wearing seat belts at the time of the accident had minor injuries and were never admitted to the hospital. Sixty-five of 224 patients (24%) without facial trauma and 121 of 237 patients (51%) with facial trauma tested positive for alcohol or drugs. The majority of the patients who tested positive for alcohol had blood alcohol levels of more than 100 mg/dL. Head injuries and blunt chest trauma were most commonly associated injuries in these patients. This study suggests that use of alcohol and drugs in occupants of the motor vehicle had a major effect on the etiology of facial trauma. Also it supports the data that suggests that the use of seat belts prevents a wide range of injuries including facial trauma in MVAs.

Nonabsorbable radioactive material in the treatment of carcinomas by local injections.

Nonabsorbable radioactive material was used in treating malignant lesions by local injection. One hundred thirty-five Lewis Wistar rats were inoculated subcutaneously with tumor cells. After 7 days, the rats grew tumors of approximately 1 X 1 X 1 cm at the injection site. The rats then were divided into two groups; 50% were kept as a control group while the other 50% received single injections of 1 mCi yttrium 90 (90Y) microspheres directly into the center of the tumor. This study shows a significant reduction of the tumor growth rate in treated animals. Tumor sizes after 4 days averaged 1.31 ml in the treated rats and 9.74 ml in the control group. Excluding animals that had complete regression of the tumor, treated rats lived an average of 30.8 days from the day of treatment compared with the control rats, which lived an average of 17.4 days. Pathology examinations showed no effects from injected radioactive materials in the liver, bone marrow or the kidney. Examination of the injected area after 6 months showed that microspheres remained locally and that the tumor was replaced with collagen tissue.

Acute appendicitis in women of childbearing age.

To find a way to decrease the incidence of laparotomies negative for appendicitis, we studied 108 female patients between the ages of 15 and 45 years who had undergone appendectomy with the diagnosis of acute appendicitis. Of these 108 patients, 56 had acute appendicitis and 52 had normal appendixes. The patients between the ages of 15 and 25 years had a 59% incidence of negative laparotomies, in comparison with those patients between 36 and 45 years old, who had an incidence of 22%. In patients with normal appendixes, 18 had no intra-abdominal pathologic findings. Twenty had pelvic inflammatory disease, and nine had ovarian abnormalities. There were no differences in the clinical symptoms, vital signs, roentgenographic findings, or other laboratory studies between the two groups. There were no in-hospital perforated appendixes in the patients who were operated on within 48 hours of admission. To decrease the incidence of negative appendectomies, we recommend in-house observation and simultaneous examination of the patient by the surgeon and a gynecologist.

Colonoscopic decompression of the colon in patients with Ogilvie's syndrome.

Pseudoobstruction of the large bowel occurs as acute distention of the colon, usually in a high risk and seriously ill patient without any mechanical obstruction. Massive distention of the colon results in perforation of the cecum and fecal peritonitis and is associated with a very high mortality rate. Laparotomy with cecostomy is the recommended surgical therapy for this problem which carries a mortality rate of over 20 percent. We have used the colonoscope to decompress the distended colon, and especially the cecum, in 10 patients with Ogilvie's syndrome, with a 90 percent success rate and no deaths or complications. The surgeon should follow the several technical guidelines mentioned herein for successful and safe performance of the procedure. These guidelines include a tap water enema of about 1,000 ml before the procedure, avoidance of the liberal use of air insufflation during the procedure, and blind insertion of the colonoscope. This procedure is not indicated in any patient with signs of peritonitis and perforation.

Ankle-level amputation.

Ankle-level amputation for diseases involving the foot can be achieved by the Pirogoff amputation instead of the Syme amputation with very good results. This technique provides a strong end-bearing stump and has the advantage that the amputated leg is essentially the same length as the patient's normal leg. With the use of modern prostheses, the results of rehabilitation are very good. We have used the Pirogoff technique for ankle-level amputations in 12 patients during the past 4 years with good results.

Modified Hartmann procedure in emergency sigmoid colectomy.

A new technique has been added to the Hartmann procedure to suture the rectal stump to the presacral fascia using black silk sutures at the time of the initial resection and closure of rectal stump. This will prevent contraction of the rectal stump behind the bladder or vagina deep in the pelvis and makes reanastomosis of the proximal colon to the rectal stump very easy. Also discussed are the advantages of the modified Hartmann procedure in cases of emergency sigmoid colectomy as opposed to the conventional three stage procedure.