ABSTRACT
Penetrating injuries such as gunshot wounds have traditionally been rare in Europe, with the result that European surgeons have only limited experience in their management. Socio-economic changes in the last decade have led to an increase in the frequency of injuries of this type, partly due to the expansion of organized crime and partly because of involvement of the European military in peace-keeping missions in Europe and elsewhere in the world. The purpose of this article is to offer some guidelines in the management of extremely serious or rarely encountered injuries to the neck, chest and peripheral arteries and discuss controversies and possible future changes in their management as a result of the extensive experience of treating penetrating trauma in our hospital.
Subject(s)
Arm Injuries/surgery , Blood Vessels/injuries , Heart Injuries/surgery , Leg Injuries/surgery , Multiple Trauma/surgery , Neck Injuries/surgery , Thoracic Injuries/surgery , Vascular Surgical Procedures , Wounds, Penetrating/surgery , Amputation, Surgical , Angiography , Arm Injuries/diagnosis , Bronchoscopy , Crime , Emergencies , Esophagus/injuries , Heart Injuries/diagnosis , Hemostatic Techniques , Humans , Leg Injuries/diagnosis , Multiple Trauma/diagnosis , Neck/blood supply , Neck Injuries/diagnosis , Practice Guidelines as Topic , Radiography, Thoracic , Socioeconomic Factors , Subclavian Artery/injuries , Thoracic Injuries/diagnosis , Thoracic Injuries/diagnostic imaging , Time Factors , Trachea/injuries , Tracheostomy , Vertebral Artery/injuries , Wounds, Gunshot/surgery , Wounds, Penetrating/diagnosis , Wounds, Penetrating/diagnostic imagingABSTRACT
Peace-keeping "out of area missions" of the Federal German Armed Forces are supported by modular container hospitals. The infrastructure of mobile container hospitals reflects the modern standard of surgery in "out of area" missions. The injury pattern of over 200 patients with war injuries, caused by AK 47 Kalaschnikov, fragments and mines are presented.
Subject(s)
Hospitals, Military/organization & administration , Military Personnel , Multiple Trauma/surgery , Warfare , Wounds, Gunshot/surgery , Humans , United NationsABSTRACT
Our experience with external skeletal fixation of complex open and closed femoral fractures in 50 conventional trauma victims is presented. Different external fixator systems were primarily used in 26 patients and secondarily in 24 patients. The authors feel that early definitive femoral fracture care in civilian and military trauma victims employing unilateral external monofixation, which avoids casts, and allows improved wound management and early mobilization of the multitrauma patient, has decreased the complication rate commonly associated with internal fixation of open femoral fractures.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation/methods , Fractures, Closed/surgery , Fractures, Open/surgery , Military Personnel , Adolescent , Adult , Fracture Fixation, Internal/adverse effects , Humans , Male , Middle Aged , Orthopedic Fixation Devices , Reoperation , Retrospective StudiesABSTRACT
Medium conditioned by silica-stimulated human peripheral blood monocytes expresses vascular suppressive activity. Rat aortic rings, after incubation in conditioned medium, exhibited comprised contraction to stimulation by norepinephrine (NE). Maximal contraction (300 +/- 51 mg tension/mg tissue) and sensitivity (-5.91 +/- 0.23 M [log EC50]) were both reduced in comparison to contraction (762 +/- 66) and sensitivity (-7.42 +/- 0.11) displayed by rings after incubation in control medium. A polyvalent antibody (Ab) against human interleukin 1 (Il-1) neutralized the suppressive activity in conditioned medium. Rings incubated in conditioned medium containing Ab exhibited normal maximal contraction (722 +/- 46) and a partial restoration of sensitivity to NE (-6.91 +/- 0.13). In contrast, incubation of rings in control medium supplemented with recombinant human Il-1 resulted in a dose-dependent suppression of aortic contraction to NE that was analogous to the defects induced by monocyte-conditioned medium. No significant differences in NE-stimulated phosphoinositide hydrolysis were present between rings incubated in Ab-treated or untreated conditioned or control media. The data suggest that monocyte-derived Il-1 may have a significant influence on vascular contractile function and that the mechanism by which Il-1 induces vascular dysfunction cannot be demonstrated to involve inhibition of NE-stimulated phosphoinositide metabolism.
