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 National Journal of Medical Research , 2012, Abstract: Background : During forensic evaluation the determination of age of contusions play a very important role. Age of contusions is normally determined based on their colour. Different authors have different interpretations of age of contusions based on colour. Objective : The aim of the present study is to have a first hand information regarding the colour changes occurring in contusions with the passage of time, in our population and also to compare the aging process of contusions in our population with the standard data available Methods: Contusions were classified into small, medium and large. Both naked eye examination of colour of contusions and microscopic examination of contusions were done. Perl’s staining was also done to confirm the presence of pigments. Results: 65 male and 15 female patients were included in the study. Majority of the cases the contusions were due to road traffic accidents. It was observed that in contusions of 24 hrs duration it was red in colour,followed by blue colour for two to three days. Contusions of four to six days were bluish black coloured and green in colour by seventh day. Microscopic examination revealed the presence of RBC in injuries less than 24 hrs duration. Lymphocytes and polymorphs were prominent in third and fourth day of injury. Perl’s stain was positive from the fifth day onwards. Conclusion : The observations of colour tone of injury and histopathological findings including special staining techniques like Perl’s stain can help the forensic pathologist to a certain extent in dating the age of medium sized contusion in moderately nourished adult subjects during the initial phases of injury. [National J of Med Res 2012; 2(3.000): 339-342]
 Indian Journal of Critical Care Medicine , 2004, Abstract: ABSTRACT: Severe pulmonary contusions occur in blunt chest trauma, especially with high velocity injuries. Pulmonary contusions following trauma may result in significant hypoxemia and decreased compliance which may progress over several days. Extensive contusions may result in respiratory difficulty or progress to adult respiratory distress syndrome, which increases mortality. We decided to review the cases of polytrauma with associated pulmonary contusions to determine the factors which influence outcome. MATERIALS AND METHODS: A retrospective chart review of all cases of trauma with pulmonary contusions on X-ray or CT scan. The cases were examined for age, type of injuries, admission APACHE II, SAPS II and SOFA scores, PaO2/FiO2 ratio, presence or absence of rib fractures, average positive fluid balance, average sedation dose, pulmonary haemorrhage, ventilator days, ICU days and hospital outcome. RESULTS: There were 18 cases of pulmonary contusions. All had associated injuries. 6 patients died, 4 in the ICU and 2 patients died 1 week after transfer to a high dependency unit, one due to sepsis and the other due to massive haemothorax. There was a significant difference in PaO2/FiO2 ratio at admission and throughout the ICU course, fluid balance and sedation dose, but not in ventilator days and ICU days between survivors and nonsurvivors. The incidence, frequency and amount of pulmonary haemorrhage were higher in the nonsurvivors. CONCLUSIONS: Close attention to improving gas exchange, and early management of hemoptysis might improve outcome in pulmonary contusions
 Mathematics , 2007, Abstract: In this paper we revisit the results of Loynes (1962) on stability of queues for ergodic arrivals and services, and show examples when the arrivals are bounded and ergodic, the service rate is constant, and under stability the limit distribution has larger than exponential tail.
 Indian Journal of Critical Care Medicine , 2007, Abstract: There have been important advances in the science of neonatal resuscitation and various international resuscitation committees have formulated evidence-based recommendations for the performance of resuscitation at birth. The new guidelines for resuscitation at birth were developed by International Liaison Committee on Resuscitation (ILCOR) and were presented at 2005 International Consensus Conference on Emergency Cardiovascular Care and Cardiopulmonary Resuscitation Science with treatment Recommendations. The European Resuscitation Council (ERC) and American Heart Association (AHA) further tailored the guidelines to meet their specific needs. In this article we have discussed the new resuscitation guidelines for newborns issued by ILCOR, American Heart Association and European Resuscitation Council.
 Brazilian Journal of Medical and Biological Research , 2001, DOI: 10.1590/S0100-879X2001001100012 Abstract: in the present study we evaluated the morphological aspect and changes in the area and incidence of muscle fiber types of long-term regenerated rat tibialis anterior (ta) muscle previously submitted to periodic contusions. animals received eight consecutive traumas: one trauma per week, for eight weeks, and were evaluated one (n = 8) and four (n = 9) months after the last contusion. serial cross-sections were evaluated by toluidine blue staining, acid phosphatase and myosin atpase reactions. the weight of injured muscles was decreased compared to the contralateral intact one (one month: 0.77 ± 0.15 vs 0.91 ± 0.09 g, p = 0.03; four months: 0.79 ± 0.14 vs 1.02 ± 0.07 g, p = 0.0007, respectively) and showed abundant presence of split fibers and fibers with centralized nuclei, mainly in the deep portion. damaged muscles presented a higher incidence of undifferentiated fibers when compared to the intact one (one month: 3.4 ± 2.1 vs 0.5 ± 0.3%, p = 0.006; four months: 2.3 ± 1.6 vs 0.3 ± 0.3%, p = 0.007, respectively). injured ta evaluated one month later showed a decreased area of muscle fibers when compared to the intact one (p = 0.003). thus, we conclude that: a) muscle fibers were damaged mainly in the deep portion, probably because they were compressed against the tibia; b) periodic contusions in the ta muscle did not change the percentage of type i and ii muscle fibers; c) periodically injured ta muscles took four months to reach a muscle fiber area similar to that of the intact muscle.
 Brazilian Journal of Medical and Biological Research , 2001, Abstract: In the present study we evaluated the morphological aspect and changes in the area and incidence of muscle fiber types of long-term regenerated rat tibialis anterior (TA) muscle previously submitted to periodic contusions. Animals received eight consecutive traumas: one trauma per week, for eight weeks, and were evaluated one (N = 8) and four (N = 9) months after the last contusion. Serial cross-sections were evaluated by toluidine blue staining, acid phosphatase and myosin ATPase reactions. The weight of injured muscles was decreased compared to the contralateral intact one (one month: 0.77 ± 0.15 vs 0.91 ± 0.09 g, P = 0.03; four months: 0.79 ± 0.14 vs 1.02 ± 0.07 g, P = 0.0007, respectively) and showed abundant presence of split fibers and fibers with centralized nuclei, mainly in the deep portion. Damaged muscles presented a higher incidence of undifferentiated fibers when compared to the intact one (one month: 3.4 ± 2.1 vs 0.5 ± 0.3%, P = 0.006; four months: 2.3 ± 1.6 vs 0.3 ± 0.3%, P = 0.007, respectively). Injured TA evaluated one month later showed a decreased area of muscle fibers when compared to the intact one (P = 0.003). Thus, we conclude that: a) muscle fibers were damaged mainly in the deep portion, probably because they were compressed against the tibia; b) periodic contusions in the TA muscle did not change the percentage of type I and II muscle fibers; c) periodically injured TA muscles took four months to reach a muscle fiber area similar to that of the intact muscle.
 Mathematics , 2013, Abstract: We study a discrete time queueing system where deterministic arrivals have i.i.d. exponential delays $\xi_{i}$. The standard deviation $\sigma$ of the delay is finite, but its value is much larger than the deterministic unit service time. We describe the model as a bivariate Markov chain and focus on the joint equilibrium distribution. We also prove that the latter decays super-exponentially fast in the quarter plane. Finally, we discuss the numerical computation of the stationary distribution, showing the effectiveness of a simple approximation scheme in a wide region of the parameters. The model, motivated by air and railway traffic, was proposed many decades ago by Kendall with the name of "late arrivals problem", but no solution has been found so far.
 Jurnalul de Chirurgie , 2005, Abstract: The prognostic of the liver trauma is conditioned by the type of the hepatic injuries. Their anatomic and hemorhagic characteristics will influence the kind of treatment: emergency laparotomy or non-surgical treatment. The most important condition for a non-surgical treatment of the liver trauma is a stable patient. Operative option is indicated for unstable patients, when there are other visceral injuries or when the surgical unit hasn't accurate imagistics posssibilities. For optimal operative management of the liver trauma, some principles need to be followed: 1) the patient is positioned with the arms at right angles on arm boards, wich allowes better access to intravenous or intraarterial lines; 2) skin preparation is for a toarco-abdominal approach; 3) the primary incision is a midline one wich can be branched with a right transverse. After laparotomy there are two situations: liver injuries without or with active haemorrhage. For the first situation, evacuation of the hemoperitoneum, lavage and drainge are the only procedures indicated. For the second types of injuries we also describe favorable and unfavorable injuries. When the hand compression of the liver is effective and hepatic injury is anterior, the hemostasis after clampage of the hepatic pedicle (Pringle maneuver) is indicated. Perihepatic packing is indicated in case of choagulopaty. Hepatic resection it isn't recommended. The unfavorable situation is association of acidose-hypotermia and choagulopaty wich cause a "biological hemorrhage". In this cases are indicated"abbreviated laparotomy" with perihepatic packing (damage control) and planned reoperation or arterial embolisation (interventional radiology). When the clampage of the hepatic pedicle it isn't efficient, probably a hepatic vein is injured and a a perihepatic packing is also indicated. The unefficiency of the perihepatic packing, the clampage of the hepatic pedicle + inferior vena cava (under and above the liver) ± aorta it is necessary to stop the active bleeding. The closure of the laparotomy it is necessary to be made very fast, especially for the "abbreviated laparotomy". In the case of trauma of the main hepatic duct an external billiary drainage it is recommended. The reoperation it is indicated in some cases: intraabdominal hyperpression syndrome, perihepatic packing, other intraabdominal complications. Conclusion: The prognostic of the liver trauma depends by the anatomical type of the injuries. Operative management of the liver trauma is very difficult. The clampage of the hepatic pedicle (with or without vena cava
 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-69 Abstract: One of the most challenging aspects of caring for burned patients is the acute resuscitation. The profound inflammatory response generated by a burn far surpasses that seen in trauma or sepsis, and the resultant fluid needs can be extreme. There is a large and ever-increasing body of research devoted to refining strategies for acute burn resuscitation, and this article attempts to summarize some the most important recent findings in the field.After treating victims of the infamous Coconut Grove fire in 1942, Cope and Moore first postulated that burn resuscitation needs may have contributions from both the patient's body weight and the size of their burn [1]. Baxter and Shires later built on this knowledge, using canine and human data, to specifically measure fluid requirements by weight and total body surface area (%TBSA). Their formula of 3.5 to 4.5 ml of lactated Ringers per %TBSA per kilogram became known as the Parkland formula after the Dallas medical complex in which their experiments took place [2]. Although the Parkland formula is still the most commonly employed resuscitation formula worldwide, it is far from a perfect solution.Ongoing research focuses on refining existing formulas to prevent complications of over-resuscitation. This includes devising novel means for titrating resuscitation, such as nurse-driven or computer-driven protocols. The composition of the fluids used in resuscitation has generated significant interest, with a particular focus on colloids and hypertonic saline. Pharmaceutical therapies that attempt to down regulate the inflammatory response such as vitamin C may have a role in acute resuscitation. Likewise, investigators are proposing the use of adjuncts such as plasmapheresis to remove inflammatory mediators from the bloodstream during resuscitation. The final topic inviting significant scrutiny is outcomes of resuscitation, both choosing the most appropriate outcomes to use and how to best measure these outcomes in clinical practi
 Jurnalul de Chirurgie , 2005, Abstract: The most important condition for a conservative treatment of the liver trauma is a stable patient. Ultrasound and computerized tomography (CT) examinations are essential for the investigation of abdominal trauma. These explorations allow visualization of solid organ anatomy and have the ability to grade and quantify the livers' injuries (Mirvis classification). After the first exploration and the decision for initial non-operative approach, the patients will be followed in the intensive care unit (hemodynamic status, biological exploration, CT or ultrasonography). In this second survey period it is possible to appear complications (hemorrhage, peritonitis, intra-abdominal hyper-pressure syndrome etc.) and emergency laparotomy can be necessary. The overall mortality for non operative approach is about 9%, and direct mortality is under 1%. Secondary operations are necessary in 7-10% from these patients. Interventional radiology techniques and endoscopic procedures (such as endoscopic retrograde cholangio-pancreatography) allowed the reduction of the secondary surgical interventions. Hospital stay depends by the grade of the liver injury. Long term follow-up it is necessary; some cystic image can appear in the liver parenchyma at CT exam after months or years from the trauma, but without clinical significance.
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