Biomedical subjects
Publications and source records attributed to B A Almskog.
Three cases of overdistension and rupture of the stomach complicating bleeding ulcer are reported. Despite early surgery two of the patients died of multiorgan failure and rebleeding. The pathogenesis, clinical picture and treatment of this rare condition are discussed. The literature is reviewed.
Stab wounds of the neck were retrospectively studied in 28 patients. Neck stabbings constituted 9% of all stab wounds recorded during the same period. Vascular injuries were most frequent, and the mortality rate was 14%. The management of neck stab wounds is discussed and three cases are presented to illustrate the difficulties and pitfalls. It is proposed that all wounds penetrating the platysma should be explored in general anaesthesia.
The effect of systemic penicillin G treatment on the local tissue damage 12 h after a high velocity missile injury in skeletal muscle has been studied in pigs (n = 13). Blood pressure, rectal temperature, hemoglobin concentrations, hematocrits, blood gases and acid base balances were followed and the tissue levels of ATP, creatine phosphate, glucose-6-phosphate, glucose and lactate were determined in control skeletal muscle as well as in muscle samples taken from the wound area. After 12 h all devitalized tissue was debrided and weighed. Penicillin G treatment slightly diminished the local tissue metabolic deterioration and significantly reduced the amount of debrided tissue as compared to untreated animals. It may be concluded that early treatment with penicillin G will considerably diminish the local tissue damage during the first 12-hour period following a high velocity missile injury.
The effect of blood loss and reinfusion after 6 h on the tissue damage around a high-velocity missile tract in skeletal muscle has been studied in pigs (n = 13). Hemodynamic variables and blood chemistry were monitored and the levels of ATP, creatine phosphate (CP), glucose, glucose-6-phosphate ( G6 -P), and lactate were repeatedly analyzed in muscle samples from the wound area and from control tissue. In vitro amino acid incorporation into proteins by isolated ribosomes was also studied. The missile injury induced pronounced local metabolic disturbances in the muscle tissue surrounding the missile tract. After 6 h these disturbances were more pronounced and extended further out from the wound channel in bled than in unbled animals. One hour after reinfusion of the shed blood, no remaining difference in the size of the metabolically disturbed tissue area between the two groups of animals could be demonstrated. It is thus concluded that a moderate hypovolemia markedly increases the metabolic deterioration around a high-velocity missile tract in skeletal muscle but that volume restitution, even if given as late as 6 h after the missile injury and the blood loss, will almost completely within 1 h reverse the effects caused by the hypovolemia.
The extent of cellular deterioration around a high-velocity missile injury was studied in canine skeletal muscle biopsies. The tissue levels of high-energy phosphates and glycolytic metabolites were analyzed in four zones surrounding the bullet tract and in an uninjured extremity. Incorporation of leucine into skeletal muscle proteins in vitro in the different zones was determined. In the tissue adjacent to the bullet tract ATP and phosphocreatine (CP) decreased significantly and remained low. No significant changes of ATP and/or CP occurred in the other zones or in the control muscle. Lactate and glucose levels increased in all zones but G6-P levels decreased in the three zones close to the wound indicating anaerobiosis and disturbed utilization of glucose. Incorporation of leucine decreased in the innermost zone and no restoration took place, but more peripherally a certain reversible decrease was seen. The present results indicate that irreversible cell damage will occur in the tissue adjacent to a high-velocity bullet tract. Reversible cellular dysfunction may occur in tissues without gross changes.
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