Long bone fractures and pulmonary dysfunction.
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Fractures, Bone↗
Biomedical subjects
P P Schimpf
Publications and source records attributed to P P Schimpf.
Quantitation and pattern of parenchymal lung injury in blunt chest trauma. Diagnostic and therapeutic implications.
Sixty-nine patients with nonpenetrating pulmonary trauma were studied by chest computed tomography (CT) within 24 hours of admission. The percentage of air-space filling was quantitated and compared with the requirement for ventilatory support. Pulmonary intraalveolar hemorrhage always is gravity dependent originating at the site of injury. Utilizing CT, the patients' pulmonary status was classified into three separate clinicoradiologic groups: Grade I injury (less than 18% air-space filling, no ventilator support required), Grade II injury (18-28% air-space filling, ventilator support sometimes required), and Grade III injury (greater than 28 air-space filling, ventilator support always required). The CT quantitation correlated with clinical functional studies and was useful in the therapeutic management of nonpenetrating lung injury.
Adolescent↗
Classification of parenchymal injuries of the lung.
Pulmonary contusion, implying interstitial and alveolar injury without significant laceration, has been accepted as the primary lung injury in nonpenetrating chest trauma. Computed tomographic (CT) findings were compared with those of chest radiography in 85 consecutive patients with chest trauma in which there was a pulmonary radiodensity consistent with pulmonary contusion or patients with a history of severe chest trauma with normal parenchyma despite rib fractures, hemothorax, pneumothorax, or widened mediastinum. CT was found to be more sensitive than radiography in that 151 abnormalities (excluding rib fractures) were demonstrated on radiographs versus 423 abnormalities on CT scans, and 99 lacerations were seen on CT scans versus five on radiographs. Pulmonary lacerations were classified into four types on the basis of CT findings and mechanism of injury: compression rupture, compression shear, rib penetration, and adhesion tears. In these cases, pulmonary laceration was shown to be an integral component of the mechanism of injury in pulmonary contusion, pulmonary hematoma, pulmonary cyst or pneumatocele, or cavitation in pulmonary contusion.
Adult↗
Free rupture of the ascending aorta: successful resuscitation at a regional trauma center.
After sustaining a free rupture of the intrapericardial ascending aorta secondary to blunt chest trauma, a 27-year-old man underwent successful aortic repair. To our knowledge, this is the first time a patient has ever survived this condition. Pericardial tamponade-together with rapid transport to the hospital and an aggressive surgical approach-was a key to the recovery of effective cardiac function and successful aortic repair. Although the patient succumbed to complications 74 days after surgery, this case illustrates the possibility of longterm survival after free rupture of the ascending aorta. The following report emphasizes the technical feasibility of controlling the perforated aortic root in such cases.
Journal Article↗
Left subclavian artery trauma: in situ vs. rib interspace mobilization for primary anastomosis.
Fifteen autopsy dissections were performed to evaluate the anatomic relationships of the left subclavian artery and primary arterial anastomosis following trauma. The vessel was transected just beyond the origin of the thyrocervical trunk, and the maximal excisable overlapping segment was determined in situ and through the first and second interspaces. By passing the mobilized left axillary artery through the first intercostal space, up to 7.5 cm of a subclavian arterial segment could be resected and primary arterial repair accomplished. The use of the first interspace to gain additional length in primary repair of the left subclavian artery is suggested as an alternative to grafting.
Adult↗