A case of traumatic fat embolism syndrome without long bone fracture.
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Prolonged peridural analgesia by morphine was used in 45 patients with severe skeletal traumas. The administration of minimal doses of morphine (0,08-0,1 mg/kg) into the peridural space facilitated earlier normalization of indices of hemodynamics and external ventilation.
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Pneumorachis, or air within the spinal canal, has rarely been described, particularly in conjunction with thoracic trauma. We report a case of pneumorachis and pneumocephalus in a patient with a tension pneumothorax and multiple closed thoracic spinal fractures.
92% of all patients with a thorax-trauma suffer from a blunt chest trauma. In the early diagnosis by plane chest X-ray only a quarter of all pathological findings in comparison to the CT of the thorax are found. In addition to that the special deviations and imaging of the thoracic organs in the plane chest X-ray have to be noted. With the demonstration of same examples the special value of the thorax-CT in early diagnosis and patient control was demonstrated. Specially in showing the grade of lung contusion, the volume of bilaterally hemato-serothoraces, ventral pneumothoraces and additional injuries CT was more sensitive. The main disadvantage is the possibly long way of transportation and a contraindication is a severe trauma of the upper extremities and an instable fracture of the spine column.
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The process of cartilage-to-bone transition (CBT) is a key event for the achievement of rigid bone healing during fracture repair. Since mineralization of cartilaginous matrix is a prerequisite for the initiation of CBT, the genetic localization of mineralization-related bone matrix proteins in CBT was examined in this study. An in situ hybridization method used on decalcified sections with digoxigenin-11-UTP labelled probes identified the cellular localizations of these genes in CBT. Cessation of osteonectin mRNA together with induction of osteopontin mRNA in chondrocyte maturation was observed during the process of CBT in the fracture callus on day 12 after fracture; osteocalcin mRNA was absent in chondrocytes of the CBT area. Induction of osteopontin mRNA in maturated chondrocytes was followed by the expression of mRNAs for osteonectin, osteopontin and osteocalcin in osteogenic cells in the ossification front of CBT. The data suggest that the switch from osteonectin to osteopontin mRNA expression in chondrocyte maturation is one of the key events during CBT. Transcriptional disorders of the expression of these molecules may be linked to the failure of fracture repair, i.e. delayed or prevented hypertrophic osteosynthesis.
In the Plymouth area, 95 patients with end-stage renal failure have undergone haemodialysis for 6 months or longer. Of the 47 patients beginning dialysis between 1967 and 1973, when water deionisers were not used routinely, a bone disease with multiple fractures, 'fracturing osteodystrophy', occurred in 18 patients and dialysis encephalopathy in 10. Of the 48 patients first dialysing between 1974 and 1979, when water deionisers used commonly, fracturing osteodystrophy occurred in only one and dialysis encephalopathy also in only one. Duration of dialysis without a water deioniser appeared to be the most important factor in the development of these two conditions. The use of water deionisers usually led to healing of fractures in patients with fracturing osteodystrophy and also led to improvement in 4 of the 11 patients with dialysis encephalopathy. Neither condition has occurred in any patient using a water deioniser from the first dialysis. Water deionisers, therefore, appeared to be effective in both the treatment and prevention of fracturing osteodystrophy and dialysis encephalopathy.
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