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Treatment of tetanus
Injury (1986) 17,217-218
Printed in
217
Great Britain
Abstracts BACTERIOLOGY AND INFECTION Treatment of tetanus One hundred and seventy-three patients with moderately severe tetanus were given either I.5 million units of penicillin 8-hourly or 500 mg of metronidazole 6-hourly for 7-10 days. All patients also received 20000 units of antitoxin daily for 6 days as well as other appropriate treatment. The two groups were closely similar in all relevant respects. Eighteen out of 76 patients receiving penicillin died compared with 7 out of 97 receiving metronidazole. Survivors spent, on average, 5 days fewer in hospital if they were given metronidazole than if they were given penicillin. Ahmadsyah I. and Sabin A. (1985) Treatment of tetanus: an open study to compare the efficacy of procaine penicillin and metronidazole. Br. Med. J. 291, 64X.
INJURIES OF THE HEAD AND SPINE Grindstone injuries Explosive shattering of grindstones caused deep and extensive wounds with embedded fragments. Two cases are reported. Meley M., Czorny K., Virte M., Chassagne J. F. and Stricker M. (1985) Craniofacial lesions by grindstone wheels. J. Trauma 25, 557. Thoracolumbar fractures When they became available, Harrington’s rods were used, on average 18 days after injury, to fix the fractures of 53 persons with fractures in the thoracolumbar region. No patient with a complete lesion above Tll showed any improvement. If fixation left bony intrusion into the vertebral canal, as shown by myelography or computed tomography about 5 months after injury, anterior decompression was carried out. Improvements of at least one grade (of five grades of paralysis) were most frequent when fixation, with or without later decompression, corrected intrusion into the vertebral canal. Ninety-five per cent of incomplete and nearly 50 per cent of complete lesions benefited. Level and type of fracture played a part in the outcome. The rods were reliable and helped to prevent bed sores; one set became infected. Lifeso R. M., Arabie K. M. and Kadhi S. K. M. (1985) Fracture of the thoraco-lumbar spine. Paraplegia 23, 207.
Deep venous thrombosis and paralysis Iodinated fibrinogen phlebography showed thrombosis in all of 23 paralysed and none of 14 unparalysed victims of spinal injury. Myllynen P., Kammonen M., Rokkanen P., Bostman 0. and Lalla M. (1985) Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: a comparison with non paralyzed patients immobihsed due to spinal fractures. J. Trauma 25, 541.
Prognostic index in head injury High levels of CK BB isoenzyme in cerebrospinal liquid, intracranial pressures above 40mmHg and age were combined to give an index that was nearly 90 per cent accurate in predicting an unfavourable outcome. Other injury, location of cerebral damage and neurological operations were not of prognostic significance. Hans P., Albert A., Born J. D. and Chapelle J.-P. (1985) Derivation of a bioclinical prognostic index in severe head injury. Intens. Care Med. 11, 186. Internal fixation of thoracolumbar fractures Scharz’s partly threaded rods were driven forwards through the pedicles above and below those of the broken vertebra and their back ends were attached to threaded rods that allowed the vertebras concerned to be forced apart, so correcting the shape of the broken body, which was packed with bone through a hole drilled in the pedicle of the broken vertebra. The device was found to be effective and reliable. Effects on recovery are not stated. Dick W., Klieger P., Magerl F., Woers 0. and Zach G. (1985) A new device for internal fixation of thoracolumbar and lumbar spine fractures: the fixateur interne! Paraplegia 23, 225.
THROMBOEMBOLISM Thromboembolism and hip fracture Heparin 3000-5000 units given intravenously four times a day for about IO days had little effect on the frequency of thrombosis compared with mechanical support and compression and with no preventive measure, but it reduced the frequency of thrombosis in the thigh and of pulmonary embolism as judged by, respectively, phlebography and measurements of ventilation and perfusion. Montrey J. S.. Kistren R. L., Kong A. Y. T., Lindberg R. F., Mayfield G. W.. Jones D. A. and Nitsunaga M. M. (1985) Thromboembolism following hip fracture. J. Trauma 25, 534. Pulmonary embolism and femoral fractures Patients receiving subcutaneous heparin and dihydroergotamine or dextran 70 in saline were found to be about as well protected from pulmonary embolism as were those given phenindione and reported in 1959. Gruber K. F. (1985) Prevention of fatal pulmonary embolism in patients with fractures of the neck of the femur. Surg. Gynecol. Obstet. 161, 37.
THORACIC AND ABDOMINAL INJURIES Splenosis and traumatic rupture When 5 years old a boy’s ruptured spleen was removed; 35 years later the same patient was again injured in a road accident and suffered rupture of ectopic mass of splenic tissue. Laker J. G., Yonehiro L. R. and Davis W. C. (1985) Traumatic rupture of splenosis. J. Trauma 25, 560. Bile duct disruption One case is reported and 94 are reviewed. Michelassi F. and Ranson J. H. C. (1985) Bile duct disruption by blunt trauma. J. Trauma 25, 454.
Printed in
217
Great Britain
Abstracts BACTERIOLOGY AND INFECTION Treatment of tetanus One hundred and seventy-three patients with moderately severe tetanus were given either I.5 million units of penicillin 8-hourly or 500 mg of metronidazole 6-hourly for 7-10 days. All patients also received 20000 units of antitoxin daily for 6 days as well as other appropriate treatment. The two groups were closely similar in all relevant respects. Eighteen out of 76 patients receiving penicillin died compared with 7 out of 97 receiving metronidazole. Survivors spent, on average, 5 days fewer in hospital if they were given metronidazole than if they were given penicillin. Ahmadsyah I. and Sabin A. (1985) Treatment of tetanus: an open study to compare the efficacy of procaine penicillin and metronidazole. Br. Med. J. 291, 64X.
INJURIES OF THE HEAD AND SPINE Grindstone injuries Explosive shattering of grindstones caused deep and extensive wounds with embedded fragments. Two cases are reported. Meley M., Czorny K., Virte M., Chassagne J. F. and Stricker M. (1985) Craniofacial lesions by grindstone wheels. J. Trauma 25, 557. Thoracolumbar fractures When they became available, Harrington’s rods were used, on average 18 days after injury, to fix the fractures of 53 persons with fractures in the thoracolumbar region. No patient with a complete lesion above Tll showed any improvement. If fixation left bony intrusion into the vertebral canal, as shown by myelography or computed tomography about 5 months after injury, anterior decompression was carried out. Improvements of at least one grade (of five grades of paralysis) were most frequent when fixation, with or without later decompression, corrected intrusion into the vertebral canal. Ninety-five per cent of incomplete and nearly 50 per cent of complete lesions benefited. Level and type of fracture played a part in the outcome. The rods were reliable and helped to prevent bed sores; one set became infected. Lifeso R. M., Arabie K. M. and Kadhi S. K. M. (1985) Fracture of the thoraco-lumbar spine. Paraplegia 23, 207.
Deep venous thrombosis and paralysis Iodinated fibrinogen phlebography showed thrombosis in all of 23 paralysed and none of 14 unparalysed victims of spinal injury. Myllynen P., Kammonen M., Rokkanen P., Bostman 0. and Lalla M. (1985) Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: a comparison with non paralyzed patients immobihsed due to spinal fractures. J. Trauma 25, 541.
Prognostic index in head injury High levels of CK BB isoenzyme in cerebrospinal liquid, intracranial pressures above 40mmHg and age were combined to give an index that was nearly 90 per cent accurate in predicting an unfavourable outcome. Other injury, location of cerebral damage and neurological operations were not of prognostic significance. Hans P., Albert A., Born J. D. and Chapelle J.-P. (1985) Derivation of a bioclinical prognostic index in severe head injury. Intens. Care Med. 11, 186. Internal fixation of thoracolumbar fractures Scharz’s partly threaded rods were driven forwards through the pedicles above and below those of the broken vertebra and their back ends were attached to threaded rods that allowed the vertebras concerned to be forced apart, so correcting the shape of the broken body, which was packed with bone through a hole drilled in the pedicle of the broken vertebra. The device was found to be effective and reliable. Effects on recovery are not stated. Dick W., Klieger P., Magerl F., Woers 0. and Zach G. (1985) A new device for internal fixation of thoracolumbar and lumbar spine fractures: the fixateur interne! Paraplegia 23, 225.
THROMBOEMBOLISM Thromboembolism and hip fracture Heparin 3000-5000 units given intravenously four times a day for about IO days had little effect on the frequency of thrombosis compared with mechanical support and compression and with no preventive measure, but it reduced the frequency of thrombosis in the thigh and of pulmonary embolism as judged by, respectively, phlebography and measurements of ventilation and perfusion. Montrey J. S.. Kistren R. L., Kong A. Y. T., Lindberg R. F., Mayfield G. W.. Jones D. A. and Nitsunaga M. M. (1985) Thromboembolism following hip fracture. J. Trauma 25, 534. Pulmonary embolism and femoral fractures Patients receiving subcutaneous heparin and dihydroergotamine or dextran 70 in saline were found to be about as well protected from pulmonary embolism as were those given phenindione and reported in 1959. Gruber K. F. (1985) Prevention of fatal pulmonary embolism in patients with fractures of the neck of the femur. Surg. Gynecol. Obstet. 161, 37.
THORACIC AND ABDOMINAL INJURIES Splenosis and traumatic rupture When 5 years old a boy’s ruptured spleen was removed; 35 years later the same patient was again injured in a road accident and suffered rupture of ectopic mass of splenic tissue. Laker J. G., Yonehiro L. R. and Davis W. C. (1985) Traumatic rupture of splenosis. J. Trauma 25, 560. Bile duct disruption One case is reported and 94 are reviewed. Michelassi F. and Ranson J. H. C. (1985) Bile duct disruption by blunt trauma. J. Trauma 25, 454.