Sten-Otto Liljedahl

Early Diagnosis and Treatment of Acute Ruptures of the Anterior Cruciate Ligament: A Clinical And Arthrographic Study Of Forty-eight Cases

Forty-eight patients with suspected acute rupture of the anterior cruciate ligament were examined under anesthesia and by arthrography. Thirty-five had complete and thirteen had Partial ruptures of the cruciate ligament. Thirty-three patients with complete rupture were treated by suture and the rest by conservative measures. Arthrography performed by a special technique was found to be a very good method of diagnosing acute ruptures of the cruciate ligaments. If the arthrogram suggests a cruciate-ligament rupture, the injured joined should always be examined under anesthesia. The results of operative treatment to date have been excellent.

OXYGEN CONSUMPTION AND WATER LOSS DURING TREATMENT OF BURNS WITH WARM DRY AIR

Abstract A group of eleven patients with burns exceeding 20% of their body-surface were kept in an environment of air warmed to 32°C (89.6°F) and dried to a relative humidity of approximately 20%. Another group of eleven patients with burns of a similar size were exposed to a normal ward temperature of 22°C (71.6°F) and at a relative humidity of 45%. Compared with the control series, the patients who were treated with warm dry air showed (1) a substantial reduction in basal metabolic rate; (2) a raised rate of evaporation of water from the burned surface; (3) a rapid drying of the burned surface, and (4) a small loss of weight associated with the reduced metabolic rate and an uncomplicated nutritional course.

Evaporative water loss from Burns, Grafts and Donor Sites

In 16 burned patients the evaporative water loss of different areas has been regularly followed during the course. The measurements were made with an evaporometer, which measures the water vapour given off locally from the surface of the burned patient. Second degree injuries, not covered by intact blister epithelium, in the beginning, were found to give off more water than third degree burns. From the latter the mean evaporation was 20 mg cm-2hr-1. Skin grafting caused immediate reduction in evaporation from the wound surface, but pronounced evaporation started from the donor area. From a practical, clinical point of view, we recommend that the blisters should be left intact as long as possible and that postoperatively in extensive burns the donor areas are covered by homografts to diminish water loss.

AETIOLOGY AND TREATMENT OF FAT EMBOLISM

The aetiology of the so‐called fat embolism is discussed, and the treatment of five cases widi this syndrome is described.

Distribution and losses of plasma proteins during the early stage of severe burns.

The rate of distribution of albumin and gamma‐G globulin was studied in patients with burns of varying degree by means of isotopically labeled proteins. The rate was highest in patients with extensive burns and higher the sooner the examination was made after the accident. By isotope studies using whole‐body counting the magnitude of the extravascular distribution of albumin as well as the losses of albumin from the wound surfaces were established. In cases of very extensive burns about one plasma pool of albumin was retained extravascularly during the first few days, and up to one plasma‐pool can be lost from the wound surfaces. The importance of adequate protein therapy is emphasized.

Studies on Burns: XI. Immunoglobulin and α2 macroglobulin patterns and bacterial flora during treatment of burns with warm dry air

Twelve out of 30 burned patients treated with warm dry air were investigated for the amounts of circulating IgG, IgM, IgA, and α2 macroglobulin and with respect to the bacterial flora.The immunoglobulins decreased from initially normal levels and reached the lowest values on days 4 and 7, IgG decreasing to 40-70% of established normal values for healthy controls. The fall of the IgM and IgA levels was less pronounced. The decrease in immunoglobulin concentration correlated roughly with the extent of burning. All the immunoglobulins increased subsequently in the course and reached maximum values after 10 days for IgM, after about 2 weeks for IgA, and after 3 weeks for IgG.Two patients with large burns died, one after 8 days in circulatory failure and the other on day 32 of septicaemia due to Ps. aeruginosa. In the latter the immunoglobulin pattern differed markedly from those of the others, in that it showed a successive decrease in concentrations to about 50% of normal values.A detailed analysis of the ba...

THE INFLUENCE OF DIFFERENT TYPES OF EARLY TREATMENT ON THE PROGNOSIS OF SEVERE BURNS

A comparison between group A, containing 426 patients treated with dextran and blood in the proportion 4:1, and group B, comprising 308 patients treated with plasma and blood in the proportion 4:1, extra protein, and adequate electrolytes, revealed significant improvement of the therapeutic results in group B and also significantly better results than those in Bull and Fishers series.

Erfahrungen mit Curare in der Bauchchirurgie

Seitdem die ersten enthusiastisehen Berichte fiber die Anwendung yon Curare in der An~tsthesiologie zu Beginn der 50iger Jahre in der amerikanisehen Fachpresse ersehienen sind, ist das Interesse ffir dieses Narkosegebiet in schnellem Anstieg begriffen. Dies wird unter anderem durch die Anzahl der Curarenarkosen an der Chirurgischen Klinik des Karolinska Sjukhus illustriert. Curare wurde zum ersten Male am Karolinska Sjukhus yon GoRD~ 1946 angewandt und wird seitdem in st~ndig gr5~erem Umfange verwendet. Es wurden im Jahre 1948 188 Kombinationsnarkose mit Curare gegeben, 1949 257, trod 1950 stieg die Anzahl bis auf 925. Dieser Berieht nmfal~t die Anwendung yon Curare in der Bauchchiru~gie, da diese auf den meisten chirurgischen Abteflungen im Zentrum des Interesses steht, und da ja die muskelerschlaffende Wirkung bier ihre vielleicht grSSte Bedeutung ffir die Methoden und l~esultate der Chirurgie hat. In der nordisehen Fachpresse hat GST~MA~ 1950 in einem Artikel fiber die Anwendung yon Curare in der thorako-abdominellen Chirurgie eine Zusammenstellung fiber dessert Geschiehte, Pharmakologie und gewisse frfihere klinische Erfahrungen yon CtTLLnN 1943 U. a. m. gemacht. Dieser, wie auch ADA~ und BnoDY (1945) weisen darauf bin, dal3 Kombinationsnarkosen mit Curare und Penthotal eine ausge. zeiehnete Muskelerschlaffung geben nnd sich besonders gut ffir Operationen im oberen Teil des Bauches eignen. In der Literatur ~drd an mehreren Stellen besonders hervorgehoben, da~ die Curarenarkose mit ihrem hemmenden Effekt auf die Atmung yon einem speziell ausgebildeten Narkotiseur gehandhabt werden soil, der daran gewShnt ist, dutch Laryngoskopie und Intubation unter allen Umstgnden einen freien Luftweg zu sichern und eine herabgesetzte Atmung zu kontrollieren. Weiterhin hat SECS~R in der I~ordisk Medicinsk Tidskrift 1950 die modernen Gesiehtspunkte fiber die l~harmakologie der curaresierenden Stoffe auseinandergelegt. Er stellt dort unter anderem lest, dab man in klinischen Dosen keine Einwirkung auf das Zentra]nervensystem bekommt nnd betont, was G~o~, LILIE~T~AL und HARVEY 1947 gezeigt h~ben, da~ Curare imstande ist, Histamin freizumachen. Man ist der Ansicht, dai~ diese