Arterial Trauma

Marin, M.L., Veith, F.J., Panetta, T.F. et al. 1994. Transluminally placed endovascular stented graft repair for arterial trauma. /. Vase. Surg. 20 466-73. 

Schwartz M, Weaver F, Yellin A et al (1993) The utility of color Doppler examination in penetrating extremity arterial trauma. Am Surg 59 375-378... 

The active drug and metabolites can be detected from the urine by thin-layer chromatography, gas-liquid chromatography, or gas chromatography-mass spectrometry. However, assays are available only at specialized centers. Treatment of acute intoxication with mescaline is virtually identical to the treatment outlined for LSD intoxication. DOM-induced vasospasm responds well to intra-arterial tolazohne or sodium nitroprusside. Major life-threatening complications of hallucinogenic amphetamine derivatives include hyperthermia, hypertension, convulsions, cardiovascular collapse, and self-inflicted trauma. 

Dissection of the internal carotid and vertebral arteries is a common cause of stroke, particularly in young patients. Although many occur due to trauma, it is estimated that over half occur spontaneously. The mechanism of stroke following arterial dissection is either by artery-to-artery embolism, by thrombosis in situ, or by dissection-induced lumenal stenosis with secondary cerebral hypoperfusion and low-flow watershed infarction. Occasionally, dissection may lead to the formation of a pseudoaneurysm as a source of thrombus formation. Vertebrobasilar dissections that extend intracranially have a higher risk of rupture leading to subarachnoid hemorrhage (SAH). ° ... 

A variety of disorders may lead to rapid, painless, monocular or binocular vision loss. This may include central retinal artery occlusion, acute narrow-angle glaucoma, trauma, or others. The differential diagnosis is complex and needs to be undertaken by an emergency department or ophthalmologist.9... 

Mesenteric arterial or venous occlusion (atrial fibrillation) Mesenteric ischemia without occlusion Trauma... 

During surgery on the heart, it is cooled to about 32-33 °C by surrounding it with a slush of ice or by infusion of the coronary arteries with a cold solution. Either treatment stops contractions of the heart. In addition, it lowers the metabohc rate so that glycolysis in cardiomyocytes is reduced and they are protected from damage that could be caused by lactic acid. For the same reason, an organ for transplantation is transferred between hospitals at a low temperature (4°C). Some hospitals now use ice to cool the head in patients admitted with trauma to the head. These manipulations are successful despite the fact that a decrease in temperature from 37 °C to about 30 °C is only 2.3% on the Kelvin scale. 

During the flow phase there is a marked increase in energy expenditure and oxygen consumption. To satisfy this, the cardiac output is increased, from a resting value of about 5 litres per minute, by two fold during mild trauma, or as much as threefold in severe trauma or sepsis. Resistance to blood flow in peripheral arteries decreases, which can lead to... 

In the B-100,E receptor-deficient WHHL rabbit, LDL is taken up by a low-affinity mechanism whose net activity increases as the concentration of LDL increases (i.e., the pathway is not subject to feedback control from intracellular cholesterol). In normal rabbits the B-100,E receptor is calculated to account for 63, 92, and 83% of LDL degraded by the liver, adrenal gland, and intestine, respectively (P18). Whether the low-affinity mechanism alone is responsible for the localized accumulations of cholesterol in artery walls or tendons, seen in human familial hypercholesterolemia and also in the WHHL rabbit, is uncertain perhaps local trauma, or some other additional factor is also required. 

Brandt T, Steinke W, Thie A et al (2000) Posterior cerebral artery territory infarcts clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. Cerebrovasc Dis 10 170-182 Cals N, Devuyst G, Afsar N et al (2002) Pure superficial posterior cerebral artery territory infarction in The Lausanne Stroke Registry. J Neurol 249 855-861 De Freitas GR, Carruzzo A, Tsiskaridze A et al (2001) Massive haemorrhagic transformation in cardioembolic stroke the role of arterial wall trauma and dissection. J Neurol Neurosurgery Psychiatry 70 672-674... 

How the temperature is measured (i.e., brain vs arterial, venous, tympanic, bladder, or rectal temperature) is also critical, as the core temperature is usually 0.3-1.1°C lower than brain temperature (51). However, it is important to consider that these values may be different in patients with acute cerebral ischemia or trauma. 

Oung C. M., LiM. S., Shum-TimD., ChiuR. C., andHinchey E. J. (1993) In vivo study of bleeding time and arterial hemorrhage in hypothermic versus normoth-ermic animals. J. Trauma 35, 251-254. 

Interaction and adhesion of biological surfaces are central considerations for other physiological conditions as well. Platelets, erythrocytes, the vascular endothelium and other tissues interact during thrombosis and hemostasis. Also, when erythrocytes come in contact with artificial surfaces, damage often occurs and blood trauma may result. Finally, the accumulation of cholesterol deposits on the interior walls of arteries is responsible for atherosclerosis. 

Q6 A thrombus is a blood clot which is fixed to the blood vessel wall. When it detaches and is carried in the blood, it is known as an embolus. Both thrombi and emboli can block blood vessels and deprive tissues of oxygen. In arteries blood clots usually form because the inner surface has been altered by deposition of atheroma. In contrast venous thrombosis results from slow or stagnant blood flow in veins, or defects in mechanisms which normally oppose inappropriate coagulation. Three major risk factors for pulmonary embolism are (i) venous stasis, (ii) hypercoagulability ofblood and (iii) injury to vascular endothelium following trauma or plaque rupture. 

Essential thrombocythemia, or idiopathic primary thrombocytosis, is another myeloproliferative disorder in which the platelet count is raised, usually to over 1000 x lO cells/1. Secondary thrombocytosis occurs in malignancy, splenectomy, hyposplenism, surgery, trauma, hemorrhage, iron deficiency, infections, polycythemia rubra vera, myelofibrosis and the leukemias. There is a tendency for arterial and venous thrombosis and, paradoxically, intracranial hemorrhage because the platelets are hemostatically defective (ArboLx et al. 1995 Harrison et al 1998 Mosso et al. 2004 Ogata et al 2005). 

Tenderness of the branches of the external carotid artery (occipital, facial, superficial temporal) points towards giant cell arteritis. Tenderness of the common carotid artery in the neck can occur in acute carotid occlusion but is more Ukely to be a sign of dissection, or arteritis. Absence of several neck and arm pulses in a young person occurs in Takayasu s arteritis (Ch. 6). Delayed or absent leg pulses suggest coarctation of the aorta or, much more commonly, peripheral vascular disease. Other causes of widespread disease of the aortic arch are atheroma, giant cell arteritis, syphihs, subintimal fibrosis, arterial dissection and trauma. 

The first operations on the carotid artery were ligation procedures for trauma or hemorrhage. The first report was in Benjamin Bell s Surgery in 1793 (Wood 1857). However, most early ligations resulted in the death of the patient. The first successful ligation was performed by a British naval surgeon, David Fleming, in 1803 (Keevil 1949). 

This operation was performed for late carotid rupture following neck trauma in an attempted suicide. The first successful ligation for carotid aneurysm was performed five years later in London by Astley Cooper (Cooper 1836). By 1868, Pilz was able to collect 600 recorded cases of carotid ligation for cervical aneurysm or hemorrhage, with an overall mortality of 43% (Hamby 1952). In 1878, an American surgeon named John Wyeth reported a 41% mortality in a collected study of 898 common carotid ligations, and contrasted this with a 4.5% mortality for ligation of the external carotid artery. 

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