Vertebral arteriovenous fistula associated with an anomalous arterial vessel.

The widespread use of angiography in patients sustaining vascular trauma has demonstrated an increased incidence in vertebral artery injuries. With the improvement in peripheral vascular techniques and the utilization of extended exposure of the vertebral artery, aggressive therapy now is generally advocated. While new concepts continue to evolve, it becomes important to report anatomical variants that are not commonly recognized. An anomalous vessel originating from the proximal subclavian artery is reported. Initial ligation of a semmingly normal vertebral artery failed to control the fistula which was fed by the anomalous vessel. The importance of complete arteriographic studies is stressed. In particular, it is important to visualize the vascular anatomy both proximally and distally to the injury in order that anomalous vessels are recognized. Arteriography will improve diagnosis, help plan operative or nonoperative therapy, and decrease the incidence of missed injuries and complications.

Peritoneal lavage. Its unreliability in gunshot wounds of the lower chest and abdomen.

The accuracy of peritoneal lavage in patients with gunshot wounds has not been previously reported. A prospective study comprised of 168 patients was designed to determine the reliability of physical examination and peritoneal lavage. Patients sustaining gunshot wounds to the lower chest and abdomen underwent clinical assessment followed up by lavage prior to operation. There was 20.2% false-negative and 15.9% false-positive physical examination results. Of the patients. 25.4% with a false-negative lavage results had a positive celiotomy. Six of 15 patients with false-negative lavage results had RBC counts less than 1,000/cu mm. Gunshot wounds differ from stab wounds because of the unpredictable trajectory, blast effect, and high likelihood of visceral injury. It can be concluded from this study that because of the inconsistent results of both lavage and physical examination, patients who sustain gunshot wounds are best treated by exploratory celiotomy.

Selenium depletion in burn patients.

Victims of major burns may be at risk for selenium (Se) depletion because increased postinjury nutrient needs are often met by total parental nutrition and tube feedings which contain little Se. This study compared Se status of 17 burn patients and 191 healthy control subjects. Se intake of burn patients was lower than the intake of control subjects when total parenteral nutrition or tube feedings were used as primary nutrient sources but was comparable to the control intake when burn patients consumed oral diets. Serial determinations each 10 days during recovery showed that burn patients had lower plasma Se, erythrocyte Se, and erythrocyte glutathione peroxidase levels, and lower 24-hr urine Se excretion. These results provide biochemical evidence of Se depletion despite exogenous Se intake within the range recommended for healthy adults. Further studies are indicated to determine if Se depletion in burn patients can be prevented by Se supplementation of total parenteral nutrition and tube feeding solutions.