ABSTRACT
Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to classifying thoracolumbar injuries within the spinal community, but there remains a need to classify, evaluate and manage thoracolumbar fractures. This article aims to provide a guide on classification of thoracolumbar spine injuries using the AO Spine Thoracolumbar Injury Classification System (AO TLICS).
Subject(s)
Spinal Cord Injuries , Spinal Fractures , Spinal Injuries , Humans , Injury Severity Score , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/injuries , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/injuries , Spinal Injuries/diagnosis , Spinal Fractures/diagnostic imagingABSTRACT
The acute haemodynamic effects of intravenous captopril were measured, and left ventricular function was analysed by radionuclide angiography in eleven patients with moderate to severe hypertension. All subjects received 1 mg captopril by bolus injection initially, followed at 10 minute intervals by 2 mg or 5 mg injections according to blood pressure response. Eight patients experienced an acute reduction of blood pressure whilst three patients remained unresponsive. The onset of action was within 5 minutes with a peak effect at 5 to 10 minutes and duration of action lasting 20 to 30 minutes. The haemodynamic effects were characterised by arteriolar dilatation (reduced systemic vascular resistance P less than 0.01), and apparent venous dilatation (reduced right atrial, pulmonary wedge pressure, P less than 0.05 and 0.01 respectively). Pulmonary vascular resistance was not altered, ejection fraction remained unchanged and isovolumic relaxation period was lengthened (119 +/- 20.1 to 147.39 +/- 21.15, P less than 0.05). Coronary perfusion pressure gradients dropped (123.8 +/- 5.6 to 107.1 +/- 11.3 mmHg, P less than 0.001) following intravenously administered captopril. Intravenous captopril is effective in reducing arterial pressure rapidly with minimal adverse effects. This suggests that it may be useful as an alternative regimen for severe hypertension. The prolongation of the isovolumic relaxation period accounted for the decrease of coronary filling load.