World journal of surgery
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The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. Patient factors such as age, extent of injury, and depth of burn in combination with microbial factors such as type and number of organisms, enzyme and toxin production, and motility determine the likelihood of invasive burn wound infection. Burn wound infections can be classified on the basis of the causative organism, the depth of invasion, and the tissue response. ⋯ A diagnosis of invasive burn wound infection necessitates change of both local and systemic therapy and, in the case of bacterial and fungal infections, prompt surgical removal of the infected tissue. Even after the wounds of extensively burned patients have healed or been grafted, burn wound impetigo, commonly caused by Staphylococcus aureus, may occur in the form of multifocal, small superficial abscesses that require surgical debridement. Current techniques of burn wound care have significantly reduced the incidence of invasive burn wound infection, altered the organisms causing the infections that do occur, increased the interval between injury and the onset of infection, reduced the mortality associated with infection, decreased the overall incidence of infection in burn patients, and increased burn patient survival.
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World journal of surgery · Feb 1998
ReviewSelective gut decontamination in intensive care and surgical practice: where are we?
Selective decontamination of the digestive tract (SDD) has been widely studied in the intensive care setting. Despite the publication of more than 50 controlled trials, it remains a controversial subject, with widely disparate views on the role of SDD. ⋯ Most individual studies have shown no effect on mortality, but meta-analyses suggest a 10% overall reduction in mortality. Despite the large number of publications to date, there remain several aspects worthy of further study.
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World journal of surgery · Feb 1998
Review Comparative StudyNutritional support and infection: does the route matter?
Questions regarding the effects of the route of nutrition began to surface shortly after the introduction of total parenteral nutrition (TPN). Although TPN has become a life-saving therapy for patients who cannot tolerate enteral nutrition, it is not the panacea it was hoped to be. ⋯ These effects do not appear to be due solely to prevention to malnutrition, as the infectious complications develop early after injury or illness. However, the lack of understanding of the mechanisms does not negate the fact that in many clinical studies the enteral route of nutrition is superior to the parenteral route in terms of reducing infectious complications in critically ill or injured patients.
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World journal of surgery · Feb 1998
ReviewReflex sympathetic dystrophy: model of a severe regional inflammatory response syndrome.
The systemic inflammatory response syndrome (SIRS) and acute reflex sympathetic dystrophy syndrome (RSD) share clinical signs of severe inflammation, a protracted course, and a similar problem of impaired oxygen utilization. The difference is that SIRS patients have these signs and symptoms systemically and are severely ill in the intensive care unit (ICU), whereas acute RSD patients are in good health and their problems are limited to one extremity. Both conditions seem to be the result of an exaggerated inflammatory response. ⋯ It is hypothesized that this situation is exquisitely suitable for studying the pathophysiology of severe inflammatory responses in humans. Only a few patients are required to perform studies of, for example, oxygen metabolism and cytokine or oxygen radical production. Assessment methods may be utilized, such as nuclear magnetic resonance spectroscopy, which cannot easily be performed in ICU patients.