Journal of investigative surgery : the official journal of the Academy of Surgical Research
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Accidental hypothermia in patients with hemorrhagic shock (HS) is associated with increased mortality. However, experimental mild and moderate hypothermia has beneficial effects. The mechanisms for beneficial effects of hypothermia have not been completely understood. Therefore, the aim of this study was to investigate the effect of hypothermia on survival, bacterial translocation (BT), and remote pulmonary injury in a controlled HS model in rats. ⋯ Mild hypothermia improved blood pressure, survival, and neurological outcome with a possible detrimental effect on pulmonary ROS production during HS in rats. These effects of hypothermia are not associated with BT.
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The aim of the study was to predict and estimate the optimal time of resection following portal vein ligation (PVL) with the aid of three dimensional (3D) computed tomography (CT) volumetry and indocyanine green (ICG) clearance in healthy liver. Following right PVL, we induced hypertrophy of the left liver lobe prior to an extended right hepatectomy. ⋯ ICG clearance has a significant prognostic value. Patients with an apparently inoperable right lobe liver tumor can be successfully treated using a two-staged procedure of portal vain ligation followed by hepatectomy. The 3D CT volumetry and ICG clearance test are essential monitoring tools in these liver resections.
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Some properties of the volatile anesthetics, such as vasodilatation and myocardial depression, combined with the sympathetic inhibition that alpha2-agonists can produce, may determine hemodynamic alterations during aortic surgery. The interaction between dexmedetomidine (DEX), an alpha2-agonist, and sevoflurane during aortic surgery is unknown. We studied the effects of DEX on hemodynamics and systemic oxygenation during aortic cross-clamping (Aox) and unclamping (UAox) in sevoflurane-anesthetized dogs. ⋯ CI, heart rate, and DO(2)I were lower, while central venous pressure (CVP) and pulmonary artery occlusion pressure were higher in DEX compared to control. After UAox, MAP, CVP and SVRI were maintained higher in DEX in relation to control. We conclude that in sevoflurane-anesthetized dogs DEX alters the cardiovascular response during aortic surgery.
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Trauma is associated with immune paresis which may predispose to postoperative sepsis. We characterized the ex vivo cytokine responses to bacterial cell wall components in whole blood from 8 patients undergoing a major musculoskeletal trauma in the form of total hip replacement. Preoperatively, at the end of operation, and at days 1 and 6 postoperatively, patient blood was obtained, anticoagulated, and incubated at 37 degrees C in the presence of peptidoglycan (PepG) or lipopolysaccharide (LPS). ⋯ The expression of IL-10 was significantly depressed at the end of surgery and at day 6. There were modest changes in PepG- and LPS-induced expression of interleukin 8 (IL-8) during the experiments. On the basis of these observations, we conclude that a musculoskeletal trauma is associated with reduced expression of TNF-alpha and IL-10 by whole blood leucocytes when exposed to endotoxin, but there is a difference between gram-positive endotoxin (PepG) and gram-negative endotoxin (LPS).
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Biography Historical Article
De Humani Corporis Fabrica surgical revolution.
De Humani Corporis Fabrica (1543), by the Belgian anatomy master Andreas Vesalius (1514-1564), represents one of the most advanced surgical revolutions in history. The creation of an anatomy book that carefully and systematically introduced the structure of the human body in a way that was truthful to the findings of human dissection had never been accomplished before. ⋯ De Humani Corporis Fabrica offered to the surgeon's world new knowledge and a systematic approach to human anatomy. The novel concepts and perspectives introduced by Vesalius constituted a real surgical revolution worthy of study in the annals of surgery.