American journal of surgery
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Severe injury is often complicated by the development of sepsis and the adult respiratory distress syndrome. Since the outcome from severe injury also correlates with changes in monocyte human leukocyte antigen (HLA)-DR expression in such patients, the present study aimed to determine whether or not there was a relationship between monocyte HLA-DR expression and indicators of early pulmonary dysfunction. ⋯ The degree of intrapulmonary shunting observed following severe trauma correlates with the failure of circulating monocytes to re-express HLA-DR antigen, and this may provide some insights into the early events that result in the adult respiratory distress syndrome after major injury.
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We use a loop ileostomy for temporary fecal diversion because of ease of technical construction and assumed low complication rate. Here, we review our complications of loop ileostomy and takedown using three techniques of closure. ⋯ Loop ileostomy and takedown are associated with low rates of serious complications (5% or less). As such, we continue to advocate use of loop ileostomy as a diversion procedure. Closure by enterotomy suture is preferred over resection. However, if resection is required, closure by stapled anastomosis is preferred over suture anastomosis.
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Prospective evaluation of the percutaneous tracheostomy by the guide wire dilating forceps (GWDF) technique. ⋯ The GWDF technique is a safe and efficient bedside alternative to open tracheostomy. Fiberscopic control is recommended to increase the safety of the procedure. Although studies of late complications are necessary, it appears to be justifiable to consider percutaneous tracheostomy for patients who require tracheostomy.
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The diagnosis of urosepsis should be entertained each time a patient has a febrile episode. Urosepsis carries with it a mortality rate of 25% to 60%. We determined the incidence and risk factors of urosepsis in the catheterized critically ill patient. ⋯ We found a 15.8% incidence of urosepsis in our patient population. Urosepsis was more likely to occur in patients over 60 years of age, patients with extended length of stay in the intensive care unit or in the hospital in general, and patients with an extended duration of urinary catheterization.