J Trauma
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In sepsis, activation of inflammatory cells and excessive production of proinflammatory cytokines leads to tissue injury, multiple organ failure, and death. We postulated that attenuation but not complete abrogation of hyperinflammation is of clinical benefit in sepsis. Because pentoxifylline (PTX) is known to decrease tumor necrosis factor (TNF)-alpha production and to increase anti-inflammatory cytokine synthesis, we tested the hypothesis that PTX treatment would change the pro- and anti-inflammatory balance and decrease mortality in a murine model of acute endotoxemia. In addition, we investigated the effects of PTX on nuclear factor (NK)-kappaB activation using lipopolysaccharide (LPS)-stimulated human peripheral blood mononuclear cells (PBMCs) as a model. ⋯ PTX enhances anti-inflammatory activity and decreases mortality in acute endotoxemia. PTX may be an important adjunct to therapies aiming to modulate the inflammatory response in sepsis.
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Substance abuse is one of the most prevalent comorbid conditions among trauma patients. Research has shown that injury can be reduced when brief interventions are provided to trauma patients who are hospitalized for substance abuse. This article presents data from a Level I trauma center that provided brief interventions daily over a 5-year period. A generic model for brief intervention is described, along with concrete details of this addiction intervention service.
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Alcohol misuse, when combined with the right circumstances, culminates in a "Perfect Storm" that has catastrophic results. Alcohol misuse impairs judgment and increases the likelihood of serious injury. Once injured, the intoxicated patient is more likely to be hypotensive and less likely to be able to protect his or her airway. ⋯ Trauma surgeons, perhaps more than other health-care providers, have a unique opportunity and a responsibility to address potential alcohol misuse with their patients. They witness the Perfect Storm almost daily and are fully aware of the short- and long-term consequences of alcohol misuse. A trauma center visit provides an opportune time and place to incorporate alcohol screening and brief interventions as a part of standard trauma care.