J Trauma
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Among many aspects, wound healing depends on early restoration of venous blood flow across wound margins. The type of surgical occlusion of vein stumps during operations was assumed to have an influence on the early postoperative reunion of vein stumps and thereby on wound healing. Currently, there are different methods of vein stump occlusion available: ligation (e.g., Vicryl), closure using metal clips (e.g., LigaClip), coagulation using manually controlled bipolar forceps, and the use of a computer-controlled bipolar system (e.g., BiClamp). The aim of this study was to surgically and histologically compare the healing process, including new vessel formation after vein occlusion using one of the methods listed. ⋯ If a reconnection of the venous flow is desirable, the use of Vicryl and LigaClip might be superior to using electrothermic occlusion methods. In contrast, electrothermic methods cause less new vessel formation as well as less inflammatory reaction.
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One of the important causes of death after blast injuries is reduced blood volume, which typically results from hemorrhage but may also result from nonhemorrhagic causes. Hemoconcentration is one such alternate cause of reduced blood volume, but its mechanism is unclear. Because blood is condensed after chest-abdomen blast injuries in rabbits, a series of experiments was conducted to clarify this phenomenon. ⋯ The preliminary results indicate that microvessels in the lungs and kidneys are the key targets of blast injuries. The damage to the microvessels leads to leakage of albumin, which is one of the important reasons for hemoconcentration in the absence of active bleeding after a blast injury. Treatment should be initiated in victims of blast injuries who are severely wounded as soon as possible after the explosion during the earliest stages of the injury to avoid the occurrence of shock or other severe complications.
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Much controversy exists over the fluid composition for hypotensive resuscitation. We previously showed that addition of 6% Dextran-70 or hetastarch to 7.5% NaCl led to heart instability and mortality. Our aim was to examine the early resuscitative effects of 7.5% NaCl with adenosine, lidocaine, and magnesium (ALM) on hemodynamics and mortality in a rat model of severe hemorrhagic shock. ⋯ Ultra-small intravenous bolus of 7.5% NaCl with ALM led to a significantly higher MAP, higher diastolic rescue, and higher rate-pressure product compared with other treatment groups. The possible clinical and military applications for permissive hypotensive resuscitation are discussed.