Arch Surg Chicago
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After thermal injury, alterations in intestinal permeability have been demonstrated and have correlated with subsequent infections. We measured intestinal permeability on the second day after severe trauma and hemorrhagic shock (ruptured abdominal aneurysm). The mean (+/- SD) lactulose-mannitol (L/M) excretion ratio was 0.012 +/- 0.005 in seven healthy control subjects, 0.069 +/- 0.034 in 11 severely traumatized patients, and 0.098 +/- 0.093 in eight patients with aneurysm, indicating a significant increase of intestinal permeability in both patient groups. ⋯ In six patients endotoxemia was present immediately after admission and before the L/M test. However, during the L/M test and 1 day afterward no circulating endotoxin was observed. The present data provide evidence for the hypothesis that increased intestinal permeability and subsequent infectious complications are independent phenomena, frequently seen in patients after severe trauma or hemorrhagic shock.
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Review Case Reports
Cytomegalovirus appendicitis in a patient with human immunodeficiency virus infection. Case report and review of the literature.
We report a case of chronic abdominal pain with subsequent development of acute right lower quadrant tenderness in a patient infected with the human immunodeficiency virus. Ultrasonography and computed tomography revealed an enlarged appendix. ⋯ The course of cytomegalovirus appendicitis in these patients was prolonged and atypical compared with noncompromised patients with acute appendicitis. Because perforation may occur, surgery is advocated when this diagnosis is suspected in the patient infected with human immunodeficiency virus.