Arch Surg Chicago
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To determine preoperative and perioperative risk factors for gastrointestinal (GI) complications following cardiac surgery. ⋯ Patients who have GI complications after cardiac surgery have a higher mortality and a longer hospital stay. The use of a left internal mammary artery seems to have a protective effect against GI complications. Based on these observations, patients may be stratified into low-, medium-, and high-risk groups.
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The cause of diminished monocyte major histocompatibility complex class II antigen expression after surgery or trauma is unclear. Interleukin-10 (IL-10) regulates inflammatory cytokine production and major histocompatibility complex class II (HLA-DR) expression in vitro. ⋯ Interleukin-10 gene expression correlates with the fall in monocyte HLA-DR antigen expression in patients undergoing major abdominal surgery and may account for the immunosuppression associated with surgical injury.
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Gastrointestinal tract (GI) complications are a well-recognized entity following burn injury. ⋯ The severity of thermal injury and systemic infection are risk factors for the development of INBD. This entity is more frequent currently because of increased survival of the more severely injured patients. Systemic infection may alter the integrity of the bowel, which becomes less "tolerant" of enteral feedings. The role of large-volume high-density enteral feedings as a usually associated event in these patients remains speculative.
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Comparative Study
Trauma deaths in a mature urban vs rural trauma system. A comparison.
To compare the timing, severity, and injury characteristics of patients dying from trauma in an urban vs a rural setting. ⋯ Patients who die in a rural area without a formal trauma system are more likely to die at the scene, are less severely injured, and are older. Rural trauma patients who are admitted to a hospital and who survived for at least 24 hours before dying are older, less severely injured, have significantly more comorbidities, and are more likely to die of multisystem organ dysfunction than their urban counterparts. These differences reflect the different patient populations and injury patterns that confront urban and rural trauma centers. The higher proportion of scene deaths in the rural environment may reflect the longer discovery and transport times that occur in a rural setting.