Arch Surg Chicago
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Forty-seven patients with jejunal diverticulosis were identified at the University California, Davis Medical Center, Sacramento, by a review of patient medical records from 1980 to 1986. Fourteen patients had complications that could be directly attributed to the presence of diverticula. Six patients had evidence of a malabsorption syndrome and responded to administration of broad-spectrum oral antibiotics. ⋯ One patient died. Nineteen patients had symptoms of epigastric pain, early satiety, and bloating for which no cause other than the presence of jejunal diverticulosis was found. Jejunal diverticulosis was an incidental finding in 14 patients treated for other gastrointestinal tract problems.
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One hundred thirty-one children underwent rigid bronchoscopy under general anesthesia for suspected aspirated foreign bodies. There were 79 boys and 52 girls, with a mean age of 2.1 years. Physical examination showed decreased breath sounds (n = 130) and wheezing (n = 119) over the affected site. ⋯ Postendoscopic complications included fever (n = 27), pulmonary infiltrate (n = 11), ventilatory support (n = 4), and pneumothorax (n = 2). Rigid bronchoscopy for aspirated foreign body in children is a safe, effective, and sometimes life-saving procedure. Morbidity is low and mortality is zero.
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This study evaluated the effects of naloxone hydrochloride in the treatment of Escherichia coli-induced shock in baboons. The baboons were studied for 12 hours and monitored for survival times. All baboons were intravenously infused for two hours with E coli and treated as follows: group 1, E coli (control); group 2, E coli plus naloxone hydrochloride, 0.5 mg/kg bolus plus 0.5 mg/kg/h for 9.5 hours; and group 3, E coli plus naloxone hydrochloride, 2.0 mg/kg bolus plus 2.0 mg/kg/h for 3.8 hours. ⋯ Mean arterial pressure was supported by the lower dose of naloxone; however, sustained leukopenia and neutropenia were not reversed by its infusion. Naloxone prevented the increase in plasma beta-endorphin level and blunted the increase in plasma cortisol level. Despite these effects, naloxone did not prevent multiple-organ disease and did not decrease mortality.
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High-frequency ventilation techniques have been demonstrated to be useful in decreasing gas loss from bronchopleural fistulas. We performed the present study to evaluate the impact of a new jet ventilator design and ventilatory frequency on hemodynamics, gas exchange, and bronchialstump gas flow in an animal model of bronchopleural fistula. Ten pigs underwent a right-sided thoracotomy and right-sided upper pulmonary lobectomy with cannulation of the upper lobe bronchus for measurement of bronchial fistula flow rate. ⋯ Hemodynamic measurements were similar in the three ventilatory modes, but oxygenation was best with UHFJV. Bronchial fistula flow was lowest with UHFJV and greatest with conventional ventilation. Ultra-high-frequency jet ventilation demonstrated superior oxygen loading, adequate carbon dioxide elimination, and the least flow through the fistula, suggesting that both ventilator design and frequency are important therapeutic variables in the management of major airway disruption.
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This study investigates the effects of sodium hypochlorite, or Dakin's solution (DS), on the function and viability of cells of the wound module (neutrophils, fibroblasts, and endothelial cells). For functional studies, the influence of DS on the in vitro migration of neutrophils was evaluated. Our data indicate that DS (2.5 x 10(-2)% to 2.5 x 10(-4)%) results in greater than 90% inhibition of the migration of both stimulated and nonstimulated neutrophils. ⋯ In contrast to neutrophils, cultured fibroblasts and endothelial cells exposed to DS (2.5 x 10(-2)% or 2.5 x 10(-3)%) for 30 minutes show marked cell injury characterized by convoluted nuclei, cytoplasmic vacuolization, dilated endoplasmic reticulum, and swollen mitochondria on electron microscopy. These data suggest that DS, even at very dilute concentrations, is toxic to cells of the wound module. We therefore recommend abandonment of the use of DS in open wounds.