Arch Surg Chicago
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Pulmonary atelectasis predisposes the lung to infection. This condition may be partly due to impaired cellular immune response of the collapsed lung segment. We postulated that atelectasis may affect alveolar macrophage (AM) antibacterial function. ⋯ However, their intracellular bactericidal activity did not change. Reexpansion of the atelectatic lobes with mechanical ventilation and 100% oxygen supplementation for four hours after six hours of atelectasis resulted in reversal of the impaired AM phagocytic activity. These observations presented insight into the mechanisms of susceptibility to lung infection in pulmonary atelectasis and the potential for its reversal.
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Inguinal hernia incarceration is one of the many conditions that can mask the presence of a ruptured aortic aneurysm. Hypotension, anemia, and retroperitoneal blood in the inguinal operative field suggest that this aneurysm is present. Delay of appropriate treatment increases the mortality from this highly lethal condition.
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Genitofemoral neuralgia is a syndrome characterized by chronic pain and paresthesia in the region of genitofemoral nerve distribution. Genitofemoral nerve entrapment has been described after inguinal herniorrhaphy, appendectomy, and cesarean section. Failure to distinguish it from ilioinguinal nerve entrapment can result in unnecessary inguinal reexploration, or patients severely debilitated from chronic pain. ⋯ If this is unsuccessful in affecting relief of symptoms, a paravertebral block of L-1 and L-2 should be considered. Using these two blocks, a rational decision can then be made to operate on either the ilioinguinal nerve or the genitofemoral nerve. We describe three cases of genitofemoral neuralgia treated by extraperitoneal excision of the genitofemoral nerve.
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Comparative Study
An experimental histopathologic study of surgical glove powders.
Tissue reactions to surgical glove powders, ie, talc (magnesium silicate) and Keoflo (low cross-linked cornstarch) were studied histologically from day 1 to 16 weeks. These materials were tested as a contaminant on the surface of surgical suture or in a pellet form implanted in abdominal muscle of rat. Use of Keoflo resulted in an intense acute inflammatory response, with a progressive decrease in the amount of starch with time after implant. ⋯ Rats implanted with talc showed an initial mild to moderate acute inflammation followed by chronic inflammatory response and granuloma formation by the third day. From the fourth week on, granulomas showed talc crystals within the giant cells surrounded by histiocytes, lymphocytes, some collagen, and fibroblasts. This study indicates that talc molecules are not absorbed, whereas low cross-linked cornstarch is an absorbable substance; therefore the latter is a safe material for use as surgical glove powder.
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We analyzed the occurrence of putative risk factors for postoperative infection in 338 patients who underwent emergency laparotomy for penetrating abdominal injury. Mortality was 3%, with nine of ten deaths directly related to infectious complications. ⋯ Other risk factors examined (shock, number of organs injured, mode of injury, and chest injury) did not contribute any additional information. Colon injury was more prevalent in patients with trauma-related infections than in those with nosocomial infections.