Arch Surg Chicago
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High levels of tumor necrosis factor (TNF) alpha messenger RNAs and interleukin (IL) 8 have been reported in leukocytes of patients with sepsis. ⋯ These results suggest that diminished lymphocyte- and monocyte-associated proinflammatory and anti-inflammatory cytokine levels are associated with worse prognosis in patients with severe sepsis.
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Advances in burn treatment including early excision of the wound have increased survival in patients treated at specialized burn centers. We hypothesized that the patients with delayed wound excision and grafting would experience deleterious outcomes. ⋯ Delays in excision were associated with longer hospitalization and delayed wound closure, as well as increased rates of invasive wound infection and sepsis. Our data indicate that early excision within 48 hours is optimal for pediatric patients with massive burns.
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Selection of proper pancreaticojejunostomy techniques according to pancreatic texture and the main duct size reduces the pancreatic fistula rate. ⋯ The proper selection of pancreatic reconstruction techniques according to our criteria may reduce the pancreatic fistula rate, eliminate risky pancreatic anastomotic leaks, and result in excellent outcomes for those undergoing pancreatoduodenectomy.
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Controversy exists regarding the use of diagnostic peritoneal lavage (DPL) vs computed tomography (CT) in the evaluation of blunt abdominal trauma. It has been suggested that one role for DPL is to diagnose bowel injuries in hemodynamically stable patients with an unreliable abdominal examination result. Our hypothesis is that CT is specific and sensitive for diagnosing hollow viscus injuries and is therefore an appropriate diagnostic modality in the hemodynamically stable blunt trauma patient with an unreliable abdominal examination result due to a depressed level of consciousness. ⋯ At our institution, CT is a reliable and accurate diagnostic modality when used to evaluate hollow viscus injuries in the hemodynamically stable blunt trauma patient with an unreliable abdominal examination result due to a depressed level of consciousness.
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Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings. ⋯ The VAC provides a safe and effective method for securing STSGs and is associated with improved graft survival as measured by a reduction in number of repeated STSGs.