Arch Surg Chicago
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Randomized Controlled Trial Clinical Trial
Effect of pentoxifylline in severe sepsis: results of a randomized, double-blind, placebo-controlled study.
To evaluate the effect of pentoxifylline on organ dysfunction, survival, and mediator response in patients with severe sepsis. ⋯ Continuous intravenous administration of pentoxifylline beneficially influenced cardiopulmonary dysfunction in patients with sepsis without adverse effects. Larger trials are needed to evaluate the efficacy in improving organ function in relation to the outcome for patients with severe sepsis.
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To compare clinical characteristics, including postoperative outcomes, in Korean patients 65 years and older with those of younger patients. ⋯ The proportion of patients 65 years and older among all surgical cases has increased in recent years. The proportion of malignant neoplasms, especially stomach cancer, was higher in the aged patients. Most operations were performed electively on the aged patients, as were those on younger patients. In the case of the acute surgical abdomen, severe diseases with an underlying malignant neoplasm were more frequently found in the aged patients. Despite their generally poor physical status, the patients 65 years and older proved to be able to tolerate elective major operations, such as radical gastrectomy for stomach cancer, when optimal perioperative management was provided. However, results of emergency operations in these elderly patients were poorer, with a higher complication rate. Therefore, the aged patient should be regarded as a candidate for surgery but with a more careful and comprehensive approach to his or her treatment perioperatively.
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Comparative Study
Efficacy of a dry fibrin sealant dressing for hemorrhage control after ballistic injury.
To determine if a dry fibrin sealant dressing (DFSD) will provide superior hemostasis when compared with regular gauze in a ballistic injury animal model. ⋯ The DFSD was superior to gauze in decreasing blood loss and maintaining blood pressure while retaining the simplicity of standard dressing application.
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To study the effect of the systemic inflammatory response syndrome (SIRS) or major elective surgery on the apoptosis of circulating polymorphonuclear neutrophils because an activated inflammatory response is terminated, in part, through the programmed cell death, or apoptosis, of its effector cells. ⋯ Circulating neutrophils from patients with SIRS or from patients who have undergone major elective surgery show delayed expression of constitutive programmed cell death, and antiapoptotic factors are present in the general circulation. While prolonged neutrophil survival may represent an appropriate adaptive response to injury, the presence of activated and apoptosis-resistant cells in an antiapoptotic environment may contribute to the systemic inflammatory injury characteristic of SIRS and predispose to the development of the multiple organ dysfunction syndrome.