Arch Surg Chicago
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To determine the relationship between gastrointestinal intramucosal pH and myocardial oxygenation during isovolemic hemodilution in dogs with critical coronary artery stenoses. ⋯ Myocardium compromised by coronary stenosis is more sensitive to normovolemic hemodilution-induced ischemia than the normally perfused gut mucosa. This limits the potential utilization of the measurement of gastrointestinal intramucosal pH as a guide to tolerable levels of anemia in critically ill patients.
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Randomized Controlled Trial Clinical Trial
A randomized, prospective trial of deep venous thrombosis prophylaxis in aortic surgery.
To study the incidence of postoperative deep venous thrombosis (DVT) in patients undergoing elective aortic reconstruction and to determine if aggressive DVT prophylaxis would reduce the incidence of DVT in these patients. ⋯ The incidence of proximal DVT in patients undergoing elective aortic reconstruction is low compared with patients undergoing other major intraabdominal general surgical procedures. The use of aggressive DVT prophylaxis did not reduce the risk of postoperative proximal DVT in this study. The selective use of DVT prophylaxis in patients undergoing elective aortic surgery should be based on associated concomitant or evolving risk factors.
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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.