Arch Surg Chicago
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Endotoxin (ETX) is thought to be the primary inducer of proinflammatory mediator release associated with bacterial sepsis. Furthermore, a number of studies indicate that preexposure of animals to high doses of ETX produces macrophages (M luminal diameters) that are refractory to ex vivo stimulation with ETX. However, it is unknown if levels of ETX comparable to those typically encountered in sepsis induce a similar refractory state in M luminal diameters. ⋯ Bacterial component(s) other than ETX per se induces the sustained dysfunction in PM luminal diameter capacity to produce proinflammatory cytokines during sepsis and/or peritonitis. Thus, agents directed against ETX alone may not be adequate in the treatment of polymicrobial sepsis.
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Our prior studies show that intravenous (IV) total parenteral nutrition (TPN) produces atrophy of the small intestine-related gut-associated lymphoid tissue and significant decreases in intestinal IgA levels, the major system of mucosal immunity. Others have noted increased small intestinal permeability, bacterial adherence and translocation, and decreased IgA levels in TPN-fed animals. Bombesin, a neuropeptide, may play a regulatory role in mucosal immunity. It is not clear whether bombesin attenuates the TPN-associated gut-associated lymphoid tissue atrophy. ⋯ Bombesin prevents the TPN-associated atrophy and dysfunction of gut-associated lymphoid tissue, supporting the concept of close neuroimmunologic interaction.
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This address was given at a biennial meeting of the Michael E. DeBakey International Surgical Society. Surgical teachers are commemorated by the imitation of their pupils in accord with the human tendency to model ourselves after our heroes. ⋯ Citations from Thomas Carlyle, Jacques Barzun, and William Bennett illustrate the role of heroes, the nature of teaching, and the importance of virtue. Lessons are drawn from the lives of John Hunter and William S. Halsted, and from the work of the DeBakey family in surgery and in the craft of medical writing.
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Comparative Study Clinical Trial
Penetrating injuries of the neck in patients in stable condition. Physical examination, angiography, or color flow Doppler imaging.
The initial assessment of penetrating injuries of the neck is controversial, with angiography remaining the gold standard for identifying vascular injuries. Recent reports suggest that physical examination might be an accurate way to evaluate these injuries. Color flow Doppler imaging has been used with promising results to assess extremity injuries, but the role of color flow Doppler imaging in neck injuries has not been studied. ⋯ The combination of a careful physical examination and color flow Doppler imaging provides a reliable way to assess penetrating neck trauma and may be a safe alternative to routine contrast angiography.
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Case Reports
Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy.
The effects of artificial pneumoperitoneum on intracranial pressure have not been clearly defined. Initial animal studies indicate that elevated intra-abdominal pressure might have a deleterious effect on intracranial pressure. ⋯ Initial opening intracranial pressure values were re-established on desufflation of the abdomen. Intracranial pressure monitoring should be considered when planning a laparoscopic procedure on patients with the potential for decreased intracranial compliance.