Arch Surg Chicago
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Comparative Study
Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving workers' compensation vs patients with commercial insurance.
To confirm our observation that patients with work-related hernias, when compared with self-employed patients, had longer recovery times and prolonged pain after hernia repairs, we reviewed our recent experience in a series of patients undergoing inguinal hernia repairs. ⋯ We believe our results confirm the observation that type of insurance coverage influences post-operative recovery time after inguinal herniorrhaphy. Other studies measuring a patient's outcome after surgical procedures such as herniorrhaphy should include type of insurance coverage as a factor that might affect early return to work. Using multivariate analysis, the only variable independently affecting the duration of pain after hernia repair was the type of insurance coverage (P < .005).
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Comparative Study
The pulmonary effect of nitric oxide synthase inhibition following endotoxemia in a swine model.
To evaluate the pulmonary effect of treatment with N-nitro-L-arginine methyl ester (NAME) with and without inhaled nitric oxide (NO) in a swine model of endotoxemia. ⋯ Systemic NO synthase inhibition failed to restore hypoxic pulmonary vasoconstriction following LPS administration. The deleterious effects of endotoxemia on pulmonary function can be improved by inhaled NO but not by systemic inhibition of NO synthase.
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To examine the effect of nitric oxide inhibition on cytokine production and immunologic function in a murine thermal-injury and an alcohol (ETOH)-ingestion model. ⋯ Thermal injury is associated with a suppression of splenocyte IL-10 production and lymphocyte proliferative response. Inhibition of nitric oxide synthesis normalized IL-10 production and significantly improved splenocyte proliferative response. These data suggest that nitric oxide is an important modulator of cytokine regulation and immunologic function in thermal injury, thereby ultimately influencing host defense.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lipolysis in burned patients is stimulated by the beta 2-receptor for catecholamines.
To determine if the cardiovascular effects of excessive catecholamines could be selectively blocked in severely burned patients without adversely affecting protein or fat kinetics. ⋯ Selective beta 1-adrenergic blockade did not reduce lipolysis; however, a beta 1- and beta 2-adrenergic blockade significantly reduced lipolysis. Thus, the increased lipolysis, characteristic of severely burned patients, is caused by stimulation of the beta 2-adrenergic receptors for catecholamines.
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Comparative Study
A decade of reduced gram-negative infections and mortality associated with improved isolation of burned patients.
To compare the incidence of gram-negative bacteremia (GNB) and mortality in patients with large burns (> or = 20% of total body surface) hospitalized in either an open ward (OW) or a single-bed isolation (IW) environment. ⋯ Improvements in isolation of burned patients were associated with decreased incidence of GNB, delayed postinjury time of GNB, and improved survival. Improved survival is likely related to decreased susceptibility as a result of longer exposure to the benefits of treatment and wound closure. These results suggest that, in patients with severe burn injuries, gram-negative infections and the related mortality can largely be prevented.