The Journal of surgical research
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The objective of this study was to determine the utility of a lateral cervical spine plain film in the evaluation of blunt trauma patients. ⋯ LCS has no value as a screening tool in the blunt trauma patient since most are either inaccurate or incomplete. It should be eliminated from the Advanced Trauma Life Support algorithm, and CTC should receive emphasis as the diagnostic gold standard.
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The traditional view that tachycardia and hypotension accompany hemorrhagic shock following injury has been challenged. This is particularly true at extremes of age. Shock index (SI) may be an alternative indicator of life-threatening bleeding after injury. Because age negatively impacts physiological reserve, we hypothesized that age multiplied by SI (Age x SI) would be a better predictor of 48 h mortality (48 MORT) compared to heart rate (HR), systolic blood pressure (SBP), or SI. ⋯ SI and Age x SI are better predictors of 48 MORT in injured patients than HR or SBP alone. SI and Age x SI should be used to identify patients at risk for early mortality following injury.
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The treatment options for complicated appendicitis in children continue to evolve. Optimal management of complicated appendicitis relies on an accurate preoperative diagnosis. We examined the accuracy of our preoperative diagnosis including computed tomography (CT) and the influence on the management of children with perforated and nonperforated appendicitis. ⋯ The correct preoperative diagnosis of appendicitis appears statistically more accurate with CT scan compared to history and physical examination alone (PPV 96.4% versus 90.8%, P = 0.045). For those with clinically suspicious complicated appendicitis, CT evaluation may direct therapy toward initial nonoperative management. The efficacy of this regimen warrants further investigation.
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Spinal cord injury remains a devastating complication of thoracic and thoracoabdominal aortic operations. We aim to investigate the neuro-protective role of adrenomedullin (AM) administered to rabbits before ischemia and during reperfusion against ischemia-reperfusion (I/R) injury. ⋯ To our knowledge, this is the first study that shows the effects of AM administered both preischemic and during reperfusion on induced oxidative damage to injured spinal cords. AM administration may significantly reduce the incidence of spinal cord injury following temporary aortic occlusion.
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None of the parameters can predict the deterioration of sepsis early enough. A new predictor allowing earlier detection of changes in septic patients' condition is indispensable. ⋯ Up-regulated IL-10 mRNA expression and diminished HLA-DR expression could be indicators of poor outcome. Furthermore, IL-10 mRNA expression measurement could predict the onset of immunoparalysis indicated by diminished HLA-DR expression earlier than IL-10 blood level measurement, leading to earlier commencement of the treatment.