The Journal of surgical research
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A decreased synthesis of interferon gamma (IFN-gamma) by TH 1 lymphocytes after cardiac operations with cardiopulmonary bypass (CPB) is part of the inflammatory response to local operative and systemic traumas. The consequences of this mechanism on the release of pro- and anti-inflammatory cytokines remain unclear. To evaluate the role of IFN-gamma, we added recombinant IFN-gamma to peripheral blood mononuclear cells (PBMCs) on the first post-operative day in an attempt to restore pre-operative values and then measured the release of pro- and anti-inflammatory cytokines in vitro. ⋯ Contrary to our expectations, the in vitro release of IL-6 and IL-8 as well as IL-10 and IL-4 was not influenced by the addition of IFN-gamma. However, TNF-alpha production in isolated PBMC cultures increased significantly on the first post-operative day. This may indicate a hyper-reactivity of PBMCs to IFN-gamma and suggests that the decrease in IFN-gamma synthesis might prevent an excessive stimulation of the non-specific immune system by high TNF-alpha levels after cardiac surgery.
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We studied the effects of early versus delayed fluid resuscitation on hemodynamic response and short-term survival in a porcine model of severe hepatic injury associated with hemorrhagic shock. ⋯ Early versus delayed fluid infusion with HSD resulted in a comparable hemodynamic response and survival 100 min after injury. No rebleeding was observed.
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Phosphodiesterase-3 inhibition has been shown to attenuate hepatic warm ischemia-reperfusion injury. The aim of this study was to investigate the effect of milrinone, phosphodiesterase-3 inhibitor, on post-ischemic microcirculation of rat livers by intravital microscopy. ⋯ The demonstrated improvement of hepatic microcirculation is certainly derived from milrinone induced cell protection in ischemia reperfusion of the liver. This effect is outlined by improved energy status and reduced liver enzyme liberation and mimics the effect of ischemic pre-conditioning.
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Colonic ischemia after aortic reconstruction is a devastating complication with high mortality rates. This study evaluates whether Colon Mucosal Oxygen Saturation (CMOS) correlates with colon ischemia during aortic surgery. ⋯ Intra-operative CMOS is a sensitive measure of colon ischemia where intraoperative events correlated well with changes in mucosal oxygen saturation. Transient changes demonstrate no problem. However, persistently low CMOS suggests colon ischemia, thus providing an opportunity to revascularize the inferior mesenteric artery or hypogastric arteries to prevent colon infarction.
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Our goal was to create surgical resident centered, interactive teaching modules rich in basic science and clinical content directly pertinent to patient care and surgical techniques that would facilitate education in the 80-h work week environment. ⋯ Teaching modules enable maximal trainee and instructor flexibility, which translates into optimal adult learning and teaching. Lecture packets can be conveyed to all residents with unlimited availability in the virtual domain. Further refinement and continued implementation will help fill the void in direct didactic teaching left by mandated work hour restrictions, allowing for more efficient learning and teaching. There is great potential for broad application of the concept and technology to other training programs.