The Journal of surgical research
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Positive end-expiratory pressure (PEEP) reduces ventilator-induced lung injury (VILI), presumably by mechanically stabilizing alveoli and decreasing intrapulmonary shear. Although there is indirect support for this concept in the literature, direct evidence is lacking. In a surfactant depletion model of acute lung injury we observed unstable alveolar mechanics referred to as repeated alveolar collapse and expansion (RACE) as measured by changes in alveolar area from inspiration to expiration (I - E(Delta)). We tested the hypothesis that over a range of tidal volumes PEEP would prevent RACE by mechanically stabilizing alveoli. ⋯ RACE occurs in our surfactant deactivation model of acute lung injury. PEEP mechanically stabilizes alveoli and prevents RACE over a range of tidal volumes. This is the first study to visually document the existence of RACE and the mechanical stabilizing effects of PEEP at the alveolar level. The ability of PEEP to stabilize alveoli and reduce shear during mechanical ventilation has important implications for therapeutic strategies directed at VILI and acute respiratory distress syndrome.
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The etiology of the coagulation changes seen with supraceliac (SC) aortic crossclamping (AXC) remains controversial; both primary fibrinolysis and clotting factor consumption have been implicated. The cause of these changes was investigated with thromboelastography (TEG), a test that measures the viscoelastic properties of thrombus to dynamically assess coagulation and fibrinolysis. ⋯ Thirty minutes of SC AXC does not result in fibrinolysis. There is increased clotting activity during SC clamping followed by decreased speed of clot formation and decreased fibrinogen levels after unclamping. These changes are consistent with clotting factor consumption.
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A comprehensive exposure to general surgery is essential for medical students pursuing careers in surgery. Occasionally, students applying for surgical residency positions must choose a subspecialty field prior to starting their residency training. Often, this decision is heavily based on their experience on various surgical clerkships. ⋯ While medical students pursuing careers in surgery have equal exposure to general surgery, their anticipated subspecialty field highly correlated with their operative exposure to that field. Thus, medical school surgical rotations appear to highly influence subspecialty choice.
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In this era of limited medical resources there is ever increasing pressure to lower costs, while preserving high-quality patient care. A dedicated craniofacial and skull base trauma team (SBT) was established at our Level I trauma center in July 1998. Previously, a rotating call panel of multiple private surgical subspecialists consulted on trauma patients with craniofacial or skull base injuries (Pre-SBT). This study was designed to assess the impact a dedicated craniofacial and skull base trauma team has on the cost and quality of patient care. ⋯ The addition of a dedicated craniofacial trauma team to a Level I trauma center provides more comprehensive care, improves efficiency, and reduces cost.
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Comparative Study
Comparison of performance 2 years after the old and new (interactive) ATLS courses.
We previously (1997) demonstrated superior clinical but similar cognitive performance after the new interactive compared to the old ATLS course. The present study is aimed at determining whether this difference was short term or maintained over time (2 years). ⋯ Although knowledge base decreases similarly with time after both courses, the new interactive course participants maintained a consistently higher clinical skill performance level at 2 years.