The Journal of surgical research
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Comparative Study
Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers.
Ventilator-associated pneumonia (VAP) is a common cause of infectious morbidity and mortality in the intensive care unit (ICU). The type of stress-ulcer prophylaxis (SUP) given to ventilated patients may, in part, be responsible. We observed an increase in VAP as ventilator bundle compliance increased and a decrease in VAP when bundle compliance decreased. We reasoned that SUP which raises gastric pH such as proton-pump inhibitors (PPIs) and histamine II (H2) receptor antagonists as opposed to SUP which does not raise pH such as sucralfate (S) may be responsible and also may alter the causative bacteria. ⋯ There was a substantial difference in VAP occurrence and in the culprit bacteria between S and PPI/H2 treated patients due perhaps to gastric alkalization.
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Microtia is a congenital deformity of the external ear that occurs in 1 of every 5000 births. Microtia reconstruction using traditional two-dimensional templates does not provide highly detailed ear shapes. Here, we describe the feasibility of using a three-dimensional (3D) ear model as a reference. ⋯ Our results show that simple microtia reconstruction can be performed using 3D ear models. The 3D-printed ear models of each patient were consistent and accurately represented the thickness, depth, and height of the normal ear. The availability of the 3D-printed ear model in the operating room reduced the amount of unnecessary work during surgery.
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Heterotopic ossification (HO) is the pathologic process of extraskeletal bone formation. Although the exact etiology remains unknown, inflammation appears to catalyze disease progression. The goal of this study is to determine the impact of the adaptive immune system on HO. ⋯ We demonstrate a prominent role for the adaptive immune system in the development of HO. In the absence of mature B- and T-lymphocytes, HO growth and development are attenuated. Furthermore, we demonstrate that mesenchymal populations from B- and T-cell deficient mice are inherently less osteogenic. This study identifies a potential therapeutic role for modulation of the adaptive immune system in the treatment of HO.
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Comparative Study
Admission hyperglycemia is associated with different outcomes after blunt versus penetrating trauma.
Stress-induced hyperglycemia is associated with worse outcomes after trauma; however, the effect of mechanism of injury has not been studied. To fill this gap, we tested the hypothesis that blunt and penetrating trauma evoke different glycemic responses which are associated with different outcomes. ⋯ This is the first study to show that hyperglycemia is associated with fundamentally different outcomes after blunt versus penetrating trauma. Patients who died were 4-8 times more likely to have hyperglycemia and penetrating, not blunt, trauma. Incorporation of hyperglycemia in injury scoring systems might improve outcome predictions after trauma.
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Among all procedures, surgical site infections (SSIs) in colorectal surgery continue to have the highest rate, accounting for 5%-45%. To prevent the bacterial colonization of suture material, which disables local mechanisms of wound decontamination, triclosan-coated sutures were developed. We assessed the effectiveness of triclosan-coated sutures used for skin closure on the rate of SSIs in colorectal cancer surgery. ⋯ The use of triclosan-coated sutures was advantageous for decreasing the risk of SSIs after colorectal surgery.