Surgery
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Although serious blunt cardiac injury (BCI) is usually fatal, patients who reach the hospital alive can have a spectrum of abnormalities. We attempted to define the clinical features that helped identify serious BCI and to evaluate outcome. ⋯ The outcome of serious blunt cardiac injury can be favorable if patients have signs of life on arrival at the hospital, the signs of injury are recognized promptly, and other injuries do not supervene.
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Our preliminary results showed that pentoxifylline improves survival after cecal ligation and puncture (CLP), even though in this model inhibition of tumor necrosis factor (TNF) activity decreases survival. In this study we tested the hypothesis that pentoxifylline improves survival after CLP, not by inhibiting TNF synthesis but by exerting its effect on leukocyte adhesiveness, neutrophil sequestration, recruitment of cells into the focus of sepsis, and interleukin-1 (IL-1) expression. ⋯ Pentoxifylline improves survival after CLP without inhibiting TNF synthesis or expression of CD11b/CD18 on leukocytes. Pentoxifylline treatment reduced lung neutrophil sequestration and IL-1 beta mRNA levels and increased cell recruitment in the peritoneum.
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Smoke inhalation injury produces substantial morbidity and mortality caused both by immediate catastrophic pulmonary failure and by the subsequent development of pneumonia. Although carbon monoxide (CO) poisoning is present to a degree in nearly all instances of smoke inhalation, the importance of CO in the pathogenesis of smoke inhalation injury remains controversial because smoke contains numerous other potential pulmonary toxins such as aldehydes, chlorine gas, and hydrochloric acid. This study was performed to determine whether CO poisoning acts as a cofactor in the evolution of inhalation injury. ⋯ CO poisoning is an important cofactor in the development of inhalation injury by acceleration of the development of ventilation/perfusion inequality after inhalation.
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More than 50% of breast cancer care in the United States occurs in women over age 65 years. This study investigates age-related differences in breast reconstruction practices after mastectomy for breast cancer. ⋯ Breast reconstruction is a safe option for older women requiring mastectomy. The full array of reconstruction options (autogenous tissue or implants, immediate or delayed) should be considered for use in women of all ages.
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The purpose of this study was to examine the mortality rate of penetrating cardiac trauma in a large urban hospital. ⋯ An isolated cardiac stab wound is a relatively innocent injury in a patient at a hospital accustomed to managing penetrating trauma expeditiously.