The Yale journal of biology and medicine
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Major trauma often precipitates major malnutrition. In many patients, this malnutrition underlies the morbidity and mortality associated with major injury, often leading to multiple organ failure and refractory sepsis. The clinical challenge is to anticipate these potential nutritional problems and intervene early and appropriately, recognizing that it is far easier to prevent malnutrition than it is to reverse it.
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Sepsis is responsible for 75 percent of late deaths following major thermal injury or traumatic injury. Efforts to prevent and/or control sepsis should include an understanding of normal host resistance, proper resuscitation techniques, and nutritional support. Recent studies identifying T suppressor cell abnormalities in burn patients and macrophage defects in trauma patients are presented in this paper. Concluding remarks regarding future directions for research and therapy in this area are also made.
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Under heat stress, a decrease of the central venous pressure (CVP) was regularly observed, raising the question of whether this reaction is a limiting factor for the circulation. In animal experiments it could be shown, however, that despite a lowered CVP, which depended on the elevated body temperatures, a high cardiac output (CO), as well as an elevated stroke volume could be maintained. A low CVP went hand in hand with a low total peripheral resistance. ⋯ In human experiments the lowered CVP had to be seen in relation to the degree of dehydration. Regardless of whether the plasma volume remained constant, as in exercise, or declined, as in thermal stress (sauna), the CVP followed the volume depletion of the vascular and extravascular space, and it might well be that under these circumstances CVP is limiting. In this case, however, the altered CVP must be seen first as a monitor for the fluid deficit and not as a factor controlling cardiac function.
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Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. ⋯ Guidelines are provided for choosing between peripheral and central total parenteral nutrition. A monitoring protocol is suggested and complications of nutritional therapy are reviewed. Safe and effective nutritional support requires considerable investment of time and effort by members of the nutrition team.
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The SP-4 culture medium, developed originally for newly isolated plant and insect mycoplasmas (spiroplasmas), has markedly improved the recovery of Mycoplasma pneumoniae from human clinical materials. This medium, in combination with a direct fluorescent antibody test, can enhance the recovery and identification of the organism by 30-40 percent over conventional culture procedures. Although these modifications are a clear improvement in diagnostic techniques for M. pneumoniae, the time required for growth and identification of the agent is still a major disadvantage for rapid clinical diagnosis. Thus, there remains a critical need for techniques that can specifically identify the major antigens (or other components) of the organism within the first week of the infection.