Current opinion in general surgery
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Injury is the leading cause of death among US children over 1 year of age. The financial burden of acute care is over $15 billion annually. ⋯ Resuscitation and assessment are discussed, emphasizing fluid management, rapid intravenous access, and the physiologic evaluation of the child in shock. Protocols for evaluating head, thoracic, abdominal, and pelvic injuries are presented in light of recent advances in the diagnosis, treatment, and rehabilitation of children sustaining these injuries.
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Many recent clinical studies focus on the critically ill or injured hypermetabolic patient and investigate nutritional factors and regimens that can potentially reduce septic complications and improve clinical outcome. In addition to better defining the amount and type of nutrients appropriate for this population, these studies provide insight into important variables such as route of nutrient administration, supplementation of formulas with immune-enhancing (or nonimmunosuppressive) nutrients, and anabolic agents that promote increased nitrogen retention and lean body mass accumulation.
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This paper reviews studies on fecal occult blood testing and sigmoidoscopy screening for colorectal cancer. Recently published data from a randomized controlled trial provides the first concrete evidence that annual screening for fecal occult blood can reduce colorectal cancer mortality by at least 33%. These results are corroborated by a nonrandomized but controlled study that showed a 43% colorectal cancer mortality reduction with early detection through fecal occult blood testing and sigmoidoscopy, and by a case-control study that showed a 31% colorectal cancer mortality reduction associated with fecal occult blood testing. Persuasive data to support screening recommendations for sigmoidoscopy are not yet available; however, results from observational studies are suggestive and should stimulate further research to assess the benefit of sigmoidoscopy screening.
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That the gastrointestinal tract performs important immunologic, metabolic, and barrier functions, in addition to nutrient digestion and absorption, has recently become clear, as have the potential deleterious consequences of loss of mucosal barrier function. Because of the potentially important relationship between nutrition and gut barrier function, this area has received increasing clinical and experimental attention over the past several years. Consequently, this review focuses on how nutrition can modulate the integrity of the gut mucosal barrier. Special attention will be given to the biology of normal intestinal barrier function, as well as to studies investigating the role of nutritionally related variables on the gut mucosal barrier.