Current opinion in general surgery
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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.
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Trauma is a major health and social problem. It is the leading cause of death for those under age 45, and is a major expense to society, in terms of direct medical expense and lost wages. Visceral injury continues to be a major cause of morbidity and mortality in the overall trauma picture. This article reviews the significant developments in the diagnosis and management in specific areas of visceral injury.
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Improvements in surgical management and intensive care therapy have enabled many patients to initially survive severe life-threatening trauma or major surgical procedures only to die after delayed bouts of sepsis. This paper reviews literature published within the past year on the effects of nutrient substitution on malnutrition, injury, and the host immune response. Topics discussed include immunodeficiencies in trauma and malnutrition, immunomodulation by nutrition, and parenteral versus enteral nutrition. We also discuss the roles of arginine, glutamine, omega-3 fatty acids, and dietary nucleotides in the host immune response.
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Several new developments promise to improve the lot of the morbidly obese. Perhaps the most important of these is the gradual recognition that morbid obesity is a serious illness that is not the result of immorality or gluttony but is, in most cases, a disabling genetically determined handicap. ⋯ The third development has been the improvement of bariatric surgery, ie, the surgery for morbid obesity, with better operations, better quality controls, and rigorous follow-up. This article reviews the newer concepts of morbid obesity as a disease, delineates the indications for surgery, describes the currently recommended operations, and presents the risks and benefits of these procedures.
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Perioperative cardiac morbidity is the leading cause of death following the administration of general anesthesia. With the aging of the population, the number of patients at significant cardiac risk for noncardiac surgical procedures is expected approximately to double over the next 30 years. Assessing cardiac risk will assume increasing importance in surgical decisions. Historical predictors, diagnostic testing predictors, and recent data concerning preoperative cardiac physiology assessment and optimization are discussed.