摘要:

BackgroundColon wounds are recognized to be highly associated with intra-abdominal abscess (IAA) after penetrating trauma, whereas gastric wounds are thought to contribute minimally to abscess because of the bactericidal effect of low pH. This study evaluated the impact of stomach or colon wounds, the contribution of other risk factors, and associated abdominal injuries on IAA.MethodsPatients with penetrating colon or stomach wounds during a 10-year period were reviewed and stratified by age, Injury Severity Score, transfusions, and associated abdominal injuries. Early deaths (<48 hours) from hemorrhage were excluded. Outcomes analyzed were IAA and death.ResultsA total of 812 patients were identified. There were 32 late deaths (4%), of which 28% were attributable to IAA and multiple organ failure. IAA rates for isolated stomach or colon wounds were 0 and 4.2%, respectively. The presence of associated injuries increased IAA rates to 7.5 and 8.8%, respectively. Independent predictors of IAA determined by multivariate analysis included age, transfusions, gunshot wounds, and associated injuries to the liver, pancreas, and kidney.ConclusionGastric injuries are equivalent to colon wounds in their contribution to IAA. Contamination from either organ without associated injury is minimally associated with IAA, but injury to both appears synergistic. The immunosuppressive effects of age and hemorrhage, in addition to significant associated injury, enhance the development of IAA.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PurposeTo compare in a randomized, prospective manner infectious complication rates associated with presacral drainage versus no drainage in the presence of penetrating rectal injury.MethodsDuring a 45-month period, 48 patients with penetrating rectal injuries were entered into a randomized, prospective study at an urban Level I trauma center. The patients were randomized to a presacral drainage group or a nondrainage group. Randomization was performed after detection of the rectal injury. Forty-four injuries were identified by proctoscopy (92%), with the rest detected intraoperatively or by physical examination. All patients with rectal injuries were included regardless of age, associated injuries, time from injury to operation, blood loss, severity of rectal injury, other abdominal organs injured, or hemodynamic stability. Rectal injuries were defined as those injuries to the large bowel distal to the peritoneal reflection. All rectal injuries underwent fecal diversion, and all drainage was accomplished using closed Jackson-Pratt drainage.ResultsForty-eight patients were studied, of whom 25 were randomized to no drainage and 23 were randomized to presacral drainage. The average age for the nondrainage group was 21.9 years, and the average age for the presacral drainage group 26.0 years. The average Penetrating Abdominal Trauma Index score was 34.3 for the nondrainage group and 32.4 for the presacral drainage group. There were two (8%) septic complications (one perirectal and one perivesical abscess) associated with the rectal injuries in the presacral drainage group. The abscesses in the drainage group resolved after computed tomography-guided drainage. There was one (4%) septic complication (rectocutaneous fistula) in the nondrainage group, which was associated with a retained missile fragment. The fistula resolved after bedside percutaneous removal of the missile fragment.ConclusionWe conclude that presacral drainage for penetrating rectal injuries has no effect on infectious complications associated with the rectal injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThe purpose of this study is to determine the hemostatic efficacy of a fibrin sealant dressing compared with a standard collagen control dressing in an animal model of kidney injury.MethodsTwenty adult male Sprague-Dawley rats were administered general anesthesia and underwent partial nephrectomy with heparin anticoagulation (300 U/kg intravenous). Treatment of the cut surface of the kidney was randomized to three groups: group I, no hemostatic agent; group II, collagen dressing; and group III, fibrin sealant dressing.ResultsBlood loss was significantly less in group III (3.39 +/- 0.63 mL) than in group I (8.64 +/- 2.26 mL) and group II (8.63 +/- 1.72 mL; p < 0.001). The percentage decrease in the mean arterial pressure was significantly less in group III (34.09 +/- 15.58%) than in group I (59.66 +/- 16.19%) and group II (60.35 +/- 15.66%; p = 0.015).ConclusionFibrin sealant dressings provide effective hemostasis and are superior to collagen dressings in an animal model of kidney injury. Additional development of fibrin sealant dressings for potential clinical use is warranted.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveWe determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury.MethodsFemoral arterial and venous catheters were placed in pentobarbital-anesthetized swine (n = 7 per group, 16-18 kg). Pigs received an external blast to the right upper abdomen at 0 minutes, followed by uncontrolled hemorrhage at 0 to 30 minutes, with anticoagulation (heparin, 200 U/kg) at 10 minutes. Pigs were resuscitated with lactated Ringer's solution (20 mL/kg) beginning at 15 minutes and then underwent laparotomy to control bleeding at 30 minutes. Lactated Ringer's solution was infused to keep mean arterial pressure greater than 70 mm Hg until 120 minutes, when repeat laparotomy was performed. Control animals (group I) underwent routine surgical procedures to terminate bleeding followed by packing if hepatic bleeding continued. The FG animals (group II) underwent routine surgical procedures plus application of FG. Avoidance of packing, estimated blood loss (EBL) during and after laparotomy, and fluid resuscitation volume were the primary end points studied.ResultsIn both groups, mean arterial pressure varied significantly from baseline to 120 minutes (group I: 100 +/- 3 to 52 +/- 11 mm Hg; group II: 99 +/- 4 to 66 +/- 3 mm Hg). Temperature decreased at the end of each experiment (group I: 37 +/- 1 to 33 +/- 1[degree sign]C; group II: 37 +/- 1 to 34 +/- 1[degree sign]C). There were no group differences in EBL before laparotomy (0-30 minutes), but from initial laparotomy to repeat laparotomy (30-120 min), EBL (group I: 875 +/- 265 mL; group II: 300 +/- 59 mL) and total fluid resuscitation (group I: 2.9 +/- 0.4 L; group II: 1.9 +/- 0.3 L) were statistically significantly less in FG pigs. Of greatest importance, six of seven control pigs required packing, but none of the FG animals were packed and none bled at repeat laparotomy.ConclusionFG stopped bleeding and eliminated the need for packing in a model of severe liver injury. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hypotensive, hypothermic, coagulopathic trauma patients with complex visceral injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo describe the nature of delayed hemothorax occurring after blunt thoracic trauma and to identify the population at risk for this complication.MethodsA retrospective review was conducted of 36 consecutive patients with hemothorax consequent to blunt trauma. Criteria for the definition of delayed hemothorax were established involving normal interval chest radiographs or computed tomographic scans during hospitalization.ResultsTwelve cases of delayed development of hemothorax were identified. Ninety-two percent of cases occurred in patients with multiple or displaced rib fractures. Presentation occurred from 18 hours to 6 days after injury. Eleven of the 12 cases were heralded by a prodrome of new pleuritic chest pain and dyspnea that occurred from 4 to 19 hours before treatment.ConclusionDelayed hemothorax after blunt trauma is a unique entity occurring in patients with multiple or displaced rib fractures. Vigilance for the recognizable prodrome in the high-risk population should allow early remediation of this complication.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundTension pneumothorax is a reported risk with pneumoperitoneum in the presence of diaphragmatic injuries. A goat model with and without diaphragmatic injury was used to determine if varying levels of intra-abdominal pressure (IAP) result in tension pneumothorax.MethodsTwenty-four goats were divided equally into four groups: (1) 5 mm Hg IAP control, (2) 15 mm Hg IAP control, (3) 5 mm Hg IAP with diaphragmatic injury, (4) 15 mm Hg IAP with diaphragmatic injury. Chest x-ray films were made and heart rate (HR), mean arterial pressure, central venous pressure (CVP), arterial blood gases, and airway pressure (AP) were measured at 10-minute intervals up to 30 minutes. Significant changes were determined by using the one-way analysis of variance and Mann-Whitney test with alpha set at p < 0.05.ResultsIn group 4, 100% (all six goats) developed radiographic evidence of tension pneumothorax by 10 minutes. Mean changes from baseline at 20 minutes for the following parameters were all significantly different from controls: HR (p < 0.05), CVP (p < 0.0001), PaO2(p < 0.001), and AP (p < 0.004). Mortality was 67% (four of six) at 25 minutes. In group 3, 100% (all six goats) of the animals developed radiographic evidence of a simple pneumothorax without mediastinal shift. In this group, there were significant changes in PaO2(p < 0.003), AP (p < 0.04), and HR (p < 0.05). Mortality was 16% (one of six) at 25 minutes.ConclusionIn this goat model of diaphragmatic injury, tension pneumothorax is a significant threat when pneumoperitoneum is maintained at 15 mm Hg IAP. Pneumoperitoneum at 5 mm Hg IAP leads to simple pneumothorax with deleterious effects on oxygenation. Changes in AP, CVP, HR, and PaO2provide early clues to the development of the problem.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundLipopolysaccharide activation (LPS2a) of macrophages is thought to occur via a CD14-dependent mechanism with a requirement for the serum factor, lipopolysaccharide binding protein. LPS-stimulated, CD14-dependent signal transduction is associated with phosphorylation of mitogen-activated protein kinase (MAPK), nuclear factor-kappa B (NF-kappa B) translocation, and secretion of tumor necrosis factor (TNF) and interleukin-1 (IL-1). Macrophage endotoxin tolerance after low-dose LPS pretreatment (LPSp) is characterized by inhibition of LPSa-stimulatedTNF and augmentation of IL-1 secretion. We sought to determine the role of CD14-dependent pathways in the induction of endotoxin tolerance by comparing the effects of LPS (p) in the presence or absence of serum.MethodsMurine peritoneal macrophages were exposed to a range of LPSpconcentrations in the presence or absence of serum. MAPK activation and NF-kappa B were assayed 30 minutes after LPSpstimulation. TNF production and IL-1 were measured 6 hours after stimulation with 100 ng/mL LPSa, with or without 24-hour 10 ng/mL LPSp.ResultsIn the presence of serum, 100 ng/mL LPSpactivated MAPK and NF-kappa B, whereas no activation of MAPK or NF-kappa B was seen at this LPSpconcentration in the absence of serum. The absence of serum during 10 ng/mL LPSpdid not prevent LPSp-mediatedinhibition of TNF secretion, and it significantly augmented IL-1 secretion after stimulation with 100 ng/mL LPSain the presence of serum.ConclusionInduction of the alterations in subsequent LPSa-stimulatedcytokine secretion characteristic of endotoxin tolerance by LPSpoccurs via a serum-independent signal transduction pathway.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundPneumococcal vaccination after splenectomy for trauma decreases the incidence of overwhelming postsplenectomy infection. The optimal timing of vaccination has not been established. This study was conducted to determine whether timing of vaccination after splenectomy affects antibody response or survival after pneumococcal challenge.MethodsSprague-Dawley rats were used for all experiments. Control rats (n = 30) were divided into three equal groups and underwent splenectomy followed by sham vaccination 1, 7, or 42 days after splenectomy. Treated rats (n = 66) were divided into three equal groups and underwent splenectomy followed by vaccination with polyvalent pneumococcal vaccine 1, 7, or 42 days after splenectomy. All rats then underwent intraperitoneal Streptococcus pneumoniae inoculation with the predetermined lethal dose for 50% of the population 10 days after vaccination. Rats were observed for a 72-hour period after inoculation, and mortality was recorded. Immunoglobulin G and immunoglobulin M antibody titers were determined before vaccination and before inoculation to determine antibody response.ResultsMortality was greater in the control group than in the treatment group (21 of 30 [70%] vs. 2 of 64 [3%]; p < 0.01). There were no differences in mortality within either the control group (1 day, 6 of 10; 7 days, 7 of 10; 42 days, 8 of 10; p = 0.62) or the treatment group (1 day, 0 of 21; 7 days, 0 of 21; 42 days, 2 of 22; p = 0.14). Immunoglobulin G and immunoglobulin M antibody responses were greater in vaccinated than in nonvaccinated rats. There was no effect of timing of vaccination on antibody response.ConclusionPneumococcal vaccine reduces mortality from postsplenectomy infection. Timing of vaccination after splenectomy does not affect survival from a pneumococcal challenge or antibody response in rats. This study supports the practice of administering vaccine within 24 hours of splenectomy when vaccine cannot be administered before surgery.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID