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Endotheliopathy trauma

Erika Gonzalez Rodriguez, Sisse R Ostrowski, Jessica C Cardenas, Lisa A Baer, Jeffrey S Tomasek, Hanne H Henriksen, Jakob Stensballe, Bryan A Cotton, John B Holcomb, Pär I Johansson, Charles E Wade
BACKGROUND: Endothelial glycocalyx breakdown elicits syndecan-1 shedding, and traumatic endotheliopathy (EoT). We hypothesized that a cutoff syndecan-1 level can identify patients with endothelial dysfunction who would have poorer outcomes. STUDY DESIGN: Prospective observational study; trauma patients with the highest level of activation admitted during July 2011-September 2013 were eligible. We recorded demographics, injury type/severity (ISS), physiology and outcome data, and quantified syndecan-1 and soluble thrombomodulin from plasma with ELISAs...
June 1, 2017: Journal of the American College of Surgeons
Lawrence N Diebel, Jonathan V Martin, David M Liberati
BACKGROUND: Systemic vascular endothelial injury is a consequence of trauma (T)/hemorrhagic shock (HS) which results in disturbances of coagulation, inflammation, and endothelial barrier integrity. The effect of T/HS on the endothelium (endotheliopathy of trauma [EoT]) is of intense research interest and may lead to EoT-directed therapies. Administration of tranexamic acid (TXA) in trauma patients is associated with a survival benefit and fewer complications if given early after injury...
June 2017: Journal of Trauma and Acute Care Surgery
PärIngemar Johansson, Jakob Stensballe, SisseRye Ostrowski
One quarter of patients suffering from acute critical illness such as severe trauma, sepsis, myocardial infarction (MI) or post cardiac arrest syndrome (PCAS) develop severe hemostatic aberrations and coagulopathy, which are associated with excess mortality. Despite the different types of injurious "hit", acutely critically ill patients share several phenotypic features that may be driven by the shock. This response, mounted by the body to various life-threatening conditions, is relatively homogenous and most likely evolutionarily adapted...
February 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
Sisse R Ostrowski, Hanne H Henriksen, Jakob Stensballe, Mikkel Gybel-Brask, Jessica C Cardenas, Lisa A Baer, Bryan A Cotton, John B Holcomb, Charles E Wade, Pär I Johansson
BACKGROUND: One third of severely injured patients present with a laboratory-based diagnosis of coagulopathy. This study investigated clinical and biomarker profile of patients with rapid thrombelastography (rTEG) coagulopathy, hypothesizing that sympathoadrenal activation and endothelial damage were drivers of this condition. METHODS: Prospective observational study of 404 trauma patients admitted to a Level 1 US Trauma Center. Patients with admission rTEG and plasma measurements of catecholamines (adrenaline, noradrenaline) and biomarkers reflecting endothelial activation/damage (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin, nucleosomes) were included...
February 2017: Journal of Trauma and Acute Care Surgery
Alex P Di Battista, Sandro B Rizoli, Brandon Lejnieks, Arimie Min, Maria Y Shiu, Henry T Peng, Andrew J Baker, Michael G Hutchison, Nathan Churchill, Kenji Inaba, Bartolomeu B Nascimento, Airton Leonardo de Oliveira Manoel, Andrew Beckett, Shawn G Rhind
BACKGROUND: Acute coagulopathy after traumatic brain injury (TBI) involves a complex multifactorial hemostatic response that is poorly characterized. OBJECTIVES: To examine early posttraumatic alterations in coagulofibrinolytic, endothelial, and inflammatory blood biomarkers in relation to sympathetic nervous system (SNS) activation and 6-month patient outcomes, using multivariate partial least-squares (PLS) analysis. PATIENTS AND METHODS: A multicenter observational study of 159 adult isolated TBI patients admitted to the emergency department at an urban level I trauma center, was performed...
September 2016: Shock
Pär I Johansson, Hanne H Henriksen, Jakob Stensballe, Mikkel Gybel-Brask, Jessica C Cardenas, Lisa A Baer, Bryan A Cotton, John B Holcomb, Charles E Wade, Sisse R Ostrowski
OBJECTIVE: Investigate and confirm the association between sympathoadrenal activation, endotheliopathy and poor outcome in trauma patients. BACKGROUND: The association between sympathoadrenal activation, endotheliopathy, and poor outcome in trauma has only been demonstrated in smaller patient cohorts and animal models but needs confirmation in a large independent patient cohort. METHODS: Prospective observational study of 424 trauma patients admitted to a level 1 Trauma Center...
March 2017: Annals of Surgery
Shibani Pati, Daniel R Potter, Gyulnar Baimukanova, David H Farrel, John B Holcomb, Martin A Schreiber
BACKGROUND: Transfusion of balanced ratios of plasma to platelets and red blood cells has been shown to reduce early death from exsanguination in trauma patients. Aside from hemostasis, recent work has shown that plasma reduces vascular endothelial permeability, inflammation, and organ edema after hemorrhagic shock (HS), all components of the endotheliopathy of trauma. We hypothesized that Kcentra could have protective effects on the endotheliopathy of trauma comparable with fresh frozen plasma (FFP)...
April 2016: Journal of Trauma and Acute Care Surgery
John B Holcomb, Shibani Pati
Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets...
2013: Hematology—the Education Program of the American Society of Hematology
L Arellanes García, G Ortiz-Ponce, C Recillas-Gispert
A peripheral corneal endotheliopathy (PCE), named autoimmune endotheliopathy was described in association with corneal graft rejection and as an isolated corneal alteration unrelated to surgery, trauma, or infection. It has also been found in patients with pars planitis (PP), but the significance of this association is unknown. The authors retrospectively reviewed the clinical charts of 53 PP patients (106 eyes) examined at the Uveitis Clinic from 1988 to 1993. Special attention was paid to the description of corneal clinical findings...
1996: Ocular Immunology and Inflammation
Xiaodong Zheng, Yasushi Inoue, Atsushi Shiraishi, Yoko Hara, Tomoko Goto, Yuichi Ohashi
BACKGROUND: Bullous keratopathy (BK), a severe sight-threatening disorder can have a variety of etiologies such as prophylactic laser iridotomy, intraocular surgery, trauma, and other ocular disorders. However, there are cases of unknown origins, among which a unique clinical entity namely pseudoexfoliation syndrome (PEX) is having increased importance. CASE PRESENTATION: In this case note, we report the clinical features and in vivo confocal microscopic and pathological findings of two BK cases of unknown cause...
2012: BMC Ophthalmology
Stephen J Dorrepaal, Kathy Y Cao, Allan R Slomovic
BACKGROUND: The leading indications for penetrating keratoplasty (PKP) have changed over recent years. This study examined the leading indications for PKP and their trends, comparing these with recently published data from other studies, including a report from our centre examining indications from 1986 through 1995. METHODS: A retrospective chart review was conducted of all patients who underwent PKP in a single practice at the University Health Network, Toronto Western Hospital, between July 1, 1996, and June 30, 2004...
April 2007: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
A A Khodadoust, A Attarzadeh
Two men (58 and 19 years of age) had an unusual recurrent, bilaterally symmetric disease process involving the cornea. It is characterized by stromal edema progressing centrally from the periphery in otherwise normal eyes. The corneal edema in each instance was closely associated with slowly moving linear keratic precipitates accompanied by the destruction of the endothelium, with minimal anterior chamber reaction. There was no history of herpetic keratitis or trauma, and serologic tests for syphilis were negative in both cases...
June 1982: American Journal of Ophthalmology
E Sutcliffe, J Baum
Seven patients presenting with acute corneal stromal edema without prior surgery, trauma, ocular disease or known exposure to noxious agents are reported. One patient had a severe iridocyclitis; two others subsequently developed herpetic keratouveitis. Four cases, however, were unassociated with other known ocular disease. All four of these patients exhibited keratic precipitates and displayed minimal or no flare and cells in the anterior chamber, although the latter was largely obscured by the corneal edema...
October 1984: Ophthalmology
C Hartmann
Perioperative iatrogenic lesions due to physico chemical trauma may worsen a primary endotheliopathy or lead to a secondary endotheliopathy with subsequent decompensation and corneal opacification. The incisions in anterior segment surgery induce permanent vertical cellular disparity, considering the peripheral endothelium in an area that may correspond to its germinative zone. Cells are lost by corneal folding, e.g., during nuclear expression or sutureinduced distortion. Floating nuclear particles and a high perfusion volume, e...
1990: Fortschritte der Ophthalmologie: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
R A Hyndiuk, R O Schultz
Surgical solutions and drugs are important in ocular surgery. These include irrigating solutions, viscoelastic substances, mydriatics and miotics, and a growing number of other agents designed to enhance intraocular surgery and its outcome. Potential for damage to the corneal endothelium and other tissues is related to the chemical composition, pH, and osmolality of the irrigating solutions that bathe tissues. Quality balanced salt solutions (BSS) are usually safe for use as an intraocular solution in patients with normal corneal endothelium...
1992: Lens and Eye Toxicity Research
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