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damage control of surgery

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https://www.readbyqxmd.com/read/29035926/damage-control-surgery-current-state-and-future-directions
#1
Daniel Benz, Zsolt J Balogh
PURPOSE OF REVIEW: Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts...
October 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29030054/inhibiting-the-cd38-cadpr-pathway-protected-rats-against-sepsis-associated-brain-injury
#2
Qian-Yi Peng, Yi-Min Wang, Cai-Xia Chen, Yu Zou, Li-Na Zhang, Song-Yun Deng, Yu-Hang Ai
BACKGROUND: The CD38/cADPR pathway has been found to play roles in various inflammatory conditions. However, whether CD38 plays a protective or detrimental effect in the central nervous system (CNS) is controversial. The aim of this study was to determine the effect of CD38/cADPR pathway in sepsis associated brain injury. MATERIALS AND METHODS: Male Sprague-Dawley rats were undergone cecal ligation and puncture (CLP) or sham laparotomies. NAD(+), cADPR and CD38 were measured in the hippocampus of septic rats at 0, 6, 12, 24, and 48 h after CLP surgery...
October 10, 2017: Brain Research
https://www.readbyqxmd.com/read/29028286/doppler-guided-goal-directed-fluid-therapy-does-not-affect-intestinal-cell-damage-but-increases-global-gastrointestinal-perfusion-in-colorectal-surgery-a-randomized-controlled-trial
#3
Kostan W Reisinger, Henriette M Willigers, Jochen Jansen, Wim A Buurman, Maarten F Von Meyenfeldt, Geerard L Beets, Martijn Poeze
Individualized, goal-directed fluid therapy (GDFT) based on Doppler measurements of stroke volume has been proposed as a treatment strategy in terms of reducing complications, mortality and length of hospital stay in major bowel surgery. We studied the effect of Doppler guided GDFT on intestinal damage as compared with standard post-operative fluid replacement. STUDY DESIGN: Patients undergoing elective colorectal resection for malignancy were randomized to standard intra- and postoperative fluid therapy or standard fluid therapy with additional Doppler guided GDFT...
October 13, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/29021779/xenon-reduces-neuronal-hippocampal-damage-and-alters-the-pattern-of-microglial-activation-after-experimental-subarachnoid-hemorrhage-a-randomized-controlled-animal-trial
#4
Michael Veldeman, Mark Coburn, Rolf Rossaint, Hans Clusmann, Kay Nolte, Benedikt Kremer, Anke Höllig
OBJECTIVE: The neuroprotective properties of the noble gas xenon have already been demonstrated using a variety of injury models. Here, we examine for the first time xenon's possible effect in attenuating early brain injury (EBI) and its influence on posthemorrhagic microglial neuroinflammation in an in vivo rat model of subarachnoid hemorrhage (SAH). METHODS: Sprague-Dawley rats (n = 22) were randomly assigned to receive either Sham surgery (n = 9; divided into two groups) or SAH induction via endovascular perforation (n = 13, divided into two groups)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28992426/predictors-of-poor-clinical-outcome-after-arthroscopic-labral-preservation-capsular-plication-and-cam-osteoplasty-in-the-setting-of-borderline-hip-dysplasia
#5
Akihisa Hatakeyama, Hajime Utsunomiya, Shoichi Nishikino, Shiho Kanezaki, Dean K Matsuda, Akinori Sakai, Soshi Uchida
BACKGROUND: Borderline developmental dysplasia of the hip (BDDH) is frequently diagnosed concurrently with cam impingement. While hip arthroscopy has advanced the treatment of hip joint pathology, including femoroacetabular impingement (FAI), arthroscopic treatment for FAI in the setting of BDDH remains a challenge amid a subset of patients. The risk factors of poor clinical results after hip arthroscopic labral preservation and FAI corrections in the setting of BDDH patients have not been well established...
October 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28990694/suprafascial-versus-traditional-harvesting-technique-for-free-antero-lateral-thigh-flap-a-case-control-study-to-assess-the-best-functional-and-aesthetic-result-in-extremity-reconstruction
#6
Michele Maruccia, Nefer Fallico, Emanuele Cigna, Pedro Ciudad, Fabio Nicoli, Emilio Trignano, Eleonora Nacchiero, Giuseppe Giudice, Diego Ribuffo, Hung-Chi Chen
Clinical applications of ALT flap have currently extended to extremity (hand and foot) as well as oral cavity reconstruction. In these anatomical areas, the traditional harvesting technique presents a few disadvantages such as bulkiness of the recipient site and potential donor site morbidity including damage to the deep fascia and skin graft adhesions. The purpose of the present study was to compare the functional and aesthetic outcomes of upper and lower extremity reconstruction with either suprafascial or subfascial harvested anterolateral (ALT) flaps...
October 9, 2017: Microsurgery
https://www.readbyqxmd.com/read/28985633/role-of-negative-pressure-therapy-as-damage-control-in-soft-tissue-reconstruction-for-open-tibial-fractures
#7
Mario Cherubino, Luigi Valdatta, Pierluigi Tos, Salvatore D'Arpa, Luigi Troisi, Pellegatta Igor, Federica Corradi, Umraz Khan
The concept of damage control orthopaedics (DCO) is a strategy that focuses on managing orthopaedic injuries in polytrauma patients who are in an unstable physiological state. The concept of DCO is an extension of damage control surgery or damage limitation surgery (DCS/DLS). Recently, it has become clear that certain patients, following extensive soft tissue trauma, could benefit from the idea of DCS. In the management of severe lower extremity trauma with exposed fracture sites, aggressive early wound excision debridement, early internal fixation, and vascularized wound coverage within a few days after trauma were proposed...
October 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28979699/autophagy-plays-a-protective-role-in-motor-neuron-degeneration-following-spinal-cord-ischemia-reperfusion-induced-spastic-paralysis
#8
Li Wang, Dongliang Feng, Yuan Liu, Sen Li, Long Jiang, Zaiyun Long, Yamin Wu
Spinal cord ischemia and reperfusion (SCIR) injury can lead to neurologic dysfunction and paraplegia, which are serious complications after shock or thoracoabdominal aortic surgery. Autophagy is a fundamental cellular process in eukaryotes, and homeostasis of autophagic activities in the cytoplasm is critical for the maintenance of neuronal function. To date, no studies have addressed the involvement of autophagy in the regulation of motor neurons in the ventral horn of the spinal cord area following SCIR-induced spastic paralysis or the underlying mechanisms of this process...
2017: American Journal of Translational Research
https://www.readbyqxmd.com/read/28974070/hypotension-during-induction-of-anaesthesia-is-neither-a-reliable-nor-a-useful-quality-measure-for-comparison-of-anaesthetists-performance
#9
R H Epstein, F Dexter, E S Schwenk
Background: Identification of statistically reliable outcomes for comparison among anaesthetists is challenging. Time-weighted intraoperative mean arterial pressure <65 mm Hg (AUC 65 ) is associated with increased odds for myocardial damage. We explored retrospectively whether such hypotension before incision was statistically reliable for peer comparison. Methods: We retrieved electronic data between 2006 and 2015 at a tertiary care, academic hospital in the USA for patients at risk for myocardial damage (inpatient after surgery, ASA physical status ≥III, ≥50 yr of age, and case duration ≥60 min)...
July 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28966685/effects-of-different-anesthesia-methods-on-postoperative-transient-neurological-syndrome-in-patients-with-lumbar-disc-herniation
#10
Shunhong Mao, Chunhua Zhu, Yulin Chang
The objective of the present study was to investigate the effects of different anesthesia methods on postoperative transient neurologic syndrome (TNS) in patients with lumbar disc herniation (LDH). Ninety-six patients with LDH were selected from November 2015 to October 2016 in Cangzhou Central hospital. All patients were treated with percutaneous transforaminal endoscopic discectomy. The patients were randomly divided into the control group and observation group, with 48 patients each. Combined spinal-epidural anesthesia was performed for patients in the control group, while epidural anesthesia was applied in the observation group...
October 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28966194/open-abdomen-in-trauma-and-critical-care
#11
Eleanor R Fitzpatrick
The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia...
October 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28966150/benchmarking-distance-control-and-virtual-drilling-for-lateral-skull-base-surgery
#12
Eduard H Voormolen, Sander Diederen, Marijn van Stralen, Peter A Woerdeman, Herke Jan Noordmans, Max A Viergever, Luca Regli, Pierre A Robe, Jan Willem Berkelbach van der Sprenkel
BACKGROUND: Novel audiovisual feedback methods were developed to improve image guidance during skull base surgery by providing audiovisual warnings when the drill tip enters a protective perimeter set at a distance around anatomical structures ('distance control'), and visualizing bone drilling ('virtual drilling'). OBJECTIVE: To benchmark the drill damage risk reduction provided by distance control. To quantify the accuracy of virtual drilling. To investigate whether the proposed feedback methods are clinically feasible...
September 28, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28964845/preperitoneal-pelvic-packing
#13
T Monchal, E Hornez, M Coisy, S Bourgouin, J de Roulhac, P Balandraud
Severe pelvic traumatisms are associated with elevated mortality because of the high risk of exsanguination from multiple sources of bleeding. Treatment should encompass resuscitation, bone stabilization and hemorrhage control by arterio-embolization or surgery. Pre-peritoneal packing has been described in hemodynamically unstable patients who need damage control. The surgical technique of this simple and effective procedure is fully described by the authors with some complementary useful technical advices.
September 27, 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/28958361/surgical-management-of-musculoskeletal-trauma
#14
REVIEW
Daniel J Stinner, Dafydd Edwards
Musculoskeletal injuries cause a significant burden to society and can have a considerable impact on patient morbidity and mortality. It was initially thought that these patients were too sick to undergo surgery and later believed that they were too sick not to undergo surgery. The pendulum has subsequently swung back and forth between damage control orthopedics and early total care for polytrauma patients with extremity injuries and has settled on providing early appropriate care (EAC). The decision-making process in providing EAC is reviewed in an effort to optimize patient outcomes following severe extremity trauma...
October 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28956242/polysomnographic-findings-in-craniopharyngioma-patients
#15
Line Pickering, Marianne Klose, Ulla Feldt-Rasmussen, Poul Jennum
PURPOSE: The purpose of this study is to evaluate whether damage to the hypothalamus due to craniopharyngioma or consequent surgery may involve the sleep-wake regulatory system, resulting in sleep disturbances and sleepiness. METHODS: Seven craniopharyngioma patients and 10 healthy controls were evaluated with sleep questionnaires including the Epworth Sleepiness Scale, polysomnography, and a multiple sleep latency test (MSLT). Five patients and eight controls had lumbar puncture performed to determine hypocretin-1 levels...
September 27, 2017: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/28948335/damage-control-surgery-for-non-traumatic-abdominal-emergencies
#16
Edouard Girard, Julio Abba, Bastien Boussat, Bertrand Trilling, Adrian Mancini, Pierre Bouzat, Christian Létoublon, Mircea Chirica, Catherine Arvieux
BACKGROUND: Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS: Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7...
September 25, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28943296/il-33-exacerbates-liver-sterile-inflammation-by-amplifying-neutrophil-extracellular-trap-formation
#17
Hamza O Yazdani, Hui-Wei Chen, Samer Tohme, Sheng Tai, Dirk J van der Windt, Patricia Loughran, Brian R Rosborough, Vikas Sud, Donna Beer-Stolz, Heth R Turnquist, Allan Tsung, Hai Huang
BACKGROUND: Neutrophils and Liver sinusoidal endothelial cells (LSECs) both contribute to sterile inflammatory injury during ischemia/reperfusion (I/R), a well-known liver surgical stress. Interleukin-33 (IL-33) has been shown to drive neutrophil infiltration during inflammatory responses through its receptor ST2. We recently reported that infiltrating neutrophils form neutrophil extracellular traps (NETs), which exacerbate sterile inflammatory injury in liver I/R. Here, we sought to determine the role of IL-33 in NET formation during liver sterile inflammation...
September 21, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28942884/overexpression-of-il-38-protein-in-anticancer-drug-induced-lung-injury-and-acute-exacerbation-of-idiopathic-pulmonary-fibrosis
#18
Masaki Tominaga, Masaki Okamoto, Tomotaka Kawayama, Masanobu Matsuoka, Shinjiro Kaieda, Yuki Sakazaki, Takashi Kinoshita, Daisuke Mori, Akira Inoue, Tomoaki Hoshino
BACKGROUND: Interleukin (IL)-38, a member of the IL-1 family, shows high homology to IL-1 receptor antagonist (IL-1Ra) and IL-36 receptor antagonist (IL-36Ra). Its function in interstitial lung disease (ILD) is still unknown. METHODS: To determine the expression pattern of IL-38 mRNA, a panel of cDNAs derived from various tissues was analyzed by quantitative real-time PCR. Immunohistochemical reactivity with anti-human IL-38 monoclonal antibody (clone H127C) was evaluated semi-quantitatively in lung tissue samples from 12 patients with idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP), 5 with acute exacerbation of IPF, and 10 with anticancer drug-induced ILD (bleomycin in 5 and epidermal growth factor receptor-tyrosine kinase inhibitor in 5)...
September 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/28940004/adjuvant-therapy-in-biliary-atresia-hopelessly-optimistic-or-potential-for-change
#19
REVIEW
Mark Davenport
Given that the aetiology of biliary atresia (BA) is complex and that there is a multiplicity of possible pathogenic mechanisms then it is perhaps not surprising that the evidence for effect of a number of different agents is contradictory. Post-operative cholangitis for instance is common, bacterial in origin and various antibiotic regimens have been tested (although none in a randomized trial) but continuation beyond the early post-operative period does not appear to offer any greater protection. There is an inflammatory reaction in about 25-35% of cases of BA illustrated by abnormal expression of class II antigen and upregulation of ICAM, VCAM and E-selectin with an infiltrate of immune-activated T cells (predominantly CD4 + Th1 and Th17) and NK cells and a systemic surge in inflammatory cytokines (e...
September 22, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28938688/drag-reducing-polymers-decrease-hepatic-injury-and-metastases-after-liver-ischemia-reperfusion
#20
Samer Tohme, Marina V Kameneva, Hamza O Yazdani, Vikas Sud, Julie Goswami, Patricia Loughran, Hai Huang, Richard L Simmons, Allan Tsung
INTRODUCTION: Surgery, a crucial therapeutic modality in the treatment of solid tumors, can induce sterile inflammatory processes which can result in metastatic progression. Liver ischemia and reperfusion (I/R) injury, an inevitable consequence of hepatic resection of metastases, has been shown to foster hepatic capture of circulating cancer cells and accelerate metastatic growth. Efforts to reduce these negative consequences have not been thoroughly investigated. Drag reducing polymers (DRPs) are blood-soluble macromolecules that can, in nanomolar concentrations, increase tissue perfusion, decrease vascular resistance and decrease near-wall microvascular concentration of neutrophils and platelets thereby possibly reducing the inflammatory microenvironment...
August 29, 2017: Oncotarget
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