Objective This study was conducted to determine if reduction of early postburn endotoxemia influences the cytokine cascade, clinical manifestations of sepsis, and mortality rate. Summary Background Data Translocational endotoxemia has been demonstrated postburn in animals and humans. Endotoxin is known to induce the cytokine cascade, which leads to the clinical manifestations of sepsis. Whether reduction of postburn endotoxemia could influence the induction of cytokines has not been demonstrated. Methods In a prospective, randomized study, 76 burn patients were given polymyxin intravenously or served as control subjects. Polymyxin B was given intravenously for 1 week postburn in doses designed to neutralize circulating endotoxemia. Results In the polymyxin group, there was a statistically significant reduction in the plasma endotoxin concentration. There was, however, no reduction in the sepsis score or the interleukin-6 levels, and no differences in mortality rates were seen between the two groups. Conclusions Early postburn translocational endotoxemia can be treated with anti-endotoxin agents such as polymyxin B. This, however, does not influence the cytokine cascade or the mortality rate. The systemic inflammatory response syndrome is caused by cytokine induction from the injury and is unaffected by a reduction in the plasma endotoxin concentration.
Intestinal infarction remains a devastating event despite improvements in clinical recognition as well as diagnostic and therapeutic modalities. Recent changes in the etiology of this disease have not been examined. A retrospective review of 121 consecutive patients over a 6-year period was undertaken. Twenty-three patients died without operation, and mortality in the remaining 98 patients was 50 per cent. The only significant predictor of mortality was an elevated serum lactate at the time of diagnosis. Thirty-one patients (26%) developed infarction while hospitalized for another disease process; excluding patients with obstruction as the etiology of infarction caused this number to rise to 39 per cent. Nonocclusive mesenteric infarction was the most common disease process. The increased incidence of nonocclusive mesenteric infarction is likely due to the development of intestinal ischemia in already systemically ill patients. Nearly half of all cases of intestinal infarction due to nonobstructive causes develop in already hospitalized patients. The development of unexplained acidosis in a postoperative or critically ill patient should prompt a search for a reversible cause of mesenteric ischemia. Intestinal infarction may represent another example of the multisystem organ failure syndrome.
The authors determined whether the preoperative placement of a pulmonary artery catheter (PAC) with optimization of hemodynamics results in outcome improvement after elective vascular surgery.The PAC commonly is used not only in patients who are critically ill, but also perioperatively in major elective surgery. Few prospective studies exist documenting its usefulness.One hundred four consecutive patients were randomized to have a PAC placed the morning of operation (group I) or to have a PAC placed only if clinically indicated (group II). Group I patients were resuscitated to preestablished endpoints before surgery and kept at these points both intraoperatively and postoperatively. Group II patients received standard care.There was one death in each group. An intraoperative or postoperative complication developed in 13 patients in group I versus 7 patients in group II (p = not significant). Group I patients received more fluid than did group II patients (5137 +/- 315 mL vs. 3789 +/- 306 mL; p < 0.003). There was no significant difference in either overall or surgical intensive care unit length of stay. Only one patient in group II required a postoperative PAC.Routine PAC use in elective vascular surgery increases the volume of fluid given to patients without demonstrable improvement in morbidity or mortality.
Septicemia is the 13th leading cause of death in the United States and its annual cost is estimated between $5-10 billion [2]. Much attention has been focused oil gramnegative septicemia and on endotoxemia in surgical patients over recent years and a variety of therapeutic modalities have been attempted [1, 6, 8, 13]. Polymyxin B, a cationic polypeptide with anti-endotoxin effects has been used as an anti-endotoxin agent for a considerable amount of time [9] and was recently confirmed to be of value as an extracorporeal fiber filter [3] that offered improved survival in thermally injured mice [5].
Journal Article Noodles Stay Hotter Longer Get access Avshalom Shalom, MD, Avshalom Shalom, MD *The Baltimore Regional Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland (affiliated with The Johns Hopkins University School of Medicine, Baltimore, Maryland)†Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel (affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel). **Address correspondence to Dr. Avshalom Shalom, Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel. Search for other works by this author on: Oxford Academic Google Scholar Amy Bryant, MD, Amy Bryant, MD †Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel (affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel). Search for other works by this author on: Oxford Academic Google Scholar Melissa Smith-Meek, MD, Melissa Smith-Meek, MD †Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel (affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel). Search for other works by this author on: Oxford Academic Google Scholar Lana R. Parsons, MD, Lana R. Parsons, MD †Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel (affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel). Search for other works by this author on: Oxford Academic Google Scholar Andrew Munster, MD Andrew Munster, MD ††Deceased Search for other works by this author on: Oxford Academic Google Scholar Journal of Burn Care & Research, Volume 28, Issue 3, May-June 2007, Pages 474–477, https://doi.org/10.1097/BCR.0B013E318053D3D2 Published: 01 May 2007
Stereotactic procedures recently have been advocated to replace most needle localization and open biopsy procedures. In order to provide a baseline for comparison at our institution, a retrospective review of our results over the last 3 years was performed. During this time period, 496 biopsies were performed in 480 patients. Needle localization was done in 311 cases, whereas the remaining 185 biopsies were done for palpable masses. There were no significant differences in either the positive rate (19.0% vs 13.5%) or the infection rate (2.6% vs 1.6%) in the two groups. Follow-up of all patients has revealed no missed carcinomas and no referrals to a plastic surgeon for a poor cosmetic result. Current breast biopsy techniques yield good results, with acceptably low morbidity rates. Given that approximately one in five needle localization biopsies detects a malignancy, a negative result following a stereotactic biopsy may not preclude a needle localization procedure. It is therefore unlikely that stereotactic procedures will lead to an overall decrease in health care costs. Surgeon involvement will be crucial to assure best and most cost-effective results.
