Surgical infections
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Surgical infections · Jan 2001
Neutrophil apoptosis is delayed by trauma patients' plasma via a mechanism involving proinflammatory phospholipids and protein kinase C.
Delayed apoptosis of primed neutrophils (PMNs) may facilitate PMN-mediated tissue injury leading to multiple organ failure (MOF). We previously reported delayed apoptosis and priming of PMNs in severely injured patients at risk for MOF. Our in vitro and in vivo data have implicated phospholipids in PMN cytotoxicity following trauma and shock. The phospholipid signaling pathway remains to be elucidated, but may involve protein kinase C (PKC). We hypothesized that circulating platelet-activating factor (PAF) and PAF-like proinflammatory phospholipids mediate delayed postinjury PMN apoptosis and that PKC is integral to the signaling pathway. ⋯ Trauma patients' plasma delays apoptosis of PMNs. Our data implicate PAF-like phospholipids in this effect, and PKC appears to be integral in the signaling process. Further elucidation of specific lipids and signaling pathways may reveal clinically accessible therapeutic targets to prevent PMN-mediated hyperinflammation.
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Surgical infections · Jan 2001
A prospective evaluation of the use of emergency department computed tomography for suspected acute appendicitis.
Computed tomography (CT) is used increasingly to evaluate suspected cases of acute appendicitis (AA) in the emergency department (ED). This prospective study was performed to test the hypothesis that the evaluation of AA by CT in the ED remains suboptimal and that erroneous interpretation diminishes its utility. ⋯ The ability of CT to predict AA is dependent on the interpretative skill of the individual interpreting the images. Widespread use of CT in the evaluation of patients for AA should be implemented with caution until institution-specific protocols are validated.
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Surgical infections · Jan 2001
Tertiary peritonitis (recurrent diffuse or localized disease) is not an independent predictor of mortality in surgical patients with intraabdominal infection.
It is well documented that tertiary peritonitis is associated with different microbiological flora and worse outcomes than secondary peritonitis. It is unknown, however, if these differences can be explained simply by the nosocomial nature of tertiary peritonitis and underlying severity of illness. ⋯ We were unable to demonstrate, when compared to secondary peritonitis, that tertiary peritonitis is a significant independent predictor of mortality when other variables are taken into account. This suggests that the high mortality associated with tertiary peritonitis is more a function of the patient population in which it occurs than the severity of the pathologic process itself.
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Surgical infections · Jan 2001
Catheter materials affect the incidence of late blood-borne catheter infection.
Adherence of bacteria and subsequent catheter-related infections (CRI) are greatly enhanced by the fibrin sheath that develops on indwelling catheters. Since the infection rate of catheters without fibrin sheaths is low and the fibrin sheath mediates bacterial adherence, catheter material is not thought to affect the incidence of late catheter-related infection. ⋯ Catheter material does affect the incidence of catheter-related infection even when catheters are coated with a fibrin sheath. This difference may relate to a difference in the fibrin sheath itself as it forms on different catheter materials.
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A current assessment of liver abscesses should allow for better understanding of the pathogenesis of the disease and improve the effectiveness of diagnosis and treatment. Amebic liver abscess occurs more commonly than pyogenic liver abscess on a worldwide basis. However, in the United States, pyogenic liver abscess predominates. The purpose of our study was to evaluate the etiology, management, morbidity, and mortality of all patients admitted to our medical center with diagnoses of pyogenic liver abscess between 1983 and 1996. ⋯ CT scan- and ultrasound-guided percutaneous drainage of pyogenic liver abscesses were safe and effective methods of treatment. The right lobe of the liver was involved in 95% of cases. Although no one species predominated, gram-negative bacteria were the most common organism cultured, and 60% of the abscesses were polymicrobial. There was no in-house mortality in this review.