J Trauma
-
Several small series have had mixed conclusions regarding the impact of obesity on outcomes of trauma patients. The purpose of the present study was to evaluate a large cohort of critically injured patients to better understand the influence of obesity on the outcomes of patients after severe blunt trauma. ⋯ Obese patients incur different injuries after severe blunt trauma than their non-obese counterparts. Despite sustaining fewer head injuries, obese patients suffer more complications, require longer stays in the hospital, more days of mechanical ventilation, and obesity is independently associated with mortality.
-
Preservation of mucosal immunity has been shown to affect the risk and outcome of pneumonia in severely injured patients. Secretory immunoglobulin A (SIgA) is the principle humoral defense of mucosal surfaces in the body and has several antiinflammatory properties. Polymorphonuclear neutrophils (PMN) function to kill invading microorganisms, but their exaggerated inflammatory responses may cause tissue injury to the host. The purpose of this study was to compare the ability of different immunoglobulin (Ig) isotypes to modulate PMN cytotoxic potential cocultured with respiratory epithelial cells challenged with bacteria. ⋯ PMN cytotoxic potential was decreased by the presence of SIgA but not IgG in an in vitro model to simulate pneumonia in vivo. SIgA may not only function to protect against microbial invasion of mucosal surfaces, but may also protect against tissue injury from an exaggerated inflammatory response.
-
Untreated traumatic aortic transection carries a mortality rate higher than 85%. Standard therapy has been open repair via a left thoracotomy with systemic heparin and is associated with a high risk of paralysis. We reviewed our experience of endoluminal stent-graft repair for treatment of acute traumatic thoracic aortic transection. ⋯ Adaptation and use of commercially available abdominal devices in the thoracic aorta has proven to be technically feasible. Urgent repair of thoracic aortic transection in the setting of blunt trauma can be transformed into a well-tolerated surgical intervention using endovascular techniques. Long-term durability of endovascular repair of traumatic thoracic transections remains unknown, but early and midterm results are promising.
-
We evaluated 70 cases of ocular injuries with intraocular foreign bodies to determine the results of surgical management. ⋯ Pars plana vitrectomy is found to be an effective therapeutic approach in removing intraocular foreign bodies, but the preoperative and postoperative complications determine the visual outcome.
-
Acute respiratory distress syndrome (ARDS) after major trauma has been associated with increased morbidity and mortality rates. Recently, there have been marked advances in defining etiologic factors and optimal management strategies for ARDS. We sought to examine whether there has been a corresponding change in the incidence and outcomes of ARDS after injury in recent years. ⋯ There has been a more than 50% reduction in the incidence of ARDS after injury during the past 5 years in our institution despite similar patient demographics and injury severities. Development of ARDS increased hospital and ICU stays but not hospital mortality.