The Yale journal of biology and medicine
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Major trauma often precipitates major malnutrition. In many patients, this malnutrition underlies the morbidity and mortality associated with major injury, often leading to multiple organ failure and refractory sepsis. The clinical challenge is to anticipate these potential nutritional problems and intervene early and appropriately, recognizing that it is far easier to prevent malnutrition than it is to reverse it.
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Sepsis is responsible for 75 percent of late deaths following major thermal injury or traumatic injury. Efforts to prevent and/or control sepsis should include an understanding of normal host resistance, proper resuscitation techniques, and nutritional support. Recent studies identifying T suppressor cell abnormalities in burn patients and macrophage defects in trauma patients are presented in this paper. Concluding remarks regarding future directions for research and therapy in this area are also made.
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Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. ⋯ Guidelines are provided for choosing between peripheral and central total parenteral nutrition. A monitoring protocol is suggested and complications of nutritional therapy are reviewed. Safe and effective nutritional support requires considerable investment of time and effort by members of the nutrition team.
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Over the past decade, there has been a significant decrease in the hospital mortality of patients with coronary artery disease. However, sudden cardiac death, which accounts for the majority of deaths from coronary artery disease, hasbeen little affected. This report reviews the pathology, electrophysiology, demographics and clinical presentation of sudden cardiac death. Emergency care and possible preventative measures are examined.