The European journal of surgery = Acta chirurgica
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The adult respiratory distress syndrome (ARDS) is a serious complication of many medical and surgical conditions, most of which do not involve direct pulmonary injury. In surgical practice, septic shock has long been recognised as an important cause of ARDS and it presents many management challenges. ⋯ The neutrophil has emerged as the central effector cell and possesses a formidable armamentarium of cytokines, enzymes, and oxygen radicals that are capable of inflicting damage to cells. In this review I examine the mechanisms underlying the recruitment and activation of neutrophils in ARDS.
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Epiploic appendagitis and omental infarction are benign self-limiting disorders. They are uncommon, though more common than is generally assumed. In both diseases the main clinical symptom is non-specific focal abdominal pain, with a normal or moderately raised white blood cell count and erythrocyte sedimentation rate. ⋯ This may result in an unnecessary laparotomy. Ultrasonography (US) and computed tomography (CT) show characteristic features in most patients, allowing a secure non-operative diagnosis. Patients correctly diagnosed can avoid an operation or costly observation in hospital.
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Most traditional opioids and non-steroidal anti-inflammatory drugs that are used to control perioperative pain have substantial side effects. The number of choices in clinical use was recently increased by two promising groups of drugs: N-methyl-D-aspartate receptor antagonists and central alpha2 agonists. One N-methyl-D-aspartate antagonist, dextromethorphan, blocks the generation of central pain sensation that arise from peripheral nociceptive stimuli by moderating the activity of N-methyl-D-aspartate. ⋯ Dexmedetomidine is a relatively new, highly selective central alpha2 agonist. Its sedative, pro-anaesthetic and pro-analgesic effects at 0.5-2 microg/kg given intravenously stem mainly from its ability to blunt the central sympathetic response by as yet unknown mechanism(s) of action. It also minimises opioid-induced muscle rigidity, lessens postoperative shivering, causes minimal respiratory depression, and has haemodynamic stabilising effects.
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Review Case Reports
Pneumopericardium and pneumoperitoneum after penetrating chest injury.