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Garcia DFV, Domingues CA, Silva FSCE, Mori ND, Brasel KJ, Kortbeek J, Ali J, Poggetti RS. Efficacy of a Novel Surgical Manikin for Simulating Emergency Surgical Procedures. Am Surg 2020. [DOI: 10.1177/000313481908501223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among Surge-Man, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.
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Affiliation(s)
- Diogo F. V. Garcia
- Discipline of Trauma Surgery, Department of Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Brazilian Committee on Trauma of the American College of Surgeons, Sao Paulo, Brazil
| | | | - Francisco S. Collet E Silva
- Discipline of Trauma Surgery, Department of Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Brazilian Committee on Trauma of the American College of Surgeons, Sao Paulo, Brazil
| | - Newton D. Mori
- Discipline of Trauma Surgery, Department of Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Brazilian Committee on Trauma of the American College of Surgeons, Sao Paulo, Brazil
| | - Karen J. Brasel
- Division of Trauma, Critical Care and Acute Care Surgery School of Medicine Oregon Health and Science University, Portland, Oregon
| | - John Kortbeek
- Departments of Surgery, Anaesthesia and Critical Care, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Jameel Ali
- Division of General Surgery Trauma Program, St. Michael's Hospital, Toronto, Canada
| | - Renato S. Poggetti
- Discipline of Trauma Surgery, Department of Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Brazilian Committee on Trauma of the American College of Surgeons, Sao Paulo, Brazil
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Garcia DFV, Domingues CA, Collet E Silva FS, Mori ND, Brasel KJ, Kortbeek J, Ali J, Poggetti RS. Efficacy of a Novel Surgical Manikin for Simulating Emergency Surgical Procedures. Am Surg 2019; 85:1318-1326. [PMID: 31908212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among SurgeMan, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.
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Affiliation(s)
- Diogo F V Garcia
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Cristiane A Domingues
- †Brazilian Committee on Trauma of the American College of Surgeons, São Paulo, Brazil
| | - Francisco S Collet E Silva
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Newton D Mori
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Karen J Brasel
- ‡Division of Trauma, Critical Care and Acute Care Surgery School of Medicine Oregon Health and Science University, Portland, Oregon
| | - John Kortbeek
- §Departments of Surgery, Anaesthesia and Critical Care, University of Calgary and Alberta Health Services, Calgary, Canada; and
| | - Jameel Ali
- ║Division of General Surgery Trauma Program, St. Michael's Hospital, Toronto, Canada
| | - Renato S Poggetti
- From the *Discipline of Trauma Surgery, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
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Kato LT, Poggetti RS, Fontes B, Massarollo PCB, Younes RN, Heimbecker AMDLC, Birolini D. Evaluation of the mortality rate caused by different periods of selective portal vein occlusion in rats. Acta Cir Bras 2008; 22:279-84. [PMID: 17625666 DOI: 10.1590/s0102-86502007000400009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 04/10/2007] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Mortality from acute selective portal vein occlusion (SPVO) is a matter of concern for surgeons during the management of traumatic portal vein injury. However, mortality rates related to different periods of SPVO remains undetermined. PURPOSE To determine the mortality rates resulting from different periods of acute SPVO in rats. METHODS Wistar male rats were randomized into 8 experimental, and 8 control groups. Experimental animals underwent SPVO during 15 to 75 minutes, and control groups underwent sham procedures. All surviving animals were followed up to 14 days for assessment of mortality rate. RESULTS Death rates varied from 0% in the 15 min SPVO group, to 100% with 65 and 75 minutes of SPVO. A strongly positive correlation was observed between mortality rates and SPVO periods (p<0.001) with either linear or quadratic regression analysis tests. All deaths in the 20 min and 25 min SPVO groups occurred after 75 min from the moment of clamping (or after 60 min from unclamping); death from 30 or more min SPVO occurred predominantly within 75 min from clamping moment (or within 60 min from unclamping). (Exact Fisher test, p=0.009). CONCLUSIONS The mortality from SPVO in rats increases with longer duration of SPVO; with deaths occurring later for short periods (<or= 25 min) of SPVO and earlier for longer periods (>or= 30 min) of SPVO.
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D'Agostino Dias M, Fontes B, Poggetti RS, Birolini D. Hyperbaric oxygen therapy: types of injury and number of sessions--a review of 1506 cases. Undersea Hyperb Med 2008; 35:53-60. [PMID: 18351127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of this work was to identify clinical data indicative of the number of hyperbaric oxygen therapy HBO2 sessions that should be prescribed for adjuvant treatment of tissue injuries of differing severity. PATIENTS A total of 1730 cases of patients treated with HBO2 using an open protocol (without a predetermined number of sessions) was examined in this study. METHOD A retrospective study involving charts review was conducted. Severity had been previously determined for the treatment of acute (fasciitis, myositis, gangrene, contaminated/infected perineal or lower extremity traumatic injuries) or chronic (osteomyelitis, pressure sore, diabetic or ischemic ulcer) injuries. Only patients that met or exceeded the supposed effective minimal treatment doses (5 sessions for acute, 10 sessions for chronic injuries) were included in the present study. RESULTS The data analysis included 1506 cases. These consisted of 1014 patients with acute injuries, who required 11 to 18 sessions (depending on injury severity), and 492 patients with chronic injuries, who required a greater (p < 0.001) number of sessions (approximately 30/patient, independent of injury severity). Global mortality was 79/1506 patients. CONCLUSION These results seem to support the initial indication of 15 HBO2 sessions for the treatment acute injuries, and 30 for treatment of chronic injuries. Prospective studies may better determine the number of sessions for the treatment of different types of injuries.
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Affiliation(s)
- M D'Agostino Dias
- Intensive Care Unity, Emergency Surgery Service, III Division of Surgical Clinics, Clinics Hospital of the University of São Paulo School of Medicine
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Fusco PEB, Poggetti RS, Younes RN, Fontes B, Birolini D. Comparison of Anterior Gastric Wall and Greater Gastric Curvature Invaginations for Weight Loss in Rats. Obes Surg 2007; 17:1340-5. [PMID: 18000725 DOI: 10.1007/s11695-007-9238-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 03/28/2007] [Indexed: 01/07/2023]
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Figueiredo AM, Poggetti RS, Quintavalle FG, Fontes B, Dalva M, Younes RN, Jatene FB, Birolini D. Isolated right atrial appendage (RAA) rupture in blunt trauma--a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness. World J Emerg Surg 2007; 2:5. [PMID: 17302990 PMCID: PMC1805426 DOI: 10.1186/1749-7922-2-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 02/15/2007] [Indexed: 11/28/2022] Open
Abstract
Background Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. Objective To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. Methods The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. Result The comparison of the data showed that wall thickness of the RAA (0.53 ± 0.33 mm) was significantly thinner than that of RA (1.11 ± 0.42 mm) (p < 0.05). Comments In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Conclusion Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma.
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Affiliation(s)
- Adoniram M Figueiredo
- Emergency Surgery Service, Clinics Hospital, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
| | - Renato S Poggetti
- Emergency Surgery Service, Clinics Hospital, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
| | - Fabio G Quintavalle
- Emergency Surgery Service, Clinics Hospital, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
| | - Belchor Fontes
- Emergency Surgery Service, Clinics Hospital, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
| | - Moise Dalva
- Emergency Surgery Service, Clinics Hospital, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
| | - Riad N Younes
- Emergency Surgery Service, Clinics Hospital, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
| | - Fabio B Jatene
- Heart Institute (INCOR), Clinics Hospital, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
| | - Dario Birolini
- Trauma Discipline, Department of Surgery, University of São Paulo Medical School, Rua Dr. Eneas de C Aguiar, 255 CEP 05403-000, São Paulo (SP), Brazil
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Abstract
BACKGROUND Many bariatric endocopic or surgical procedures performed today reduce gastric capacity and/or induce an early sensation of satiety, alone or in combination with a distal enteric intervention. A form of prosthetic gastric wrap was used in the past for treating obesity with a high rate of reintervention. Nissen gastric fundoplication used in the treatment of gastroesophageal reflux disease induces a small but significant weight loss. We report the effect of gastric greater curvature invagination on weight in rats. METHODS 30 rats were randomly divided into 3 groups. 10 rats in the first group (sham) were anesthesized and weighed. The rats from the second group (lap) were in addition submitted to a laparotomy plus visceral manipulation. In the third group (inv), invagination of the greater curvature of the stomach was added. All animals were weighed on the 7th and 21st days. They were then autopsied on the 21st day. RESULTS The mean body weight of the invagination group became statistically less than the laparotomy and sham groups at 7 and 21 days. The mean weight of the peritesticular fat pad from the inv group was also significantly less than from the sham group but not different from the lap group. CONCLUSION Gastric greater curvature invagination significantly decreases weight in rats.
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Affiliation(s)
- Pedro E B Fusco
- Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil.
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Fusco PEB, Marino HLT, Natal SRB, Ducatti LSS, Poggetti RS, Kauffman P, Puech-Leão P, Birolini D. Enxerto aorto-femoral por via laparoscópica: modelo experimental. J Vasc Bras 2005. [DOI: 10.1590/s1677-54492005000400018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Verificar a exeqüibilidade de enxerto aorto-femoral por via laparoscópica. MÉTODO: Operamos porco de 75 kg sob anestesia geral. Empregando a técnica do avental (apron) de Dion, expusemos a aorta por laparoscopia. Brevemente, em decúbito dorsal horizontal, dissecamos um "avental" do peritônio parietal esquerdo. A dissecção prosseguiu com rotação medial do cólon esquerdo. O avental, posteriormente fixo à linha mediana, serviu de anteparo às alças intestinais. Pinçamos a aorta e realizamos enxerto aorto-femoral com o tempo abdominal totalmente laparoscópico. RESULTADO: O enxerto foi realizado com sucesso, e o fluxo sangüíneo na prótese foi demonstrado através da incisão femoral. CONCLUSÃO: O enxerto aorto-femoral experimental laparoscópico é exeqüível através da exposição com a técnica do avental.
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Collet e Silva FS, José Neto F, Figueredo AM, Fontes B, Poggetti RS, Birolini D. Cardiac herniation mimics cardiac tamponade in blunt trauma. Must early resuscitative thoracotomy be done? Int Surg 2001; 86:72-5. [PMID: 11890345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Blunt rupture of the pericardium is a rare injury. Strangulated cardiac hernia following blunt trauma is one cause of reversible cardiac arrest. Traumatic pericardial tears usually have delayed diagnoses and carry high mortality rates (64%). Clinical signs mimic cardiac tamponade during the primary survey. We report here two cases of blunt trauma. Both patients arrived alive in the emergency room and presented signs of cardiac tamponade caused by pericardial rupture.
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Affiliation(s)
- F S Collet e Silva
- Emergency Surgery Department, The Hospital Das Clinicas University of São Paulo School of Medicine, Sao Paulo, Brazil.
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Collet e Silva FD, Ramos RC, Zantut LF, Poggetti RS, Fontes B, Birolini D. Laparoscopic pneumoperitoneum in acute peritonitis does not increase bacteremia or aggravate metabolic or hemodynamic disturbances. Surg Laparosc Endosc Percutan Tech 2000; 10:305-10. [PMID: 11083214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The use of laparoscopy in generalized peritonitis has become increasingly frequent in recent years. However, CO2 pneumoperitoneum in association with increased intraperitoneal pressure may have deleterious effects in patients with hemodynamic or metabolic disturbances caused by bacterial peritonitis. The purpose of this study was to investigate the effect of CO2 pneumoperitoneum on bacteremia, mean arterial pressure, and blood gas disturbances in an animal model of bacterial peritonitis. Dogs were anesthetized, orally intubated, and subjected to experimental peritonitis by intraperitoneal inoculation of a suspension containing Escherichia coli and sterile dog feces. The animals were randomly assigned to two groups: control animals were maintained under anesthesia, and the insufflated animals were subjected to intraperitoneal CO2 insufflation. Bacterial peritonitis provoked the appearance of bacteremia and a significant decrease in mean arterial pressure, pH, bicarbonate, and base deficit. The induction of bacterial peritonitis did not significantly influence pH in the control group and partial pressure of arterial CO2 in either group. Thirty minutes of CO2 pneumoperitoneum did not influence the effect of bacterial peritonitis on the analyzed variables. These results suggest that laparoscopic CO2 pneumoperitoneum does not aggravate bacteremia or metabolic and hemodynamic disturbances induced by bacterial peritonitis.
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Affiliation(s)
- F D Collet e Silva
- University of São Paulo School of Medicine, Department of Surgery, São Paulo, Brazil
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Rocha EP, Dias MD, Szajmbok FE, Fontes B, Poggetti RS, Birolini D. Tracheostomy in children: there is a place for acceptable risk. J Trauma 2000; 49:483-5; discussion 486. [PMID: 11003327 DOI: 10.1097/00005373-200009000-00016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tracheostomy in children remains controversial regarding the risk of complications. METHODS Forty-six trauma patients (35 male and 11 female, mean age = 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head injury plus coma. Tracheostomy was performed with standard technique after 5.9 days (range, 2-12 days) of intubation. RESULTS There were no deaths from tracheostomy, but six deaths resulted from severe head injury. One child was discharged with tracheostomy. The 39 survivors remained with tracheostomy 16.14 days (range, 4-71 days) in the intensive care unit. After cannula removal, 31 remained asymptomatic; 8 had respiratory distress: 2 were normal, 5 had endoscopic treatment for subglottic granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheostomy. In 1997, the 18 patients located for follow-up were asymptomatic. At endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and 1 had 20% tracheal stenosis from tracheostomy. CONCLUSION Most complications after tracheostomy result from intubation. Tracheostomy has an acceptable risk in children with severe head injury who need prolonged ventilatory support.
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Affiliation(s)
- E P Rocha
- Emergency Surgery Department ICU, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Souza AL, Poggetti RS, Fontes B, Birolini D. Gut ischemia/reperfusion activates lung macrophages for tumor necrosis factor and hydrogen peroxide production. J Trauma 2000; 49:232-6. [PMID: 10963533 DOI: 10.1097/00005373-200008000-00008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gut ischemia followed by reperfusion (I/R) is implicated as a prime initiating event in the mechanism of multiple organ failure after trauma and hemorrhagic shock. Several lines of evidence indicate that macrophages are involved in this prime event. Our purpose was to evaluate hydrogen peroxide (H2O2) and tumor necrosis factor (TNF) production and phagocytosis by lung macrophages in a gut I/R model of multiple organ failure in rats. METHODS In the experimental group (I/R), Wistar rats (n = 35) were anesthetized and subjected to a median laparotomy, and the superior mesenteric artery was clamped for 45 minutes followed by 60 minutes of reperfusion. In the control group (LAP) (n = 37), animals underwent sham laparotomy. After the period of reperfusion, bronchoalveolar lavage (BAL) was performed and the resulting BAL cells were assayed for H2O2 production using the horseradish peroxidase-mediated red phenol oxidation method. TNF release was determined using the L929 cells bioassay. Zymosan phagocytosis by BAL macrophages was quantitated using phase microscopy. RESULTS H2O2 release in BAL cells of I/R rats (19.90 +/- 7.98 nmol/L/2 x 10(5) cells) is statistically higher than in the LAP group (10.92 +/- 5.01 nmol/L per 2 x 10(5) cells) (p = 0.0155), and the TNF production by BAL cells of the I/R group (38.09 +/- 20.79 units per 10(6) cells) was significantly higher than that of LAP rats (17.16 +/- 13.35 units per 10(6) cells) (p = 0.0281). Phagocytic activity of BAL mac. Macrophages of I/R rats was not statistically different from LAP animals. CONCLUSION These results suggest that BAL macrophage play a role in the mechanism of acute lung injury after trauma and hemorrhagic shock.
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Affiliation(s)
- A L Souza
- Surgical Emergency Department, Hospital das Clinicas-University of São Paulo School of Medicine, Brazil
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Kawahara N, Zantut LF, Poggetti RS, Fontes B, Bernini C, Birolini D. Laparoscopic treatment of gastric and diaphragmatic injury produced by thoracoabdominal stab wound. J Trauma 1998; 45:613-4. [PMID: 9751560 DOI: 10.1097/00005373-199809000-00035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- N Kawahara
- Emergency Department, Hospital das Clinicas - University of Sao Paulo School of Medicine and LIM-62, SP, Brazil
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Mitteldorf C, Poggetti RS, Zanoto A, Branco PD, Birolini D, Castro de Tolosa EM, Rocha e Silva M. Is aortic occlusion advisable in the management of massive hemorrhage? Experimental study in dogs. Shock 1998; 10:141-5. [PMID: 9721982 DOI: 10.1097/00024382-199808000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Occlusion of the thoracic aorta is meant to improve cerebral and cardiac perfusion in the moribund, exsanguinating trauma patient. Yet clinical and experimental experience shows no evident benefit from this critical maneuver, and hind limb paralysis (HLP) is a feared complication. Our study is intended to verify whether aortic occlusion can decrease further blood loss and therefore be useful during treatment of hemorrhagic shock. Four groups of 10 dogs were submitted to hemorrhagic shock and treated with blood (40 mL/kg) and saline (35 mL/kg). Group I was then submitted to intermittent intra-aortic occlusion (IIAO), Groups II and III to IIAO and to a second bleeding (rebleeding), and Group IV to rebleeding only, without IIAO. All dogs received volume replacement during this rebleeding phase and were kept alive for 8 days. Five dogs died and seven had HLP in the three groups submitted to IIAO. Death and HLP occurred even in the dogs of Group I, which were not submitted to a second bleeding. IIAO reduced blood loss from 139 mL/kg to 48 mL/kg. There were no complications or deaths among the 10 dogs in Group IV. Although efficient in reducing blood loss, IIAO was associated with a 16% mortality and 23% of HLP, whereas volume replacement alone was tolerated without complications or death. We conclude that IIAO is dangerous while treating severe hemorrhagic shock even after volume replacement and hemodynamic stabilization.
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Affiliation(s)
- C Mitteldorf
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brazil
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Steinman M, da Silva LE, Coelho IJ, Poggetti RS, Bevilacqua RG, Birolini D, Rocha e Silva M. Hemodynamic and metabolic effects of CO2 pneumoperitoneum in an experimental model of hemorrhagic shock due to retroperitoneal hematoma. Surg Endosc 1998; 12:416-20. [PMID: 9569361 DOI: 10.1007/s004649900694] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diagnostic laparoscopy has been used in abdominal trauma patients, although its role is not well defined. The safety of laparoscopic evaluation in trauma patients with severe intraabdominal hemorrhage has not yet been analyzed. The purpose of this study is to evaluate the hemodynamic and metabolic effects of CO2 pneumoperitoneum (COI) in hemorrhaged animals through a retroperitoneal hematoma (RH). METHODS Twenty-two 15-20-kg mongrel dogs were monitored for systemic and pulmonary hemodynamics, inferior vena cava pressure, and arterial blood gases. After 1 h of baseline, all animals were submitted to a RH. After 45 min the dogs were randomized into two groups. Control (CTR): dogs were submitted only to a RH; pneumoperitoneum (PN): dogs were submitted to a RH and 45 min later they were insufflated to an intraabdominal pressure of 10 mmHg with medical-grade CO2 gas for 30 min. Echocardiography was performed, only in PN animals, at baseline, 45 and 60 min after RH. RESULTS RH induced a shock condition with low, sustained levels of arterial pressure, cardiac index, left ventricular stroke index, base excess, and oxygen delivery which were further depressed following COI. Three deaths occurred in the PN group, all of them toward the end of COI. During COI, hypercapnia was observed in one animal. COI did not impair systolic function or ejection fraction. CONCLUSIONS COI with an IAP of 10 mmHg may be deleterious in animals with hemorrhagic shock due to an intraabdominal lesion. These findings could be clinically significant in abdominal trauma patients.
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Affiliation(s)
- M Steinman
- Trauma Division, Department of Surgery, Hospital das Clínicas-University of São Paulo-Brazil
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Souza Júnior ADL, Poggetti RS, Fontes B, Bernini CO, Figueiredo AM, Branco PD, Birolini D. [Traumatic rupture of duodenal diverticulum. Report of a case and literature review]. Rev Hosp Clin Fac Med Sao Paulo 1996; 51:247-9. [PMID: 9239899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Duodenal diverticulum is a common anatomic abnormality. Its inflammatory perforation is a rare complication, with less than 100 cases reported in the available literature. Traumatic perforation is exceedingly rare (only 3 cases reported). In this report one more case of traumatic perforation is presented, and the literature is reviewed focusing on the pathogenic, diagnostic and therapeutic aspects of this severe disease.
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17
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Abstract
Traumatic injuries of the extrahepatic biliary tract are infrequent, occurring in approximately 0.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury due to blunt abdominal trauma is rare. This study reviewed patients with injuries of the extrahepatic biliary tract due to abdominal trauma over a 6-year period to determine the incidence, trauma scores, associated injuries, surgical treatment performed, complications and mortality rate. We report our experience with 14 patients with extrahepatic biliary tract trauma. A review of the literature and the discussion about the management are presented.
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Affiliation(s)
- L F Zantut
- Cirurgia do Trauma, Faculdade de Medicina, Universidade de São Paulo, Brazil
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18
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Abstract
Gallstone ileus, a mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen through a fistula, although not common, deserves to more carefully studied due to its morbidity and mortality. Its incidence among older-age groups explains its association with chronic and degenerative diseases, which increase the complexity of the treatment choice. The need and appropriateness of a surgical approach to a cholecystenteric fistula to solve the obstructive emergency, in a one or two stage procedure, has been discussed in the literature. It has also been reported that gallstone ileus is an uncommon cause of upper intestinal obstruction. Intestinal obstruction is seen more frequently after a gallstone impacts at the ileocecal valve. The authors report a case of gallstone ileus as a cause of upper intestinal obstruction and discuss its diagnosis and treatment.
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Affiliation(s)
- I Szajnbock
- Hospital das Clínicas, College of Medicine, University of São Paulo (USP), Brazil
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19
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Fontes B, Poggetti RS. [Mechanisms and evaluation of multiple organ and system failure after trauma]. Rev Hosp Clin Fac Med Sao Paulo 1996; 51:72-7. [PMID: 9008937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple organ failure (MOF) is a major cause of death of ICU trauma patients. Despite intensive clinical and experimental investigation, the exact physiopathology of this syndrome is unclear. Although diverse cellular and humoral mediators have been identified, their mechanistic role is still debated. In this article the authors discuss recent results of this investigation. They present recently published criteria for MOF quantification, and focus on the mechanisms and mediators of MOF syndrome, emphasizing the role of sepsis, the intestinal ischemia/reperfusion MOF model, the role of polymorphonuclear neutrophil, and the relationship between adult respiratory distress syndrome (ARDS) and the development of MOF syndrome.
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Affiliation(s)
- B Fontes
- Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo
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20
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Zantut LF, Machado MA, Volpe P, Poggetti RS, Birolini D. Autotransfusion with laparoscopically salvaged blood in trauma: report on 21 cases. Surg Laparosc Endosc Percutan Tech 1996; 6:46-8. [PMID: 8808560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Autotransfusion is being increasingly used to avoid the complications of homologous blood transfusion. In abdominal trauma, however, the collected blood may be contaminated by intestinal contents when digestive or urinary lesions are present. In such situations, the reinfusion of blood is contraindicated. We present our experience with autotransfusion of blood collected by laparoscopy from the abdominal cavity of 21 trauma patients. Laparoscopy allowed the aspiration of blood and, at the same time, permitted diagnosis of visceral lesions, avoiding reinfusion of contaminated blood. No complications occurred, and hematocrit values were significantly elevated. This procedure may represent the only possible method of blood transfusion in Jehovah's Witnesses, as with one patient in our series.
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Affiliation(s)
- L F Zantut
- Department of Surgery, University of São Paulo School of Medicine, Brazil
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21
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Steinman M, Steinman E, Poggetti RS, Birolini D. [Abdominal surgical emergencies in patients with acquired immunodeficiency syndrome]. Rev Assoc Med Bras (1992) 1996; 42:19-24. [PMID: 8935671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Patients with Acquired Immunodeficiency Syndrome (AIDS) may present acute abdomen with modified clinical manifestations which may lead to errors and delays in preoperative diagnosis, with frequent delays in treatment. PURPOSE To study clinical signs, diagnostic criteria, etiology, surgical management and mortality in patients with AIDS submitted to exploratory laparotomy. METHODS We reviewed the records of thirty-one AIDS patients admitted in the period 1986-1993 at the Emergency Surgical Service--Hospital das Clínicas, University of São Paulo submitted to exploratory celiotomy due to acute abdome. RESULTS Abdominal pain was the most frequent symptom and the diagnosis of acute abdome was made based upon physical examination, laboratory tests and imaging techniques. Gastrointestinal tract perforation was the most frequent cause of acute abdome, mainly due to Cytomegalovírus infection. All patients presented postoperative complication, specially wound infection. Mortality rate was 42% due to sepsis and multiple organ failure. CONCLUSION Based upon these data we conclude that: AIDS patients usually present masked clinical signs of acute abdomen; stomas should be formally indicated. Mortality is extremely high due to immunocompromised state, delayed diagnosis and treatment and non therapeutic celiotomies.
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Affiliation(s)
- M Steinman
- Serviço de Cirurgia de Emergência, Universidade de São Paulo, SP
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22
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Abstract
Oxidative injury is a mechanism common to both ischemia-reperfusion (IR) and leukocyte-mediated injury. Reperfused tissue beds and elaborated mediators can activate a cascade of intercellular and interorgan injuries that often precipitates multiple organ failure. Initiation of lung injury by gut IR is a case in point, but concomitant liver injury may have been overlooked because of the absence of comparably sensitive physiological markers. In this study, we explore the hypothesis that occurrence of portally derived oxidant-induced liver dysfunction may be detected with both sensitivity and specificity. We simulated pure oxidative injury to the liver and separated the contributions from secondary systemic oxidation. Both tissue and plasma indicators were evaluated, each reflecting aspects of oxidation, membrane integrity, and metabolic function. Tissue markers readily detect oxidative liver injury, but systemic 3-hydroxybutyrate (3-OHB) concentration and ketone body ratio (KBR) are the most sensitive. Comparison of 3-OHB concentrations against the corresponding KBR can be used to distinguish adjustments within a physiological range from the transition into injury.
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Affiliation(s)
- R S Poggetti
- Department of Surgery, Denver General Hospital, Colorado
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23
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Zantut LF, Machado MA, Volpe P, Poggetti RS, Birolini D. [Traumatic injuries of the gallbladder and of the extrahepatic biliary tract: analysis of 45 cases]. Rev Assoc Med Bras (1992) 1995; 41:53-9. [PMID: 7550416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Injury of the extra-hepatic biliary tract is infrequent, occurring in approximately 3.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury caused by blunt abdominal trauma is rare. PURPOSE--Retrospective analysis of 5069 patients with abdominal trauma treated at the Department of Surgery University of São Paulo School of Medicine over a six-year period from 1986 through 1991. METHODS--Forty five patients with gallbladder and extra-hepatic ducts injury were identified (0.89%) and divided in two groups according to the nature of trauma: 12 caused by non-penetrating injuries and 33 to penetrating injuries. Records, including operative and pathology reports, were reviewed to study the site of injury, associated intra-abdominal injuries, incidence, trauma scores, treatment, morbidity, mortality rates and correlated with the nature of the trauma. RESULTS--Overall mortality was 24.4%. The incidence was greater in patients sustaining penetrating abdominal trauma (p < 0.05). Forty of the 45 patients (88.9%) had liver lacerations, the most commonly seen injuries. The patients with blunt abdominal trauma had significant different trauma scores (p < 0.05) than those with penetrating trauma, indicating greater severity in this group of patients. CONCLUSION--There is a relation between severity of trauma and incidence of extra-hepatic biliary tract injury. However, in the penetrating trauma, the incidence of trauma is correlated with the direction of the wound and there is no relation with the severity of trauma. The greater mortality seen in the patients sustaining non-penetrating injury (p < 0.05) supports this observation.
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Affiliation(s)
- L F Zantut
- Disciplina de Cirurgia do Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de S. Paulo
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24
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Szajnbok I, Lorenzi F, Rodrigues Júnior AJ, Zantut LF, Poggetti RS, Steinman E, Birolini D. Gallstone ileus resulting in strong intestinal obstruction. SAO PAULO MED J 1995; 113:721-5. [PMID: 8578083 DOI: 10.1590/s1516-31801995000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecyst-enteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.
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Affiliation(s)
- I Szajnbok
- Trauma Surgery Discipline, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
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25
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Machado MA, Volpe P, Souza Júnior AL, Poggetti RS, Branco PD, Birolini D. [Traumatic injuries of the pancreas: report of 65 cases]. Rev Hosp Clin Fac Med Sao Paulo 1994; 49:238-42. [PMID: 7610335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
With the aim of aiding the accurate diagnosis and treatment of patients with pancreatic injuries, we reviewed the medical records of sixty-five patients, treated for traumatic pancreatic lesions at the Department of Surgery of the University of São Paulo in the 5-year period from 1989 through 1993. Records, including operative and pathology reports, were reviewed and the location of the pancreatic injury, associated intra-abdominal injuries, type of injury, trauma scores, treatment, complications and mortality rates recorded. There were 58 male and seven female patients with a mean age of 28.3 years (range, 2-77 years). Of the 65 pancreatic injuries, 45 (69.2%) were caused by penetrating wounds and twenty by blunt trauma. The most frequent site of lesion was the head of the pancreas (38.5%). Associated injuries were found in all but five of the patients. In the 65 patients, 170 intra-abdominal injuries were found (2.6 per patient). Twenty-eight of the 65 patients (43.1%) had liver lacerations. Lacerations of major abdominal vessels (27 patients), gastric lacerations (25 patients) and colorectal lacerations (17 patients) were the next most frequent injuries. Fifteen out of twenty patients died within two days after the accident from severe concomitant injuries. Simple drainage was performed in 33 patients, distal pancreatectomy in 17 and duodenopancreatectomy in six patients. Pancreas-related complications occurred in 20 (30.7%) out of 57 patients who survived the initial operation. We concluded that the type of repair employed in our series was related to the class of injury and clinical conditions (based on trauma scores). Therefore, whenever possible, conservative management (no pancreatic resection) was employed in patients that sustained class I and II injuries and pancreatic resection in class III and IV injuries.
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Affiliation(s)
- M A Machado
- Disciplina de Cirurgia do Trauma do Hospital, Faculdade de Medicina, Universidade de São Paulo
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26
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Volpe P, Machado MA, Martini AC, Steinman E, Poggetti RS, Branco PD, Birolini D. [A fatal case of lower gastrointestinal hemorrhage: report of case and review of the literature]. Rev Hosp Clin Fac Med Sao Paulo 1994; 49:179-82. [PMID: 7871329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Gastrointestinal hemorrhage continues to be a major medical problem. Even with improvements in both diagnostic and therapeutic, a significant number of patients still require surgical intervention for control of hemorrhage. When the source of persistent lower gastrointestinal hemorrhage is unknown, subtotal colectomy is a conceptually rational management choice. The authors present a case of massive lower gastrointestinal hemorrhage with unusual fatal outcome. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.
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Affiliation(s)
- P Volpe
- Serviço de Cirurgia Geral, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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27
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Machado MA, Ikejiri CI, Borrelli M, Steinman M, Figueiredo AM, Poggetti RS, Branco PD, Birolini D. An unusual case of four iliac veins injured by gunshot: case report and review of the literature. J Trauma 1994; 36:442-3. [PMID: 8145339 DOI: 10.1097/00005373-199403000-00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Multiple injuries of iliac veins are uncommon and frequently fatal. An unusual case in which there were injuries of the four iliac veins by gunshot is described. Prompt control of hemorrhage is required. Because our patient was in unstable condition, ligation of the four iliac veins was performed and the abdomen was packed. After a complicated course, the patient was discharged after 40 days in good condition. Although venous repair is often recommended, ligation in extensive injuries may be necessary, and is usually well tolerated in young, previously healthy individuals like our patient.
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Affiliation(s)
- M A Machado
- Department of Surgery, University of São Paulo School of Medicine, Brazil
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28
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Machado MA, de Souza Júnior AL, Poggetti RS, Utiyama EM, Branco PD, Birolini D. [Risk factors in emergency surgery relaparotomy]. Rev Hosp Clin Fac Med Sao Paulo 1994; 49:17-20. [PMID: 8029609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Reintervention in abdominal surgery involves the difficulty of precise indication and the limitations of surgical technics during the operation. It may bring to evidence professional errors. It presents a very high morbimortality index. In order to establish risk factors and death rate, we comparatively analysed the initial diagnoses, the number, the cause and the time of relaparotomy, the existence of associated diseases, the age and the illness severity, using APACHE-II after the first surgical intervention. During a two years period starting 1990 we retrospectively analysed charts of 40 patients submitted to relaparotomy in the Emergency Service of Hospital das Clínicas of Medicine University of São Paulo.
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Affiliation(s)
- M A Machado
- Disciplina de Cirurgia do Trauma do Hospital das clínicas da Faculdade de Medicina da Universidade de São Paulo
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29
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Zantut LF, Machado MA, Volpe P, Poggetti RS, Birolini D. [Gallbladder injury in abdominal trauma: analysis of 32 cases]. Rev Hosp Clin Fac Med Sao Paulo 1993; 48:283-8. [PMID: 8029601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Gallbladder lesion is infrequent, occurring in approximately 0.5 to 8.5% of all patients with blunt and penetrating abdominal trauma. The incidence of gallbladder injury in such cases is low. This study reviewed 32 patients with gallbladder injury due to abdominal trauma over a 6-year period to determine the complications, associated injuries, and mortality rate.
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Affiliation(s)
- L F Zantut
- Disciplina de Cirurgia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo
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30
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Zantut LF, Machado MA, Volpe P, de Lima MJ, Poggetti RS, Birolini D. [Conservative treatment of severe liver trauma: report of a case and review of therapeutic methods]. Rev Hosp Clin Fac Med Sao Paulo 1993; 48:235-241. [PMID: 8165411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The emergency surgical treatment of severe hepatic traumas still carries a high mortality risk. We report a case of severe blunt trauma to the liver managed without surgery under CT guidance. This attitude requires haemodynamic stability of the patient, close monitoring in a surgical intensive care unit and repeated CT scans. Laparoscopy was used to the management of hemoperitoneum due to rupture of hematoma and diagnosis and treatment of bile leakage. Conservative treatment is a reasonable option in selected hemodynamically stable patient with severe hepatic trauma.
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Affiliation(s)
- L F Zantut
- Disciplina de Cirurgia, Trauma do Hóspital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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31
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Zantut LF, Machado MA, Volpe P, Poggetti RS, Birolini D. Bilateral diaphragmatic injury diagnosed by laparoscopy. Rev Paul Med 1993; 111:430-2. [PMID: 8108638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Rupture of the diaphragm from blunt trauma is uncommon, but greatly improved prehospital care and transportation of victims has increased the frequency at which patients who sustain this injury arrive at the emergency room alive. We report a case of bilateral diaphragmatic rupture from blunt abdominal trauma in a 33-year old man. Diagnosis was established by laparoscopy after suggestive chest X-rays, liver scintigraphy, CT scan and magnetic resonance imaging. The methods used to diagnose this condition are analyzed.
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Affiliation(s)
- L F Zantut
- Disciplina de Cirurgia do Trauma, Hospi8tal das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brasil
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32
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Sallum EA, Mori ND, Novo FC, Poggetti RS, Branco PD, Birolini D. [Gastric wounds: study of 85 patients]. Rev Hosp Clin Fac Med Sao Paulo 1993; 48:119-22. [PMID: 8248701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
During January 1987 and December 1990 we studied 85 patients (75 males), the age varying between 6 and 47 years (mean 27.6) sustaining penetrating (81 patients) and blunt (4 patients) gastric wounds. The mortality rate was 17.6% (15 patients) with four deaths occurring during the surgical procedure as consequence of critical associated injuries. Only one death happened as consequence of gastric wound; 6 patients died during the first 24 hours of hospitalization because of irreversible shock, 9 deaths came about after the first day of hospitalization (4 sepsis, 3 respiratory failure, 2 head trauma). The morbidity rate among the 81 patients that survived after surgical treatment was 39.5% (32 patients). The main postoperative gastric complication was vomiting in 10 patients (5 presenting vagus nerve injury and 5 sustaining pancreatic and/or another hollow viscus wounds) one patient presented with gastric suture dehiscence. Among the 12 patients sustaining vagus nerve injury the presence of gastric complication was higher in the group that was not submitted to pyloroplasty (6 patients). Analysing the patients presenting gastric and pancreatic injuries we verified that morbidity rate was statistically significantly higher in this group (69.2%) than in overall morbidity (39.5%).
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Affiliation(s)
- E A Sallum
- Pronto Socorro Central, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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33
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Machado MA, Ikejiri CI, Borrelli Júnior M, Steinman M, Figueiredo ADM, Poggetti RS, Branco PD, Birolini D. [Simultaneous injury of 4 iliac veins by firearm: report of a case and review of the literature]. Rev Hosp Clin Fac Med Sao Paulo 1993; 48:123-6. [PMID: 8248702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Iliac vessel injuries constitute approximately 10 percent of all vascular traumatic lesions. The high mortality rate is due to the massive exsanguination and the high frequency of associated injuries. Iliac vein injury occurs either isolated or in association with the arterial lesion. Multiple injuries of iliac veins are uncommon and frequently fatal. An unusual case, in which there were injuries of the four iliac veins by gunshot is described. A review of literature of this condition and a discussion about the diagnosis, treatment and factors affecting mortality rate is presented. No other such case has been found reported.
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Affiliation(s)
- M A Machado
- Disciplina de Cirurgia do Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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34
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Ikejiri CI, Machado MA, Borrelli Júnior M, Zamboni W, Poggetti RS, Branco PD, Birolini D. [Traumatic right diaphragmatic hernia: report of a case and review of the diagnostic methods]. Rev Hosp Clin Fac Med Sao Paulo 1993; 48:35-8. [PMID: 8235268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Rupture of the right hemidiaphragm from blunt trauma is uncommon. Better management and more rapid transportation of victims has increased the frequency with which patients sustaining this injury are arriving at the emergency room alive. A case of right-sided diaphragmatic hernia from blunt trauma in a 36-year-old man is reported. Diagnosis was established by chest x-ray, CT scan and digital exploration after unsuccessful thoracoscopy. The methods used for diagnosis of this condition are analysed.
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Affiliation(s)
- C I Ikejiri
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo
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35
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Abstract
The nonresectional approach to major liver trauma is clearly preferred. Unfortunately, trachotomy with vessel ligation, selective hepatic arterial ligation, perihepatic pack, and fibrin glue are not viable options with high-energy bilobar liver injuries. We have fashioned a balloon tamponade device that has proved very effective for these transfixing hepatic gunshot wounds.
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Affiliation(s)
- R S Poggetti
- Department of Surgery, Denver General Hospital, Colorado 80204-4507
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36
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Zantut LF, Machado MA, de Souza AL, Volpe P, Rodrigues Júnior AJ, Poggetti RS, Birolini D. Gallbladder injuries due to blunt abdominal trauma: report on five cases and review of the literature. Rev Paul Med 1992; 110:285-8. [PMID: 1341028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of São Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature.
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37
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Bensard DD, Anderson BO, Banerjee A, Nelson DW, Poggetti RS, Berens RL, Harken AH. Platelet activating factor alters receptor-coupled function in the isolated perfused rat heart. J Surg Res 1992; 53:321-5. [PMID: 1328766 DOI: 10.1016/0022-4804(92)90055-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sepsis induces primary myocardial dysfunction. Yet, both hyper- and hypodynamic cardiac states characterize the sepsis syndrome, suggesting a modulatory role of septic mediators. Platelet activating factor (PAF), implicated in the pathogenesis of sepsis, is an endogenous phospholipid with diverse intracellular and extracellular effects. The purpose of this study was to investigate the influence of PAF (1) upon basal mechanical function of the heart, (2) upon receptor-coupled function of the heart, and (3) on basal and stimulated myocardial function at differing concentrations. In order to focus on the relationship between PAF and cardiac mechanical function, rat hearts were isolated and crystalloid perfused using a modified Langendorf preparation. Separate hearts received intracoronary vehicle (5% ethanol, 2.5% BSA) or PAF (20 or 40 microM) as a bolus, followed 10 min later by 0.25 microM isoproterenol (beta-receptor agonist) infusion over 3 min. Both 20 and 40 microM PAF produced a rapid decrease in rate pressure product (RPP = HR X LVDPmax) relative to control (P < 0.05). The depressive effect of PAF upon basal myocardial function did not persist and by 10 min RPP was not different (P > 0.05) among the groups. Isoproterenol infusion increased (P < 0.05) RPP in all groups. However, hearts pretreated with 20 microM PAF demonstrated a greater (P < 0.05) response to beta-adrenergic stimulation relative to vehicle-pretreated controls. This amplified response to isoproterenol was not observed with pretreatment at a higher concentration of PAF (40 microM, P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D D Bensard
- Department of Surgery, University of Colorado Health Sciences Center, Denver 80262
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38
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Abstract
Gut bacteria translocation has been invoked as a prime cause of early postinjury death. To examine this hypothesis, we obtained emergency department blood cultures in 132 acutely injured patients requiring urgent laparotomy for trauma. In the latter half of these patients, mesenteric lymph node and liver biopsy cultures were also performed. The incidence of early bacteremia was 11% (10/94) in the patients without shock compared with 32% (12/38) in the group with shock. The majority (73%) were gram-positive bacteremias. Most notably, Staphylococcus was isolated in 13% (5/38) of the patients with shock, but these isolates were of no apparent clinical significance. In contrast, 18% (7/38) of the patients with shock had enteric bacteremias, and all of these patients died. Cultures were positive in 11% of the liver samples and 15% of the mesenteric lymph nodes. With the exception of two patients with concurrent enteric bacteremias, these hepatic and mesenteric lymph node bacteria were of no clinical significance. In conclusion, bacterial translocation occurs infrequently, and virtually all enteric bacteria were found in dying patients; the cause or effect remains to be defined.
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Affiliation(s)
- F A Moore
- Department of Surgery, General Hospital Denver, CO 80204-4507
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39
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Abstract
We have recently reported that 45 min of gut ischemia causes moderate 125I-albumin lung leak at 6 hr of reperfusion which was reversed at 18 hr. Our purpose was to determine the effect of a second insult, low dose endotoxin (LPS, 2.5 mg/kg), given 6 hr after gut ischemia/reperfusion (I/R) on this lung injury as assessed by 125I-albumin leak, neutrophil influx (myeloperoxidase assay, MPO), histopathology, and mortality. Rats were randomized to either sham laparotomy (LAP) or 45 min of superior mesenteric artery occlusion and 6 hr later were treated with LPS or saline. At 18 hr reperfusion the lungs were harvested, assayed for 125I-albumin leak and MPO, and microscopically examined by an unbiased observer after routine H&E staining. We observed that LPS increased lung neutrophil levels both with or without gut I/R. However, only the combined insult (I/R + LPS) increased 125I-albumin leak at 18 hr of reperfusion. Lung histology confirmed that the sequential combination of I/R + LPS caused marked interstitial edema and neutrophil sequestration accompanied by alveolar edema, hemorrhage, and fibrinous exudate, while I/R or LAP + LPS did not. The mortality rate of I/R + LPS was 39% which was significantly higher than LAP alone (0%), gut I/R alone (0%), or LAP + LPS (4%). In conclusion, a delayed exposure to low dose endotoxin converts moderate gut I/R-induced lung dysfunction into advanced organ failure.
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Affiliation(s)
- K Koike
- Department of Surgery, Denver General Hospital, Colorado 80204
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40
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Poggetti RS, Moore FA, Moore EE, Koeike K, Banerjee A. Simultaneous liver and lung injury following gut ischemia is mediated by xanthine oxidase. J Trauma 1992; 32:723-7; discussion 727-8. [PMID: 1613831 DOI: 10.1097/00005373-199206000-00008] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have previously shown that gut ischemia/reperfusion (I/R) causes simultaneous liver and lung dysfunction and that neutrophils play a critical role in this process. The purpose of this study was to ascertain whether xanthine oxidase (XO) was likewise operational. Normal and XO-inactivated rats (given a tungsten-enriched, molybdenum-depleted diet for 3 weeks) underwent 45 minutes of occlusion of the superior mesenteric artery, and control rats were subjected to a sham laparotomy. After zero and six hours of reperfusion, blood was sampled and livers and lungs harvested. Iodine-125-labeled albumin leak was used as a marker for pulmonary and liver capillary permeability barrier function, and serum acetoacetate/3-hydroxybutyrate (AcAc/3-OHB) levels as an index of hepatic mitochondrial redox state. Gut ischemia/six hours of reperfusion (I/R) increased the 125I albumin lung/blood ratio and the 125I albumin liver/blood ratio; AcAc/3-OHB levels decreased significantly. Xanthine oxidase activation eliminated the observed lung and liver capillary leak as well as the hepatic metabolic derangement induced by gut I/R. In conclusion, the simultaneous lung and liver dysfunction produced by gut I/R is mediated by XO.
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Affiliation(s)
- R S Poggetti
- Department of Surgery, Denver General Hospital, Colorado
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41
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Abstract
We have previously shown that gut ischemia/reperfusion (I/R) causes liver dysfunction in vivo (increased [I125]albumin leak, decreased mitochondrial redox potential). Our purpose was to investigate liver dysfunction due to gut I/R in an ex vivo model where oxygen delivery (DO2) could be controlled. Rats underwent laparotomy (sham) or 45 min of superior mesenteric artery (SMA) occlusion (I/R) and 6 hr later the gut and liver were isolated in situ. Pressures were monitored while recirculating blood was perfused via the hepatic artery (2.5 ml/min) for 90 min and the SMA (7.5 ml/min) for the first 30 min, then the portal vein (7.5 ml/min) for 60 min. Both gut and liver DO2 and VO2 (Fick method) were maintained throughout the study period in the gut I/R as well as sham groups. Despite maintenance of liver VO2, however, gut I/R resulted in a marked and persistent reduction in bile flow. In conclusion, dysfunctional bile production after gut I/R is not due to impaired VO2, but rather gut-liver signaling yet to be defined.
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Affiliation(s)
- R S Poggetti
- Department of Surgery, Denver General Hospital, Colorado
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42
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Abstract
The purposes of this study were to characterize the temporal relationship of distant organ dysfunction after mesenteric ischemia/reperfusion (I/R), and to ascertain if the neutrophil is critical to this process. Normal and neutrophil-depleted rats (vinblastine sulfate, 0.75 mg/kg intravenously) underwent 45 minutes of superior mesenteric artery occlusion and after 0, 6, and 18 hours of reperfusion, blood was sampled and liver and lungs were harvested. Iodine 125 albumin leak was used as a marker for pulmonary and liver injury, and serum acetoacetate/3-hydroxybutyrate (AcAc/3-OHB) was used as an index of hepatic mitochondrial redox state. Gut I/R at 6 hours increased 125I-albumin lung/blood ratio (gut I/R, 0.077 +/- 0.006; control, 0.045 +/- 0.004) and 125I-albumin liver/blood ratio (gut I/R, 0.120 +/- 0.007; control, 0.077 +/- 0.003), while AcAc/3-OHB decreased significantly (gut I/R, 0.420 +/- 0.040; control, 0.880 +/- 0.120). Neutrophil depletion eliminated these changes at 6 hours (blood AcAc/3-OHB, 0.720 +/- 0.100; 125I liver/blood, 0.068 +/- 0.006; 125I lung/blood, 0.046 +/- 0.007). We conclude the following: (1) intestinal I/R produces simultaneous liver and lung injury; (2) injury was present at 6 hours but is reversed at 18 hours; and (3) the I/R-induced liver and lung injuries were neutrophil mediated.
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Affiliation(s)
- R S Poggetti
- Department of Surgery, Denver (Colo) General Hospital
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43
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Abstract
Major trauma provokes a stress response which is mediated, in part, via glucagon, catecholamines, and cortisol. These stress hormones modulate the choice of energy substrate for various tissues. While glucose and fatty acids are considered the preferred fuels, ketone bodies (26/ATP/mole) may be a viable alternative. In this study, we measured the concentrations of acetoacetate and beta-hydroxybutyrate (3-OHB) in the portal as well as systemic circulations of 10 critically injured patients (revised trauma score = 6.8 +/- 0.5, injury severity score = 27 +/- 3) during the first 5 postoperative days. At 6 hr postinjury, 3-OHB was elevated in the portal system (0.34 +/- 0.01 mM) while depressed systemically (0.09 +/- 0.02 mM), indicating that the gut was capable of ketogenesis. In contrast, at 24 hr, 3-OHB rose systemically (0.39 +/- 0.02 mM) while decreasing in portal blood (0.09 +/- 0.01 mM) implying gut ketone consumption. Moreover, the systemic ketone body ratio became elevated at 24 hr, suggesting an enhanced liver energy status. In summary, we believe ketogenesis is stimulated by major trauma. Initially, the gut supports ketone concentration in the systemic circulation, whereas, by 24 hr, the gut becomes a ketone consumer and the liver maintains circulating levels.
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Affiliation(s)
- R S Poggetti
- Department of Surgery, Denver General Hospital, Colorado
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Anderson BO, Poggetti RS, Shanley PF, Bensard DD, Pitman JM, Nelson DW, Whitman GJ, Banerjee A, Harken AH. Primed neutrophils injure rat lung through a platelet-activating factor-dependent mechanism. J Surg Res 1991; 50:510-4. [PMID: 1710005 DOI: 10.1016/0022-4804(91)90033-i] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bacterial lipopolysaccharide (LPS) promotes transient lung neutrophil sequestration. These LPS-primed neutrophils, when stimulated by an N-formyl peptide (FNLP), promote lung injury. We hypothesized that LPS-primed, FNLP-stimulated neutrophils promote lung injury through a platelet-activating factor (PAF)-dependent mechanism. Rats were pretreated with either saline or WEB2170, a PAF receptor antagonist (10 mg/kg po). One hour after pretreatment, rats were administered intraperitoneal LPS (salmonella typhimurium lipopolysaccharide, 500 micrograms/kg) followed 6 hr later by intravenous FNLP (250 micrograms/kg infused over 30 min). Two hours after the initiation of FNLP infusion, rats were sacrificed and assays were performed to measure: (1) lung neutrophil sequestration with myeloperoxidase (MPO) activity; (2) circulating neutrophil activation with nitroblue tetrazolium (NBT) staining, and (3) lung microvascular leak with 125I-albumin flux. We found that lung myeloperoxidase, circulating neutrophil NBT staining, and lung 125I-albumin flux were increased (P less than 0.05) in saline-pretreated LPS/FNLP rats, relative to control. While lung MPO remained increased (P less than 0.05) in WEB2170-pretreated LPS/FNLP rats, circulating neutrophil NBT and lung 125I-albumin flux were decreased (P less than 0.05) relative to those in saline-pretreated rats. We conclude that PAF mediates LPS/FNLP-induced neutrophil activation and lung injury, but is independent from lung neutrophil sequestration. Thus, lung neutrophil sequestration does not inevitably produce lung injury. Rather, neutrophils can accumulate in the lung without causing lung injury if neutrophil activation can be blocked.
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Affiliation(s)
- B O Anderson
- Department of Surgery, University of Colorado Health Sciences Center, Denver 80262
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45
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Branco PD, Poggetti RS, Bernini CDO, Birolini D. [Balloon tamponade in transfixing wounds of the liver: immediate results]. Rev Hosp Clin Fac Med Sao Paulo 1988; 43:20-5. [PMID: 3249876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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46
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Bernini CO, Branco PD, Birolini D, Poggetti RS, Aun R. [Injuries of the inferior vena cava. Analysis of 75 cases]. AMB Rev Assoc Med Bras 1986; 32:84-8. [PMID: 3493507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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