Non-operative management for penetrating splenic trauma: how far can we go to save splenic function?

Background: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures.

Early decreased neutrophil responsiveness is related to late onset sepsis in multitrauma patients: An international cohort study.

Background: Severe trauma can lead to the development of infectious complications after several days, such as sepsis. Early identification of patients at risk will aid anticipating these complications. The aim of this study was to test the relation between the acute (<24 hours) inflammatory response after injury measured by neutrophil responsiveness and the late (>5 days) development of septic complications and validate this in different trauma populations.

Serum lipase should be the laboratory test of choice for suspected acute pancreatitis.

Background. Serum lipase and amylase are biochemical analyses used to establish the diagnosis of acute pancreatitis (AP). Despite lipase having been shown internationally to be a more sensitive and specific test, amylase remains a popular first-line test.

Penetrating thorax injury leads to mild systemic activation of neutrophils without inflammatory complications.

Introduction: Trauma is one of the major causes of morbidity and mortality. Thoracic injuries are associated with inflammatory complications such as ARDS. The pathogenesis of this complication after pulmonary injury is incompletely understood, but neutrophils are thought to play a pivotal role.

Long-term results of stent graft treatment of subclavian artery injuries: management of choice for stable patients?

Background: The management of penetrating subclavian artery injuries poses a formidable surgical challenge. The feasibility of stent graft repair is already established. General use of this modality is not widely accepted due to concerns regarding the long-term outcome in a generally young patient population.

Benefit/risk profile of high-dose antithrombin in patients with severe sepsis treated with and without concomitant heparin.

A randomised, prospective, placebo-controlled phase III multicentre clinical trial (KyberSept) has been performed to test the efficacy of high-dose antithrombin therapy in patients with severe sepsis. Concomitant low-dose heparin has been routinely given in two thirds of patients for deep vein thrombosis prophylaxis. This study analyses heparin - antithrombin interactions in terms of long-term mortality, adverse events, and thromboembolic events.

Telavancin versus standard therapy for treatment of complicated skin and skin structure infections caused by gram-positive bacteria: FAST 2 study.

Telavancin is a bactericidal lipoglycopeptide with a multifunctional mechanism of action. We conducted a randomized, double blind, active-control phase II trial. Patients > or = 18 years of age with complicated skin and skin structure infections caused by suspected or confirmed gram-positive organisms were randomized to receive either telavancin at 10 mg/kg intravenously every 24 h (q24h) or standard therapy (antistaphylococcal penicillin at 2 g q6h or vancomycin at 1 g q12h).

High-dose antithrombin III in the treatment of severe sepsis in patients with a high risk of death: efficacy and safety.

Objective: To explore if patients with severe sepsis and with a predicted high risk of death (according to the Simplified Acute Physiology Score II) might have a treatment benefit from high-dose antithrombin III.

Design: Subgroup analysis of a randomized, placebo-controlled, double-blind, prospective phase III study.

Setting: Unifactorial and multifactorial reanalysis of prospectively defined populations from the KyberSept trial.

Neurologic outcome after penetrating extracranial arterial trauma.

Purpose: We undertook this study to determine factors that adversely affect outcome in patients with penetrating injury to the extracranial cerebral vasculature. Patients and methods Medical records were reviewed for all patients who had undergone surgical intervention to treat penetrating injury to the extracranial cerebral arteries between January 1989 and December 1999. Forensic autopsy findings were also reviewed for all patients who died as a result of their injury.

Duodenal injuries: surgical management adapted to circumstances.

Objectives: To evaluate the results of an evolving policy of primary repair of duodenal injuries, when considered feasible and safe, complemented by pyloric exclusion if any doubt as to the integrity of the repair existed.

Patients And Methods: A prospective analysis of all patients with surgically identified duodenal injuries treated at a single institution over a 3-year period.

Results: In 30 patients studied, there were four deaths (13%) and an overall complication rate of 47%.