A Review of the Analgesic Benefi ts and Potential Complications Related to Epidural Corticosteroid Injections.

The Institute of Medicine has reported that greater than 115 million adults in the United States are living with some form of chronic pain. Back pain is the most prevalent and is associated with high individual morbidity and increased healthcare costs. One approach for the management of chronic back pain involves the injection of corticosteroids in the epidural space.

The impact of leader moral humility on follower moral self-efficacy and behavior.

This study utilizes social-cognitive theory, humble leadership theory, and the behavioral ethics literature to theoretically develop the concept of leader moral humility and its effects on followers. Specifically, we propose a theoretical model wherein leader moral humility and follower implicit theories about morality interact to predict follower moral efficacy, which in turn increases follower prosocial behavior and decreases follower unethical behavior. We furthermore suggest that these effects are strongest when followers hold an incremental implicit theory of morality (i.

Optimal end-organ protection for thoracic and thoracoabdominal aortic aneurysm repair using deep hypothermic circulatory arrest.

Background: Despite the advent of numerous protective strategies, thoracic and thoracoabdominal aortic replacement remains a high risk. While mortality rates have improved over the last 15 years, the incidence of adverse outcomes (including stroke, renal failure, and paraplegia, as well as death) remains at 13% to 30% in all published series. The use of deep hypothermic cardiopulmonary bypass with circulatory arrest has been associated with high morbidity in the past; however, we report a single surgeon's experience of improved end-organ protection with low morbidity and mortality utilizing this technique.

Sepsis-induced failure of hepatic energy metabolism.

Hypothesis: Recent evidence suggests that sepsis may induce an uncoupling of oxidative phosphorylation. The purpose of this study was to quantify temporal changes in hepatic oxygen consumption and cellular energy state with increasing severity of sepsis and thus assess the interrelationship of these parameters as either primary defect or compensatory response.

Main Outcome Measures: Pseudomonas aeruginosa was infused intravenously in eight instrumented anesthetized swine inducing a progressive severity of sepsis to shock.

Increased tissue oxygen extraction and acidosis with progressive severity of sepsis.

Background: Lactic acidosis and increased production of CO(2) are common in septic shock. Presumably, both acidosis and CO(2) enhance the release of oxygen from hemoglobin. The purpose of this study was to assess the relationship of oxygen utilization, CO(2) production, acidosis, and hemoglobin oxygen (Hgb-O(2)) dissociation with progressive severity of sepsis to shock.

Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn.

Background: Severe burn induces a systemic hypermetabolic response, which includes increased energy expenditure, protein catabolism, and diminished immunity. We hypothesized that early burn excision and aggressive enteral feeding diminish hypermetabolism.

Methods: Forty-six burned children were enrolled into a cohort analytic study.

Influence of fever on the hypermetabolic response in burn-injured children.

Background: Burn injury typically elicits a hypermetabolic response characterized by increased energy expenditure and muscle protein catabolism.

Hypothesis: Fever further increases energy expenditure and muscle loss in otherwise highly hypermetabolic burn patients.

Design: Retrospective analysis of experimental study.

Hyperglycemia exacerbates muscle protein catabolism in burn-injured patients.

Objective: The purpose of this study was to assess if hyperglycemia influences energy expenditure or the extent of muscle protein catabolism in severely burned adults.

Design: Retrospective study.

Setting: Burn intensive care unit at a university hospital.

Beta-blockade and growth hormone after burn.

Objective: To determine whether propranolol and growth hormone (GH) have additive effects to combat burn-induced catabolism.

Summary Background Data: Both GH and propranolol have been attributed anabolic properties after severe trauma and burn. It is conceivable that the two in combination would have additive effects.

Energy expenditure and caloric balance after burn: increased feeding leads to fat rather than lean mass accretion.

Objective: Resting energy expenditure (REE) is commonly measured in critical illness to determine caloric "demands" and thus nutritive needs.

Summary Background Data: The purpose of this study was to 1) determine whether REE is associated with clinical outcomes and 2) determine whether an optimal caloric delivery rate based on REE exists to offset erosion of lean mass after burn.

Methods: From 1995 to 2001, REE was measured by indirect calorimetry in 250 survivors of 10 to 99%TBSA burns.