Changes in NO Availability and Transpiration Rate Are Associated With a Rapid Diurnal Adjustment of Anion Contents as Well as N and Water Fluxes Between the Roots and Shoots.

Understanding interactions between water and nitrate fluxes in response to nitrate availability and transpiration rate is crucial to select more efficient plants for the use of water and nitrate. Some of these interactions were investigated in intact plants by combining a non-destructive gravimetric device with NO labeling. The set-up allowed high-resolution measurement of the effects of a cross-combination of two concentrations of KNO or KCl (0.

Oesophageal stent placement to treat a massive iatrogenic duodenal defect after laparoscopic cholecystectomy.

Iatrogenic duodenal injury occurring during laparoscopic cholecystectomy (LC) is managed surgically, though rarely a large, persistent fistula is refractory to surgical interventions. We present the case of a 40-year-old woman transferred to our centre following elective LC for a reported perforated duodenal ulcer. An uncontained leak was found to originate from a 1.

Interhospital transfer of liver trauma in New Mexico: a state of austere resources.

Background: There is debate in the trauma literature regarding the effect of prolonged prehospital transport on morbidity and mortality. This study analyzes the management of hepatic trauma patients requiring surgery and compares the outcomes of the group that was transferred to the University of New Mexico Hospital (UNMH) from outside institutions, to the directly admitted group.

Materials And Methods: The UNMH Trauma Database was queried from 2005-2012.

The sentinel placement of an open abdomen negative pressure unit.

The open abdomen is a common condition after a trauma necessitating celiotomy with the inability to close the fascia either due to damage control surgery or abdominal compartment syndrome. Traditionally the open abdomen has been approached with the use of the open abdomen temporary abdominal closure (Barker Vacuum Pack Dressing). More recently there has been the addition of the ABThera™ open abdomen negative pressure unit introduced by KCI.

Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives?

Background: In the rural setting, long distances may necessitate that a patient undergo emergency laparotomy before transfer to a regional trauma center for definitive management. The purpose of this study was to review the experience of three regional trauma centers with such treated patients.

Methods: This study was a retrospective chart review of patients who underwent emergency laparotomy for trauma before transfer, identified from the respective databases of participating centers over a 6-year period.

Trauma patient willingness to participate in alcohol screening and intervention.

Background: Screening and brief interventions for alcohol disorders in the trauma setting are not routine. Perceived barriers to screening and treatment include the perception that patients find the topic offensive and the feasibility of screening all patients. The hypothesis of the study was that discussing alcohol use would be acceptable to patients independent of race or screening test score.

Patient outcomes in academic medical centers: influence of fellowship programs and in-house on-call attending surgeon.

Background: There are very few data on characteristics or policies that improve patient outcomes in academic medical institutions. We were interested in 2 such policies or characteristics that are commonly implemented in academic centers: an in-house on-call attending physician policy and the existence of postgraduate medical education.

Hypothesis: An in-house attending surgeon on-call policy and the presence of trauma and critical care fellowship programs improve outcomes of critically injured patients.

Blood culturing practices in a trauma intensive care unit: does concurrent antibiotic use make a difference?

Background: Febrile trauma patients have repeated blood cultures drawn during a prolonged hospitalization. We examined the diagnostic yield of blood cultures in severely injured patients to determine whether concurrent antimicrobial therapy or prophylactic administration of antibiotics affects blood culture growth. We also determined how rapidly growth changed to determine whether total numbers of blood cultures could be decreased.

Intoxicated motor vehicle passengers warrant screening and treatment similar to intoxicated drivers.

Background: Alcohol interventions decrease alcohol consumption and recurrent injury. The study hypotheses are (1) intoxicated passengers are similar to intoxicated drivers in crashes and driving under the influence of alcohol (DUI), and (2) DUI conviction rates after injury are low.

Methods: Intoxicated motor vehicle occupants hospitalized for injury in 1996-1998 were matched to the state traffic database for crashes and DUI.

Evaluation of cervical spine in intensive care patients following blunt trauma.

The aim of this study was to review a Level 1 trauma center's use of early (< 72 hours from injury) limited MRI to "clear" cervical spine extradural soft tissue injuries in ICU patients sustaining blunt trauma. A retrospective review of the records of patients meeting entry criteria during 1997 was performed. Demographic data, cervical spine radiographic and imaging evaluation, results, and follow-up information were gathered.

Antibiotic bead production.

We are reporting a practical technique for the production of antibiotic beads for use in combating musculoskeletal infections. The technique utilizes bead molds with tobramycin powder mixed with polymethylmethacrylate on twisted wire strands to produce strands of 25 beads of various sizes. These beads are gas sterilized and available for use "off the shelf" in a manner that is much more efficient than traditional production by hand on the back table in the operating room.

Predictors of outcome in trauma during pregnancy: identification of patients who can be monitored for less than 6 hours.

Background: The first objective of this study was to identify risk factors in pregnant patients suffering blunt trauma predictive for uterine contractions, preterm labor, or fetal loss. The second objective was to identify patients who can safely undergo fetal monitoring for 6 hours or less after blunt trauma by selecting out those patients demonstrating the identified risk factors.

Methods: A retrospective chart review was performed from January 1, 1990, through December 31, 1998.

A prospective evaluation of video-assisted thoracic surgery for persistent air leak due to trauma.

Background: The time required for air leak resolution after chest trauma is not well described. Based on an institutional review of posttraumatic air leaks our hypothesis was that video-assisted thoracic surgery (VATS) for persistent posttraumatic air leak would decrease chest tube days and length of stay compared with nonoperative management.

Methods: Patients were offered VATS versus nonoperative management when air leaks persisted longer than 3 days and the patients were otherwise ready for discharge.

Stab wounds to the back/flank in hemodynamically stable patients: evaluation using triple-contrast computed tomography.

Triple-contrast computerized tomography (3CT) has been proposed as a method to detect high-risk injuries in hemodynamically stable patients with stab wounds (SWs) to the back/flank and to successfully triage patients with low-risk scans into a potentially cost-effective treatment algorithm. The purpose of this study was to retrospectively review our experience with the use of 3CT for diagnostic accuracy of SWs to the back/flank and to evaluate potential decreased length of stay (LOS) in the hospital for patients with low-risk scans and no associated injuries. Seventy-nine hemodynamically stable patients met criteria for inclusion in this review.

In-house versus on-call attending trauma surgeons at comparable level I trauma centers: a prospective study.

Background: The purpose of this study was to prospectively compare patient outcomes based on the presence of in-house versus on-call attending trauma surgeons at comparable Level I trauma centers.

Methods: Two designated Level I trauma centers agreed to prospectively review trauma admissions over a 6-month period, one institution with 24-hour in-house trauma attending surgeons (IH), and the other with trauma-attending surgeons taking call from home (OC) available to the hospital within 15 minutes of notification. A 6-month prospective study was conducted reviewing all trauma patients admitted to both trauma centers with an Injury Severity Score > or =16.

Evaluation of pulmonary infections in patients with extremity fractures and blunt chest trauma.

The use of preventive antibiotics has become the standard of care in the management of patients with multiple trauma who have injuries at risk for infection. In many areas of surgical practice, preventive antibiotic utilization has been restricted to the perioperative period only. In this study we reviewed a series of trauma patients with combined blunt chest injuries and extremity fractures to determine whether the duration of postoperative antibiotic administration would have adverse effects upon nosocomial pneumonia rates and severity.

Falls and ejections from pickup trucks.

The medical records of 50 patients who sustained injuries during falls or ejections from pickup truck beds and were admitted to the University of New Mexico Level I Trauma Center between January 1985 and December 1989 were retrospectively examined. Falls and ejections commonly involve young adults, and usually occur in the summer months during the afternoon or evening. Twenty-three individuals were thrown from the pickup truck bed during a motor vehicle collision and 27 simply fell out, and this distinction was not related to age or ethanol use.

Protein and energy tolerance by stressed geriatric patients.

Nutritional support of stressed geriatric patients remains empiric and has classically been limited by tolerance. Although the hypermetabolic response is known to increase protein and calorie demands, tolerance to increased loads of delivered nutrients in older patients has been questioned. We compared tolerance to nutrient delivery and nitrogen metabolism in 38 stressed surgical patients over age 65 to 38 Injury Severity Score or disease matched younger controls.

Obligatory negative nitrogen balance following spinal cord injury.

Obligatory nitrogen losses due to paralysis in the spinal cord-injured (SCI) patient prevent positive nitrogen balance (NB) regardless of the calorie and protein intakes. Ten patients with SCI and 20 controls with nonspinal cord injury (NSCI) matched for time, sex, age, and injury severity score (ISS) were admitted to our Level I trauma center. In both groups, total nutritional support was delivered within 72 hours of admission based on predicted energy expenditures (PEE = Harris-Benedict equation x 1.

Barotrauma associated with high-frequency jet ventilation for hypoxic salvage.

Most reports describe reduction in proximal airway pressures with high-frequency jet ventilation. This led us to speculate that high-frequency jet ventilation might reduce barotrauma by providing alveolar ventilation at lower airway pressures. We describe a group of patients in whom a high incidence of barotrauma was observed after institution of high-frequency jet ventilation despite reduction in measured airway pressures.

A computerized approach to injury description.

The study of trauma has been handicapped from its inception by the absence of a single coherent method of cataloging injuries. The AIS and ICD-9 systems have failed to fill this void because they lack the precision necessary to describe surgically treated injuries. We conceived a simple system of injury description in which injuries are rapidly encoded using a microcomputer in sufficient detail to distinguish among millions of different injuries.