Sildenafil increases muscle protein synthesis and reduces muscle fatigue.

Reductions in skeletal muscle function occur during the course of healthy aging as well as with bed rest or diverse diseases such as cancer, muscular dystrophy, and heart failure. However, there are no accepted pharmacologic therapies to improve impaired skeletal muscle function. Nitric oxide may influence skeletal muscle function through effects on excitation-contraction coupling, myofibrillar function, perfusion, and metabolism.

Crew resource management improved perception of patient safety in the operating room.

To improve safety in the operating theater, a company of aviation pilots was employed to guide implementation of preprocedural briefings. A 5-point Likert scale survey that assessed the attitudes of operating room personnel toward patient safety was distributed before and 6 months following implementation of the briefings. Using Mann-Whitney analysis, the survey showed a significant (P < .

Assessment of adverse events in the demise of pediatric burn patients.

Background: Given the contention that survival is to be expected from even the most severely burned child, then, intuitively, at least some pediatric burn victims die because of suboptimal care. The purpose of this study is to assess the impact of any adverse events that may have contributed to the death of burned children.

Methods: Four surgeons with specialty training in pediatric burn care reviewed the clinical course and autopsy findings of 71 burned children who died after admission to a burn center during a 10-year interval.

Preoperative maneuvers to avert postoperative respiratory failure in elderly patients.

Background: The elderly appear particularly vulnerable to pulmonary complications following surgical procedures.

Objective: The purpose of this study was to identify and assess the merit of various maneuvers employed to mitigate respiratory difficulties in elderly patients undergoing surgery.

Results: The literature revealed evidence that diminishing sputum production with selective antibiotics and augmentation of sputum clearance with assisted coughing, postural drainage, and bronchodilators were deemed important.

Quantification of amino acid transport through interstitial fluid: assessment of four-compartment modeling for muscle protein kinetics.

The purpose of this study was to assess a novel technique for quantifying in vivo muscle protein metabolism and phenylalanine transport in septic patients and normal volunteers and thereby assess the influence of sepsis on muscle protein kinetics. In patients resuscitated from sepsis, blood flow and edema may influence the extent of muscle loss. Six adult patients septic from pneumonia underwent a study protocol consisting of infusion of isotopic phenylalanine, indocyanine green dye, and sodium bromide; biopsies of skeletal muscle; and sampling from the femoral artery, vein, and interstitial fluid.

Splanchnic oxygen consumption is impaired during severe acute normovolemic anemia in anesthetized humans.

Background: In conscious humans, reduction in hemoglobin concentration to 5 g/dl did not produce inadequate systemic oxygenation. However, systemic measures of inadequate oxygenation may not be sufficiently sensitive to detect inadequate oxygenation in individual organs such as splanchnic organs. The authors tested the hypothesis that acute normovolemic anemia to hemoglobin less than 6.

Quantification of protein metabolism in vivo for skin, wound, and muscle in severe burn patients.

Background: In response to injury, muscle catabolism can be extensive, and in theory, the wound consumes amino acids to support healing. The purpose of this study is to assess a technique by which in vivo protein kinetics of muscle, wound, and normal skin can be quantified in burn-injured patients.

Methods: Study protocol consisting of infusion of d5 phenylalanine; biopsies of skeletal muscle, skin, and donor-site wound on the leg; quantification of blood flow to total leg, wound, and skin; and sequential blood sampling from the femoral artery and vein.

Supportive care in acute respiratory distress syndrome.

Although the central focus of acute respiratory distress syndrome (ARDS) is the pathology within the lung, ARDS is very much a systemic disease. As such, the whole body needs care and support while the disease process within the lung runs its course. The issues of pain management, sedation, fluid balance, nutrition, metabolic and hormonal processes, infection control, and patient positioning are important for any patient in a critical care setting.

Hemodynamic and metabolic effects of selective beta1 adrenergic blockade during sepsis.

Background: Selective beta adrenergic antagonists are commonly used to reduce myocardial demise in patients at risk for cardiac-related death. The purpose of this study was to examine the hemodynamic and metabolic effects of cardiac selective beta adrenergic blockade in patients.

Methods: Muscle protein kinetics were quantified using isotopic tracer methodology in 6 moderately septic, mechanically ventilated patients with pneumonia before and then at the conclusion of a 3-hour infusion of esmolol of sufficient dose to reduce heart rate by 20% from baseline.

National survey of surgical morbidity and mortality conferences.

Background: Morbidity and mortality conferences historically have been a paramount meeting for education and quality assurance within surgical departments of teaching institutions. The purpose of this survey was to assess the present educational value and the quality assurance aspect of surgical mortality conferences.

Methods: Surveys were sent to every academic surgical training program director within the United States and Canada (n = 127) and queried the general format and an individual's experience and attitude toward their institutions conference.

Comparison of peripheral metabolic effects of insulin and metformin following severe burn injury.

Objective: Both insulin and metformin have been shown to attenuate hyperglycemia and reduce net muscle protein catabolism following burn injury. The purpose of this study was to compare the peripheral metabolic effects of insulin and metformin in severe burn patients.

Methods: Six adult patients with burns greater than 40% of their body surface underwent metabolic evaluation utilizing isotopic dilution of phenylalanine, femoral arterial and venous blood sampling, and sequential biopsies of leg muscle.

Temporal changes in cellular energy following burn injury.

Availability of ADP is a predominant influence on respiratory control. Associated with severe burn injury is an increase in energy expenditure. The purpose of this study was to determine the temporal changes in ATP, ADP, NAD, and NADH following severe burn and thereby assess any related alterations in respiratory control and energy deficit.

Utility of acellular allograft dermis in the care of elderly burn patients.

Background: Because skin thins with advancing age, traditional thickness skin grafts cannot always be obtained in very elderly burn patients without creating a new full-thickness wound at the skin graft donor site.

Materials And Methods: In an attempt to circumvent this problem, acellular allograft dermis (Alloderm, Life Cell Corp., The Woodlands, TX) and thin autograft (depth 0.

Influence of metformin on glucose intolerance and muscle catabolism following severe burn injury.

Summary Background Data: Hyperglycemia and accelerated muscle catabolism have been shown to adversely affect immune response and survival. The purpose of this study was to determine the effect of metformin on glucose kinetics and muscle protein metabolism in severely burned patients and assess any potential benefit of metformin in this clinical setting.

Methods: In a double-blind, randomized manner, 8 adult burn patients received metformin (850 mg every 8 hours x 7 days), while 5 burn patients received placebo.

Angiosarcoma of the of scalp with calvarium involvement in a 50-year-old African-American man.

Background: Angiosarcoma of the scalp is a rare, aggressive, and deadly cancer that affects mainly elderly Caucasian men.

Objectives: The insidious and masquerading presentation of angiosarcoma poses enormous diagnostic challenges for primary care providers.

Patients/methods: We present a case of a 50-year-old black man referred for evaluation of a 3.

In vivo muscle amino acid transport involves two distinct processes.

We have tested the hypothesis that transit through the interstitial fluid, rather than across cell membranes, is rate limiting for amino acid uptake from blood into muscle in human subjects. To quantify muscle transmembrane transport of naturally occurring amino acids, we developed a novel 4-pool model that distinguishes between the interstitial and intracellular fluid compartments. Transport kinetics of phenylalanine, leucine, lysine, and alanine were quantified using tracers labeled with stable isotopes.

Increased VLDL-TAG turnover during and after acute moderate-intensity exercise.

Purpose And Methods: Breakdown rates of very low density lipoprotein triacylglycerols (VLDL-TAG) were quantified before (3 h), during (45 min), and after (3 h) moderate physical exercise at 40% VO2 max in young sedentary subjects (four male and four female, age 29.8 +/-1.6 yr, BMI 24.

Extremity hyperinsulinemia stimulates muscle protein synthesis in severely injured patients.

Insulin has a well-recognized anabolic effect on muscle protein, yet critically ill, severely injured patients are often considered "resistant" to the action of insulin. The purpose of this study was to assess the in vivo effects of hyperinsulinemia on human skeletal muscle in severely injured patients. To accomplish this goal, 14 patients with burns encompassing >40% of their body surface area underwent metabolic evaluation utilizing isotopic dilution of phenylalanine, femoral artery and vein blood sampling, and sequential muscle biopsies of the leg.

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.

Metabolic response of muscle to alanine, glutamine, and valine supplementation during severe illness.

Background: Alanine and glutamine are released from muscle in response to critical illness. Subsequent depletion of glutamine from muscle is proposed as a principal factor in the limitation of muscle protein synthesis in severely ill patients. The objective of this study was to assess the peripheral metabolic response to enteral supplementation of alanine, glutamine, and valine in critically ill patients.

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.

Exogenous nitric oxide increases basal leg glucose uptake in humans.

This study addressed the role of blood flow and nitric oxide in leg glucose uptake. Seven subjects (5 men, 2 women) were studied during conditions of resting blood flow and increased blood flow, achieved by infusion of the nitric oxide (NO) donor sodium nitroprusside (SNP) into the femoral artery. Femoral arterial and venous blood samples were obtained and blood flow was determined by infusion of indocyanine green dye.