The real risk of splenectomy after discharge home following nonoperative management of blunt splenic injury.

Background: The postdischarge natural history of nonoperative blunt splenic injury (BSI) has not been adequately elucidated. As a result, outpatient management is poorly defined. Population-based outpatient data would provide clinicians with an estimate of baseline risk of postdischarge splenectomy after nonoperative management of BSI.

Antibiotic-coated ePTFE decreases graft colonization and neointimal hyperplasia.

Background: Synthetic vascular conduits used in traumatic or infected fields have a high failure rate leading to catastrophic consequences including amputation and death. Although efforts to coat vascular grafts with antibiotics have had varying results, we developed a novel coating technique for expanded-polytetrafluoroethylene (ePTFE), which has proven to be effective in vitro. Thus, we hypothesized that the coated grafts would resist infection and have decreased neointimal hyperplasia when used in vivo in a large animal model.

Prevention of delayed gastric emptying after esophagectomy: a single center's experience with botulinum toxin.

Background: Impaired gastric emptying after esophagectomy contributes to significant morbidity and delayed recovery. Traditional measures to prevent this include pyloromyotomy and pyloroplasty. These procedures are associated with known complications and do not always prevent delayed gastric emptying.

Spondyloarthropathies and bone resorption: a possible role of heat shock protein (Hsp70).

Spondyloarthropathies consist of chronic inflammatory disorders genetically linked with each other through HLA-B27 molecules, and are connected with the destruction of periarticular bone and also with systemic bone loss in many cases. Expected molecular mechanisms behind these conditions overlap the functions of Hsp70s, a group of major molecular chaperones and cytokines. Hsp70s may control disease progression via inhibition of unfolded HLA-B27 protein accumulation and alteration of ER stress signaling.

Roger T. Sherman Lecture. Advances in the management of blunt thoracic aortic injury: Parmley to the present.

This article traces the evolution in management of blunt aortic injury (BAI) over the past 50 years from the time of the seminal description from Parmley in 1958. There have been major advances in both diagnostics and treatment paradigms with very rapid technologic advances occurring over the past decade. For many years, conventional aortography was the principle diagnostic tool, but it has been replaced by the progression of CT.

Efficacy of monotherapy in the treatment of Pseudomonas ventilator-associated pneumonia in patients with trauma.

Background: Controversy persists regarding the optimal treatment regimen for Pseudomonas ventilator-associated pneumonia (VAP). Combination antibiotic therapy is used to broaden the spectrum of activity of empiric treatment and provide synergistic bacteriocidal activity. The relevance of such "synergy" is commonly supposed but poorly supported.

Necessity of repeat head CT and ICU monitoring in patients with minimal brain injury.

Background: Recent publications have dismissed the need for routine repeat computed tomography (CT) scans in patients with minimal brain injury (MBI) (Glasgow Coma Scale score 13-15 with positive initial CT) unless physical examination changes. In an attempt to better allocate scarce resources, we hypothesized that not only was repeat head CT unnecessary but also routine intensive care unit (ICU) monitoring of these patients with MBI and stable examinations were unnecessary.

Methods: All blunt injured patients admitted to a level I trauma center from January 2005 through December 2007 who met our criteria for MBI (Glasgow Coma Scale score 14-15 with positive initial CT) were reviewed.

Aripiprazole prescribing patterns and side effects in elderly psychiatric inpatients.

Objective: This analysis examined dosing patterns and safety of aripiprazole in elderly inpatients.

Methods: A total of 52 elderly inpatients treated with aripiprazole over 3 years were retrospectively identified to examine dosing patterns and side effects associated with use of aripiprazole.

Results: The most common psychiatric diagnoses in these patients were schizophrenia/schizoaffective disorder (29%), bipolar disorder (25%), and major depressive disorder (23%).

Best practices: an intervention to promote evidence-based prescribing at a large psychiatric hospital.

An intervention to affect prescribing behavior was implemented at a large psychiatric hospital. Articles providing support for appropriate dosing of quetiapine were distributed to physicians, and peer discussions about prescribing practices were held. From April 2005 through December 2006, low-dose quetiapine prescriptions ( View Article and Find Full Text PDF

Evaluation of the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting.

Objective: Cutaneous afferent nerves contribute to joint proprioception. The aim of this study was to retrospectively analyze the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting in comparison to controls.

Methods: The proprioception of the ankle in 24 patients after sural nerve harvesting was investigated.

Human polymerized hemoglobin for the treatment of hemorrhagic shock when blood is unavailable: the USA multicenter trial.

Background: Human polymerized hemoglobin (PolyHeme, Northfield Laboratories) is a universally compatible oxygen carrier developed to treat life-threatening anemia. This multicenter phase III trial was the first US study to assess survival of patients resuscitated with a hemoglobin-based oxygen carrier starting at the scene of injury.

Study Design: Injured patients with a systolic blood pressure View Article and Find Full Text PDF

Utility of preliminary bronchoalveolar lavage results in suspected ventilator-associated pneumonia.

Background: More than one half of lower respiratory cultures are negative for ventilator-associated pneumonia (VAP) and final reporting requires 72 hours to 96 hours. A previous retrospective study concluded that preliminary bronchoalveolar lavage (BAL) culture results (pBAL), reported at approximately 24 hours, accurately predicted final BAL culture results (fBAL). Our objective was to verify the predictive value of pBALs for fBALs, and evaluate the use of insignificant (1-99,999 cfu/mL) pBALs for rapid discontinuation of empirical antibiotics.

Predictors of aripiprazole treatment continuation in hospitalized patients.

Objective: Aripiprazole is a second-generation antipsychotic that is increasingly prescribed in a variety of psychiatric disorders. The goal of this study was to investigate patient and treatment factors associated with aripiprazole treatment continuation on hospital discharge in psychiatric inpatients.

Method: This was a retrospective cohort analysis of patients admitted to a psychiatric hospital between January 1, 2003, and June 30, 2006, and treated with aripiprazole.

Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of ventilator-associated pneumonia (VAP). This prospective, open-label, multicenter clinical trial compared the early microbiological efficacy of linezolid (LZD) therapy with that of vancomycin (VAN) therapy in patients with MRSA VAP.

Methods: A total of 149 patients with suspected MRSA VAP were randomized to receive either LZD, 600 mg, or VAN, 1 g every 12 h.

Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure.

Objective: The options for abdominal coverage after damage control laparotomy or abdominal compartment syndrome vary by institution, surgeon preference, and type of patient. Some advocate polyglactin mesh (MESH), while others favor vacuum-assisted closure (VAC). We performed a single institution prospective randomized trial comparing morbidity and mortality differences between MESH and VAC.

Improved survival of critically ill trauma patients treated with recombinant human erythropoietin.

Background: A randomized, double-blind, placebo-controlled, multicenter trial (EPO-2, N = 1,302) in anemic critically ill patients demonstrated a 29-day survival benefit in the trauma subgroup receiving epoetin alfa (mortality 8.9% vs. 4.

Impact of intracranial pressure monitor prophylaxis on central nervous system infections and bacterial multi-drug resistance.

Background: Routine intracranial pressure monitor (ICP) prophylaxis is not practiced at our institution. Nevertheless, some patients receive de facto prophylaxis as a result of the use of antibiotics for injuries such as open or facial fractures. We tested the hypothesis that prophylactic antibiotics do not reduce the incidence of central nervous system (CNS) infections but instead are associated with the acquisition of multi-drug resistant (MDR) bacterial infections.

Prosthetic vascular conduit in contaminated fields: a new technology to decrease ePTFE infections.

Vascular reconstruction using prosthetic materials in contaminated fields can lead to infection, graft loss, and subsequent amputation. We hypothesized that minocycline and rifampin bound to an ePTFE graft using a unique methacrylate technology would provide for resistance from infection and controlled antibiotic elution. Kirby Bauer susceptibility testing was performed on plates overlaid with Staph aureus (SA) and Staph epidermidis (SE) using 6 mm diameter discs of uncoated graft or antibiotic coated graft (ABX).

Reduction in inadequate empiric antibiotic therapy for ventilator-associated pneumonia: impact of a unit-specific treatment pathway.

Empiric antibiotic therapy is routinely initiated for patients with presumed ventilator-associated pneumonia (VAP). Reported mortality rates for inadequate empiric antibiotic therapy (IEAT) for VAP range from 45 to 91 per cent. The purpose of this study was to determine the effect of a unit-specific pathway for the empiric management of VAP on reducing IEAT episodes and improving outcomes in trauma patients.

New vitals after injury: shock index for the young and age x shock index for the old.

Background: The traditional view that tachycardia and hypotension accompany hemorrhagic shock following injury has been challenged. This is particularly true at extremes of age. Shock index (SI) may be an alternative indicator of life-threatening bleeding after injury.

Impact of gender on outcomes after blunt injury: a definitive analysis of more than 36,000 trauma patients.

Background: The concept that premenopausal female patients are more resistant to shock than male patients has been shown in numerous preclinical models. The more relevant effect of gender on clinically important outcomes after trauma is less clear. Clinical studies have been conflicting, both supporting and refuting the protective effects of gender on outcomes, primarily because of limitations in sample size and patient stratification.

Impact of airbags on a Level I trauma center: injury patterns, infectious morbidity, and hospital costs.

Background: To date, no study has evaluated the potential impact of supplemental restraint use on resource use at a Level I trauma center. We hypothesized that airbag use would be related to decreased injury severity of motor vehicle collision survivors admitted to a Level I trauma center, leading to a decrease in infectious morbidity and hospital resource use.

Study Design: Using the trauma registry, motor vehicle collision victims admitted during an 11-year period were identified.