Abdominal wall hernias: risk factors for infection and resource utilization.

Background: Abdominal wall hernia repairs are common surgical procedures. Several recent reports have studied the outcomes of elderly patients undergoing inguinal hernia repair and documented a morbidity rate ranging from 5-57% and a mortality rate ranging from 1.6-14%.

Structural proteome of human colostral fat globule membrane proteins.

Milk fat globule membrane (MFGM) contains proteins derived from the apical membrane of secreting epithelial cells of the mammary gland. Between 2-4% of total human milk protein content is associated with the fat globule fraction, as MFGM proteins. While MFGM proteins have very low classical nutritional value, they play important roles in various cell processes and defence mechanisms for the newborn.

Blood transfusion, independent of shock severity, is associated with worse outcome in trauma.

Background: We have previously shown that blood transfusion in the first 24 hours is an independent predictor of mortality, intensive care unit (ICU) admission, and increased ICU length of stay in the acute trauma setting when controlling for Injury Severity Score, Glasgow Coma Scale score, and age. Indices of shock such as base deficit, serum lactate level, and admission hemodynamic status (systolic blood pressure, heart rate) and admission hematocrit were considered potential confounding variables in that study. The objectives of this study were to evaluate admission anemia and blood transfusion within the first 24 hours as independent predictors of mortality, ICU admission, ICU length of stay (LOS), and hospital LOS, with serum lactate level, base deficit, and shock index (heart rate/systolic blood pressure) as covariates.

[Clinical study of the imaging validity in detecting infiltration of the mesenteric-portal axis in pancreatic carcinoma].

The authors examine the value of different imaging techniques (CT, MRI) in the diagnosis of the involvement of the mesenteric-portal vessels in the pancreatic cancer. In 20 jaundiced patients they obtained in all cases a correct diagnosis about the etiology of the jaundice. The correspondence of the preoperative imaging study with the involvement of the mesenteric-portal vessels was respectively 73% for the CT and 78% for the MRI.

[Thyroid metastasis from renal carcinoma. Clinical case].

Metastatic thyroid tumours are uncommon among reported clinical cases, but are more frequent in autopsy series. The most common sites of the primary tumours are the breast (21%), kidney (12%) and lung (11%) and in some cases are detected only at autopsy. The clinical presence of thyroid tumefaction, whether associated or not with compressive symptoms, in a patient with a history of surgical treatment for renal cell carcinoma should lead to the suspicion of a metastatic nodule.

Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients.

Background: Pneumonia is one of the most common nosocomial infections in hospitalized patients. The risk of nosocomial pneumonia increases with age, severity of acute illness and preexisting co-morbid conditions. Ventilator-associated pneumonia (VAP) significantly increases morbidity, length of stay, resource utilization and mortality.

Reduction of IL-10 and nitric oxide synthesis by SR31747A (sigma ligand) in RAW murine macrophages.

Background: There are several subtypes of sigma receptor, one of which is found throughout the immune system. SR31747A is a unique sigma ligand that possesses potent immune modulatory properties. Previous in vivo studies have documented that administration of SR31747A in murine models of sepsis resulted in decreased proinflammatory (IL-1, IL-6, TNF-alpha) and increased anti-inflammatory (IL-10) response (serum, splenocyte).

Trauma in the elderly: intensive care unit resource use and outcome.

Background: As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe consequences from traumatic injuries compared with the young, presumably resulting in increased resource use. In this study, we sought to examine ICU resource use in trauma on the basis of age and injury severity.

[Reoperations in thyroid surgery].

The Authors examine etiology, incidence and hazards related to reoperation in thyroid surgery either for benign either for malignant pathology. The Authors present, then, 26 secondary operations performed in the Unit of Surgical Pathology of the Department of Surgical Sciences Chieti University: 15 for benign, 11 for malignant pathology. In the cases of thyroid malignant pathology, in 2 patients (operated in different hospitals) there was a parenchimatous recurrence, in 2 patients a lymphnodal recurrence.

Persistent systemic inflammatory response syndrome is predictive of nosocomial infection in trauma.

Background: Admission systemic inflammatory response syndrome (SIRS) score has been previously reported to be an accurate predictor of infection and outcome in trauma. However, these data were limited to only one SIRS score at admission. A prior study in surgical intensive care unit (ICU) patients reported that the SIRS score on ICU day 2 declined after completion of resuscitation, and was a more accurate predictor of outcome.

Severe anemia after gastrointestinal hemorrhage in a Jehovah's Witness: new treatment strategies.

Objective: Management of severe anemia in a critically ill Jehovah's Witness is challenging. In the past, conservative therapy was the only option available to the practitioner. Recently, new interventional treatment strategies have become available, including human and bovine hemoglobin substitutes and high-dose recombinant human erythropoietin.

[Clinical experience in tumors of the common bile duct].

The authors, after a short review of the literature present 6 cases of cancer of the common bile duct. One was localized at the hepatic hilus, three in the middle of the c.b.

A proteomic approach to evaluate the butyrophilin gene family expression in human milk fat globule membrane.

Human butyrophilin (BTN) expression in milk fat globule (MFGM) was evaluated using two dimensional electrophoresis (2-DE) as the separation technique, and peptide mass mapping by matrix-assisted laser desorption/ionisation-mass spectrometry (MALDI-MS) as the identification tool. Since milk composition changes throughout lactation time, 2-DE maps in the pH range 4-7 of colostral MFGM and mature MFGM were compared, showing only slight differences in BTN spot distribution. The BTN gene family codes for seven proteins (BTN, BTN2A1, BTN2A2, BTN2A3, BTN3A1, BTN3A2, BTN3A3), their presence in human tissues has to date been evaluated only at a transcriptional level.

A statewide population-based study of gender differences in trauma: validation of a prior single-institution study.

Background: Women usually have lower mortality rates than men do at any age. This pattern is observed for most causes of death from chronic diseases. Significant controversy still exists about gender differences in outcomes in trauma.

Predictors of mortality in adult trauma patients: the physiologic trauma score is equivalent to the Trauma and Injury Severity Score.

Background: Several statistical models (Trauma and Injury Severity Score [TRISS], New Injury Severity Score [NISS], and the International Classification of Disease, Ninth Revision-based Injury Severity Score [ICISS]) have been developed over the recent decades in an attempt to accurately predict outcomes in trauma patients. The anatomic portion of these models makes them difficult to use when performing a rapid initial trauma assessment. We sought to determine if a Physiologic Trauma Score, using the systemic inflammatory response syndrome (SIRS) score in combination with other commonly used indices, could accurately predict mortality in trauma.

Preoperative anemia in colon cancer: assessment of risk factors.

Anemia is common in cancer patients and is associated with reduced survival. Recent studies document that treatment of anemia with blood transfusion in cancer patients is associated with increased infection risk, tumor recurrence, and mortality. We therefore investigated the incidence of preoperative anemia in colorectal cancer and assessed risk factors for anemia.

Seeding from early stage gallbladder carcinoma after laparoscopic cholecystectomy.

In the last years laparoscopic cholecystectomy has become the "gold standard therapy" in the treatment of symptomatic cholelitiasis, but it is necessary to keep into account some problems and risks that can arise from laparoscopic technique. One of these risks is represented surely by the disregarding of a gallbladder carcinoma. The authors report a case of peritoneal seeding of an unsuspected gallbladder carcinoma following laparoscopic cholecystectomy.

Increased thymic mass and circulating naive CD4 T cells in HIV-1-infected adults treated with growth hormone.

Objective: To determine whether treatment with growth hormone (GH) enhances thymopoiesis in individuals infected with HIV-1.

Methods: Five HIV-1-infected adults were treated with GH for 6-12 months in a prospective open-label study. Immunological analyses were performed before GH treatment and repeated at 3 month intervals after GH initiation.

Gastric remnant carcinoma: reevaluation of screening endoscopy.

A 67-year-old male presented with complaints of chronic postprandial pain in the epigastric region. The patient had undergone a vagotomy, antrectomy, and loop gastrojejunostomy for peptic ulcer disease 25 years prior. Abdominal computed tomography (CT) revealed markedly thickened walls of the gastric remnant with infiltration of the adjacent fat planes.

Accumulation of DC-SIGN+CD40+ dendritic cells with reduced CD80 and CD86 expression in lymphoid tissue during acute HIV-1 infection.

Background: Dendritic cells (DC) are target cells for HIV-1 and play a key role in antigen presentation and activation of T cells.

Objective: To characterize interdigitating DC in lymphoid tissue (LT) with regard to maturation, expression of cytokines and co-stimulatory molecules in HIV-1-positive patients.

Methods: DC were characterized by immunohistochemistry and in situ imaging in LT from patients with acute HIV-1 infection (aHI), antiretroviral treated patients, long-term non-progressors/slow progressors with HIV-1 infection (LTNP/SLP), patients with AIDS, HIV-1-negative controls and patients with acute Epstein-Barr virus (EBV) infection.

Advanced proximal colon cancer.

Background: Two recent studies have documented that sigmoidoscopy as a screening tool for colorectal cancers may miss advanced proximal colonic neoplasms. The purpose of this study was to assess the prevalence of distal synchronous lesions in patients with proximal colon cancer. We sought to determine if screening sigmoidoscopy would have missed these proximal colon cancers.

[Study of the possibility of an effect of biliary disease on the occurrence of chronic pancreatitis].

The authors report a series of patients suffering from chronic pancreatitis and underline the high frequency of biliary pathology in these subjects. The authors remind, then a research performed, some years ago, by one of them. In such a research the performing of an anastomosis between the pancreatic duct and the biliary common duct in a series of experimental animals caused an acute pancreatitis or in the surviving animals a chronic pancreatitis.

Surgical site infections: reanalysis of risk factors.

Background: Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. During 1986-1996 the Center for Disease Control and Prevention's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations (2.6%).