How interventional radiology changed the practice of a trauma surgeon.

Trauma Surgery, with the assistance of advanced technology especially in Imaging (formerly Radiology), enables it to have patient management approaching John Hunter's ideal of treatment by stratagem rather than the "force" of an open operation.

Total mediastinal traverse with isolated internal mammary artery transection.

Transmediastinal gunshot wounds are infrequent but life-threatening injuries. The course of the projectile and the bullet track often is unpredictable. Prompt and specific diagnostic and therapeutic interventions are necessary to quickly identify and repair potentially life-threatening injuries to the heart, great vessels, and the aerodigestive tract.

Emergency cricothyrotomy.

Emergency cricothyrotomy is a potentially lifesaving surgical procedure used to gain prompt access to an otherwise compromised and inaccessible airway. The purpose of this photoessay is to demonstrate the technique of the procedure in a step-by-step manner so that the physician can perform this intervention with ease and facility in the most stressful of circumstances.

Dysfunctional immune-privilege in morbid obesity: implications and effect of gastric bypass surgery.

Background: Despite the epidemiological evidence linking obesity and cancer, there has never been a causal link. We believe the chronic inflammation present in obesity may predispose the obese to cancer through Fas-receptor over-expression and L-selectin under-expression in leukocytes, and elevated Fas ligand secretion in tumors affecting the morbidly obese.

Methods: Leukocytes from 25 patients having gastric bypass surgery were compared to 15 normal controls preoperatively and at 1, 3, 6, and 12 months postoperatively using flow cytometry to measure CD3, CD4, CD8, CD56, CD62 (L-selectin), CD69, and CD95 (Fas antigen) expression on T lymphocytes, B lymphocytes, natural killer cells, and neutrophils.

The effect of diabetes on endothelin, interleukin-8 and vascular endothelial growth factor-mediated angiogenesis in rats.

In diabetes mellitus, there is a problem of both premature atherosclerosis as well as impaired collateralization. Studies were performed using the rat corneal angiogenesis model as a surrogate for collateralization to determine the effect of diabetes mellitus on endothelin (ET)-1, ET-3, vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8)-mediated angiogenesis. In an initial group of experiments, streptozotocin-induced diabetes resulted in impairment of ET-1-mediated angiogenesis from 69% to 32%, but was only impaired from 74% to 59% for ET-3.

Effect of surgically-induced weight loss on leukocyte indicators of chronic inflammation in morbid obesity.

Background: Recent evidence suggests that morbid obesity is a chronic inflammatory condition that may be associated with immune dysfunction. To test this hypothesis, we investigated several leukocyte cell surface markers of chronic inflammation and followed their response to surgically-induced weight loss.

Methods: 26 patients having Roux-en-Y gastric bypass (RYGBP) for morbid obesity (BMI > 40) were compared to 10 normal controls (BMI < 25).

Diagnostic and therapeutic laparoscopy for trauma: a technique of safe and systematic exploration.

Laparoscopy has a limited role in the evaluation of a stable trauma patient. The main concern addressed in the literature is a significant potential for missed visceral injury and a minimal role for therapeutic application. We present a simple technique for systematic abdominal exploration for a suspected intraabdominal injury in a series of three consecutive trauma patients (two penetrating injuries, one blunt) at a level-one trauma center.

Duodenal varices: a novel treatment and literature review.

Hemorrhage associated with duodenal varices is an uncommon but often fatal manifestation of portal hypertension. We report a case of duodenal varices, review the literature, and present a new treatment modality. A 63-year-old man presented with hematemesis and hematochezia.

Lower extremity compartment syndrome following a laparoscopic Roux-en-Y gastric bypass.

Background: Bariatric surgery has the potential for serious complications. A case is presented of unilateral lower extremity compartment syndrome after a laparoscopic Roux-en-Y gastric bypass performed in the modified lithotomy position.

Case Report: A 38-year-old female (weight 134.

The effect of obesity on neutrophil Fc receptors and adhesion molecules (CD16, CD11b, CD62L).

Background: There is a large body of epidemiological data associating obesity with a wide variety of clinical disease processes, including cancer and wound infections. However, defining the specific defects of neutrophils has proved difficult and often contradictory.

Methods: 27 patients having gastric bypass surgery for obesity (BMI > 40) were compared with 10 normal controls (BMI < 26).

Laparoscopic repair of traumatic perforation of the urinary bladder.

Laparoscopy as a diagnostic modality in trauma has been reported. However, therapeutic laparoscopy for trauma remains a controversial subject. We present a case of laparoscopic repair of a traumatic bladder rupture.

Preperitoneal herniation into a laparoscopic port site without a fascial defect.

Background: Port site herniation is an uncommon event that usually occurs as a result of incomplete fascial closure. This allows the omentum or viscera to herniate through the incompletely closed defect. However, in laparoscopic surgery for morbid obesity, the omentum and viscera can herniate through the thick preperitoneal space even with a complete closure of the fascia.

Preoperative radiographic staging for ureteral injuries is not warranted in patients undergoing celiotomy for trauma.

Preoperative radiographic staging of the urinary tract has been shown to be inaccurate with regard to the ureter. The purpose of this study was to assess the need for radiographic staging of the injured patient for the diagnosis of ureteral injury before operative exploration. We conducted a retrospective review of all patients who sustained injury of the ureter as the result of external trauma over an 8 Y2-year period at an urban and suburban Level I trauma center.

Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis.

Background: Perforated appendicitis is associated with a significant risk of postoperative abdominal and wound infection. Only a few controversial studies evaluate the role of laparoscopy in perforated appendicitis. The significance of conversion from laparoscopy to open appendectomy for perforated appendicitis is not well defined.

Blocking prostaglandin E2 after trauma attenuates pro-inflammatory cytokines and improves survival.

Major injury leads to impaired immune responses and increases the risk of infectious complications. Following trauma, increased prostaglandin E2 (PGE2) levels may be important in immunodysregulation. We hypothesized that blocking PGE2 with NS-398, a selective COX-2 inhibitor, during the first 24 h after injury may modify the immune response and protect the host from a subsequent septic challenge.

Main pulmonary artery laceration after blunt trauma: accurate preoperative diagnosis.

Blunt chest trauma is associated with a variety of lethal injuries, many of which are responsible for prehospital mortality. Major intrathoracic vascular injury accounts for a vast majority of these fatal injuries. Patients surviving after main pulmonary artery injury are rare.

Effects of traditional versus delayed resuscitation on serum lactate and base deficit.

Objective: To test the hypothesis that delayed resuscitation of hemorrhagic shock produces a less severe shock insult than traditional resuscitation, characterized by repeated episodes of alternating hypotension and normotension.

Methods: Female pigs were divided into three groups. Sham operated controls (C) (n = 4), sustained hypotension (SS) (n = 6), and hypotension with multiple cycles of shock and resuscitation (SR) (n = 6).

Simplified technique of mesh fixation during laparoscopic repair of abdominal ventral hernia.

The current techniques for intraperitoneal mesh fixation are complex and time-consuming. We present here a simple technique for the fixation of the mesh during laparoscopic intraperitoneal ventral hernia repair.

A laparoscopic approach to posterior gastric wall leiomyomectomy.

Leiomyomas represent 2% of gastric tumors. Commonly, gastric leiomyomas are clinically silent. Most often they become clinically apparent due to bleeding from ulceration of the overlying gastric mucosa.

A new approach in the management of incarcerated hernia. Emergency laparoscopic hernia repair.

The authors describe the case of a 74-year-old male presenting with an incarcerated epigastric hernia. An algorithm for successful management of such a case is proposed.