Early Trauma-Induced Coagulopathy is Associated with Increased Ventilator-Associated Pneumonia in Spinal Cord Injury Patients.

Introduction: Early trauma-induced coagulopathy may increase susceptibility to nosocomial infections such as ventilator-associated pneumonia. However, the relationship between trauma- induced coagulopathy and the development of ventilator-associated pneumonia in spinal cord injury patients has not been evaluated.

Methods: We conducted a 5-year retrospective study of 300 spinal cord injury patients admitted to Level 1 trauma center.

Thermodynamic aspects of therapeutic hypothermia.

Therapeutic hypothermia (TH) is an important treatment for post-cardiac arrest syndrome. Despite its widespread practice, only limited data describe the thermodynamic aspects of heat transfer during TH. This paper reviews the principles of human body heat balance and provides a conceptual model for characterizing heat exchange during TH.

Therapeutic plasma exchange rapidly improves cardiac allograft function in patients with presumed antibody-mediated rejection.

Background: Allograft dysfunction due to presumed antibody-mediated rejection (pAMR) is one of the most serious complications of heart transplantation. Combination therapies of high-dose steroids, intravenous immune globulin, and/or therapeutic plasma exchange (TPE) are often used in this setting.

Methods: We performed a 9-year retrospective review of all episodes of pAMR treated with TPE at our institution.

PSA response to neoadjuvant androgen deprivation is an independent prognostic marker and may identify patients who benefit from treatment escalation.

Purpose: To determine whether prostate-specific antigen (PSA) measurement after initiation of androgen deprivation therapy (ADT) but prior to the start of radiotherapy (RT) pPSA is an independent predictor of biochemical relapse-free survival (bRFS). We also sought to determine the effect, if any, of factors affecting bRFS for patients who did not achieve pPSA<0.5 ng/mL.

Predictors of patient medication compliance on the day of surgery and the effects of providing patients with standardized yet simplified medication instructions.

Background: Anesthesiologists are responsible for optimizing patients' preoperative medications, including maximizing their compliance with preoperative medication instructions. The authors hypothesized that a standardized, simplified instruction sheet presented and verbally reinforced during the preanesthesia clinic visit would improve patient medication compliance on the day of surgery.

Methods: An unmatched case-control design was applied, with nonrandomized, preintervention (controls) and postintervention (cases) data collected.

Hernia en masse.

Described is the case of a patient who developed symptoms compatible with small bowel obstruction approximately 16 hours after a difficult self-performed left inguinal hernia reduction. Exploratory laparotomy was performed, and release of an incarcerated loop of ileum was performed. A large inguinal hernia defect also was found, and this was repaired with a Cooper's ligament repair.

Gallstone ileus.

Gallstone ileus, although uncommon, requires urgent and appropriate surgical therapy if unacceptable morbidity and mortality are to be avoided. Enterolithotomy alone remains the mainstay of operative treatment for gallstone ileus, but the additional performance of a one-stage cholecystectomy and repair of fistula if desirable if the condition of the patient will allow it. One must use good judgment in selecting a surgical procedure.

Nutritional support of the surgical patient.

Malnutrition, unfortunately, is not uncommon and malnourished patients suffer increased morbidity and mortality from surgery. Identification of protein-calorie deficient patients can be performed rapidly and inexpensively through standard techniques of nutritional assessment. If the gastrointestinal tract is available, safe and economic nutritional support may be provided by mouth or by tube feeding.

Metabolic abnormalities in patients supported with enteral tube feeding.

One hundred patients supported with enteral tube feeding were evaluated for biochemical abnormalities. The following metabolic complications were observed: hyperglycemia (29%), hypoglycermia (2%) hypernatremia (10%), hyponatremia (31%), hyperkalemia (40%) hypokalemia (8%), hyperphosphatemia (14%) hypophosphatemia (30%) hypomagnesemia (3%), hypozincemia (11%), and hypocupremia (3%). Because of the extensive range of biochemical problems, it is recommended that subjects on tube feeding be evaluated periodically for metabolic abnormalities.

INVESTIGATION OF A DIATOM POPULATION FROM MINE TAILINGS IN NYE COUNTY, NEVADA, U. S. A.(1).

A diatom population consisting of 31 taxonomic entries was found in tailings from an abandoned mine near Ichthyosaur Paleontologic State Monument, Nye County, Nevada, U.S.A.