Protamine Reversal of Heparin After Cardiopulmonary Bypass Increases Lung Resistance, Not Elastance.

BACKGROUND: Protamine, an immunologically active, cationic amine, has been suspected of impairing lung mechanics when administered after cardiopulmonary bypass (CPB) to reverse heparin. Whether such adverse changes are an effect of protamine itself, the formation of heparin-protamine complexes, the extent of heparin anticoagulation, or its chemical reversal is not known. METHODS AND RESULTS: Using a computer-controlled, forced-ventilation method over a variety of physiological tidal volume (V(T)) and frequency (f) combinations, we prospectively studied 18 adult, elective patients before systemic heparinization and after protamine reversal to confirm and, possibly, elucidate an etiology for any adverse pulmonary effects.

Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail.

Background: The purpose of this two-part investigation was to test the feasibility, safety, and efficacy of immediate weight-bearing after treatment of fractures of the shaft of the femur with a statically locked intramedullary nail.

Methods: In the first part of the investigation, a biomechanical study was performed to determine the fatigue strength of eleven different statically locked intramedullary nail constructs. Segmentally comminuted midisthmal fractures were simulated with use of sections of polyvinyl chloride pipe; each construct was cyclically loaded in compression with use of physiologically relevant loads in a materials testing machine at eight hertz.

Co-occurring severe mental illness and substance use disorders: a review of recent research.

Objective: Understanding the complex diagnostic and treatment issues posed by the co-occurrence of severe mental illness and substance use disorders has become a necessary exercise in current psychiatric practice. The authors reviewed research studies from the past six years that have contributed to our knowledge about effective assessment, diagnosis, course of illness, and treatment approaches. Research on special populations, including women, persons infected with HIV, and violent patients, is highlighted.

Mortality in patients with bilateral femoral fractures.

Objectives: To determine and compare the mortality rates of patients with bilateral versus unilateral femoral fractures and to determine the contribution of the femoral fracture to, and identify risk factors for, such mortality.

Study Design: Retrospective analysis using trauma registry data on consecutive blunt trauma patients with unilateral (800 patients, group I) or bilateral (eighty-five patients, group II) femoral fractures.

Methods: Univariate data analysis was performed to compare the groups' ages, Injury Severity Scores, Glasgow Coma Scale values, mortality, and the presence of adult respiratory distress syndrome (ARDS).

Restoring abdominal wall integrity in contaminated tissue-deficient wounds using autologous fascia grafts.

Necrotizing abdominal wall infections, enteric fistulae, or exposed prosthetic material after ventral hernia repair often results in a loss of abdominal wall integrity. Further surgical reconstruction with prosthetic material is usually contraindicated in the contaminated wound because of the high infection rate necessitating prosthetic removal and further abdominal wall debridement. Consequently, for the past 9 years, we have been using free grafts of autologous fascia lata to replace deficient abdominal wall fascia and muscle in situations where prosthetic material is contraindicated and local tissue rearrangement (i.