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J Trauma. 2002 Jun;52(6):1097-101.
The need for early angiographic embolization in blunt liver injuries.
Wahl WL, Ahrns KS, Brandt MM, Franklin GA, Taheri PA.
Division of Trauma Burn and Emergency Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0033, USA. wlwahed.umich.edu
BACKGROUND: Although nonoperative management of blunt liver injury (BLI) has become standard practice, adjuncts to nonoperative therapy, such as angiographic embolization, have not been well characterized. METHODS: Patients with BLI were retrospectively identified at our American College of Surgeons-verified Level I trauma center from January 1997 through February 2001. Patients were stratified into four groups: those who received angiographic embolization (AE) as an early intervention when BLI was initially diagnosed (EARLY-AE); those who underwent AE after liver-related operation or later in the hospital course (LATE-AE); those treated with operation only (OR-ONLY); and nonoperative patients who also did not undergo AE (NO-OR). RESULTS: There were 126 patients with BLI, of whom 94 were NO-OR, 20 were OR-ONLY, 6 had LATE-AE, and 6 had EARLY-AE. The NO-OR group had significantly lower liver Abbreviated Injury Scale scores. Liver Abbreviated Injury Scale scores were not different between the EARLY-AE, LATE-AE, and OR-ONLY groups. Liver-related mortality was not lower for those treated with AE. There was a trend toward lower mortality for just the EARLY-AE group compared with the LATE-AE and OR-ONLY groups (0% vs. 50% and 35%). The number of units of packed red blood cells transfused and the number of liver-related operations were lower in the EARLY-AE compared with the LATE-AE group, but liver-related complications were not different between the EARLY-AE, LATE-AE, or OR-ONLY groups. AE was successful in arresting hemorrhage in 83% of the cases. CONCLUSION: In this small series, we observed similar morbidity and mortality with AE compared with operative therapy. EARLY-AE did decrease blood use and the number of liver-related operations. AE can be performed on severely injured patients with comparable liver-related mortality and complications. Further study of the timing of and outcomes from AE is needed.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045636&dopt=Abstract hemorrhage
J Trauma. 2002 Jun;52(6):1147-52.
Fluid resuscitation improves hemodynamics without increased bleeding in a model of uncontrolled hemorrhage induced by an iliac artery tear in dogs.
Bruscagin V, de Figueiredo LF, Rasslan S, Varicoda EY, Rocha e Silva M.
Emergency Service, Santa Casa School of Medicine, Sao Paulo, Brazil.
BACKGROUND: Fluid resuscitation administered before hemorrhage control for trauma victims sustaining penetrating abdominal injury is controversial. Our objective was to evaluate intra-abdominal blood loss and hemodynamic and metabolic effects of no fluid resuscitation, small-volume 7.5% sodium chloride/6% dextran-70 (HSD), or large-volume lactated Ringer's (LR) solution during intra-abdominal vascular injury and uncontrolled hemorrhage. METHODS: In pentobarbital-anesthetized dogs (n = 26, 17 +/- 0.3 kg), a suture was placed through the common iliac artery to produce a 3-mm tear when the exteriorized suture lines were pulled after incision closure. Dogs were randomized to three groups, according to the treatment used after 20 minutes of uncontrolled hemorrhage: controls, no fluid resuscitation (CT group) (n = 6); the HSD group (4 mL/kg over 4 minutes, n = 6); and the LR group (32 mL/kg over 15 minutes, n = 6). After 40 minutes of uncontrolled bleeding, animals were killed, and intra-abdominal blood loss was measured. RESULTS: Eight dogs died from severe hemorrhagic shock before randomization and were excluded. After 20 minutes, animals presented lower blood pressure (approximately 35 mm Hg), low cardiac output (approximately 1.0 L/min/m(2)), and metabolic acidosis (pH approximately 7.23, base excess approximately -9 mmol/L). After HSD and LR solution, arterial pressure presented a transient increase, but remained below baseline. Two animals died before the end of the experiment, both in the LR group. Cardiac index was partially improved in the LR and HSD groups, whereas the CT group sustained a low-flow state. There were no significant differences between groups regarding intra-abdominal blood loss (CT group, 47.8 +/- 5.9 mL/kg; HSD group, 41.7 +/- 2.3 mL/kg; and LR group, 49.4 +/- 0.7 mL/kg). CONCLUSION: Fluid resuscitation with either large-volume LR solution or small-volume HSD, during uncontrolled hemorrhage from intra-abdominal vascular injury, produced hemodynamic and metabolic benefits, without additional blood loss, whereas no fluid resuscitation was associated with sustained low cardiac output and hypotension.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045645&dopt=Abstract hemorrhage
J Cereb Blood Flow Metab. 2002 Jun;22(6):689-96.
Hypoxia-inducible factor-1alpha accumulation in the brain after experimental intracerebral hemorrhage.
Jiang Y, Wu J, Keep RF, Hua Y, Hoff JT, Xi G.
Departments of Neurosurgery and Physiology, University of Michigan, Ann Arbor, Michigan 48109, USA.
Hypoxia-inducible factor-1 (HIF-1), a transcription factor composed of HIF-1alpha and HIF-1beta protein subunits, has been implicated in cellular protection and cell death in cerebral ischemia. The extent to which HIF-1 plays a role in brain pathology during intracerebral hemorrhage (ICH) is unknown. This study determined whether HIF-1alpha is upregulated at different time points in a rat model of ICH and the role of thrombin and red blood cell lysis in upregulation. Recently, thrombin has been implicated as a nonhypoxic regulator of HIF-1alpha in cultured smooth-muscle cells. Male Sprague-Dawley rats received intracerebral infusions of saline, autologous whole blood, blood plus hirudin, thrombin, thrombin plus hirudin, or lysed erythrocytes. Rats were killed at different time points for Western blot analysis, immunohistochemistry, immunofluorescent double staining, and reverse transcription polymerase chain reaction measurements of HIF-1alpha. HIF-1alpha protein levels increased without changing HIF-1alpha messenger RNA levels after intracerebral infusions of blood, thrombin, and lysed erythrocytes. HIF-1alpha positive cells, which proved to be neurons, were found in the brain after ICH. Hirudin, a specific thrombin inhibitor, reduced HIF-1alpha upregulation in response to both thrombin and blood. This study demonstrates that perihematomal HIF-1alpha protein is upregulated after ICH. This phenomenon is an early response of brain parenchyma to the clot. Thrombin and erythrocyte lysate are involved in HIF-1alpha upregulation through reducing HIF-1alpha degradation.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045667&dopt=Abstract hemorrhage
Orbit. 2001 Dec;20(4):291-295.
Hemorrhagic cavernoma or ruptured dermoid of the orbit: Diagnosis with MRI.
Born C, Rademaker J, Hosten N, Felix R.
Department of Radiology, Charite, Campus Virchow-Hospital, Humboldt-University, Berlin, Germany
MRI is a useful tool to study space-occupying lesions of the orbit. We present two cases of intraorbital lesions that were found to be a hemorrhagic cavernous hemangioma and a ruptured dermoid, respectively. The difficulties in arriving at the diagnosis of these rare entities with MRI are discussed. In general, dermoids are characterized by a peripheral, extra-conal location in the immediate vicinity of an orbital suture, while cavernous hemangiomas tend to be intraconal. Secondary complications of both entities, such as hemorrhage or rupture, may alter the characteristic MRI signal patterns found in uncomplicated lesions. Inflammatory reactions may be observed. The signal of the fatty dermoid and the hemorrhagic part of a cavernoma are both of high intensity on the T1-weighted images, and this may lead to diagnostic difficulties.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045906&dopt=Abstract hemorrhage [PubMed - as supplied by publisher]
Orbit. 1999 Jun;18(2):123-130.
Malignant melanoma of the choroid presenting as orbital cellulitis: report of two cases with a review of the literature.
Biswas J, Ahuja VK, Shanmugam MP, Kurian R, Fernandez T.
Medical and Vision Research Foundation, Chennai, India
Orbital cellulitis can be the initial presentation of malignant melanoma of the choroid when such tumors undergo necrosis or extrascleral extension. We report two unusual cases of malignant melanoma of the choroid presenting with gradual dimness of vision for only two months. Histopathology revealed malignant melanoma of the choroid with extensive necrotic hemorrhages within the tumor. There was extensive infiltration of the sclera with acute inflammatory cells. No evidence of intra- or extrascleral extension by the tumor was seen. Metastatic work-up revealed no evidence of secondary deposits. An unusual presentation of malignant melanoma of the choroid is reported, together with the pathogenic mechanisms and a review of the literature.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12045997&dopt=Abstract hemorrhage [PubMed - as supplied by publisher]
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The most ostensive feature that distinguishes us human from chimps and other primates is the lack of bodily hair. During evolutionary process, we have lost the majority of hair. Hair is no longer a biologically essential part of our body, just
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