Postinjury Primary Abdominal Compartment Syndrome

Postinjury abdominal compartment syndrome (ACS) has evolved during the 1980s together with the introduction of damage control surgery (DCS) principles. DCS made it possible to salvage severely injured trauma patients who previously would have exsanguinated due to uncontrollable coagulopathic bleeding. These patients had severe hemorrhagic shock; their abdomens were tightly packed and had ongoing massive resuscitation. ACS is a lethal complication of the damage control patients. For today the pathophysiological characteristics of ACS are described, the intra-abdominal pressure is measured on many intensive care units. Postinjury ACS (primary and secondary) is one of the better characterized etiological types of ACS: risk factors, diagnostic criteria, independent predictors and preventive strategies are all well documented. Since the mortality of full-blown postinjury ACS is still unacceptably high and does not seem to improve with earlier decompression, prevention is the recommended strategy to decrease the morbidity and mortality. Open abdomen is one of the important preventive strategies but it is not free from morbidity and mortality. With aggressive open abdomen management in postinjury ACS these complications can be minimized. More importantly, timely hemorrhage control and hemostatic resuscitation are the likely solutions for more efficient prevention of the postinjury ACS.     

The interpretation of intra-abdominal pressures from animal models: the rabbit to human example

IntroductionThe importance of the abdominal wall characteristics in intraabdominal pressure (IAP), intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are poorly understood. The applicability of laboratory research findings to human scenarios is unknown due to the potential differences in abdominal wall elastance (AWE) amongst species. The aims of the study are to describe the AWE curve in rabbits and to compare it to the available human data.Materials and methodsProspective experimental animal study in the setting of research laboratory. Male New Zealand White rabbits weighting 2.7 kg ± 0.1 kg, were anesthetized and the AWE was determined by infusion of lactated Ringer's solution into the peritoneal cavity whilst the IAP was measured. A meta-analysis of peer-reviewed studies was conducted to define human AWE.ResultsThe described AWE was lower in the rabbit than in humans. The function comparing human and rabbit was: log_e human IAP = (0.58 log_e rabbit IAP + 1.6).ConclusionsThe AWE can vary amongst species. This study determined the relationship to allow the comparison of rabbit and human IAP. The proposed mathematical function is important for the advancement of interpretation and understanding of animal research into IAH and ACS. We recommend developing model-specific functions comparing individual animal models’ IAP and that of humans.     

Primary prevention of disc degeneration-related symptoms

Introduction

It has been shown previously that a history of low back pain often begins in childhood or adulthood. Indeed, the prevalence of severe back symptoms among schoolchildren is not insignificant. Possibilities for the primary prevention of intervertebral disc degeneration-related conditions are poorly reported in the literature despite the assumed socio-economical impact of the prevention of these conditions.

Methods

In this review, the authors have collated published data on the prevalence and risk factors of childhood low back pain as well as the structure and results of published primary prevention programs.

Results

The prevalence of self-reported low back pain is 7–65 % among children and it increases with age. Several lifestyle factors have been reported as significant risk factors for back pain, many of which are related to the schools. Current educational primary prevention programs in schools show no clear or long-term stable effect.

Conclusion

Considering the growing evidence about the importance of normal and bad posture, an exercise-based posture correction program is suggested as a school-based primary prevention of disc degeneration-related symptoms. Further, prospective randomized studies with more than 20 years follow-up, however, are strongly required to confirm it.

     

Integrity® bare-metal coronary stent-induced platelet and endothelial cell activation results in a higher risk of restenosis compared to Xience® everolimus-eluting stents in stable angina patients

Drug-eluting stenting (DES) has become a reliable tool for coronary stenting; however, its direct effects on platelet and endothelium function differ from those of bare-metal stenting (BMS). This study involved a periprocedural analysis of various biomarkers of cellular activation after elective DES (Xience^®, Abbott Vascular, Santa Clara, CA, USA) or BMS (Integrity^®, Medtronic, Minneapolis, MI, USA). Forty-nine stable angina patients were recruited: 28 underwent BMS, and 21 received everolimus-eluting stents. Samples were collected (i) prior to stenting, (ii) at 24 hours after procedure, and (iii) after 1 month of dual antiplatelet therapy. Platelet activation was analyzed by surface P-selectin positivity in parallel with plasma levels of soluble P-selectin, CD40L and platelet-derived growth factor (PDGF). Endothelial cell (EC) activation was detected by measuring markers of early (von Willebrand factor) and delayed response (VCAM-1, ICAM-1, E-selectin). Patients were followed for 6 months for the occurrence of restenosis or stent thrombosis. Increased platelet activation was sustained regardless of stent type or antiplatelet medication. Concentrations of most EC markers were more elevated after BMS than after DES. No stent thrombosis was seen, but six BMS subjects displayed restenosis with significantly higher sCD40L (779 [397–899] vs. 381 [229–498] pg/mL; p = 0.032) and sICAM-1 (222 [181–272] vs. 162 [153–223] ng/mL; p = 0.046) levels than in those without complication, while DES patients exhibited significantly decreased PDGF (572 [428–626] vs. 244 [228–311] pg/mL; p = 0.004) after 1 month. Nonresponsiveness to antiplatelet drugs did not influence these changes. In conclusion, the degree of platelet and EC activation suggests that Xience^® DES may be regarded a safer coronary intervention than Integrity^® BMS, with a lower risk of in-stent restenosis.     

Relationship between ventilatory function and age in master athletes and a sedentary reference population

Ageing is accompanied with a decline in respiratory function. It is hypothesised that this may be attenuated by high physical activity levels. We performed spirometry in master athletes (71 women; 84 men; 35–86 years) and sedentary people (39 women; 45 men; 24–82 years), and calculated the predicted lung age (PLA). The negative associations of age with forced expiratory volume in 1 s (FEV₁; 34 mL·year^?1) and other ventilatory parameters were similar in controls and master athletes. FEV_1pred was 9 % higher (P?<?0.005) and PLA 15 % lower (P?=?0.013) in athletes than controls. There were no significant differences between endurance and power athletes and sedentary people in maximal inspiratory and expiratory pressure. Neither age-graded performance nor weekly training hours were significantly related to lung age. Life-long exercise does not appear to attenuate the age-related decrease in ventilatory function. The better respiratory function in master athletes than age-matched sedentary people might be due to self-selection and attrition bias.     

Paraneoplastic thrombocytosis in gastrointestinal cancer

It has been demonstrated recently in several solid tumors that thrombocytosis at diagnosis may correlate with tumor invasion, metastatic progression and worse outcome. Several details of the pathomechanism of the relationship of thrombocytosis and cancer have been elucidated; however, the complete process is not clearly understood. Several hypotheses have been proposed. Recently, it was suggested that in ovarian cancer elevated IL-6 production by the tumor may induce increased megakaryopoiesis via hepatic thrombopoietin production leading to thrombocytosis. The importance of the prognostic power of elevated platelet count is still debated in gastrointestinal cancer. The aims of this review were to evaluate the prognostic significance of thrombocytosis in gastrointestinal tumors, to see whether clinical practice confirmed the hypotheses and to reveal the causes of the inconsistent findings.