E-Only Articles
The Iliad and the Odyssey of metallic foreign body extraction: commentary on “Novel methods of removing metallic foreign body from human soft tissue: a report of 7390 cases”
Surgeons have been extracting metallic foreign bodies (MFB) for centuries. Perhaps the earliest literary account comes from Homer's epic poem The Iliad (ca BC 800), based on events of the Trojan War from Greek mythology. Makaon operated on an arrow wound to the abdomen of King Menelaus by extracting the arrow, sucking blood from the wound to remove poison, and applying a salve [1]: The shaft he drew, but left the head behind. Straight the broad belt with gay embroidery graced, He loosed; the corslet from his breast unbraced; Then suck'd the blood, and sovereign balm infused, Which Chron gave, and Aesculapius used [2].Strategies to prevent sepsis-induced intensive care unit–acquired weakness: are there any options? Commentary on “Comparison of melatonin and oxytocin in the prevention of critical illness polyneuropathy in rats with surgically induced sepsis”
Intensive care unit-acquired weakness (ICUAW) is one of the leading causes of morbidity in critically ill patients and a significant risk factor for the development of chronic critical illness. In 2008, 727,000 patients were hospitalized for sepsis, with mortality rate of 17% at an estimated cost of $14.6 billion [1]. The risk of critical illness neuromuscular abnormalities in patients with sepsis, multiorgan failure, or prolonged mechanical ventilation is reported to be as high as 46% [2].Radical gastrectomy with para-aortic lymphadenectomy for carcinoma? The controversy continues. Commentary on Risk Factors for Metastasis to Para-Aortic Lymph Nodes in Gastric Cancer: A Single Institution Study in China. Journal of Surgical Research
Gastric cancer is the fourth most common cancer worldwide and the second leading cause of cancer death. The highest incidence of gastric cancer is in Eastern Asia. China has 463,000 new cases a year, whereas the United States as an annual incidence of 21,000 cases [1]. Intestinal type gastric cancer is more prevalent in high-risk areas and is influenced by environmental factors. Because the incidence and histology are variable by region, there remains significant worldwide controversy regarding management of the disease.A blood test for acute rejection after renal transplantation? Commentary on “Osteopontin level correlates with acute cellular renal allograft rejection”
End-stage renal disease affects over 500,000 patients each year in the United States. Currently, over 92,000 people wait on the kidney transplant list in the United States alone, where approximately 16,000 transplants occur annually [1]. With such a discrepancy between supply and demand, graft survival is critical. Yet, even with advances in transplantation technique and immunosuppression, year one acute rejection rates remain between 10% and 20% [2]. Acute rejection begins subclinically and progression may lead to irreversible organ damage or graft loss.Is acute appendicitis in the weather forecast?
Acute appendicitis remains the most common abdominal surgical emergency [1]. In the United States alone, approximately 280,000 appendectomies are performed each year [2], and approximately 11 of every 10,000 Americans will develop acute appendicitis in their lifetime [3]. Despite the frequency with which this disease occurs, the exact etiology in most cases remains elusive. In monitoring changes in the epidemiology of acute appendicitis around the world, there have been many theories, which have raised more questions than answers.Cardiotrophin-1, an antiinflammatory cytokine; is there a therapeutic role in orthotopic liver transplantation?
Living donor liver transplantation was introduced in 1988 [1–3]. Since its first clinical application, living donor liver transplantation has been gradually accepted [4] for patients with end-stage liver disease. In recent years, living donor or cadaveric split liver transplantation has been a valuable alternative in solving the problem of organ shortage and has shown significantly improved clinical outcomes [5]. With reduction of graft size, the chance of primary graft nonfunction is increased.Curcumin for the Prevention of Acute Lung Injury in Sepsis: Is It More Than the Flavor of the Month?
Curcumin is found in the popular spice turmeric, which is a member of the ginger family. It gives curry its bright yellow color and it is even used as a food color [1]. It has been used for thousands of years as a Chinese and Indian herbal medication [2]. Curcumin has long been known to have anti-inflammatory properties since the 1950s, especially in murine models. Tham and co-workers demonstrated that a curcuminoid substance reduced the lethality in induced abdominal sepsis in mice [3]. The mechanism might be due to up-regulation of peroxisome proliferator-activated receptor (PPAR)-gamma, an anti-inflammatory nuclear receptor.Understanding the Brain-Heart Axis in Neurological Trauma
The cardiovascular physiologic effects of traumatic brain injury remain only partially understood. The autoregulatory manifestations of closed head injury have long been considered to be a catecholamine-mediated phenomenon [1]. Tachycardia, hypertension, coronary vasoconstriction resulting in cardiac ischemia, and arrhythmia have been attributed to sympathetic over activity [2]. However, these responses may not be physiologic [3]. Cardiac function is also regulated by baroreceptors, which are mediated by central paraganglionic neurons [4].The Impact of Trauma Admissions in the Elderly
Elderly patients may decrease their work and physical activities as they get older. Do they require more frequent hospital admission following trauma? Is this due to underlying co-morbid conditions, risk factors such as osteoporosis or dementia, or do they have more frequent injury? What is the economic impact of this hospital care and, in an era of shrinking resources, what steps may reduce the cost? In an article recently published in the Journal of Surgical Research, Chang and his co-workers reported on the California experience in 2008.Modulating the Inflammatory Response in Sepsis
Death from sepsis is still the most common cause of death in the intensive care unit and the 13th most common cause of mortality overall [1]. While treatment of the primary etiology has improved the outcome, mortality rates remain up to 50% [2]. This is likely due to the increase of circulating pro-inflammatory mediators that result in multiple organ dysfunction, initially described by Hack et al. in 1989 [3]. It is clear from experimental and clinical studies that patients with sepsis have elevated cytokine levels [4].
