Abstract:
INTRODUCTION:There is a documented association between critically ill patients who are in refractory shock and adrenal insufficiency. The underlying pathophysiology may be related to ischemia, necrosis, reperfusion, or resuscitative dilution. We hypothesize this blunted adrenal response is due to ischemia and necrosis of the adrenal parenchyma. METHODS:Thirty Sprague-Dawley rats were intravascularly catheterized and hemorrhagic shock induced to a mean arterial pressure of 65 mm Hg. After 4 hours of hypotension, fluid resuscitation was initiated with a crystalloid solution (Lactated Ringers). A control group underwent catheterization without hemorrhage. Serum corticosterone levels were measured and adrenal glands harvested for histologic evaluation of hemorrhagic necrosis. RESULTS:Baseline corticosterone was 30.8 ng/mL in control animals and 35.3 ng/mL in hemorrhagic animals (P = 0.10). One hour after hemorrhage, corticosterone was maximally stimulated at 406.2 ng/mL and in control animals was 35.0 ng/mL (P = 0.0001). In experimental animals after 4 hours of hypovolemia, corticosterone dropped to 308.9 ng/mL (P = 0.0001). At 6 hours, corticosterone levels dropped to 149.0 ng/mL in experimental animals (P = 0.0001). Adrenal microscopy showed 1.5+ hemorrhagic necrosis in experimental animals compared with 0.0+ in controls (P = 0.004). CONCLUSION:Our model suggests that ischemia and necrosis of the adrenal glands may be responsible for the adrenal insufficiency seen in patients with hemorrhagic shock. Further research may enable clinicians to discern earlier which patients will benefit from adrenal corticoid replacement.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Rushing GD,Britt RC,Britt LDdoi
10.1097/01.sla.0000216759.36819.1bsubject
Has Abstractpub_date
2006-05-01 00:00:00pages
652-4; discussion 654-6issue
5eissn
0003-4932issn
1528-1140pii
00000658-200605000-00011journal_volume
243pub_type
杂志文章abstract:OBJECTIVE:To evaluate the potential benefit of cytology of the peritoneal lavage obtained during diagnostic laparoscopy for staging gastrointestinal (GI) malignancies. SUMMARY BACKGROUND DATA:Peritoneal lavage is a simple procedure that can be performed during laparotomy for GI tumors. Tumor cells in the lavage fluid ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199812000-00002
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:To examine the development of acute kidney injury (AKI) after burn injury as an independent risk factor for increased morbidity and mortality over initial hospitalization and 1-year follow-up. BACKGROUND:Variability in fluid resuscitation and difficulty recognizing early sepsis are major barriers to preventi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001979
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:This study investigated the pathogenesis of water and sodium metabolism derangements in obstructive jaundice. SUMMARY BACKGROUND DATA:Obstructive jaundice is associated with hypodipsia, depletion of extracellular water, alterations of the water and sodium regulating hormones, and an increased incidence of re...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199401000-00012
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To determine the incidence of isolated gastrocnemius and soleal vein thrombosis (IGSVT) and the effect of anticoagulation on venous thromboembolism (VTE) events in patients with IGSVT. SUMMARY BACKGROUND DATA:Although IGSVT is diagnosed with increasing frequency, the clinical significance and optimal managem...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181c1ae95
更新日期:2010-04-01 00:00:00
abstract:OBJECTIVE:To compare the outcomes of bilateral subtotal (BST) versus total thyroidectomy (TT) for benign bilateral thyroid disease (BBTD). BACKGROUND:The extent of thyroid resection in benign goiter is controversial. Potential advantages of TT over BST may include: one-stage removal of incidental thyroid cancer, and a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182360118
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To assess whether weekday of surgery influences long-term survival in esophageal cancer. BACKGROUND:Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared with earlier in the week. METHODS:This population-based cohort study included 98% of all esophageal c...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001324
更新日期:2016-06-01 00:00:00
abstract::Total hemolytic complement (CH50), conversion of C3 by inulin and cobra venom factor (CoVF), and immunochemical levels of Clq, C4, C2, C3, C5, factor B, properdin, C3b inactivator (KAF), and immunoglobulins (Igs) G, A, and M were measured in the sera of ten patients with abdominal trauma and ten medical patients with ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197807000-00017
更新日期:1978-07-01 00:00:00
abstract::The prognostic and postoperative monitoring capabilities of the CEA assay were compared to pathological staging of the operative specimens, clinical followup including endoscopy, radiology and scanning techniques, as well as DNCB skin testing and laboratory enzyme determinations (alkaline phosphatase and transaminase)...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197601000-00002
更新日期:1976-01-01 00:00:00
abstract::Forty-three patients (mean age 62 +/- 1 years) were treated for ventricular septal defect (VSD) secondary to myocardial infarction. Whenever possible, operation was postponed until six weeks post-onset chest pain. However, hemodynamic instability, evidenced by cardiogenic shock, refractory pulmonary edema, or a rising...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197709000-00004
更新日期:1977-09-01 00:00:00
abstract:OBJECTIVE:To evaluate (1) levels of the host-defense/antimicrobial peptide LL-37 in patients with trauma and hemorrhagic shock (HS) and (2) the effects of a synthetic host-defense peptide; Pep19-4LF on multiple organ failure (MOF) associated with HS. BACKGROUND:HS is a common cause of death in severely injured patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002186
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:To analyze the clinical course, treatment, complications, outcome, and quality of life (QOL) in patients with perineal/perianal rhabdomyosarcoma (PRMS) treated within the CWS-86, -91, -96, and -2002P trials. BACKGROUND:Although multiple international study trials exist for the treatment of rhabdomyosarcoma, ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e3182a6f320
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:To investigate whether the accuracy of magnetic resonance imaging (MRI) after neoadjuvant systemic therapy (NST) is affected by molecular features of primary breast cancer and the use of human epidermal growth factor receptor 2 (HER2)-targeted agents. BACKGROUND:Improved understanding of factors affecting th...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182686bd9
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:Our objective was to evaluate the safety and durability of biologic mesh for single-staged reconstruction of contaminated fields. INTRODUCTION:The presence of contamination during ventral hernia repair (VHR) poses a significant challenge. Some advocate for a multistaged reconstructive approach with delayed d...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182849871
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the influence of preoperative dysplasia grade, appearance, and site on risk and location of cancer in patients with colitis. BACKGROUND:The ability to predict the presence and location of cancer in colitis patients with dysplasia is essential to facilitate recommendations regarding the necessity ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31828e7417
更新日期:2014-02-01 00:00:00
abstract:SUMMARY BACKGROUND DATA:During the past five decades, significant improvements have been made in the diagnosis and treatment of thoracic outlet syndrome (TOS) secondary to sports activities, breast implants, or median sternotomy. METHODS, RESULTS, AND CONCLUSIONS:Of more than 15,000 patients evaluated for TOS, 3914 un...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199810000-00017
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVES:To develop a risk prediction model for serious complications after bariatric surgery. BACKGROUND:Despite evidence for improved safety with bariatric surgery, serious complications remain a concern for patients, providers and payers. There is little population-level data on which risk factors can be used to ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318230058c
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVE:To develop a model of established respiratory immunity against Pseudomonas aeruginosa pneumonia and to investigate the effects of route and type of nutrition on this immunity. SUMMARY BACKGROUND DATA:Diet influences the ability of gut-associated lymphoid tissue (GALT) to maintain mucosal immunity. Complex en...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199902000-00016
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis. SUMMARY BACKGROUND DATA:It has not been determined whether endotoxin translocation in small amounts is a physiological phenomenon or whether it is a potential health hazard. METHODS:Blood endotoxin, ant...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000082711.77096.71
更新日期:2003-08-01 00:00:00
abstract:OBJECTIVE:To examine the first decade of experience with minimal access surgery, with particular attention to issues of training surgeons already in practice, and to provide a set of recommendations to improve technical training for surgeons in practice. SUMMARY BACKGROUND DATA:Concerns about the adequacy of training ...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-200102000-00003
更新日期:2001-02-01 00:00:00
abstract:OBJECTIVE:This review summarizes reporting of complications of esophageal cancer surgery. BACKGROUND:Accurate assessment of morbidity and mortality after surgery for cancer is essential to compare centers, allow data synthesis, and inform clinical decision-making. A lack of defined standards may distort clinically rel...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e3182480a6a
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:To assess survival after liver resection and transplantation in patients with hepatocellular carcinoma (HCC) beyond Milan criteria. BACKGROUND:The role of liver resection and transplantation remains controversial for patients with HCC beyond Milan criteria. Resection of advanced tumors and transplantation u...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001866
更新日期:2016-10-01 00:00:00
abstract::Estrogen (ER), progesterone (PgR), and androgen (AR) receptors were measured in two simultaneous or subsequent specimens taken each from 259 patients with breast cancer. We studied in 182 patients results from receptor assays, either from one tumor or from the primary tumor, and a lymph node metastasis, and in 77 sequ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198503000-00008
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to assess feasibility and outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LPD). BACKGROUND:Whereas expert centers have reported promising outcomes of LPD, nationwide analyses have raised concerns on its safety, especially during the learning curve. M...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002563
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:To investigate the safety of radical resection for retroperitoneal sarcoma (RPS). BACKGROUND:The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resec...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002250
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate expression of cancer risk-associated biomarkers in columnar epithelium at squamocolumnar junctions produced by an ablation procedure and proton pump inhibitors in incompletely ablated Barrett's esophagus (BE) patients that were nondysplastic prior to ablation. SUMMARY BA...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000224913.19922.7e
更新日期:2006-12-01 00:00:00
abstract::During the years 1954 through 1964, 259 individuals with primary malignant melanoma had an elective node dissection. Microscopic metastases were found in 15% of these patients. The presence of only a microscopic focus of involvement gave a 10-year cure rate of 67%; metastasis larger than a microscopic focus in a singl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197707000-00014
更新日期:1977-07-01 00:00:00
abstract::Little information has been reported on the metabolic characteristics of the totally pancreatectomized patient or the efficacy of medical management after radical pancreatic surgery. The prospective evaluation of 49 such patients, with 31% followed for 48 or more months, forms the basis of this report. The major immed...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199108000-00007
更新日期:1991-08-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to define the best available option for video capture of surgical procedures for educational and archival purposes, with a view to identifying methods of capturing high-quality footage and identifying common pitfalls. SUMMARY BACKGROUND DATA:Several options exist for those who wish ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000250441.69758.cd
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To review a single center's 10-year experience with liver transplantation (LTx) for the biliary atresia-polysplenia syndrome (BA-PS) and to define surgical and clinical guidelines for its management. SUMMARY BACKGROUND DATA:BA is the most common indication for pediatric liver transplantation (LTx) and is ass...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199804000-00022
更新日期:1998-04-01 00:00:00
abstract::Pancreas transplantation has evolved dramatically since its introduction in 1966. As new centers for transplantation have developed, the evaluation of complications associated with pancreas transplantation has led to advances in surgical technique. Furthermore, surgical alterations of the pancreas resulting from trans...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199206000-00005
更新日期:1992-06-01 00:00:00