Retroperitoneal packing as part of damage control surgery in a Danish trauma centre – fast, effective, and cost-effective

<p>Abstract</p> <p>Background</p> <p>Retroperitoneal packing in patients with severe haemorrhage is a cornerstone of modern pelvic fracture management. However, few Danish trauma surgeons have experience with this procedure, and trauma audits show that many hesitate to perform the procedure, indicating a need for hands-on training for this simple and potentially lifesaving procedure.</p> <p>Materials and methods</p> <p>During a six-month period, trauma surgeons were taught the retroperitoneal packing procedure using human corpses at the Department of Pathology at Aarhus University Hospital.</p> <p>Results</p> <p>The course consisted of a 30 minute long single training session in retroperitoneal packing. Twenty-three sessions were held. Forty-two trauma surgeons (the entire staff at Aarhus Trauma Centre) and ten observers completed the course. Afterwards, all participants felt competent to perform the procedure.</p> <p>Conclusion</p> <p>All 42 surgeons at our local trauma organisation learned a simple lifesaving operation within a short time period. In the 12 months following the completion of the course, 11 patients were treated with packing without any hesitation and with success. Damage control surgery with packing was cost-effectively implemented at our centre with great ease and rapidity.</p

30-days mortality in patients with perforated peptic ulcer: A national audit

Anne Nakano1,4, J&amp;oslash;rgen Bendix2, Sven Adamsen3, Daniel Buck4, Jan Mainz5, Paul Bartels1, Bente N&amp;oslash;rg&amp;aring;rd4,61The Danish National Indicator Project, Regionshuset Aarhus, Aarhus, Denmark; 2Department of Gastrointestinal Surgery L, Aarhus University Hospital, Denmark; 3Digestive Disease Center, Section for Gastrointestinal Surgery, Copenhagen, Denmark; University Hospital Herlev, Denmark; 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 5Department of Psychiatry Region North, Denmark and Institute of Public Health, University of Southern Denmark, Odense, Denmark; 6Center for National Clinical Databases, South, Odense University Hospital, and Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, DenmarkBackground: In 2005, The Danish National Indicator Project (DNIP) reported findings on patients hospitalized with perforated ulcer. The indicator &amp;ldquo;30-days mortality&amp;rdquo; showed major discrepancy between the observed mortality of 28% and the chosen standard (10%).Rationale: An audit committee was appointed to examine quality problems linked to the high mortality. The purpose was to (i) examine patient characteristics, (ii) evaluate the appropriateness of the standard, and (iii) audit all cases of deaths within 30 days after surgery.Methods: Four hundred and twelve consecutive patients were included and used for the analyses of patient characteristics. The evaluation of the standard was based on a literature review, and a structured audit was performed according to the 115 deaths that occurred.Results: The mean age was 69.1 years, 42.0% had one co-morbid disease and 17.7% had two co-morbid diseases. 45.9% had an American Association of Anaesthetists score of 3&amp;ndash;4. We found no results on mortality in studies similar to ours. The audit process indicated that the postoperative observation of patients was insufficient.Discussion: As a result of this study, the standard for mortality was increased to 20%, and the new indicators for postoperative monitoring were developed. The DNIP continues to evaluate if these initiatives will improve the results on mortality.Keywords: mortality, perforated peptic ulcer, ulcer, audi

Administration of Panobinostat Is Associated with Increased IL-17A mRNA in the Intestinal Epithelium of HIV-1 Patients

Intestinal CD4+ T cell depletion is rapid and profound during early HIV-1 infection.This leads to a compromised mucosal barrier that prompts chronic systemic inflammation.The preferential loss of intestinal T helper 17 (Th17) cells in HIV-1 disease is a driver of the damage within the mucosal barrier and of disease progression.Thus, understanding the effects of new therapeutic strategies in the intestines has high priority. Histone deacetylase (HDAC) inhibitors (e.g., panobinostat) are actively under investigation as potential latency reversing agents in HIV eradication studies. These drugs have broad effects that go beyond reactivating virus, including modulation of immune pathways. We examined colonic biopsies from ART suppressed HIV-1 infected individuals (clinicaltrials.gov: NCT01680094) for the effects of panobinostat on intestinal T cell activation and on inflammatory cytokine production. We compared biopsy samples that were collected before and during oral panobinostat treatment and observed that panobinostat had a clear biological impact in this anatomical compartment. Specifically, we observed a decrease in CD69+ intestinal lamina propria T cell frequency and increased IL-17A mRNA expression in the intestinal epithelium. These results suggest that panobinostat therapy may influence the restoration of mucosal barrier function in these patients

Administration of Panobinostat Is Associated with Increased IL-17A mRNA in the Intestinal Epithelium of HIV-1 Patients

Intestinal CD4+ T cell depletion is rapid and profound during early HIV-1 infection. This leads to a compromised mucosal barrier that prompts chronic systemic inflammation. The preferential loss of intestinal T helper 17 (Th17) cells in HIV-1 disease is a driver of the damage within the mucosal barrier and of disease progression. Thus, understanding the effects of new therapeutic strategies in the intestines has high priority. Histone deacetylase (HDAC) inhibitors (e.g., panobinostat) are actively under investigation as potential latency reversing agents in HIV eradication studies. These drugs have broad effects that go beyond reactivating virus, including modulation of immune pathways. We examined colonic biopsies from ART suppressed HIV-1 infected individuals (clinicaltrials.gov: NCT01680094) for the effects of panobinostat on intestinal T cell activation and on inflammatory cytokine production. We compared biopsy samples that were collected before and during oral panobinostat treatment and observed that panobinostat had a clear biological impact in this anatomical compartment. Specifically, we observed a decrease in CD69+ intestinal lamina propria T cell frequency and increased IL-17A mRNA expression in the intestinal epithelium. These results suggest that panobinostat therapy may influence the restoration of mucosal barrier function in these patients