Trauma liver

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

Portal hypertension is a consequence of increased resistance to blood flow through the portal vein. Increased resistance is usually due to restructuring of intrahepatic tissue (sinusoidal damage) but may also be caused by presinusoidal damage such as portal vein occlusion from trauma, malignancy, or thrombosis. A third (and the least common) mechanism is outflow obstruction of the hepatic vein. This latter damage is posthepatic, and normal liver structure is maintained. This chapter will focus on portal hypertension caused by intrahepatic damage from cirrhosis. 

HbSS) hallmark of SCD Chronic hemolytic anemia is common Patients may develop infarction of the spleen, liver, bone marrow, kidney, brain, and lungs Gallstones and priapism also may develop Slow healing lower extremity ulcers may develop usually after infection or trauma Hgb 7-10 g/dL (70-100 g/L or 4.4-6.2 mmol/L)... 

Respiratory, hematological, liver, and renal effects were not observed in 11 hexachloroethane-exposed workers. The identification of hexachloroethane in the plasma of these workers confirmed exposure, although the workers were wearing protective equipment. Mild dermal irritation was noted that may have been from exposure or a result of a local trauma effect of the protective equipment. 

Intermediate-Duration Exposure. A study (Selden et al. 1994) of 11 workers who wore protective equipment while being exposed to hexachloroethane for 5 weeks showed no respiratory, hematological, liver, or kidney effects at plasma levels of 7.3 + 6 pg/L (Selden et al. 1993). Because mild dermal effects were noted, the principal exposure route may have been dermal. The dermal effects may also have been a result of trauma from the protective equipment. Because of the protective equipment, it is not possible to determine exposure levels. 

In patients with type 1 insulin-dependent diabetes mellitus not adequately treated with insulin, fatty add release from adipose tissue and ketone synthesis in the liver exceed the ability of other tissues to metabolize them, and a profound, life-threatening ketoaddosis may ocxnir. An infection or trauma (causing an increase in cortisol or epinephrine) may predpitate an episode of ketoaddosis. Patients with type 2 non-insulin-dependent diabetes meUitus (NIDDM) are much less likely to show ketoaddosis. The basis for this observation is not completely understood, although type 2 disease has a much slower, insidious onset, and insulin resistance in the periphery is usually not complete. Type 2 diabetics can develop ketoacidosis after an infection or trauma. In certain populations with NIDDM, ketoaddosis is much more common than previously appredated. 

In the ebb phase, there is increased activity of the sympathetic nervous system and increased plasma levels of adrenaline and glucocorticoids but a decreased level of insulin. This results in mobilisation of glycogen in the liver and triacylglycerol in adipose tissue, so that the levels of two major fuels in the blood, glucose and long-chain fatty acids, are increased. This is, effectively, the stress response to trauma. These changes continue and are extended into the flow phase as the immune cells are activated and secrete the proinflammatory cytokines that further stimulate the mobilisation of fuel stores (Table 18.2). Thus the sequence is trauma increased endocrine hormone levels increased immune response increased levels of cytokines metabolic responses. 

The increased oxidation of fatty acids decreases the rate of glucose utilisation and oxidation by muscle, via the glucose/fatty acid cycle, which accounts for some of the insulin resistance in trauma. An additional factor may be the effect of cytokines on the insulin-signalling pathway in muscle. An increased rate of fatty acid oxidation in the liver increases the rate of ketone body production the ketones will be oxidised by the heart and skeletal muscle, which will further reduce glucose utilisation. This helps to conserve glucose for the immune and other cells. 

Figure 18.5 A summary of the biochemical, physiological and immunological changes brought about by cytokines in response to trauma. Cytokines can be produced in trauma from macrophages, lymphocytes, endothelial cells in the tissue that is damaged, and also by Kupffer cells if the liver is damaged. IL-1, IL-6 - interleukins 1 and 6 TNF - tumour necrosis factor, IFN - interferon.

The introduction of the Krumdieck sheer enabled a more optimal and reproducible preparation of liver slices (Figure 12.1). With this technique the thickness of the slices is adjustable to a value as low as 100 pm. The slicing procedure itself is performed in a buffer assuring minimal trauma of the tissue. In addition, the Krumdieck sheer provides a rapid and automated... 

Steroids that aid in muscle development are called anabolic steroids. They are synthetic derivatives of testosterone, thus have the same muscle-building effect as testosterone. There are more than 100 different anabolic steroids which, vary in structure, duration of action, relative effects and toxicities. Androstenedione, stanozolol and dianabol are anabolic steroids. They are used to treat people suffering from traumas accompanied by muscle deterioration. The use of anabolic steroid can lead to a number of dangerous side-effects, including lowered levels of high density lipoprotein cholesterol, which benefits the heart, and elevated levels of harmful low density lipoprotein, stimulation of prostate tumours, clotting disorders and liver problems. 

Arthritis, chronic colitis, peptic ulcer, gastritis, enteritis, influenza, liver diseases, hypothyroidism, chronic nephritis, myocardial infarction, myocarditis, severe blood loss, trauma, severe dehydration and allergies. 

Rheumatic arthritis, rheumatoid arthritis, trauma, strain, myocardial infarction, angina pectoris, sequelae of cerebrovascular accident, chronic hepatitis, cirrhosis of the liver, enlarged spleen, various tumors, as well as psychiatric disorders. 

Saito et al., 1993) and Parkinson s diseases (Vanderklish and Bahr, 2000). The list could continue to include organ ischemia, stroke, brain trauma, various platelet syndromes, hypertension, liver dysfunction, and some types of cancer Table 1 offers a panorama of the diseases that have most frequently been linked to calpains. A role for these proteases in the genesis of these conditions has been generally inferred from... 

Figure 6. Whole body nitrogen balance and cellular hydration of skeletal muscle. Data were obtained from humans. A healthy subjects (n = 17) B liver tumors (n = 5), C polytrauma day 2 and D day 9 after trauma (n = 11) E acute necrotizing pancreatitis (n = 6) F burn patients (n = 4). (From Haussinger et. al., 1993.)...

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