Fat embolism syndrome after femur fracture with intramedullary nailing: case report.

Fat embolism syndrome is a life-threatening condition that can develop after orthopedic injury and surgery. This syndrome developed in a 19-year-old man after a traumatic femoral fracture that was surgically repaired with intramedullary nailing. The complications experienced by the patient highlight the importance of prevention and early detection of fat embolism syndrome. Although minimization of the syndrome focuses primarily on prehospital care and early stabilization of a patient's condition, prevention of the potential consequences requires early detection by bedside nurses who care for trauma and orthopedic patients. Detailed nursing assessment and rapid recognition and reporting of the signs and symptoms associated with fat embolism syndrome are key to improving the outcomes of these patients.

Stilbazulenyl nitrone decreases oxidative stress and reduces lung injury after hemorrhagic shock/resuscitation and LPS.

Multiorgan failure is a major cause of late morbidity and mortality after trauma. Reactive oxygen species generated during shock/resuscitation contribute to tissue injury by priming the immune system for an exaggerated response to subsequent inflammatory stimuli such as LPS. Stilbazulenyl nitrone (STAZN) is a novel second-generation azulenyl nitrone that has been shown to have potent antioxidant properties in a rat model of brain ischemia. We hypothesized that STAZN may confer protection against lung injury after shock/resuscitation and LPS by reducing oxidative stress and lowering the production of NF-kappaB-dependent pro-inflammatory cytokines. Sprague-Dawley rats were submitted to a two-hit model of lung injury involving hemorrhagic shock/resuscitation and subsequent intratracheal LPS injection, with and without intraperitoneal injections of STAZN. STAZN reduced overall lung injury in response to LPS alone and also after shock/resuscitation plus LPS. STAZN also reduced plasma levels of 8-isoprostane, a proxy measure of oxidative stress, indicating its antioxidant activity in vivo. The effect of STAZN was, at least in part, related to its effect on nuclear translocation of NF-kappaB and generation of the pro-inflammatory cytokine TNF-alpha. Azulenyl nitrones such as STAZN represent a promising novel class of antioxidants for treating organ injury.

Hypertonic resuscitation of hemorrhagic shock prevents alveolar macrophage activation by preventing systemic oxidative stress due to gut ischemia/reperfusion.

BACKGROUND: The gut is a target organ of shock/resuscitation (S/R); however, it also contributes to distant inflammation through the generation of oxidants. S/R with antioxidants such as N-acetylcysteine (NAC) prevents lipopolysaccharide (LPS)-induced cytokine production and NF-kappaB activation in rat alveolar macrophages. Therefore, we hypothesized that hypertonic saline (HTS) might exerts its protective effect by preventing gut ischemia/reperfusion injury, thus decreasing oxidative stress and distant priming in alveolar macrophages. METHODS: A two-hit rat model of shock resuscitation was used. Plasma levels of 8-iso-prostaglandin, a marker of lipid peroxidation, was quantified by eicosanoid immunoassay with acetylcholinesterase kit. Gut histology with hematoxylin and eosin staining was performed 1 to 6 hours after resuscitation. Alternatively, alveolar macrophages from bronchoalveolar lavage (BAL) at end resuscitation were incubated in vitro with LPS (0.01 mug/mL), and NF-kappaB translocation was observed by immunofluorescent staining with anti-p65 antibody. RESULTS: HTS resuscitation prevented leukosequestration in the alveolar space, and it abrogated the progressive rise in blood 8-iso-prostaglandin production observed with Ringer's lactate (RL) resuscitation. Inhibition of oxidant stress with NAC corresponded with the ability of HTS to prevent S/R-induced edema, villus flattening, and mucosal sloughing in the mid-ileum. LPS-induced NF-kappaB translocation in alveolar macrophages after RL was 42% compared to 20% after HTS. Similar attenuation was observed with NAC resuscitation (16%). CONCLUSIONS: HTS resuscitation prevents systemic oxidative stress by reducing gut ischemia/reperfusion injury and consequently attenuates distant alveolar macrophage priming, thereby reducing LPS-induced NF-kappaB nuclear translocation in alveolar macrophages and organ injury. This represents a novel mechanism whereby HTS exerts its immunomodulatory effects.

Effects of Sequential Calcium Chloride, Ziram, and Yeast Orchard Sprays on Postharvest Decay of Pear.

The most effective nutritional, fungicidal, and biological control treatments previously evaluated for control of postharvest decay in pear were evaluated for 3 years as factorial treatments to determine the best combinations for an integrated program. Calcium chloride sprays during the growing season reduced incidence of side rot in each year and of blue mold in 1 year, while ziram was effective against side rot in 1 year and blue mold in 2 years. Ziram, but not calcium chloride, provided control of gray mold and bull's-eye rot. Application of the yeast Cryptococcus infirmominiatus to pear fruit 1 week before harvest at a concentration of 1.0 to 1.5 × 108 CFU/ml resulted in establishment of large populations of yeast on fruit surfaces, but did not reduce postharvest fungal decay incidence in 3 years of testing. In 1 year, ziram sprays applied 2 weeks before harvest significantly reduced yeast populations on fruit subsequently treated with C. infirmo-miniatus. Sequential treatments with calcium chloride and ziram are indicated in an integrated program to take advantage of their differential effectiveness to broaden the range of control of pear postharvest decay pathogens.

Right ventricular infarction during left ventricular assist system support.

Left ventricular assist devices are frequently used to bridge patients to cardiac transplantation. As this experience grows, new and unanticipated complications will occur. This report describes a 50-year-old man with ischemic cardiomyopathy being bridged to cardiac transplantation who suffered an acute right ventricular infarction during the interval of support.

Reduced platelet glutathione peroxidase activity and serum selenium concentration in atopic asthmatic patients.

BACKGROUND: Asthmatic inflammation results in increased oxygen free radical generation and assessment of the activity of the selenium (Se) dependent anti-oxidant enzyme, glutathione peroxidase (GSH-Px) in asthma may therefore be important. OBJECTIVE: To test the hypothesis that reduced GSH-Px activity and Se intake contribute to asthmatic inflammation, platelet and whole blood GSH-Px activities and serum and whole blood Se concentrations were measured and compared in atopic and non-atopic asthmatic patients and non-asthmatic control subjects. METHODS: GSH-Px activities of whole blood and isolated platelets were assessed in 41 asthmatic patients (33 atopic) and 41 age- and sex-matched non-asthmatic subjects (15 atopic) by spectrophotometric assay based on the oxidation of NADPH. Se concentrations were determined by semi-automated fluorimetric assay. RESULTS: Mean (+/-SD) platelet GSH-Px activity was lower in asthmatic (89.5 +/- 45.7 mumol NADPH oxidized min-1 g-1 of protein) than in non-asthmatic subjects (109.9 +/- 41.9; P = 0.038) and in atopic (89.7 +/- 45.1, n = 48) compared with non-atopic subjects (113.7 +/- 40.9, n = 34; P = 0.016). Mean whole blood GSH-Px activity was also lower in atopic (12.2 +/- 5.2 mumol NADPH oxidized min-1 g-1 of Hb) than in non-atopic subjects (14.5 +/- 4.2; P = 0.038). In non-asthmatic subjects, the mean whole blood GSH-Px activity was lower in men (9.9 +/- 3.5) than in women (14.5 +/- 3.7; P = 0.0004) and was positively correlated with age (r = 0.51; P = 0.0006). Mean serum Se was lower in asthmatic (1.07 +/- 0.12 mumol/L) than in non-asthmatic subjects (1.16 +/- 0.31; P = 0.036). Using multiple linear regression, asthma was an independent predictor of decreased platelet GSH-Px after gender, age and serum Se were taken into account (P = 0.048) while atopy was a significant predictor of low whole blood GSH-Px independent of asthma, gender, age and whole blood Se (P = 0.033). CONCLUSIONS: In addition to Se status, atopy, gender and age all appear to influence GSH-Px activity, although the relative importance of these factors may differ in asthmatic and non-asthmatic populations. It seems likely that the reduced activity of this enzyme in platelets and blood may reflect mechanisms associated with the pathogenesis and severity of asthma.

Prosthetic joint infections in the elderly.

PURPOSE: The aim of this study was to review risk factors, presenting symptoms and signs, organisms causing infection, treatment modalities, and outcomes in elderly patients with infection of prosthetic joints. PATIENTS AND METHODS: Patients over 60 years of age treated at the University of Michigan Hospital or Ann Arbor Veterans Administration Medical Center from 1977 to 1987 who had a diagnosis of prosthetic joint infection were reviewed. Early infections were defined as those occurring within 12 months of insertion of the prosthesis; late infections were those occurring more than 12 months after insertion. RESULTS: Fifty-one episodes of infection in 38 elderly patients were reviewed. There were 20 infections in prosthetic hips and 31 infections in prosthetic knees. Twenty-seven infections occurred early and 24 occurred late. Coagulase-negative staphylococci, Staphylococcus aureus, and Group D enterococci were the organisms most commonly isolated (33%, 27%, and 24% of episodes, respectively). Pseudomonas aeruginosa and other gram-negative bacilli were the causative organisms in approximately a third of the infections, and anaerobic organisms were noted in almost one fourth of episodes. In 33 episodes, the infected device was eventually completely removed, but infection resolved in only 20 of these 33 episodes (61%). In 18 episodes treated without removal of the device, none resolved. Outcome was poor; only five patients could walk without assistance, six patients developed contiguous osteomyelitis, two required amputation, and three died. CONCLUSIONS: Infection of prosthetic joints in elderly patients is a serious disease with poor functional outcome. The device has to be removed in order to clear the infection, and even then the infection is often difficult to eradicate.