ABSTRACT
Background: Far reaching sub-specialization tends to become obligatory for surgeons in most Western countries. It is suggested that exposure of surgeons to emergency laparotomy after trauma is ever declining. Therefore, it can be questioned whether a generalist (i.e., general surgery) with additional differentiation such as the trauma surgeon, will still be needed and can remain sufficiently qualified. This study aimed to evaluate volume trends and outcomes of emergency laparotomies in trauma. Methods: A retrospective cohort study was performed in the University Medical Center Utrecht between January 2008 and January 2018, in which all patients who underwent an emergency laparotomy for trauma were included. Collected data were demographics, trauma-related characteristics, and number of (planned and unplanned) laparotomies with their indications. Primary outcome was in-hospital mortality; secondary outcomes were complications, length of ICU, and overall hospital stay. Results: A total of 268 index emergency laparotomies were evaluated. Total number of patients who presented with an abdominal AIS > 2 remained constant over the past 10 years, as did the percentage of patients that required an emergency laparotomy. Most were polytrauma patients with a mean ISS = 27.5 (SD ± 14.9). The most frequent indication for laparotomy was hemodynamic instability or ongoing blood loss (44%).Unplanned relaparotomies occurred in 21% of the patients, mostly due to relapse of bleeding. Other complications were anastomotic leakage (8.6%), intestinal leakage after bowel contusion (4%). In addition, an incisional hernia was found in 6.3%. Mortality rate was 16.7%, mostly due to neurologic origin (42%). Average length of stay was 16 days with an ICU stay of 5 days. Conclusion: This study shows a persistent number of patients requiring emergency laparotomy after (blunt) abdominal trauma over 10 years in a European trauma center. When performed by a dedicated trauma team, this results in acceptable mortality and complication rates in this severely injured population.
Subject(s)
Laparotomy/standards , Wounds and Injuries/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Child , Child, Preschool , Cohort Studies , Female , Hospital Mortality , Humans , Laparotomy/methods , Laparotomy/statistics & numerical data , Male , Middle Aged , Netherlands , Retrospective Studies , Specialization/trends , Trauma Centers/organization & administration , Trauma Centers/standards , Trauma Centers/statistics & numerical data , Wounds and Injuries/physiopathologyABSTRACT
The protamine of squid is one of the most arginine-rich protamines (77%, mol/mol). It possesses a leading sequence that is posttranslationally removed during spermatogenesis in a manner that is analogous to that observed in some of its vertebrate protamine counterparts. In this paper we describe the gene sequence of the protamine of the squid Loligo opalescens. This represents the first complete gene sequence ever reported for an invertebrate protamine. Like those of vertebrate protamines, the messenger RNA is polyadenylated but the gene does not contain an intron. The promoter region contains the major transcriptional regulatory elements (CRE, TATA box, and CAP) that are also characteristic of the vertebrate protamine genes. It is unclear whether the similarities of protamines in species from both the deuterostome and the protostome branches represent the result of phylogenetic conservation or evolutionary convergence.
Subject(s)
Arginine/genetics , Decapodiformes/genetics , Protamines/genetics , Amino Acid Sequence , Animals , Base Sequence , Blotting, Northern , DNA Primers , DNA, Complementary/genetics , Electrophoresis, Polyacrylamide Gel , Gene Components , Molecular Sequence Data , Sequence Alignment , Sequence Analysis, DNAABSTRACT
An updated comparative analysis of protamines and their corresponding genes is presented, including representative organisms from each of the vertebrate classes and one invertebrate (squid, Loligo opalescens). Special emphasis is placed on the implications for sperm chromatin organization and the evolutionary significance. The review is based on some of the most recent publications in the field and builds upon previously published reviews on this topic.
