Assuntos
Endometriose/complicações , Hemorragia Gastrointestinal/etiologia , Doenças do Colo Sigmoide/complicações , Colonoscopia , Diagnóstico Diferencial , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirurgia , Humanos , Pessoa de Meia-Idade , Recidiva , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The management of arterial injuries has evolved from simple cauterization of the time of Ambrose Paré to the more complex repairs of today. Through history there has been much learned from combat regarding the management of vascular injuries. Starting in World War I, vascular registries have been established to further study and refine the management of these injuries. One of the most pivotal registries was the Vietnam Vascular Registry established by Dr Norman Rich. The lessons learned from these registries have been carried on to the current conflicts with the establishment of the Global War on Terror Vascular Initiative. We compare 100 lower extremity vascular injuries from the Vietnam Vascular Registry to 100 injuries in the Global War on Terror Vascular Initiative database as we continue to improve the future with lessons from our past.
Assuntos
Campanha Afegã de 2001- , Aniversários e Eventos Especiais , Extremidade Inferior/irrigação sanguínea , Medicina Militar/história , Sistema de Registros , Procedimentos Cirúrgicos Vasculares/história , Lesões do Sistema Vascular/história , Saúde dos Veteranos/história , Guerra do Vietnã , Difusão de Inovações , Feminino , História do Século XX , Humanos , Masculino , Medicina Militar/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapia , Saúde dos Veteranos/tendênciasRESUMO
BACKGROUND: Polytetrafluoroethylene (PTFE) and Dacron are commonly used as arterial conduits in vascular trauma or infection when vein interposition graft may not be available. This study used a previously validated large animal model of polymicrobial infection to assess the patency and infectious resistance of a novel, antibiotic-impregnated graft material compared with PTFE and Dacron. METHODS: Forty-eight animals were placed into five groups for a 21-day survival period. A 6-mm PTFE, Dacron, or antimicrobial-bonded graft was used to replace the iliac artery and then inoculated with 1 × 107 colonies/mL of genetically labeled Pseudomonas aeruginosa and Staphylococcus aureus. Native vessels with and without contamination served as control groups. The primary end points were graft patency (determined by duplex ultrasound and necropsy) and graft infection (culture with molecular analysis). Secondary end points included physiologic measurements, blood cultures, laboratory data, and histopathology. RESULTS: At 21 days, 50% of PTFE, 62.5% of Dacron, and 100% of the antimicrobial-bonded grafts remained patent (P = .04). PTFE and Dacron had an equivalent number of overall infections, 87.5% and 75%, respectively (P = 1.0). There was no significant difference of infectious organisms between standard materials. The infection rate of the antimicrobial-bonded graft (25%) was significantly less than that of both PTFE and Dacron (P < .01), and all of these infections were secondary to P. aeruginosa. Clinical data did not vary significantly between groups. There were no mortalities in the protocol secondary to graft blowout or sepsis. CONCLUSIONS: The antimicrobial-bonded graft material outperformed standard PTFE and Dacron in the setting of polymicrobial infection with regard to graft patency and infection. The novel prosthetic material appears to be resistant to infection with S. aureus and to limit the growth of P. aeruginosa. Additional studies are recommended to explore the role of this antibiotic-bonded graft for use in the setting of vascular infection or trauma.