Ethnicity exerts a powerful impact on medical care. We cannot determine from our data whether these differences stem from differences in pain behavior of the patients or differences in medical staff's perception and treatment of such patients.
Background:We sought to determine the effi cacy and safety of perioperative treatment with methylprednisolone on the development of lung injury after pulmonary thromboendarterectomy. Methods: This was a randomized, prospective, double-blind, placebo-controlled study of 98 adult patients with chronic thromboembolic pulmonary hypertension who were undergoing pulmonary thromboendarterectomy at a single institution. The patients received either placebo (n 5 47) or methylprednisolone (n 5 51) (30 mg/kg in the cardiopulmonary bypass prime, 500 mg IV bolus following the fi nal circulatory arrest, and 250 mg IV bolus 36 h after surgery). The primary end point was the presence of lung injury as determined by two independent, blinded physicians using prospectively defi ned criteria. The secondary end points included ventilator-free, ICU-free, and hospitalfree days and selected levels of cytokines in the blood and in BAL fl uid. Results: The incidence of lung injury was similar in both treatment groups (45% placebo, 41% steroid; P 5 .72). There were no statistical differences in the secondary clinical end points between treatment groups. Treatment with methylprednisolone, compared with placebo, was associated with a statistically signifi cant reduction in plasma IL-6 and IL-8, a signifi cant increase in plasma IL-10, and a signifi cant reduction in postoperative IL-1ra and IL-6, but not IL-8 in BAL fl uid obtained 1 day after surgery. Conclusions: Perioperative methylprednisolone does not reduce the incidence of lung injury following pulmonary thromboendarterectomy surgery despite having an antiinfl ammatory effect on plasma and lavage cytokine levels.CHEST 2012; 141(1):27-35Abbreviations: CPB 5 cardiopulmonary bypass; mPAP 5 mean pulmonary artery pressure; NYHA 5 New York Heart Association; PTE 5 pulmonary thromboendarterectomy; PVR 5 pulmonary vascular resistance
In patients who are hypotensive after blunt abdominal trauma and not hemodynamically stable enough to undergo diagnostic CT, negative US findings virtually exclude surgical injury, while positive US findings indicate surgical injury in 64% of cases.
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