Traumatic pancreatic injuries are rare, and guidelines specifying management are controversial and difficult to apply in the acute clinical setting. Due to sparse data on these injuries, we carried ...out a retrospective review to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. We hypothesize a higher morbidity and mortality rate in patients treated surgically when compared to patients treated non-surgically.
We performed a retrospective review of data from four trauma centers in New York from 1990-2014, comparing patients who had blunt traumatic pancreatic injuries who were managed operatively to those managed non-operatively. We compared continuous variables using the Mann-Whitney
test and categorical variables using the chi-square and Fisher's exact tests. Univariate analysis was performed to determine the possible confounding factors associated with mortality in both treatment groups.
Twenty nine patients were managed operatively and 32 non-operatively. There was a significant difference between the operative and non-operative groups in median age (37.0 vs. 16.2 years,
= 0.016), grade of pancreatic injury (grade I; 30.8 vs. 85.2%,
value for all comparisons <0.0001), median injury severity score (ISS) (16.0 vs. 4.0,
= 0.002), blood transfusion (55.2 vs. 15.6%,
= 0.0012), other abdominal injuries (79.3 vs. 38.7%,
= 0.0014), pelvic fractures (17.2 vs. 0.00%,
= 0.020), intensive care unit (ICU) admission (86.2 vs. 50.0%,
= 0.003), median length of stay (LOS) (16.0 vs. 4.0 days,
<0.0001), and mortality (27.6 vs. 3.1%,
= 0.010).
Patients with traumatic pancreatic injuries treated operatively were more severely injured and suffered greater complications than those treated non-operatively. The greater morbidity and mortality associated with these patients warrants further study to determine optimal triage strategies and which subset of patients is likely to benefit from surgery.
Inflammation in traumatic spinal cord injury (SCI) has been proposed to promote damage acutely and oppose functional recovery chronically. However, we do not yet understand the signals that initiate ...or prolong inflammation in persons with SCI. High-Mobility Group Box 1 (HMGB1) is a potent systemic inflammatory cytokine-or damage-associated molecular pattern molecule (DAMP)-studied in a variety of clinical settings. It is elevated in pre-clinical models of traumatic spinal cord injury (SCI), where it promotes secondary injury, and strategies that block HMGB1 improve functional recovery. To investigate the potential translational relevance of these observations, we measured HMGB1 in plasma from adults with acute (≤ 1 week post-SCI, n = 16) or chronic (≥ 1 year post-SCI, n = 47) SCI. Plasma from uninjured persons (n = 51) served as controls for comparison. In persons with acute SCI, average HMGB1 levels were significantly elevated within 0-3 days post-injury (6.00 ± 1.8 ng/mL, mean ± standard error of the mean SEM) or 4-7 (6.26 ± 1.3 ng/mL, mean ± SEM), compared with controls (1.26 ± 0.24 ng/mL, mean ± SEM; p ≤ 0.001 and p ≤ 0.01, respectively). In persons with chronic SCI who were injured for 15 ± 1.5 years (mean ± SEM), HMGB1 also was significantly elevated, compared with uninjured persons (3.7 ± 0.69 vs. 1.26 ± 0.24 ng/mL, mean ± SEM; p ≤ 0.0001). Together, these data suggest that HMGB1 may be a common, early, and persistent danger signal promoting inflammation in individuals with SCI.
Traumatic spinal cord injury (SCI) induces changes in the immune system, both acutely and chronically. To better understand changes in the chronic phase of SCI, we performed a prospective, ...observational study in a research institute and Department of Physical Medicine and Rehabilitation of an academic medical center to examine immune system parameters, including peripheral immune cell populations, in individuals with chronic SCI as compared to uninjured individuals. Here, we describe the relative frequencies of T cell populations in individuals with chronic SCI as compared to uninjured individuals. We show that the frequency of CD3+ and CD3+ CD4+ T cells are decreased in individuals with chronic SCI, although activated (HLA-DR+) CD4+ T cells are elevated in chronic SCI. We also examined regulatory T cells (T
regs
), defined as CD3+ CD4+ CD25+ CD127lo and CCR4+, HLA-DR+ or CCR4+ HLA-DR+. To our knowledge, we provide the first evidence that CCR4+, HLA-DR+ or CCR4+ HLA-DR+ T
regs
are expanded in individuals with SCI. These data support additional functional studies of T cells isolated from individuals with chronic SCI, where alterations in T cell homeostasis may contribute to immune dysfunction, such as immunity against infections or the persistence of chronic inflammation.
In a pilot study from an American College of Surgeons (ACS)-verified Level One Trauma Center, we performed a retrospective analysis of patients with cervical spine fractures with or without spinal ...cord injury (SCI). Long-term mortality was determined from the National Death Index as of December 31, 2013.
Examine the influence of age and presence of SCI on time-to-surgery and long-term mortality in patients with cervical spine fractures.
Cervical spine fractures with or without SCI disproportionately impact the elderly, who constitute an increasing percentage of the US population. Early surgical intervention is a safe, modifiable factor that enables early mobilization and may reduce complications. Because of increased comorbidities, surgical treatment of elderly patients with cervical spinal fractures is complex, but prolonged time to surgery is increasingly considered as a factor impacting potential recovery after SCI.
Retrospective chart review using hospital medical charts and mortality data from the National Death Index.
Data from patients with cervical spine fractures treated surgically were analyzed, with nearly equal numbers under and over age 65. There was no statistically significant difference between the 2 age groups with respect to time-to-surgery or long-term mortality. In addition, there was no statistically significant difference between the 2 groups of patients, with or without SCI, with respect to time-to-surgery or long-term mortality.
There was no statistically significant differences between patients by age or by SCI status with respect to time-to-surgery or long-term mortality.
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