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Article: Ethanol abuse and the trauma patient.

Maier, R V

2001 Volume 2, Issue 2, Page(s) 133–41; discussion 141–4

Abstract: Background: Alcohol intoxication has long been associated with an increased risk of injury from a number of mechanisms and with trauma recidivism. It is less certain whether alcohol abuse is associated with worse outcomes for a given degree of injury.!## ...

Abstract	Background: Alcohol intoxication has long been associated with an increased risk of injury from a number of mechanisms and with trauma recidivism. It is less certain whether alcohol abuse is associated with worse outcomes for a given degree of injury. Methods: Review of the pertinent English-language literature. Results: The vasodilator effects of alcohol may hamper fluid resuscitation, especially in head-injured patients. Acute and chronic alcohol intoxication both have substantial effects on the cellular and molecular responses necessary to fight infection. High alcohol concentrations exert an immunosuppressive effect on production of proinflammatory cytokines such as tumor necrosis factor and interleukin-1. However, the clinical effects of the immunosuppression are variable and difficult to discern in heterogeneous trauma patient populations with variable degrees of intoxication. Conclusion: Alcohol has a profound impact on the epidemiology of injury, but the physiology and biochemical effects in an individual patient may be difficult to predict. Identification of intoxicated persons is essential, despite economic disincentives to do so, because even brief targeted intervention programs can decrease substantially the patient's risk of subsequent injury.
MeSH term(s)	Alcohol-Related Disorders/complications ; Humans ; Outcome Assessment (Health Care) ; Trauma Severity Indices ; Wounds and Injuries/etiology
Language	English
Publishing date	2001
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/109629601750469456
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Article: Pathogenesis of multiple organ dysfunction syndrome--endotoxin, inflammatory cells, and their mediators: cytokines and reactive oxygen species.

Maier, R V

Surgical infections

2000 Volume 1, Issue 3, Page(s) 197–204; discussion 204–5

Abstract: Multiple organ dysfunction syndrome (MODS) is caused by an overwhelming, uncontrolled systemic inflammatory response that is activated by a number of hostile stimuli including sepsis, hypovolemic shock, and severe trauma resulting in massive tissue ... ...

Abstract	Multiple organ dysfunction syndrome (MODS) is caused by an overwhelming, uncontrolled systemic inflammatory response that is activated by a number of hostile stimuli including sepsis, hypovolemic shock, and severe trauma resulting in massive tissue injury. The indiscriminate activation of the inflammatory response due to these insults causes loss of the host's ability to localize the inflammation to the focus of the problem, leading to systemic inflammation and severe host tissue damage and subsequent MODS. While the major players, namely neutrophils, macrophages, endotoxin, cytokines, and oxidants have been known for some time, the disease processes responsible for the pathogenesis of MODS have only recently been elucidated. Our newly found knowledge has resulted in the development of novel therapeutic strategies to prevent or treat MODS, such as scavenging toxic oxygen species and inhibiting endotoxin, or cytokine production, or cytokine activity. Unfortunately, these strategies have not resulted in improved mortality rates among patients with MODS. The complex nature of the host response to severe insults combined with the fact that the host has multiple, redundant parallel systems to deal with various insults has made it difficult for clinical interventions to adequately ameliorate the disease process among patients at risk for MODS. The purpose of this article is to attempt to "dissect out" several individual components of the inflammatory response that play important roles in the development of MODS and to review some potentially beneficial approaches to combat these harmful processes.
MeSH term(s)	Animals ; Cytokines/physiology ; Endotoxins/physiology ; Humans ; Macrophages/physiology ; Multiple Organ Failure/etiology ; Multiple Organ Failure/immunology ; Multiple Organ Failure/metabolism ; Neutrophils/physiology ; Reactive Oxygen Species/metabolism
Chemical Substances	Cytokines ; Endotoxins ; Reactive Oxygen Species
Language	English
Publishing date	2000
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/109629600750018123
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Article: Pentoxifylline in sepsis.

Maier, R V

Archives of surgery (Chicago, Ill. : 1960)

1998 Volume 133, Issue 4, Page(s) 466

MeSH term(s)	Humans ; Multiple Organ Failure/prevention & control ; Pentoxifylline/therapeutic use ; Phosphodiesterase Inhibitors/therapeutic use ; Research Design ; Sepsis/drug therapy
Chemical Substances	Phosphodiesterase Inhibitors ; Pentoxifylline (SD6QCT3TSU)
Language	English
Publishing date	1998-04
Publishing country	United States
Document type	Letter
ZDB-ID	80055-7
ISSN	1538-3644 ; 0004-0010 ; 0096-6908 ; 0272-5533
ISSN (online)	1538-3644
ISSN	0004-0010 ; 0096-6908 ; 0272-5533
DOI	10.1001/archsurg.133.4.466
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Article: To be or not to be?

Maier, R V

Surgery

1992 Volume 112, Issue 2, Page(s) 121–129

MeSH term(s)	Costs and Cost Analysis ; Education, Medical, Graduate/economics ; General Surgery/education ; Health Care Costs ; Income ; Internship and Residency ; Medicine ; Physician's Role ; Reimbursement Mechanisms ; Relative Value Scales ; Specialization
Language	English
Publishing date	1992-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
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Article: The relationship between trauma center volume and outcome.

Nathens, A B / Maier, R V

Advances in surgery

2001 Volume 35, Page(s) 61–75

Abstract: In spite of the limited direct evidence available, increasing data support a positive volume-outcome association in trauma care. When coupled with the extensive indirect data suggesting that regions with organized systems of trauma care are associated ... ...

Abstract	In spite of the limited direct evidence available, increasing data support a positive volume-outcome association in trauma care. When coupled with the extensive indirect data suggesting that regions with organized systems of trauma care are associated with lower trauma-related mortality rates than regions where the number of centers and their level of commitment are unlimited and untested, there is little doubt that experience improves outcome and that volume plays a critical role in the accrual of experience. Although regionalization of trauma care has the inevitable consequence of increased prehospital transport times, particularly in rural areas remote from large trauma centers, some states have designed inclusive systems where a large number of smaller centers have been verified and designated as lower level trauma centers (i.e., level 3-5). The process of trauma center verification holds these smaller volume centers to a standard of care such that the quality of care of the trauma patient may exceed that of other, less-regulated aspects of medical or surgical care. Several reports have suggested that trauma outcomes in smaller rural level 3 centers or centers with dedicated trauma programs with appropriate, functional triage protocols are comparable to national norms, thus reflecting the importance of commitment to outcome. These data suggest that quality of care does not only follow volume, particularly when stipulations and requirements are clear regarding the process of care and ongoing quality assurance.
MeSH term(s)	Hospital Mortality ; Humans ; Quality Assurance, Health Care ; Quality Indicators, Health Care ; Regional Medical Programs ; Survival Rate ; Trauma Centers/standards ; Trauma Centers/utilization ; Treatment Outcome ; United States ; Utilization Review
Language	English
Publishing date	2001
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	411889-3
ISSN	1878-0555 ; 0065-3411
ISSN (online)	1878-0555
ISSN	0065-3411
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Article: Sympathectomy for causalgia: experience with military injuries.

Hassantash, S A / Maier, R V

The Journal of trauma

2000 Volume 49, Issue 2, Page(s) 266–271

Abstract: Background: Causalgia is a rare disease in civilian practice, and most reports regarding causalgia in the literature are from major extended wars. To increase awareness of this syndrome, our wartime experience with this disease is presented.: Methods!# ...

Abstract	Background: Causalgia is a rare disease in civilian practice, and most reports regarding causalgia in the literature are from major extended wars. To increase awareness of this syndrome, our wartime experience with this disease is presented. Methods: The charts of patients with causalgia referred to two university hospitals for treatment from 1985 to 1989 were retrospectively studied. Characteristics of the cause, clinical manifestations, and the response to therapy were evaluated. Results: Among 1,564 patients with peripheral nerve injuries, there were 54 cases (3.4%) of causalgia. All of the patients, except five, were injured in battle by high-velocity bullets or missiles. Upper extremities were involved in 28 patients (52 %) and lower extremities in 26 patients (48%). The most common presenting symptoms were as follows: burning pain, 100%; wet extremity, 100%; cold extremity, 93%; sensitivity to cold, 89%; paresthesia, 78%; and color changes in the extremities, 55%. In 48 patients (89%), pain was relieved by sympathetic block (3 patients had permanent cure). Six patients had no response to the blocks (11%). Of 45 patients who had temporary relief, all underwent sympathectomy. All of these patients had complete relief of symptoms in the immediate postoperative period and for follow-up from 1 to 6 years. Conclusion: Causalgia is essentially a war casualty disease. The condition is associated with burning pain, hyperesthesia, and symptoms of sympathetic overactivity. Sympathectomy is effective and the treatment of choice, particularly for patients who respond temporarily to sympathetic blocks.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Causalgia/epidemiology ; Causalgia/etiology ; Causalgia/surgery ; Female ; Humans ; Iran/epidemiology ; Male ; Medical Records ; Middle Aged ; Military Personnel ; Pain/prevention & control ; Retrospective Studies ; Sympathectomy ; Wounds, Penetrating/complications
Language	English
Publishing date	2000-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	219302-4
ISSN	1529-8809 ; 0022-5282 ; 1079-6061
ISSN (online)	1529-8809
ISSN	0022-5282 ; 1079-6061
DOI	10.1097/00005373-200008000-00012
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Article: Lipid mediators in the pathophysiology of critical illness.

Bulger, E M / Maier, R V

Critical care medicine

2000 Volume 28, Issue 4 Suppl, Page(s) N27–36

Abstract: Inflammatory lipid mediators are produced by the metabolism of membrane phospholipids following a number of different stimuli. These mediators lead to a variety of cellular and systemic responses which contribute to the manifestations of the systemic ... ...

Abstract	Inflammatory lipid mediators are produced by the metabolism of membrane phospholipids following a number of different stimuli. These mediators lead to a variety of cellular and systemic responses which contribute to the manifestations of the systemic inflammatory response syndrome in the critically ill patient. These mediators include platelet-activating factor and the eicosanoids, including prostaglandins, thromboxanes, leukotrienes, and HETEs. This review seeks to evaluate the current role of these mediators in the pathophysiology of critical illness. We will focus on recent studies concerning the modulation of these pathways as a potential therapeutic strategy for management of these critically ill patients. This includes the gamut from nutritional strategies to alter the cellular membrane lipid composition, thereby effecting the substrate available to produce these lipid byproducts, to intracellular inhibitors to alter production of these mediators, to receptor blockage and enhanced clearance to inhibit their effects.
MeSH term(s)	Cell Membrane/metabolism ; Critical Illness ; Humans ; Inflammation Mediators/physiology ; Lipids/physiology ; Phospholipases A/biosynthesis ; Phospholipases A/metabolism ; Phospholipids/metabolism ; Prostaglandins/physiology ; Respiratory Distress Syndrome, Adult/metabolism ; Respiratory Distress Syndrome, Adult/physiopathology ; Second Messenger Systems/physiology ; Sepsis/physiopathology ; Shock/metabolism ; Shock/physiopathology ; Shock/therapy ; Systemic Inflammatory Response Syndrome/etiology ; Systemic Inflammatory Response Syndrome/prevention & control
Chemical Substances	Inflammation Mediators ; Lipids ; Phospholipids ; Prostaglandins ; Phospholipases A (EC 3.1.1.32)
Language	English
Publishing date	2000-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/00003246-200004001-00004
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Article: Antioxidants in critical illness.

Bulger, E M / Maier, R V

Archives of surgery (Chicago, Ill. : 1960)

1999 Volume 136, Issue 10, Page(s) 1201–1207

Abstract: Oxidative stress has been implicated in the manifestations of critical illnesses, including ischemia and reperfusion injury and systemic inflammatory states. This review describes the evidence for increased oxidative stress in critically ill patients and ...

Abstract	Oxidative stress has been implicated in the manifestations of critical illnesses, including ischemia and reperfusion injury and systemic inflammatory states. This review describes the evidence for increased oxidative stress in critically ill patients and explores the data regarding antioxidant therapy for these conditions. Antioxidant therapies reviewed include N-acetylcysteine, selenium, vitamins E and C, superoxide dismutase, catalase, lazaroids, and allopurinol. We focus on the results of these interventions in animal models and human trials, when available.
MeSH term(s)	Animals ; Antioxidants/metabolism ; Antioxidants/therapeutic use ; Critical Illness/therapy ; Humans ; Oxidative Stress
Chemical Substances	Antioxidants
Language	English
Publishing date	1999-08-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80055-7
ISSN	1538-3644 ; 0004-0010 ; 0096-6908 ; 0272-5533
ISSN (online)	1538-3644
ISSN	0004-0010 ; 0096-6908 ; 0272-5533
DOI	10.1001/archsurg.136.10.1201
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Article: Endothelial changes after shock and injury.

Maier, R V / Bulger, E M

New horizons (Baltimore, Md.)

1996 Volume 4, Issue 2, Page(s) 211–223

Abstract: The endothelial cell (EC) was once though to be a passive bystander in the inflammatory response to shock and injury. We now know, however, that these cells play a central role in the coordination of the response to injury. Hypovolemic shock following ... ...

Abstract	The endothelial cell (EC) was once though to be a passive bystander in the inflammatory response to shock and injury. We now know, however, that these cells play a central role in the coordination of the response to injury. Hypovolemic shock following traumatic injury initiates two primary mechanisms of cellular damage. These include ischemia/reperfusion injury and acute inflammation. The EC has four key functions that are altered by these states: a) control of coagulation, b) regulation of vascular tone, c) control of vascular permeability, and d) regulation of leukocyte adhesion and trafficking. In the settings of ischemia/reperfusion and acute inflammation, the EC takes on a proinflammatory phenotype and as such becomes prothrombotic, demonstrates enhanced vascular permeability, and becomes chemoattractant, facilitating leukocyte adhesion, activation, and migration. In this article, we explore each of the four EC functions in detail along with the alterations that occur when the proinflammatory phenotype becomes manifest. In addition, we elucidate novel therapeutic strategies that have arisen from this research.
MeSH term(s)	Animals ; Blood Coagulation/physiology ; Capillary Permeability/physiology ; Cell Adhesion/physiology ; Endothelium, Vascular/metabolism ; Endothelium, Vascular/physiology ; Humans ; Inflammation/complications ; Inflammation/physiopathology ; Leukocytes/physiology ; Reperfusion Injury/complications ; Reperfusion Injury/physiopathology ; Shock/complications ; Shock/physiopathology ; Shock, Traumatic/complications ; Shock, Traumatic/physiopathology ; Vasomotor System/physiopathology
Language	English
Publishing date	1996-05
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Review
ZDB-ID	1178377-1
ISSN	1063-7389
ISSN	1063-7389
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Article: Re; Witzke JD et al. Stapled versus hand sewn anastomes in patients with small bowel injury: a changing perspective. J Trauma. 2000;49:660--665.

Brundage, S I / Maier, R V / Jurkovich, G J

The Journal of trauma

2001 Volume 51, Issue 1, Page(s) 180–182

MeSH term(s)	Abdominal Injuries/surgery ; Anastomosis, Surgical ; Humans ; Intestine, Small/injuries ; Intestine, Small/surgery ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Randomized Controlled Trials as Topic ; Surgical Staplers ; Survival Rate ; Suture Techniques
Language	English
Publishing date	2001-07
Publishing country	United States
Document type	Comparative Study ; Letter
ZDB-ID	219302-4
ISSN	1529-8809 ; 0022-5282 ; 1079-6061
ISSN (online)	1529-8809
ISSN	0022-5282 ; 1079-6061
DOI	10.1097/00005373-200107000-00039
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