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Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a “planned second-look” laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.
Phenological observations and sex ratios in Marchantia chenopoda L. (Hepaticae: Marchantiaceae)
(1992)
Sex ratios were determined for 15 populations of Marchantia chenopoda L. along Puerto Rico. Sex was determined for twenty randomly selected individuals from each population. A female bias was observed in most populations. A census of reproductive structures of M. chenopoda was performed every two weeks in order to determine phenology. The highest archegoniophore count was observed to occur in January and February; minimum and maximum fertilization distances were 0.7 cm and 65 cm, respectively. Young sporophytes were most frequently observed at the beginning of the rainy season, in April and May. The highest frequency of mature sporophytes occurred during the dry season, in January and February. Capsules opened mostly during the heavy rainy season, from August to November. Protonemata were observed in the periphery of the population. Most young sporophytes aborted at the end of the moderate to heavy rainy season, from June to August. Immature gemmae cups were most frequent at the beginning of the rainy season, in April and May. Mature gemmae cups were observed throughout the rainy season, but were most frequent in September.