Search PubMed⌕ Search

Biomedical subjects

G Grotte

Publications and source records attributed to G Grotte.

At least 19 recordsLinked to original sources
PubMed2000

Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England. The North West Regional Cardiac Surgery Audit Steering Group.

OBJECTIVE: To study the use of the Parsonnet score to predict mortality following adult cardiac surgery. DESIGN: Prospective study. SETTING: All centres performing adult cardiac surgery in the north west of England. SUBJECTS: 8210 patients undergoing surgery between April 1997 and March 1999. MAIN OUTCOME MEASURES: Risk factors and in-hospital mortality were recorded according to agreed definitions. Ten per cent of cases from each centre were selected at random for validation. A Parsonnet score was derived for each patient and its predictive ability was studied. RESULTS: Data collection was complete. The operative mortality was 3.5% (95% confidence interval 3.1% to 3.9%), ranging from 2.7% to 3.8% across the centres. On validation, the incidence of discrepancies ranged from 0% to 13% for the different risk factors. The predictive ability of the Parsonnet score measured by area under the receiver operating characteristic curve was 0.74. The mean Parsonnet score for the region was 7.0, giving an observed to expected mortality ratio of 0.51 (range 0.4 to 0.64 across the centres). A new predictive model was derived from the data by multivariate analysis which includes nine objective risk factors, all with a significant association with mortality, which highlights some of the deficits of the Parsonnet score. CONCLUSIONS: Risk stratified mortality data were collected on 100% of patients undergoing adult cardiac surgery in two years within a defined geographical region and were used to set an audit standard. Problems with the Parsonnet score of subjectivity, inclusion of many items not associated with mortality, and the overprediction of mortality have been highlighted.

Aged↗
PubMed1994

Early and late results following combined coronary bypass surgery and mitral valve replacement.

To study the effect of various perioperative and operative variables, we analysed the results of 66 consecutive patients undergoing mitral valve replacement (MVR) and coronary artery bypass grafting (CABG). The mean age was 61.2 years (34 males and 32 females), the mean follow-up 54.71 +/- 7.8 months. The hospital mortality rate was 7.6% (5/66). New York Heart Association (NYHA) functional class (P < 0.01), left ventricular global wall motion score (increased scores indicating impaired function, P = 0.005) and cross-clamp time (P < 0.05) were associated with hospital mortality. There was no significant relationship of age (certainly up to the age of 70), cause of mitral valve disease, severity of mitral regurgitation, number of grafts, presence of angina, or previous myocardial infarction with hospital mortality. There were eight late deaths, survival at 1, 3 and 5 years was 92.4%, 83.2% and 80.2%, respectively. Although there was a trend for pulmonary vascular resistance (P = 0.15), NYHA class (P = 0.18) and aortic cross-clamp time (P = 0.09) to be associated with late survival, the only factor significantly related to late survival was global wall motion score (P = 0.001), i.e. those with scores of more than 10. Severity of mitral regurgitation and cause of mitral valve disease have been reported as being related to late survival in patients undergoing combined CABG and MVR, but we have found no such relationship. Our results indicate that both hospital and late mortality after this operation are strongly correlated with left ventricular function.

Adult↗
PubMed1984

Urinary incontinence in children: treatment with free autogenous muscle transplantation.

Free autogenous muscle transplantation has now been carried out in 13 patients with anal incontinence and 16 patients with urinary incontinence. In anal incontinence the results have been excellent; all patients were improved and 12 out of 13 reached an acceptable level of continence. In 10 patients with urinary incontinence the results were good, with increase of functional bladder capacity and abandonment of nappies during the day. Two patients were improved and 4 were failures. Cinematographic studies in both anal and urinary incontinence clearly demonstrated the muscular activity of the transplants and confirmed the existence of a reinnervation process. The longest postoperative observation time is now 7-years in the anal patients and 6 years in the urinary patients.

Adolescent↗
PubMed1983

Neuron-specific enolase as a differential marker in a case of retroperitoneal tumour.

In some cases of retroperitoneal tumour, preoperative investigations fail to conclusively differentiate between neuroblastoma and Wilms' tumour. Diagnostic difficulties can be encountered also intraoperatively, and even the histopathological presentation can be equivocal. According to earlier results, neuron-specific enolase (NSE) in tumour extract can be used as a marker for neuronal tissue and thus offers a new diagnostic criterion differing neuroblastoma from e.g. Wilms' tumour. This paper presents a case of Wilms' tumour where a low content of NSE in the tumour extract correctly indicated a non-neuronal tumour, whereas preoperative presentation and primary histopathology suggested a neuroblastoma.

Child↗
PubMed1982

Neuron specific enolase: a marker for differential diagnosis of neuroblastoma and Wilms' tumor.

Thirteen human neuroblastoma and six Wilms' tumor biopsies have been analyzed for neuron specific enolase (NSE). THe relative activity of NSE in the neuroblastomas (including ganglioneuroblastoma and ganglioneuroma) ranged from 28% to 62.5% of total enolase activity. The corresponding figures for the Wilms' tumors were 1% to 4.5%. It appears that NSE can serve as a biochemical marker for neuroblastoma and be useful in the differential diagnosis of neuroblastoma and Wilms' tumor.

Child↗
PubMed1982

H-type tracheo-oesophageal fistula in children with special reference to surgical management and to repair of recurrent nerve injury.

The majority of tracheo-oesophageal fistulas are best treated by a cervical approach, in which there is an obvious risk of injuring the recurrent laryngeal nerve. Usually there is a temporary dysfunction, but if the nerve is completely divided, an attempt at microsurgical direct end-to-end anastomosis is worth while, which is here proven in a child of three weeks of age.

Esophagoscopy↗
PubMed1982

Are there two different forms of neuroblastoma?

Spontaneous regression occurs in approximately 7% of all neuroblastoma cases. There seem to be at least two different mechanisms of regression, a) differentiation of the tumor cells against benign non-proliferative ganglioneuroma cells and b) spontaneous disappearance of the neuroblastoma cells via cytolysis. The initial loss of growth control of the spontaneously regressing neuroblastomas might be the result of an overproduction of trophic and growth-stimulating factors or by a shortage or absence of factors initiating neuronal differentiation. These cells should not have genetic defects. In contrast, the major part of neuroblastomas represent a malignant type of tumor with cells which probably have genetic defects. In the following study, a model is demonstrated to investigate the biochemical mechanisms underlying the maturation of human neuroblastoma cells using 12-0-tetradecanoylphorbol-13-acetate (TPA) in human neuroblastoma cell cultures.

Cell Differentiation↗
PubMed1981

Phenotypic changes of human neuroblastoma cells in culture induced by 12-O-tetradecanoyl-phorbol-13-acetate.

SK-N-SH and SH-SY5Y human neuroblastoma cells treated by 12-)-tetradecanoyl-phorbol-13-acetate(TPA) express morphological and biochemical changes, which indicate that differentiation towards more mature cells has occurred. The most prominent morphological changes were the development in 40-60% of the cells of cell-surface projections longer than 50 micrometers and cytoplasmic neurosecretory granules demonstrated by electron microscopy. At the biochemical level, TPA induced a two-fold increase in the relative activity of neuron-specific enolase and 30- to 40-fold increase in noradrenaline and adrenaline concentrations. A decrease in proliferation rate of TPA-treated cells was observed. The biological effects of TPA were slightly potentiated by nerve growth factor.

Cell Division↗
PubMed1981

Neuron-specific enolase in relation to differentiation in human neuroblastoma.

The presence of the two forms of enolase, neuron-specific enolase (NSE) and non-neuronal enolase (NNE), have been examined in biopsy material of human neuroblastoma, ganglioneuroblastoma, ganglioneuroma and cultured neuroblastoma cells, after separation with ion exchange chromatography. The enolase activities were inhibited in the presence of NaCl but remained active in KCl, which were used in the chromatographic step. The relative NSE levels in the neuroblastoma tissues were found to be lower than in the histopathologically more differentiated forms of the tumour, i.e. ganglioneuroblastoma and ganglioneuroma. The human neuroblastoma in vitro cell lines SK-N-SH, SH-SY5Y, SK-N-MC and IMR-32 contained considerably lower relative levels of NSE compared to the levels in the neuroblastoma biopsies. After treatment of the cultured cells with nerve growth factor or dibutyryl-cAMP some cells showed morphological differentiation and concomitantly an increase in the NSE levels. The results indicate that NSE might be useful as a marker for differentiation in human neuroblastoma.

Biopsy↗
PubMed1981

Complete parenteral nutrition in the surgery of the newborn infant.

A regimen of complete parenteral nutrition (CPN), including glucose, amino acids, fat, water- and fat-soluble vitamins and minerals, was used in 10 newborn infants operated on for gastrointestinal malformations. By giving more than 90 kcal/kg/day (376 kJ) and approximately 2.1 g amino acids/kg/day, normal weight gain and nitrogen retention were obtained. 3-Methylhistidine excretion was measured in 4 infants and a correlation to the nitrogen retention was found. Normal fat clearance rates, triglyceride and cholesterol concentrations in serum were measured in all infants except in one pre-term. One preterm infant had very low levels of zinc in serum and red cells and had clinical signs of zinc deficiency. The regimen seemed to suit full-term infants very well but it is possible that even more energy should be supplied to pre-term infants and perhaps also different amounts of trace elements.

Acid-Base Equilibrium↗
PubMed1979

Postoperative causes of death in pediatric surgery: analysis and conclusions for the therapy.

The mortality of children with posterolateral diaphragmatic hernia (PDH) is mainly dependent upon the degree of lung hypoplasia. Other less significant factors are dysmaturity, associated anomalies, infection and haemorrhages. Children with grave cyanosis from PDH immediately after birth have a poor prognosis due to persistent foetal circulation with pulmonary vascular hypertension and right-left shunting. A better understanding and treatment of this persistent foetal circulation may considerably improve the surgical mortality, though in some cases the lung hypoplasia may be too far advanced.

Ductus Arteriosus, Patent↗
PubMed1978

A new treatment of anal incontinence in children: free autogenous muscle transplantation.

A new method is presented for the treatment of anal incontinence in children, including free autogenous muscle transplantation. The primary step is denervation of a skeletal muscle, which 2 wk later is transplanted and placed as a U-sling around the rectum, imitating the position and function of the puborectalis muscle. The transplant is placed in close contact with innervated muscles, which act as reinnervation sources. The results in five consecutive patients are highly promising. An early sign of improvement is the occurrence of a sensation of rectal fullness. All the patients reached an acceptable degree of continence, including abandonment of the use of napkins, 4-12 mo after surgery.

Adolescent↗
PubMed1977

Successful treatment of pseudomonas aeruginosa--ventriculitis with intraventricular gentamicin in a child with hydrocephalus.

A hydrocephalic child, who was operated with a ventriculo-peritoneal shunt at the age of 1 month, developed ventriculitis due to Pseudomonas aeruginosa at 8 months. After removal of the shunt and successively increasing intramuscular and intraventricular doses of gentamicin the patient was cured and a new shunt could be inserted. As high 24-hour gentamicin level in the cerebrospinal fluid as 76 microgram/ml was reached without any apparent toxic signs.

Cerebrospinal Fluid Shunts↗
PubMed1977

Posterolateral diaphragmatic hernia--long-term results.

During the years 1965--1974, 125 cases of posterolateral diaphragmatic hernia have been operated at five departments of pediatric surgery in Sweden. The overall operative mortality was 50%. A follow-up investigation included 19 cases, where in 12 cases spirometry and in 11 cases studies of the mobility of the diaphragm were included. Physical examination revealed excellent results in most cases. Lung function studies, however, show a moderate (20--30%) reduction, which is not surprising with regard to lung hypoplasia and impaired movement of the diaphragm on the operated side. In adolescence and younger age, these patients are mostly in excellent condition; but later, when lung function is also reduced by the age factor, their neonatal condition may be of importance.

Adolescent↗