Physician/hospital relationships.
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Communication↗
Biomedical subjects
M Klein
Publications and source records attributed to M Klein.
Implications of laparoscopic cholecystectomy for surgical residency training.
BACKGROUND: Widespread adoption of minimal access techniques forced a generation of abdominal surgeons to re-learn many standard abdominal procedures. This threatened to reduce the pool of suitable "training" operations for surgical residents. METHODS: Operator grade, duration of operation, acute/elective operation, conversion rate, complications, and postoperative stay were recorded prospectively on all laparoscopic cholecystectomies (LC) since 1992. This data was evaluated to determine how the introduction of LC affected residents' training. RESULTS: The percentage of LCs performed by residents increased progressively to reach 58%. Operating time was longer for trainee surgeons, particularly for acute cases (145+/-50 minutes vs 111+/-54 minutes, p<0.05); however, conversion rate, incidence of complications, and postoperative stay were no different. CONCLUSIONS: LC can be performed by surgical trainees with similar complication rates and outcomes as those of qualified surgeons. Once institutional experience has accumulated, this procedure can be integrated into residency training.
Adolescent↗
Improvement of epidermal adhesion by surface modification of craniofacial abutments.
Craniofacial implants may present peri-implant inflammation because there is no close adhesion of the epithelium to abutments and because of bacteria infiltrating the subcutaneous tissue through the gap. Therefore an attempt was made to improve adhesion of epithelium to abutments. In an in vitro model, adhesion of epithelial cells (HaCat cells) to nonmodified and 3 modified Brånemark System abutment surfaces was quantified. It was found that more cells were adherent in sequence at silicone-coated surfaces, sandblasted surfaces, and collagen-coated (Types I and IV) surfaces than on nonmodified abutments. It was concluded that it is possible to improve epidermal adhesion to abutments through modification of abutment surfaces.
Bacterial Physiological Phenomena↗
Carcinoma of the small intestine in Crohn's disease--occurrence in a bypassed loop.
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Adenocarcinoma↗
[Mitochondrial disorder secondary to inflammation in polymyositis. Two cases].
Two cases of polymyositis were followed using phosphorus nuclear magnetic resonance spectroscopy. The spectra recorded during remission were normal, but those collected from the gastrocnemius muscle during the active phase of the diseases showed an increased inorganic phosphate level or a decreased phosphocreatine content. The intracellular pH was normal. These findings may be related to an impairement in mitochondrial metabolism secondary to the inflammatory process. Moreover, the fact that the abnormalities observed disappeared after treatment suggests that phosphorus NMR spectroscopy could be used as a non-invasive method in the follow-up of polymyositis, but this must be confirmed by further studies.
Adenosine Triphosphate↗
Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?
AIM: An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. METHODS: Thirty-eight patients (ASA classification 1 and 2) undergoing elective colorectal cancer surgery were allocated at random to 2 groups. Group 1 consisted of 19 patients who received an admixture of 80% oxygen and 20% nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir. Group 2 consisted of 19 patients who received an admixture of 70% nitrous oxide and 30% oxygen during anesthesia, followed by administration of 30% oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1, during the first 2 hours in the recovery room. Wound infection was evaluated daily during hospital stay and after 7 days, 2 weeks, and 1 month. RESULTS: The incidence of wound infection was 12.5% in group 1 and 17.6% in group 2 (p=0.53). CONCLUSIONS: The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.
Aged↗
Laryngeal mask airway and the Robinow syndrome.
The Robinow syndrome is an extremely rare congenital syndrome that causes facial malformations, as well as genital, cardiac and skeletal abnormalities. Patients with this syndrome undergo several operations during their life. Because of the facial abnormalities they carry a potential risk for difficult intubation. We describe the case of a boy who underwent several operations with documented difficult intubation. The laryngeal mask airway provided a good solution for airway control and afforded adequate ventilation under both controlled mechanical ventilation and spontaneous breathing.
Abnormalities, Multiple↗
[Cervix carcinoma in pregnancy].
In this retrospective study we discuss 12 cases of cervical cancer diagnosed during pregnancy. At the time of diagnosis of cervical cancer 11/12 patients were older than 29 years. According to FIGO 3/12 cases were in stage Ia1 cervical carcinoma and 9/12 in stage Ib. After a follow up of at least 35 months no recurrence occurred. We believe, that pregnancy has no negative effect on prognosis of cervical cancer.
Adult↗
[Survey of institutions of the Japanese health system].
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Cancer Care Facilities↗
Acute cerebral and peripheral circulation disorders.
The main characteristic of the present therapeutic strategy in acute cerebral ischemias, peripheral occlusive arterial disease, hyperviscosity, hypovolemic and other shock syndromes is the rapid counteraction on the underlying regional and general microcirculation insufficiency by administration of Dextrans (40 and 60 or 70 respectively) causing increase of reduced (micro)flow and metabolism, antithrombotic effects and volume replacement. Including the respectively needed precaution and concomiting therapy (stabilization of B. P., heart and metabolism disorders, electrolyte correction, analgetics, antibiotics etc.) the chances for improvement or reversibility of the pathophysiological and clinical dysfunctions and for rehabilitation can be elevated by these conceptions. Dextran 60 (70) is superior to blood and gelatine in intensity and keeping volume replacement (until to 25-30% of lossed volume), in microcirculatory and hemodilution potency and with regard to risks and economic aspects. The use of these programs is very successful also in geriatrics.
Arterial Occlusive Diseases↗
[The helminth fauna of the gastrointestinal tract of young cattle in northwest Germany].
Ten unmedicated animals of a controlled anthelmintic trial were used to analyse the present gastrointestinal helminth fauna of young cattle from the northwest of Germany. This survey done in August revealed Ostertagia ostertagi to represent the most prevalent and abundant species followed by Cooperia oncophora and Nematodirus helvetianus. O. lyrata, O. leptospicularis, C. zurnabada, C. punctata, Trichostrongylus axei, Haemonchus contortus, Bunostomum phlebotomum, Capillaria bovis and Trichuris discolor were less prevalent and abundant. These findings are closely similar to findings from investigations more than 20 years ago although since that time anthelmintics have been used increasingly.
Animals↗
[Prepartal mumps infection, a risk for the newborn infant?].
Mumps infection during pregnancy is on account of the antibody prevalence rate a rare event. With a case report and the review of the recent literature we want to show that there is no danger for the infection of the newborn child.
Adult↗
[Rubella infection in pregnancy in naturally acquired immunity].
This case-report concerns the problem of rubella-reinfection in pregnancy (17th week of gestation). Inspite of documented maternal immunity infection was followed by transmission of virus to the fetus. Nowadays in most countries antenatal maternal screening for rubella seems to be sufficient. The observation of cutaneous exanthema, however, demands further investigation, even if maternal immunity was documented.
Adult↗
Evaluation of cerebrovascular processes and their reactions to pharmacotherapy by means of ultrasonic methods.
Calculation of diameter, wall movement, systolic and diastolic flow velocity in the vertebral and carotid artery by means of ultrasonic A-mode-echography and DOPPLER sonography permits identification and quantitative evaluation of cerebrovascular processes in extracranial and intracranial branches and their response to stress, especially in general and regionally accentuated arteriosclerosis, e.g. in predominant vertebrobasilar insufficiency. Their principal reagibility to pharmacotherapy under certain extracerebrovascular preconditions ins demonstrated by significant increase of the reduced hemodynamic parameters accompanied with significant elevation of decreased orthostatic BP after treatment with Raubasine, Dihydroergotamine and Dihydroergocristine.
Aged↗
Do family physicians 'prevent' cesarean sections? A Canadian exploration.
In Canada the rate of births attended by family physicians has declined in parallel with a rise in cesarean births. This reciprocal association has been most marked in those provinces with a relative abundance of obstetricians, a falling birth rate, and large metropolitan areas. Yet, the perinatal mortality rate, with one exception, is virtually the same in all provinces, both where the obstetricians provide most maternity care and where the family physicians play the dominant role. Thus, societal, environmental, and interprofessional issues have more to do with the rising number of cesarean sections and the decline of family physician-attended births than any objective measurement of quality of care. There is evidence that low-technology, high-continuity approaches for women at no anticipated risk are as safe or safer than the universal application of highly interventive care for all. This paper presents an attempt to determine if the decline in family physician-attended births in Canada is related to the rise in the cesarean section rate.
Adult↗
[Amodiaquine-induced agranulocytosis. Description of 4 cases and review of the literature].
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Adult↗