Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “EXIT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMed2001

[The EX-utero Intrapartum Technique (EXIT) procedure in Italy].

Aim of the study was to present the first two Italian cases of C-section performed with the EXIT procedure (EX-utero Intrapartum Technique). Deliveries were performed at the Division of Obstetrics and Gynecology of the Hospital of Padua in cooperation with the Pediatric Surgery Department, both tertiary care centers. The first case was a twin with a huge neck mass (cystic hygroma) and the second a fetus with an oropharyngeal mass (epignathus). Airway patency could have been compromised at birth in both of them. EXIT procedure consists in securing the airway of the fetus partially delivered and still connected with the placenta. This technique leaves an intact feto-placental circulation and guarantees a normal fetal oxygenation while fetal airway patency is secured. Both the fetuses were successfully intubated and the C-section ended up in a short period of time without maternal and fetal complications. The EXIT technique, performed for the first time in 1989 and now in many centers abroad, can be considered a safe procedure as long as a multidisciplinary approach is carried out. The EXIT procedure is indicated whenever fetal airways can be compromised at birth, that is when oropharyngeal masses, laryngeal atresia, cystic hygroma and goiter are encountered during prenatal ultrasound.

Adult↗
PubMedDate not supplied

Emergence of mupirocin-resistant Staphylococcus aureus in chronic peritoneal dialysis patients using mupirocin prophylaxis to prevent exit-site infection.

OBJECTIVE: To determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit. METHODS: Three swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more. RESULTS: Staphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study. CONCLUSION: We report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.

Adult↗
PubMed2001

Effect in a rat model of heparinized peritoneal dialysis catheters on bacterial colonization and the healing of the exit site.

We performed a prospective, double-blind, randomized study to evaluate whether stable surface heparinization of silicone peritoneal dialysis (PD) catheters prevents bacterial colonization or biofilm formation and improves healing of the exit site. Heparinized catheters were implanted in 20 Sprague-Dawley rats (group H) and non heparinized catheters in another 20 (group C). The PD catheters, constructed of silicon tubing with two polyester cuffs, were patterned after the standard Tenckhoff catheter. A covalent multipoint method of attachment onto polymeric surfaces was used for stable, permanent chemical immobilization of heparin on the PD catheter. Dialysis exchanges (25-mL instillation volume) were performed twice daily for 4 weeks through the permanent catheter. Prophylactic antibiotics were not used. The exit sites were evaluated at 2-week intervals. The extent of biofilm coverage on the intraperitoneal portion of the catheter (obtained at the end of the experiment) was assessed, and sonicated fluid from the catheter tip was cultured for evaluating bacterial colonization of the catheter. Exit-site scores in group H were lower than in group C (p = 0.052) at the end of week 4. Bacterial colonization tended to be less common in group H [2 of 12 catheters (17%)] than in group C [8 of 15 catheters (53%); p = 0.058], but the extent of biofilm, the peritonitis rate, and the inflammation score of tissue adjacent to the cuff were not different between the groups. Those data suggest that heparinized PD catheters can be a practical approach to the prevention of bacterial colonization and can improve healing of the exit site.

Animals↗
PubMed1992

A new catheter to prevent exit-site infection in peritoneal dialysis.

In order to prevent exit-site infection, we studied a new Tenckhoff-derived catheter, named the "Malpighi catheter," capable of avoiding sinus tract formation. The outer cuff of this new device is 3.5 cm long and is deliberately positioned half-extruded; in fact, half of the cuff remains outside the skin exit-site. The implantation technique is identical to that of the standard two-cuff Tenckhoff catheter. We implanted eight Malpighi catheters in 5 CAPD and 3 IPD patients. The observation period was 146 patient-months (range 14-23, M +/- SD 18.2 +/- 3.3). We observed excellent adhesion between the outer cuff and surrounding tissue. Actually, by pulling the catheter the skin around the half-extruded cuff becomes cone-shaped, with the cone's apex tightly stuck to cuff and the sinus tract disappearing completely. Only one case of exit-site infection by Staphylococcus aureus and two cases of ulcer of the skin beneath the external part of the half-extruded cuff were observed. These complications were resolved completely. No catheter needed to be removed and there were no leakages. The histological study of the cuff showed a good infiltration of the dacron cuff by fibrous tissue. On the grounds of our preliminary experience, we believe that the absence of the sinus tract, the formation of an efficient mechanical and bacterial barrier and the reduction of exit-site infection incidence are all factors that encourage further research.

Aged↗
PubMed1992

Exit-site/tunnel infection and catheter outcome in peritoneal dialysis patients.

STUDY OBJECTIVE: To study exit-site/tunnel infections and catheter outcomes in peritoneal dialysis patients. DESIGN: The study was designed to investigate exit-site (ESI)/tunnel infections (TI) and catheter losses in all chronic PD catheters inserted in ESRD patients from 9/88 to 9/91. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: Seventy-three patients (40 males, 33 females) underwent 78 double-cuff coiled swan-neck catheter implantations surgically. The curettage of exit site was performed weekly for tunnel infection refractory to medical management. The subcutaneous cuff was excised in persistent ESI/TI. RESULTS: Fifty-nine episodes of ESI/TI in 34 patients were observed over 946 patient-months. Thirty-nine patients experienced no ESI/TI, 27 patients had one and seven had two or more episodes of ESI/TI. Four patients had five episodes of peritonitis associated with ESI/TI. Eight recurrent episodes of ESI/TI with S. aureus in 8 patients were treated successfully with Rifampin. Seven subcutaneous cuffs were excised successfully in 7 patients with tunnel infection, five with S. aureus and two with Pseudomonas aeruginosa. No catheter was removed due to ESI/TI or ESI/TI associated peritonitis. CONCLUSIONS: Aggressive exit site care including repeated curettage, excision of the subcutaneous cuff and appropriate antibiotics reduced significantly catheter losses related to ESI/TI.

Bacterial Infections↗
PubMedDate not supplied

Effect of local mupirocin application on exit-site infection and peritonitis in an Indian peritoneal dialysis population.

BACKGROUND: Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India. METHODS: This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application. RESULTS: Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect. CONCLUSIONS: Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.

Administration, Topical↗
PubMed1991

A new method to evaluate the CAPD-catheter-exit and other percutaneous devices.

A method that has proved to be the most sensitive approach for the early diagnosis of infection of the oral mucosa around dental implants has been used to monitor the exit-sites of percutaneous devices. For three months the state of the skin-catheter interface of 13 CAPD-patients was examined every four weeks. This examination included the measurement of pocket depth with the aid of a periodontal probe, the measurement of SFFR (sulcus-fluid-flow-rate) using standardized filter paper strips and a bacteriological swab of the exit-site. The results obtained demonstrated that SFFR can be measured around percutaneous implants. The measurement of SFFR appeared to be more useful in the monitoring of exit-sites of percutaneous devices than the measurement of pocket depth or the use of bacteriological swabs. Further studies for prolonged periods are necessary to determine whether measurement of SFFR can reliably predict onset of exit-site infection before clinical signs become evident.

Adult↗
PubMed1989

Staphylococcus aureus nasal carriage, exit-site infection and catheter loss in patients treated with continuous ambulatory peritoneal dialysis (CAPD).

Over a three-year period, 217 episodes of bacterial peritonitis occurred in 183 patient years. Thirty-seven episodes were due to Staphylococcus aureus and 19 (51%) of these required removal of the catheter to eradicate infection. This compared with catheter loss in 4/63 (6.3%) coagulase negative staphylococci infections (p less than 0.001); 7/67 (9.5%) culture negative peritonitis (p less than 0.001); and 10/30 (33.3%) episodes due to gram-negative organisms (p less than 0.05). Over half (51.3%) the episodes due to S. aureus were associated with exit-site infections, and this rose to 100% (10/10) with recurrent peritonitis (p less than 0.01). A prospective analysis of nasal carriage and exit-site infections due to S. aureus was carried out in 87 patients. Exit-site infections were present in 21 (24%), almost entirely due to different strains as judged by sensitivity patterns and phage typing. Nasal carriage, defined as two positive swabs within the study period, was present in 20 (23%) patients. Fourteen (70%) of these had exit-site infections due to the same strain as that isolated from the nose, whereas no patient grew different strains from either site. Nasal carriage increased the risk of infection sixfold (p less than 0.001).

Catheters, Indwelling↗
PubMed1977

Effect of cations on tetraehtylammonium exit from mouse kidney cortex slices.

Exit of 14C-tetraethylammonium (TEA) was studied in mouse kidney cortex slices incubated in Krebs-Ringer bicarbonate buffer (37 degrees C, pH 7.4) aerated with O2-CO295:5 v/v%. Substitution of Na+ in the wash out buffer by K+, Rb+ or the organic cations TEA and choline resulted in a stimulation of exit which, however, may be secondary to concomitant biochemical changes in the tissue (increase of water content and relative loss of K+) seen in the presence of these cations. However, enhancement of 14C-TEA exit although less pronounced was also produced of low organic cation concentrations having no effect on tissue water and K+. The latter specific effect on 14C-TEA exit may represent an interaction phenomenon in renal organic cation transport of accelerative exchange diffusion type.

Animals↗
PubMed1983

Shored gunshot wound of exit. A phenomenon with identity crisis.

Shored gunshot wound of exit is produced when the outstretched skin is impaled, sandwiched, and crushed between the outgoing bullet and the unyielding object over the exit site, thus leaving an abrasion collar on the wound margin. Proper coaptation of the wound margin is impossible because of the loss of skin just like those observed in entrance wounds. In contrast to the entrance wound, the supported exit wound shows a scalloped or punched-out abrasion collar and sharply contoured skin in between the radiating skin lacerations marginating the abrasion (Fig. 1). Should gunpowder be observed around the exit site, it is often unevenly distributed, and is not associated with searing, gunpowder stippled abrasion, tatooing, and deposition of soot.

Biomechanical Phenomena↗
PubMed1984

Reduction of military high-altitude parachute entanglement using the controlled alternating parachute exit system.

The phenomenon of high-altitude parachute entanglement (HAE) results when two paratroopers have both a simultaneous and weak exit from the jump doors. They are then caught in the aircraft's slipstream and collision and entanglement follow. To avoid this phenomenon, the Controlled Alternating Parachute Exit System (CAPES) was introduced. CAPES focused upon manipulation of the exit technique to eliminate simultaneous paratrooper exit. Data from 90,894 consecutive parachute jumps revealed that the CAPES is highly successful in reducing te rate of high-altitude entanglement and the associated injury rate. CAPES seems to reduce the mid-altitude entanglement (MAE) and its injury rate but the results did not reach statistical significance as measured by chi square technique. The rate of landing or ground injuries, was essentially unchanged by the CAPES.

Accidents, Aviation↗
PubMed1994

Lack of correlation between nasal cultures positive for Staphylococcus aureus and the development of S. aureus exit-site infections: results unaffected by routine mupirocin treatment of nasal S. aureus carriage.

Whether nasal carriage of Staphylococcus aureus is associated with an increased risk of S. aureus exit-site infection remains controversial. We performed nasal cultures prior to peritoneal dialysis catheter placement in all of our patients beginning in September 1990. We also performed nasal cultures on a cohort of patients already on peritoneal dialysis. Patients with positive cultures received a prescription for a ten-day course of intranasal mupirocin. Exit-site and nasal cultures were performed on every subsequent office visit until the end of the study in April 1993. The initial visit and three widely-spaced subsequent visits were chosen for data analysis. There were 68 patients entered into the study. Data from a total of 272 visits were analyzed. The patients ranged in age from 18-80 years. There were 27 diabetics. We found no correlation between initial positive nasal cultures and the subsequent development of a S. aureus exit-site infection. All identified nasal carriers were treated with mupirocin. However, the subsequent development of a S. aureus exit-site infection could not be correlated to a prior S. aureus carrier state or lack thereof.

Administration, Intranasal↗
PubMedDate not supplied

The effect of antibiotic prophylaxis on the healing of exit sites of peritoneal dialysis catheters in rats.

OBJECTIVE: To evaluate the influence of intraperitoneal (i.p.) antibiotic (AB) prophylaxis on the quality of healing and infection rates of exit sites in peritoneal dialysis catheters. STUDY DESIGN: Twenty-one Sprague-Dawley rats were dialyzed 3 times per day for 6 weeks. Dianeal solution containing AB was used for all the rats during the first 5 days. The animals were randomized on the sixth day into three groups: group A (AB-free after randomization), group B (AB for 3 weeks), and group C (AB during 6 weeks). Scores were given to each exit site according to the observation. Mean scores from each group were compared in an attempt to find significant differences between the groups. Dialysate and exit-site drainage samples were taken weekly for microbiology. RESULTS: Eight episodes of peritonitis were diagnosed, six in group A and two in group B. The most common bacteria causing peritonitis were gram-negative rods. The mean scores were not significantly different between groups C and B throughout the study, even after the discontinuation of the prophylaxis. Group A, when compared to the other two groups, had significantly higher scores after the second week and throughout the rest of the study. CONCLUSION: Intraperitoneal antibiotic prophylaxis for 3 weeks after catheter implantation is an effective way to prevent early colonization of exit sites, providing a better healing quality and lower incidence of catheter-related infection. Although the extension of the prophylaxis for 6 weeks seems to be beneficial, it was not statistically proven in this study.

Animals↗
PubMed1998

A new salvage procedure for peritoneal dialysis catheters with exit site infections.

The management of catheter-related infections has become a major challenge in continuous ambulatory peritoneal dialysis treatment. We identified five patients on continuous ambulatory peritoneal dialysis who failed conservative medical management for exit site infections. Each patient underwent incision and debridement along the subcutaneous course of the catheter, exteriorization of the superficial cuff, and establishment of a new exit site at the medial aspect of the wound. This novel technique of incision and debridement along the subcutaneous tunnel and relocation of the exit site has not been described in the literature. In four of five patients, this technique controlled the exit site infection and arrested the progression of the infection to peritonitis, preventing the need for catheter removal.

Adult↗
PubMed2000

Exit wave reconstructions using through focus series of HREM images.

The through focus exit wave reconstruction technique uses a series of high resolution electron microscopy images to reconstruct the complex electron wavefunction at the exit plane of the specimen. The feasibility of the through focus exit wave reconstruction method and its most important limitations are discussed. It is shown that-provided all aberrations of the microscope are well corrected for-a large improvement in the interpretability of the information can be obtained.

Biophysical Phenomena↗
PubMed1990

Deep splenic lymphatic vessels in the mouse: a route of splenic exit for recirculating lymphocytes.

A study of pathways of lymphocyte migration through mouse spleen revealed lymphatic channels closely following arteries in trabeculae and white pulp. Because there is no detailed record of the layout of deep splenic lymphatics in the mouse, or other species, we present our observations in this paper, relating our findings to normal migratory pathways of lymphocytes through the spleen. Lymphatics draining the spleen are so inconspicuous that they often are not mentioned in anatomical discussions. The data presented clearly demonstrate 1) the existence and layout of deep lymphatic vessels in the mouse spleen, and 2) that migrating lymphocytes exit white pulp via these lymphatic vessels. CD4+ and CD8+ T cell subsets migrated proximally along the central artery from distal (dPALS) to proximal periarterial lymphatic sheaths (pPALS) and exited via deep lymphatic vessels that originate there. B cells migrated from dPALS to enter lymphatic nodules (NOD), thus segregated from T cells. B cells then migrated toward and exited via deep lymphatics. The appearance of labelled lymphocytes in lymph coincided with their disappearance from white pulp compartments. Labelled T cells were observed in splenic lymphatics as early as 1 hr after intravenous infusion but took, on average, about 6 hr. B cells took somewhat longer. Thus T and B cells entered and left white pulp through shared pathways, but took divergent intermediate routes through dedicated zones, pPALS for T cells, NOD for B cells.

Animals↗
PubMed2005

Histone deacetylase 1 is required for cell cycle exit and differentiation in the zebrafish retina.

Histone acetylation is an important epigenetic mechanism for the control of eukaryotic transcription. The histone deacetylase 1 (HDAC1) gene has been implicated in controlling the transcription of core cell cycle regulators, but the in vivo role of HDACs in cell cycle regulation is still poorly understood. Loss of HDAC1 activity causes underproliferation in several contexts during vertebrate development. In contrast, we show here that HDAC1 has the opposite effect in the zebrafish visual system, where loss of HDAC1 activity leads to failure of cells to exit the cell cycle in the retina and in the optic stalk. The effect of HDAC1 on cell cycle exit is cell-autonomous, and loss of HDAC1 in the retina leads to up-regulation of cyclin D and E transcripts. These results demonstrate that the in vivo role of HDAC1 in regulating cell cycle progression is region-specific, as HDAC1 promotes cell cycle exit in the retina but stimulates proliferation in other cellular contexts.

Alleles↗
PubMed1988

Entrapment neuropathy of the ulnar nerve at its point of exit from the flexor carpi ulnaris muscle.

The ulnar nerve normally enters the flexor carpi ulnaris (FCU) proximally and anteriorly between the humeral and ulnar heads of the muscle. After an intramuscular course of several centimeters, the nerve exits the FCU distally to lie in a tissue plane between the FCU and the flexor digitorum profundus (FDP). A patient with ulnar neuropathy studied by intraoperative electroneurography demonstrated major focal conduction block at the point where the nerve exited the FCU. A fivefold increase in amplitude and reversal of a dispersed, irregular compound muscle action potential to a more normal configuration occurred with stimulation just distal to the point of exit. There was no evidence by inspection, probing, or electroneurography of compression in the retrocondylar groove or at the cubital tunnel. In a series of 100 cadaver dissections, the intermuscular septum between FCU and FDP was thick and tough in several specimens. This septum may represent a site of ulnar nerve entrapment.

Electrodiagnosis↗