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At least 271 records · Page 15Linked to original sources
PubMed1999

[Temporary balloon occlusion as therapy of uncontrollable arterial hemorrhage in multiple trauma patients].

PURPOSE: Presentation of temporary balloon occlusion as an interventional radiological method for managing hemorrhage in multiply injured patients with uncontrollable loss of blood. METHOD: Temporary, non-selective arterial occlusion by introduction of a balloon catheter contralaterally to the source of bleeding has been performed since 1992 on 7 patients with multiple injuries, hemorrhagic shock requiring reanimation, and angiographic demonstration of an arterial hemorrhage in the supply region of the internal iliac artery with complex pelvic fracture. In each case a PTA balloon catheter was introduced transfemorally, non-selectively positioned proximal to the bleeding source, and left in place for 24-48 h under manometric control. Control angiographies were performed prior to catheter removal. RESULTS: The bleeding was stopped immediately in all 7 patients. The hemodynamic stability made transport and thus further surgical management and/or a short-term treatment in the intensive-care station possible. Control angiographies confirmed that the bleeding had stopped in all patients. CONCLUSIONS: We recommend temporary balloon occlusion as a rapid and effective method for the management of bleeding in otherwise uncontrollable traumatic hemorrhages in the supply region of the internal iliac artery.

Adult↗
PubMed2003

Comparison of voice characteristics following three different methods of treatment for laryngeal cancer.

INTRODUCTION: Laryngeal cancer treatment has become more complex and diversified in past decades. Many different methods of treatment have evolved, and most have been able to restore the patient's function and maintain some form of functional speech. This study was designed to evaluate the voice and speech characteristics of patients who have undergone different treatments for laryngeal cancer and to compare those characteristics with those of age- and sex-matched normal laryngeal speakers. METHODS: Twenty-two male subjects participated in the study. Five men were treated with radiation therapy, 6 men had supracricoid partial laryngectomy, 6 men had undergone total laryngectomy with tracheoesophageal puncture, and 5 men were normal laryngeal speakers. Acoustic, aeromechanical, and perceptual assessments of speech were collected. RESULTS: Significant age effects were found for maximum phonation times. As age increased, maximum phonation time decreased (p < .005). Significant differences were found between groups for the following dependent variables: percentage of voiceless phonation, maximum phonation time, laryngeal airway resistance, subglottal pressure, oral flow, and word intelligibility. Trends in the data for differences between groups were noted for the following acoustic variables: noise-to-harmonics ratio, jitter, and shimmer. CONCLUSIONS: All patients developed or maintained a source of voicing after treatment and could use speech functionally, as demonstrated by normal sentence intelligibility. The radiation treatment group had voices that differed the least from the control group, whereas the opposite was true for the surgical groups, especially for those with total laryngectomy.

Age Factors↗
PubMed1992

The treatment of diabetic retinopathy: a view for the internist.

PURPOSE: To review the status of surgical and medical therapy for diabetic retinopathy from the perspective of the non-ophthalmologist. DATA SOURCES: Relevant English-language articles published from January 1981 to July 1991 were identified through MEDLINE. Other relevant articles were obtained from the authors' personal database. STUDY SELECTION: For the review of surgical treatment, large randomized, controlled trials were selected. For the review of medical treatment, randomized studies comparing intensive insulin treatment with conventional insulin therapy were selected, as were double-blind, randomized, controlled trials of aldose-reductase inhibitor therapy and antiplatelet therapy in patients with diabetic retinopathy. DATA EXTRACTION: Emphasis is on findings from large, multicenter, randomized, controlled studies. DATA SYNTHESIS: Surgery is effective in three clinical situations: Panretinal (scatter) photocoagulation is effective treatment for proliferative retinopathy that is likely to progress to severe visual loss, with such therapy resulting in a 50% to 60% decrease in the main outcome (visual acuity of 5/200 or less; focal photocoagulation decreases the incidence of deterioration of visual acuity by 60% in patients with clinically significant macular edema, but no benefit of photocoagulation has been shown in patients with mild-to-moderate background diabetic retinopathy; and vitrectomy is effective in improving visual acuity only in patients with severe, complicated proliferative retinopathy. Intensive insulin therapy has not been consistently effective in short-term studies with small numbers of subjects. Results of the Diabetes Control and Complications Trial should show whether intensive insulin therapy affects the course of diabetic complications. Aldose-reductase inhibitors have not shown efficacy in changing the course of diabetic retinopathy. Results of trials using antiplatelet agents are controversial. CONCLUSIONS: Current therapy of diabetic retinopathy is based on detection and surgical treatment of advanced lesions. Medical interventions that effectively halt the progression or prevent the development of diabetic retinopathy are needed.

Aldehyde Reductase↗
PubMed1978

Clinical spectrum of septic pulmonary embolism and infarction.

Management of septic pulmonary embolism now suggests a predictability of the clinical course which often allows an early decision regarding the need for definitive thoracotomy. Sixty patients have been treated within the past 5 years. Antibiotics were employed in all patients, administered whenever possible according to cultures. In 12 patients thoracotomy was required. This involved decortication and varying amounts of pulmonary resection from wedge excision to pneumonectomy. Early appreciation of septic pulmonary embolism and prompt thoracotomy can frequently obviate the need for tardy open drainage procedures with consequent prolonged recovery. Sources of emboli must be controlled. Interruption of the inferior vena cava, vein excision, aggressive control of peripheral abscesses, and excision of the tricuspid valve may be required. Reliance on antiocagulants alone to control emboli is dangerous, and proper surgical intervention and antibiotic therapy reduce the need for long-term anticoagulation.

Adult↗
PubMed1993

Performance comparison among children fitted with myoelectric and body-powered hands.

Seventy-six children with unilateral below-elbow amputation were fitted in random sequence with a myoelectric (MYO) and a body-powered (BP) prosthetic hand of identical size, shape, and glove color. Subjects ranged from six to 17 years, nine months and included 67 children with congenital limb deficiency and nine who sustained traumatic amputation. After training, each child wore each hand for three months. On the form board test requiring only prosthetic use, subjects took 13.7% longer with the MYO and committed more errors with the MYO, specifically in dropping objects and delaying their grasp and release. Object displacement, the most common error, occurred nearly as often with BP as MYO. MYO was minimally faster on a test of ten practical activities designed for bimanual prehension. Card playing was 39.8% faster with BP, whereas donning socks, cutting paper, and bandage application were 27.8%, 12.5%, and 10.9% faster with MYO. Performance with both hands was rated as decidedly poorer than normal quality. No major clinically important differences were found in the comparison of performance.

Activities of Daily Living↗
PubMed1998

A new method to prevent wound infection: a controlled clinical trial in patients with combined liver and bile duct resection.

INTRODUCTION: Despite advances in antibiotic prophylaxis, postoperative wound infection remains a major source of morbidity after digestive surgery. Its prevention is a challenging problem, especially in high-risk patients. The authors introduced a new method to prevent surgical wound infections and evaluated its efficacy in a prospective, randomized trial in markedly high-risk patients. METHODS: Patients with biliary tract carcinoma who were scheduled to undergo combined liver and extrahepatic bile duct resection with biliary reconstruction were randomly assigned to one of two groups, well matched in terms of clinical characteristics at baseline. In one group the new treatment was employed (sealed group, n=31), and in the other the wound was treated in the usual fashion (open group, n=28). In the sealed group, povidone-iodine gel was administered to the subcutaneous tissue, and the skin and peritoneum were approximated with a continuous suture. Wound infection was registered up to 30 days after surgery. RESULTS: Wound infection occurred in 18 patients: 5 (16%) patients in the sealed group and 13 (46%) in the open group (P<0.05). All 18 underwent preoperative percutaneous transhepatic biliary drainage and had positive bile culture findings. In 13 of these 18 patients (72%) the microorganisms isolated from the infected wound were identical to those in the bile. CONCLUSIONS: Our results confirm the close association between infected bile and wound infection in hepatobiliary surgery. Our new method, "direct wound sealing," is simple, easy to perform, virtually cost-free, and has the potential to prevent wound infections even in markedly high-risk patients.

Anti-Infective Agents, Local↗
PubMed2005

Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective.

BACKGROUND: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including beta-lactams and aminoglycosides. METHODS: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (beta-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. RESULTS: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. CONCLUSION: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.

Anti-Bacterial Agents↗
PubMed1997

Long-term survival after hepatic cryosurgery versus surgical resection for metastatic colorectal carcinoma: a critical review of the literature.

OBJECTIVE: To critically assess the evidence for long-term survival after hepatic resection and hepatic cryosurgery for metastatic colorectal cancer. The purpose of this review is to determine if a randomized controlled trial comparing these two treatment modalities is justified. DATA SOURCES: A review of the medical literature from 1973 to 1995 using the MEDLINE and CANCERLIT databases. References were also retrieved from the bibliographies of identified articles and from experts in the field of hepatobiliary and pancreatic surgery. STUDY SELECTION: One hundred and seventy-eight studies were reviewed. Studies presenting original data on the results of hepatic resection or cryotherapy for colorectal liver metastases were selected. Studies were excluded if they did not present survival data longer than 2 years. Studies pertaining to resection for fewer than 60 patients with colorectal metastases to the liver were excluded. DATA EXTRACTION: Data forms were designed before studies were examined in detail. All studies that met the inclusion and exclusion criteria were reviewed and the identified data extracted and tabulated. DATA SYNTHESIS: No controlled studies were identified, only case series. Four reports on hepatic cryosurgery and 9 on hepatic resection met the study criteria. The cryosurgery studies were methodologically poor; the resection studies were larger and more methodologically sound. The median follow-up for cryosurgery ranged from 12 to 28.8 months, that for resection 21 to 69 months. There is clear evidence that hepatic cryosurgery has a role in the management of selected patients with colorectal metastases to the liver. However, valid conclusions cannot be made about the 5-year survival rate. The results of the studies on hepatic resection in patients with colorectal metastases to the liver have greater validity and consistency, with 5-year survival rates of 20% to 40%. CONCLUSIONS: Although hepatic cryosurgery offers some unequivocal and other potential advantages over surgical resection for colorectal metastases to the liver, the published data do not support its use in patients with resectable disease outside a clinical trial, and do not yet justify a randomized trial. A study that collects prospective data on 2 groups of patients (resectable v. unresectable) who differ only in the anatomic location of their metastases within the liver is needed.

Carcinoma↗
PubMed1996

[Nosocomial infections in head and neck surgery. 2. A prospective study].

Nosocomial infections are defined as infections that occur during hospitalization but were not present at admission. Nosocomial infections have been found to occur in 6% of all hospitalizations and are present mainly in intensive care units and surgical wards. These infections extend the time of hospitalization and therefore increase the cost of care. Between July and December 1993, all nosocomial infections occurring in 304 patients of the surgical ward of the University ENT Department, Cologne, were recorded prospectively. These were classified into wound, implant, urinary tract, respiratory, skin or mucosal infections, nosocomial bacteremias and gastrointestinal infections. The overall prevalence of nosocomial infections was 15.4%. Of these, 9.2% were postoperative wound infections, 2.6% respiratory infections, and 2.3% infections of the skin and mucosa. The incidence of urinary tract infections was 0.7%, while bacteremias occurred in 0.3%. No implant or gastrointestinal infections occurred. Microbial analysis demonstrated 9 gram-positive and 15 gram-negative bacterial and 8 candidal infections. Nineteen cultures were negative. Among the bacteria cultured three were methicillin-resistant. The time of hospitalization was extended from a normal average of 9.52 days to 25.7 days. The distinct risk of a nosocomial infection in the treatment of hospitalized patients requires and accurate documentation of all acquired infections. Determination of the source of infection, the method of spread and microbial analysis including the spectrum of organism resistance is necessary in order to decrease the infection rate and to prevent establishment of a nosocomial infection. These requirements at the least are an important part of quality control in the surgical disciplines.

Cross Infection↗
PubMed1998

Outbreak of Staphylococcus schleiferi wound infections: strain characterization by randomly amplified polymorphic DNA analysis, PCR ribotyping, conventional ribotyping, and pulsed-field gel electrophoresis.

Within a 1-year period, six surgical-site infections (SSI) caused by Staphylococcus schleiferi were observed in the department of cardiac surgery of Ignatius Hospital, Breda, The Netherlands. Since outbreaks caused by this species of coagulase-negative staphylococci have not been described before, an extensive environmental survey and a case control study were performed in combination with molecular typing of the causative microorganism in order to identify potential sources of infection. Variability, as detected by four different genotyping methods (random amplification of polymorphic DNA [RAPD], conventional and PCR-mediated ribotyping, and pulsed-field gel electrophoresis [PFGE] of DNA macro restriction fragments), appeared to be limited both among the clinical isolates and among several control strains obtained from various unrelated sources. Among unrelated strains, RAPD and PCR-mediated ribotyping identified two types only, whereas seven different types were identified in a relatively concordant manner by conventional ribotyping and PFGE. The latter two procedures proved to be the most useful tools for tracking the epidemiology of S. schleiferi. Four of the outbreak-related strains were identical by both methods, and two isolates showed limited differences. In the search for a potential source of S. schleiferi infection, two slightly different PFGE types were encountered on several occasions in the nose of a single surgeon. These strains were, however, clearly different from the outbreak type. In contrast, S. schleiferi cultures remained negative for two persons identified on the basis of case control analysis. It was demonstrated that SSI caused by S. schleiferi had a clinical impact for patients comparable to that of a wound infection caused by Staphylococcus aureus. This report describes the first well-documented outbreak of S. schleiferi infection. A source of the outbreak was not detected.

Aged↗
PubMed2005

Association between compensation status and outcome after surgery: a meta-analysis.

CONTEXT: Compensation, whether through workers' compensation or through litigation, has been associated with poor outcome after surgery; however, this association has not been examined by meta-analysis. OBJECTIVE: To investigate the association between compensation status and outcome after surgery. DATA SOURCES: We searched MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL, the Cochrane Controlled Trials Register, and reference lists of retrieved articles and textbooks, and we contacted experts in the field. STUDY SELECTION: The review included any trial of surgical intervention in which compensation status was reported and results were compared according to that status. No restrictions were placed on study design, language, or publication date. Studies were selected by 2 unblinded independent reviewers. DATA EXTRACTION: Two reviewers independently extracted data on study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type. DATA SYNTHESIS: Two hundred eleven studies satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (workers' compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and 1 described a benefit associated with compensation. A meta-analysis of 129 studies with available data (n = 20,498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval, 3.28-4.37 by random-effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all subgroups. CONCLUSIONS: Compensation status is associated with poor outcome after surgery. This effect is significant, clinically important, and consistent. Because data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Compensation status should be considered a potential confounder in all studies of surgical intervention. Determination of the mechanism for this association requires further study.

Compensation and Redress↗
PubMed1999

Lymph-node dissection in pancreatic cancer -- what are the facts?

BACKGROUND: The surgical therapy of ductal adenocarcinoma of the pancreas is well standardized around the world, with the exception of the extent of the resection of regional lymph nodes and peripancreatic soft tissue. This much-debated issue has become apparent after several Japanese reports that were able to demonstrate better survival after extensive lymph-node clearance. These results, however, could not be achieved using similar techniques in the Western world. The reason for these apparent differences in surgical results result from the application of two different staging systems (UICC and JPS) and the fact that the study designs of the compared trials are not comparable. The most desirable source of information coming from a randomized controlled study is, to date, only available from one trial which was not able to demonstrate a significant survival difference. CONCLUSION: So far, there is no substantial proof that extensive lymph-node clearance is beneficial for the patient. It has been shown, however, that in specialized centers these procedures do not carry an increased risk of perioperative morbidity and mortality compared with standard resections. In those institutions, the efficacy of extended resections needs to be further evaluated in prospective randomized trials, preferably based on the "International Documentation System for Pancreatic Cancer", which allows data acquisition independent of the staging system applied.

Adenocarcinoma↗
PubMed2004

Hysteroscopic training: the butternut pumpkin model.

Operative hysteroscopy involves significant hand-eye coordination, utilizing energy sources, video imaging, and the safe control of distending media. We describe a safe, effective, inexpensive, and reproducible method of developing the skills and hand-eye coordination for diagnostic and operative hysteroscopy. In this inanimate model, advanced surgical skills can be practiced, and realistic, simulated electrosurgery including resection of the endometrium and rollerball ablation can be performed.

Australia↗
PubMed1979

After-loading transperineal iridium-192 wire implantation of the prostate.

Aided by suprapubic surgical access, after-loading transperineal iridium-192 wire implantations have been done for prostatic cancer in 16 patients, with major complications in 3. Personnel exposure is reduced, and, more especially, precision and flexibility of dose control and source geometry are improved. The technique is thought to render permanent implantation with grains or seeds obsolete.

Humans↗
PubMed1996

Acute epistaxis. How to spot the source and stop the flow.

The goals of epistaxis treatment are control of hemorrhage, prevention of cardiovascular and airway compromise, and determination of the cause and the source of bleeding. Distinguishing anterior from posterior epistaxis is important because therapeutic approaches differ. Epistaxis can usually be managed nonsurgically, but a surgical procedure is sometimes necessary. Cauterization, nasal packing, and use of an intranasal tampon or balloon catheter are effective nonsurgical interventions, but they may cause sinusitis, middle ear effusion, patient discomfort, and hypoxia. Surgical interventions include arterial ligation, endoscopic cauterization, and angiographic embolization. These highly effective methods incur the risks of general anesthesia and require technical expertise. A thorough and methodical approach to epistaxis is necessary, with otolaryngologic consultation when appropriate.

Acute Disease↗
PubMed1996

[The pathophysiological and intensive care-resuscitation aspects of septic shock].

Sepsis and septic shock continue to be the most common causes of death and multiple organ failure among patients in intensive care units. The standard therapeutic regimens include surgical removal of the source of sepsis, antimicrobial therapy, optimizing oxygenation, volume resuscitation, and treatment with catecholamines. The ever extending knowledge of the pathophysiological role played by cytokines and nitrous oxide in septic shock promote the efforts to control their synthesis and pharmacologic action in clinical situations. New therapeutic approaches have become available, including the administration of high doses immunoglobulins, monoclonal antibodies against endotoxin, pentoxilfyline and nitrous oxide inhibitors. Based on the encouraging findings, controlled clinical studies are undertaken to assay with precision their clinical efficacy.

Critical Care↗
PubMed1984

Human exposure to nickel.

In order of abundance in the earth's crust, nickel ranks as the 24th element and has been detected in different media in all parts of the biosphere. Thus, humans are constantly exposed to this ubiquitous element, though in variable amounts. The average natural nickel exposure from food in the past has probably been somewhat, but not much, below current levels. Nickel is a useful metal, particularly in various alloys, in batteries and in nickel-plating. Nickel compounds are used especially as catalysts and pigments. In nickel-producing or nickel-using industries, about 0.2% of the work force may be exposed to considerable amounts of airborne nickel. In addition, nickel release, e.g., into cutting oils, and skin contact with nickel-containing or nickel-plated tools and other items may add to an occupational nickel hazard. Occupational exposures may lead to the retention of 100 micrograms of nickel per day. Environmental nickel levels depend particularly on natural sources, pollution from nickel-manufacturing industries and airborne particles from combustion of fossil fuels. Absorption from atmospheric nickel pollution is of minor concern. Vegetables usually contain more nickel than do other food items; high levels have been found in legumes, spinach, lettuce and nuts. Certain products, such as baking powder and cocoa powder, have been found to contain excessive amounts of nickel, perhaps related to nickel leaching during the manufacturing process. Soft drinking-water and acid beverages may dissolve nickel from pipes and containers. Leaching or corrosion processes may contribute significantly to the oral nickel intake, occasionally up to 1 mg/day. Scattered studies indicate a highly variable dietary intake of nickel, but most averages are about 200-300 micrograms/day. In addition, skin contact to a multitude of metal objects may be of significance to the large number of individuals suffering from contact dermatitis and nickel allergy. Finally, nickel alloys are often used in nails and prostheses for orthopaedic surgery, and various sources may contaminate intravenous fluids. Thus, human nickel exposure originates from a variety of sources and is highly variable. Occupational nickel exposure is of major significance, and leaching of nickel may add to dietary intakes and to cutaneous exposures. Preventive efforts should mainly be directed towards adequate control of these exposure sources.

Absorption↗
PubMed2002

Management of uterine leiomyomata: what do we really know?

OBJECTIVE: To systematically review the literature on the surgical and nonsurgical management of uterine leiomyomata. DATA SOURCES: Published literature in English on the management of uterine leiomyomata published from 1975 through 2000 was identified in MEDLINE, CINAHL, CancerLit, EMBASE, HealthSTAR, and the Cochrane Database of Systematic Reviews. Search terms included "leiomyomata," "fibroids," "hysterectomy," and "myomectomy." STUDY SELECTION: Study designs considered included controlled trials, prospective trials with historical controls, prospective or retrospective cohort studies, and series with at least 20 cases. Original research studies or relevant reviews were included if the study population included women with uterine leiomyomata, and data were provided relevant to one or more of nine prespecified research questions. TABULATION, INTEGRATION, AND RESULTS: Inconsistency in reporting of severity of symptoms, uterine anatomy, and response to therapy prevented meaningful comparison of studies in most cases, and prevented performance of meta-analysis in all cases. This was true of both surgical and nonsurgical treatments. CONCLUSION: The available evidence on the management of uterine leiomyomata is of poor quality. Patients, clinicians, and policymakers do not have the data needed to make informed decisions about appropriate treatment. Given the prevalence of this condition and its substantial impact on women's lives, obtaining these data should be a high research priority.

Adult↗