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PubMed2005

Size, volume and weight of the stomach in patients with morbid obesity compared to controls.

BACKGROUND: There is no mention in surgical literature regarding anatomic measurements of the stomach in patients with morbid obesity. We investigated by a prospective study the length of the lesser and greater curvature, the volume or total capacity and the weight of the stomach in morbidly obese patients compared to controls. METHODS: 30 patients with different degrees of morbid obesity were compared to 20 controls. Measurements included length of both curvatures of the stomach, weight and total volume of saline needed to distend the stomach. Patients with morbid obesity were submitted to resectional gastric bypass. The stomach of controls was obtained from autopsy material during the first day after death. RESULTS: The length of the lesser curvature, total gastric capacity and weight of the stomach of morbidly obese patients were similar to control subjects. The length of greater curvature was significantly less in patients with morbid obesity. CONCLUSIONS: No significant differences were found in anatomic measurements of the stomach between control subjects and patients with morbid obesity.

Adolescent↗
PubMed2006

Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients.

BACKGROUND: We evaluated laparoscopic sleeve gastrectomy (LSG) on major co-morbidities (hypertension, type 2 diabetes / impaired glucose tolerance, obstructive sleep apnea syndrome (OSAS) and on American Society of Anesthesiologists (ASA) operative risk score in high-risk super-obese patients undergoing two-stage laparoscopic biliopancreatic diversion with duodenal switch (LBPD-DS). METHODS: 41 super-obese high-risk patients (mean BMI 57.3+/-6.5 kg/m(2), age 44.6+/-9.7 years) were entered into a prospective study (BMI > or = 60, or BMI > or = 50 with at least two severe co-morbidities, no Prader-Willi syndrome, no conversion, minimum follow-up 12 months). 9 patients had BMI > or = 60. 17 patients (41.4%) had OSAS on C-PAP therapy. In 10 patients, at least one intragastric balloon had been positioned and 4 had undergone laparoscopic adjustable gastric banding, all with unsatisfactory results. At surgery, 41.5% were classified ASA 4 and 58.5% as ASA 3 (mean ASA score 3.4+/-0.5). Patients underwent evaluation every 3 months postoperatively and were restaged at 12 months and/or before the second step. RESULTS: 60% of major co-morbidities were cured and 24% improved. Average BMI after 6 and 12 months was 44.5+/-8.1 and 40.8+/-8.5 respectively (mean follow-up 22.2+/-7.1 months). After 12 months, 57.8% of the patients were co-morbidity-free and 31.5% had only one major co-morbid condition. At restaging, 20% of patients were still classified as ASA score 4 (OSAS on C-PAP therapy). 3 patients showed BMI <30 and were co-morbidity-free 12 months after LSG. CONCLUSIONS: LSG represents a safe and effective procedure to achieve marked weight loss as well as significant reduction of major obesity-related co-morbidities. The procedure reduced the operative risk (ASA score) in super-obese patients undergoing two-stage LBPD-DS.

Adult↗
PubMed2005

Severe maternal morbidity in Canada, 1991-2001.

BACKGROUND: Although death rates are often used to monitor the quality of health care, in industrialized countries maternal deaths have become rare. Severe maternal morbidity has therefore been proposed as a supplementary indicator for surveillance of the quality of maternity care. Our purpose in this study was to describe severe maternal morbidity in Canada over a 10-year period, among women with or without major pre-existing conditions. METHODS: We carried out a retrospective cohort study of severe maternal morbidity involving 2,548,824 women who gave birth in Canadian hospitals between 1991 and 2000. Thirteen conditions that may threaten the life of the mother (e.g., eclampsia) and 11 major pre-existing chronic conditions (e.g., diabetes) that could be identified from diagnostic codes were noted. RESULTS: The overall rate of severe maternal morbidity was 4.38 per 1000 deliveries. The fatality rate among these women was 158 times that of the entire sample. Rates of venous thromboembolism, uterine rupture, adult respiratory distress syndrome, pulmonary edema, myocardial infarction, severe postpartum hemorrhage requiring hysterectomy, and assisted ventilation increased substantially from 1991 to 2000. The presence of major pre-existing conditions increased the risk of severe maternal morbidity to 6-fold. INTERPRETATION: Severe maternal morbidity occurs in about 1 of 250 deliveries in Canada, with marked recent increases in certain morbid conditions such as pulmonary edema, myocardial infarction, hemorrhage requiring hysterectomy, and the use of assisted ventilation.

Adult↗
PubMed2005

Association between the existence of calves persistently infected with bovine viral diarrhea virus and commingling on pen morbidity in feedlot cattle.

OBJECTIVE: To determine the association between the existence of a calf persistently infected (PI) with bovine viral diarrhea virus (BVDV) and pen morbidity. ANIMALS: 5,041 calves in 50 pens at a feedlot in Iowa. PROCEDURE: In a longitudinal study, ear notches were collected from cattle and tested for BVDV antigen. Characteristics of each pen (owner, sex, disease rate, number of groups, and source) were recorded. The association between the existence of a BVDV-PI calf and morbidity in each pen was examined. RESULTS: Commingling was associated with an increase in respiratory tract disease (odds ratio [OR], 3; 95% confidence interval [CI], 2.5 to 3.6). Ten BVDV-PI calves (10/5,041 [0.2%]) were identified in 8 of 50 pens. A BVDV-PI calf was associated with reduced pen-level respiratory tract disease (OR, 0.7; 95% CI, 0.5 to 0.9). Disease prevalence (mean +/- SD morbidity, 7.9 +/- 3.1%) was lowest in pens containing single-source cattle and a BVDV-PI calf (4 pens containing 302 cattle), compared with single-source cattle with no BVDV-PI calf (mean morbidity, 11.89 +/- 9.7%; 31 pens containing 3,093 cattle), commingled cattle with no BVDV-PI calf (mean morbidity, 29.3 +/- 16.22%; 11 pens containing 1,127 cattle), and commingled cattle with a BVDV-PI calf (mean morbidity, 28.6 +/- 10.1%; 4 pens containing 519 cattle). CONCLUSIONS AND CLINICAL RELEVANCE: Commingling was the greatest risk factor associated with morbidity in each pen. A BVDV-PI calf in a pen was not associated with increased disease prevalence in commingled groups.

Animal Husbandry↗
PubMed1999

Post natal maternal morbidity patterns in mothers delivering in Gweru City (Midlands province).

OBJECTIVES: To determine morbid conditions suffered by mothers during the first six weeks post delivery and risk factors associated with them in Gweru district. DESIGN: A cross sectional survey. SETTING: Gweru district hospital, Monomotapa, Mkoba 1 and Mkoba polyclinic. SUBJECTS: A consecutive sample of 201 mothers residing in Gweru district who delivered in these facilities during the month of June 1997. MAIN OUTCOME MEASURES: Morbid conditions, magnitude and the risk factors. RESULTS: During follow up checks on recruited mothers, turn up rates were 82% and 63% at two and six weeks respectively. Fifty eight percent (58%) of the mothers reported at least one morbid condition within the first 24 hours post delivery and pain was a dominant feature. At two weeks, 56% of those who turned up predominantly presented with sepsis in areas of the reproductive tract. The figure fell to 35% among mothers who turned up at six weeks and a mixture of pain and sepsis were the predominant complaints. Episiotomies caused a lot of pain post operatively and the risk of subsequent sepsis was high, (OR: 9; 95% CI: 1.16 < OR < 69.7; p = 0.020). Statistically significant associations were found between backache and multiparity (OR: 1.89; 95% CI: 1 < OR < 3.4; p = 0.040) and also between Caesarian section and some morbid conditions (OR: 4.14; p = 0.002; 95% CI 2.05 < OR < 10.91). The prevalence rate of HIV was 29.4%. HIV positivity was associated with marriage below the age of 19 years (OR: 2.4; 95% CI 1.21 < OR < 3.8; p = 0.024). There was no association between HIV serostatus and maternal morbidity. Use of traditional medication during pregnancy was reported by 42% of mothers, but it did not have any immediately observable intrapartum of post partum effects. Similarly the place of delivery was not associated with post natal maternal morbidity. CONCLUSION: The first two weeks post delivery were the most critical for the mother in terms of post natal maternal morbidity. Sepsis associated pain was the predominant condition. To improve the effectiveness of post natal care, a review within the first two weeks post delivery is an essential intervention, in addition to the routine six weeks check.

Adult↗
PubMed2000

Changes in nutritional status and morbidity over time among pre-school children from slums in Pune, India.

OBJECTIVE: To investigate changes in nutritional status and morbidity over time among pre-school slum children. DESIGN: Longitudinal. METHODS: Children in the age group of 0-5 years from three slums in Pune (n = 845) were studied for a period of two years. Measurement of weight (up to 20 g) and height (up to 0.1 cm), morbidity (in last 7 days) and clinical assessment was undertaken once every four months. RESULTS: Peak prevalence of malnutrition was observed around 18 months and shorter period (3.5 months) of exclusive breastfeeding was probably responsible. Morbidity was generally higher in rainy season and was associated with wasting but not stunting. Gastrointestinal illness and fever contributed 50% of total morbidity days. Higher morbidity affected significantly growth velocities in weight throughout pre-school age. Height velocities were significantly low upto three years of age but there appeared no scope for catch-up growth as velocities remained similar thereafter. Higher morbidity in younger children (less than 2 years) led to deterioration of nutritional status over time in 30% to 50% children. CONCLUSION: Shorter period of exclusive breastfeeding results in undernutrition at an early age among slum children. Morbidity further deteriorates the nutritional status

Anthropometry↗
PubMed2000

[Calculation of the morbid risk in genetic-epidemiologic studies of age-dependent diseases].

Distributions of age at onset are widely used in the genetic epidemiology of age-dependent diseases. Examples are estimation of recurrent risks in genetic counselling and testing genetic hypotheses in segregation and linkage analyses. In this study, morbidity parameters are defined, including age-specific morbidity rates, morbidity net risk (incidence), and cumulative incidence (population risk, an integrated measure of population susceptibility to the disease at the moment of the study). Age-specific morbidity risks are calculated from the respective morbidity rates, which are analogous to mortality rates used in demography. Population data typically used for calculation of morbidity rates are discussed. Methods of calculation of morbidity rates based on the data of single and interval epidemiological studies are described. Methods for calculating standard errors of these parameters, estimating their statistical reliability, and testing statistical hypotheses are discussed.

Aging↗
PubMed2002

[Perioperative mortality and morbidity in the year 2000 in 502 Japanese certified anesthesia-training hospitals: with a special reference to ASA-physical status--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety].

Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 certified training hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to ASA physical status (ASA-PS). The total number of anesthesia available for this analysis was 897,733. The percentages of patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E are 38.0, 40.3, 8.5, 0.4, 4.3, 5.3, 2.5, and 0.7%, respectively. Mortality and morbidity from all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and surgical problems were as follows. The incidences of cardiac arrest (per 10,000 cases of anesthesia) were 1.11, 3.26, 12.25, 54.60, 0.77, 4.46, 21.08 and 217.75 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 6.89, 20.22, 62.18, 148.21, 6.71, 20.38, 106.72 and 592.21 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7 postoperative days) after cardiac arrest were 0.26, 0.77, 3.69, 41.60, 0.00, 1.06, 9.42 and 163.31 per 10,000 cases of anesthesia in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.32, 1.38, 9.75, 70.20, 0.26, 2.12, 29.15 and 353.02 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthesia than in elective anesthesia. ASA-PS correlated well with overall mortality and morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.23, 0.50, 1.32, 0.00, 0.00, 0.85, 2.69 and 4.95 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 3.13, 5.56, 11.46, 5.20, 3.87, 5.94, 13.90 and 14.85 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.03, 0.03, 0.00, 0.00, 0.00, 0.21, 0.45 and 3.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.03, 0.06, 0.00, 0.00, 0.00, 0.21, 0.45 and 6.60 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rate totally attributable to anesthesia among patients with good physical status (ASA-PS of I, II, I E, II E) was 0.05. Anesthetic management was mainly responsible for critical events in patients with good physical status, while coexisting diseases were in those with poor physical status. Surgical problems including procedures and massive hemorrhage were the leading causes of mortality in patients with good physical status. We reconfirmed that ASA-PS is useful to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation in those with poor physical status. Reducing mortality and morbidity from surgical problems is also required for improving perioperative mortality.

Anesthesia↗
PubMedDate not supplied

[Morbidity and mortality related to anesthesia and surgery in 60 patients treated with bariatric surgery].

OBJECTIVE: To identify the factors predicting morbidity and mortality in patients undergoing bariatric surgery for morbid obesity in our hospital. METHOD: Sixty bariatric surgery patients whose body mass indexes (BMI) exceeded 35 kg.m-2 were studied retrospectively. We examined the incidence of associated disease, the perioperative period, type of surgery, anesthetic technique, postoperative analgesia and the incidence of major complications. RESULTS: Fifty-one women and 9 men (mean age 43.33 +/- 10.25 years, mean BMI 46.41 +/- 6.04 kg/m-2) were studied. The incidences of high blood pressure (55%) and obstructive sleep apnea syndrome (40%) were high. Nine patients (15%) were physical status (ASA) I, 18 (30%) were ASA II, 27 (45%) were ASA III and 6 (10%) were ASA IV. Major complications developed in 3 cases (5%) in the first 24 h and in 8 (13.33%) in the first 7 days. The mortality rate was 0% among ASA I and II patients, 3.7% (1 death) among ASA III patients, and 33.33% (2 deaths) among ASA IV patients. All who died were men. The only factor that predicted morbidity in the first week after surgery was BMI. Both morbidity in the first 24 h and mortality were associated with greater underlying disease in our patients undergoing bariatric surgery. CONCLUSION: Major complications of bariatric surgery occurred in 18.3% of our patients and mortality was 5%. Physical status was a prognostic factor for both early (24 h) postoperative morbidity and mortality in our morbidly obese patients, whereas BMI was related to morbidity during the first week after surgery.

Adult↗
PubMedDate not supplied

[Environmental sanitation and typhoid-paratyphoid infection morbidity in Valencia].

BACKGROUND: We intend to study the evolution of morbidity by typhoid-paratyphoid infections (TPI) in Spain and Valencia (1940-1990) as well as TPI morbidity and degree of sanitation in Valencia. METHODS: Data related to morbidity, as well as the sanitation basic data in Valencia, have been obtained from official sources. Morbidity rates belonging to Spain and Valencia have been calculated. RESULTS: It is found a decreasing trend of morbidity in Spain and Valencia. By Health Areas, a great decrease stands out in Valencia-City and, as a general rule, the highest rates belonged to the lowest automatic chlorination percentages. In general, there is an improvement in chlorination, sewers and sewage-depuration equipment. CONCLUSIONS: TPI morbidity in Spain shows a decreasing trend in both cases; it is more evident in Valencia when establishing a relation of TPI morbidity with the degree of hygiene by Health Areas of Valencia, an inverse relation appears and the highest rates belong to the interior Areas. The conclusion is that there is a remarkable improvement in the hygiene general situation in Valencia; in the city as well as in all the Health Areas.

Chlorine↗
PubMed1992

Excess morbidity associated with interhospital transport.

A prospective study was performed to determine whether excess morbidity occurred in critically ill and injured pediatric patients during interhospital transport compared with morbidity in a control group. Control observations were made during the first 2 hours of pediatric intensive care unit (PICU) care of patients emergently admitted from within the same institution and not requiring interhospital transport. The first 2 PICU hours of control patients corresponded to the interval of transport in those who required interhospital transfer. Transport care was provided by nonspecialized teams from referring hospitals. Morbidity occurred in 20.9% of 177 transported patients, exceeding the morbidity rate of 11.3% in 195 control patients (P < .05). The difference in morbidity was due to intensive care-related adverse events (eg, plugged or dislodged endotracheal tubes, loss of intravenous access) in 15.3% and 3.6% of transported and control patients, respectively (P < .05). Physiologic deterioration occurred at similar rates of 7.9% and 8.7% in transported and control patients, respectively (P > .05). Slightly greater pre-ICU severity of illness in transported than control patients (median Pediatric Risk of Mortality Score = 10 and 7, respectively, P < .05) and greater pre-ICU therapy relative to severity (P < .05) in control patients are potential confounding sources of the morbidity differences. If patients are stratified into subgroups of similar pre-ICU severity, an excess of intensive care-related adverse events in transported patients remains evident in the severe subgroup (P < .05). Further investigation is warranted to determine whether specialized transport teams can reduce the excess morbidity associated with interhospital transport of critically ill and injured pediatric patients.

Child↗
PubMed1992

Morbidity in early childhood: differences between girls and boys under 10 years old.

The aim of the study was to investigate the differences in presented morbidity and use of health services among boys and girls in early childhood. The study was performed using data collected by the continuous morbidity registration project of the department of general practice at Nijmegen University. All recorded morbidity, referrals to specialists and admissions to hospitals were recorded by the registration project. The study population included children born in four practices from 1971 to 1984. The children were followed up until the age of five years and if possible until the age of 10 years. The morbidity of the children had been categorized into three levels of seriousness of diagnosis and 15 diagnostic groups as part of the registration project. Boys presented more morbidity than girls in the first years of their lives. For the age group 0-4 years this was true for all levels of seriousness of diagnosis except the most serious. In this younger age group significantly more boys than girls suffered respiratory diseases, behaviour disorders, gastroenteritis and accidents. Girls suffered from more episodes of urinary infection than boys in both age groups. More boys were referred to specialists and admitted to hospital than girls. The findings of this study suggest that not only inborn factors can explain the sex differences in presented morbidity and use of health services in early childhood. In particular, differences between girls and boys in terms of non-serious morbidity and referral and admission rates suggest a different way of handling health problems in boys and girls in early childhood both by parents and doctors.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed2001

Lower lip cancer morbidity in three regions in South Bulgaria for a period of 15 years (1985-1999).

INTRODUCTION: In most of the countries lower lip cancer in men varies from 1.0 case per 100 000 (in England) to 8.9 cases per 100 000 (in Hungary). We have set as a PURPOSE: To follow the dynamics in lower lip cancer morbidity in three regions in South Bulgaria. MATERIALS AND METHODS: A cohort study of lower lip cancer is performed for a period of 15 years. RESULTS: In 1985 lower lip cancer morbidity for the three regions was 4.3 cases per 100 000 and in 1999 it was 3.49 cases per 100 000. Morbitdity retains a comparatively high level. In 1985 morbidity in men was 8.5 cases per 100 000 and in women it was 0.7 cases per 100 000. In 1999 the incidence of morbidity in men decreased to 4.9 cases per 100 000, while in women it increased to 2.1 cases per 100 000. The incidence of morbidity rises with age. The factor that most influences morbidity is smoking. A definite role plays also poor condition of the teeth (carious teeth, bad prostheses and crowns, dental calculus). CONCLUSION: The incidence of morbidity in lower lip cancer in men is 4 times as high as that in women.

Bulgaria↗
PubMedDate not supplied

[Respiratory morbidity in the first year of life of preterm infants discharged from a neonatal intensive care unit].

OBJECTIVE: The objective of this study was to verify the incidence of respiratory morbidity in the first year of life in very low birth weight preterm infants and also to compare the presence of respiratory morbidity in the first year of life according to neonatal risk factors. METHODS: This is a prospective cohort study. We studied preterm newborn infants weighing less than 1,500 g and with gestational age less than 34 weeks who were born between 1998 and 2000. During the first year of life, the infants received monthly medical follow-up and during each visit we evaluated the patients considering the presence of obstructive airway syndrome and/or pneumonia and/or hospital admission due to respiratory conditions. The incidence rate of respiratory morbidity in the first year of life was measured. Chi-squared test was used to compare proportions. RESULTS: The cohort was constituted of 97 preterm infants with mean birthweight of 1,113 g and mean gestational age of 28 weeks. The incidence rates of obstructive airway syndrome, pneumonia and hospital admission were 28, 36 and 26%, respectively. The incidence rate of respiratory morbidity was 53%. There was a significant difference between the incidence rates of respiratory morbidity among infants who had a prolonged use of oxygen (83%) and those who did not (43%). CONCLUSION: More than 50% of the infants presented respiratory morbidity in the first year of life and there was a high percentage of pneumonia and hospitalization due to respiratory conditions. Infants who had a prolonged use of oxygen presenting with higher respiratory morbidity incidence rate than infants who did not use oxygen for a long period.

Brazil↗
PubMed1992

Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score.

OBJECTIVE: To relate morbidity and mortality risk to preoperative severity of illness in patients undergoing coronary artery bypass grafting. DESIGN: Retrospective analysis of 5051 patients using univariate and logistic regression to identify risk factors associated with perioperative morbidity and mortality. Prospective application of models to a subsequent 2-year validation cohort (n = 4069). SETTING: Cleveland Clinic Foundation. PATIENTS: All adult patients undergoing coronary artery bypass graft surgery between July 1, 1986, and June 30, 1988 (reference group), and July 1, 1988, and June 30, 1990 (validation group). MAIN OUTCOME MEASURES: Mortality and morbidity (myocardial infarction and use of intra-aortic balloon pump, mechanical ventilation for 3 or more days, neurological deficit, oliguric or anuric renal failure, or serious infection). MAIN RESULTS: Emergency procedure, preoperative serum creatinine levels of greater than 168 mumol/L, severe left ventricular dysfunction, preoperative hematocrit of 0.34, increasing age, chronic pulmonary disease, prior vascular surgery, reoperation, and mitral valve insufficiency were found to be predictive of mortality. In addition to these factors, diabetes mellitus, body weight of 65 kg or less [corrected], aortic stenosis, and cerebrovascular disease were predictive of morbidity. Logistic regression equations were developed, and a simple additive score for clinical use was designed by allocating each of these risk-factor values of 1 to 6 points. Both methods predict mortality. Increased morbidity was demonstrated with increases in score. CONCLUSIONS: The logistic or clinical models developed are superior to the currently available methods for comparing mortality outcome and provide previously unavailable information on morbidity based on preoperative status. The clinical scoring system is useful for preoperative estimates of morbidity and mortality risks.

Aged↗
PubMed1989

Antibiotic prophylaxis for surgery in morbidly obese patients.

The rate of wound infections in morbidly obese patients who underwent gastroplasty surgery at our institution was 16.5% compared with a rate of 2.5% in normal-weight patients who underwent clean-contaminated surgery. Both groups received 1 gm of cefazolin intramuscularly before surgery was performed. We hypothesized that this regimen of prophylaxis did not provide adequate tissue levels in the morbidly obese. Morbidly obese patients who were undergoing gastroplasty were randomly selected to receive 1 gm cefazolin in the buttock fat, buttock muscle, or by intravenous injection. A fourth group of morbidly obese patients received 2 gm of cefazolin intravenously. Normal-weight patients who were undergoing upper abdominal surgery received 1 gm of cefazolin intravenously. At incision and closure, both blood and tissue levels of cefazolin were significantly (p less than 0.001) lower for all morbidly obese patients who received 1 gm cefazolin when compared with the blood and tissue levels of the drug found in normal-weight patients. The cefazolin levels obtained were below the minimal inhibitory concentrations of greater than 2 micrograms/ml for gram-positive cocci and of greater than 4 micrograms/ml for gram-negative rods. Only when the morbidly obese patient received 2 gm cefazolin were both the serum and adipose tissue levels adequate. For a 4-month period, all morbidly obese patients received 2 gm cefazolin prophylaxis, and the wound infection rate dropped to 5.6% compared with the previous rate of 16.5% (p less than 0.03). We conclude that antibiotic prophylaxis must be specially tailored to the needs of these obese patients.

Adipose Tissue↗
PubMed1979

[Morbidity during regular dialysis treatment and after renal transplantation (author's transl)].

Renal transplantation was associated with a lesser degree of morbidity than chronic dialysis treatment in a group of 48 patients with end-stage renal failure. Morbidity was defined as total days of in-patient hospitalization divided by total days of risk. The morbidity during chronic intermittent dialysis, with a mean observation time of 296.1 (20 to 2255) days, was 11.8%, whereas after renal transplantation, with a mean observation time of 1004.0 (131 to 2400) days, only 7.6% of all days at risk were spent in hospital. Morbidity rises to 38.1% during chronic dialysis if all dialysis days on an out-patient basis are considered as hospitalization days. Morbidity was lowest (3.8%) in patients sent home for the first time with a functioning graft. Cardiac complications and fluid lung were the most common causes for morbidity during haemodialysis treatment; morbidity after renal transplantation was mainly due to renal rejection and infections under non-specific immunosuppression. Social and occupational rehabilitation was better after renal transplantation than during haemodialysis treatment. It can be concluded from these data that with regard to the quality of life renal transplantation is the preferable alternative in the management of end-stage renal failure.

Adolescent↗
PubMed1985

The 'healthy worker effect' on morbidity rates.

Studies relating mortality and occupation are difficult to interpret because of the "healthy worker effect." That effect is primarily due to the fact that individuals entering the labor force are in reasonably good health. A similar phenomenon might be expected in a comparison of morbidity among members of an occupational group with that of the general population. A comparison of morbidity among different population and occupation groups is made possible through the Household Interview Survey (HIS) of the National Center for Health Statistics. Data from the HIS for the years 1969 through 1974 were combined to form a sample classified according to race, sex, age, occupation, and occurrence of various health conditions. Among subjects between 25 and 59 years of age, age-specific morbidity ratios and standardized morbidity ratios were computed for blue-collar and professional/managerial employees and for unemployed who were either seeking or not seeking employment. There appears to be a "healthy worker morbidity effect" for chronic, but not for acute, conditions just as there is for mortality. The healthy worker effect for chronic morbidity maintains itself and, in fact, appears to increase throughout the 35-year period of stable employment. The age-specific morbidity ratio may have considerable theoretical importance for evaluating the related mortality experience of employed populations.

Adult↗