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At least 343 records · Page 19Linked to original sources
PubMed2002

Perioperative brachytherapy for pretreated chest wall recurrence of breast cancer.

PURPOSE: To demonstrate the technical aspects of high-dose-rate afterloading (HDR-AL) brachytherapy for isolated local chest wall recurrence of breast cancer pretreated with mastectomy and axillary node dissection plus postoperative radiotherapy. CASE REPORT: A 63-year-old female patient with left ductal breast cancer, pT2pN1biM0, was reoperated for an isolated local chest wall recurrence 13 years after primary treatment (mastectomy, axillary dissection, and 50 Gy postoperative irradiation). Radical surgery would have involved extreme mutilation. Reoperative surgical margins of 3 mm width were involved, and four parallel afterloading catheters were placed intraoperatively in this histologically positive margin site. Perioperative HDR-AL (Ir-192 stepping source, 370 GBq activity, dose rate: reference air kerma rate at 1 m 40.84 mGy/h kg) was performed. Dose per fraction: 6 Gy to the reference line, two fractions per week, total dose 30 Gy. Follow-up after secondary treatment: 5 years. RESULTS: Firm local control and 5-year disease-free survival were obtained with perioperative HDR-AL therapy; staging procedures (clinical exam, MRI, abdominal ultrasound, and bone scan) showed no evidence of disease. The development of radiodermatitis did not exceed grade 2 level and healed spontaneously within 6 weeks. CONCLUSIONS: Isolated local chest wall relapse can be effectively controlled by wide surgical excision and perioperative reirradiation with HDR-AL. This technique may represent a treatment alternative to ultraradical surgery, with equal healing probability and a better quality of life. Small-volume irradiation of the postoperative scar can be performed with HDR-AL brachytherapy, and long-term local control can be achieved with a total dose of 30 Gy.

Brachytherapy↗
PubMed2005

Expression and distribution of tumor necrosis factor alpha in human lumbar intervertebral discs: a study in surgical specimen and autopsy controls.

STUDY DESIGN: Immunohistochemical study of tumor necrosis factor alpha expression in autopsy and surgical specimens of human lumbar intervertebral discs. OBJECTIVES: To investigate the occurrence and localization of tumor necrosis factor alpha in intervertebral disc tissue and to correlate its expression with age and the degree of disc degeneration. SUMMARY OF BACKGROUND DATA: The source and origin of discogenic pain are as yet unknown. Recently identified changes of the cellular phenotype during senescence and disc pathology with partly phagocytic properties suggest an 'inflammatory' phenotype. Tumor necrosis factor alpha is one of the most potent proinflammatory cytokines possibly modulating cellular phenotypes. It may also promote pain induction. Very little is known about the occurrence and localization of tumor necrosis factor alpha in intervertebral disc tissue of defined age and degree of histologic tissue degeneration. METHODS: The study population comprised 20 cross-sections of the complete motion segment of human lumbar vertebrae (age range 0-86 years) obtained at autopsy and 28 surgical disc specimens of individuals undergoing lumbar surgical interventions for various reasons. The temporospatial distribution of tumor necrosis factor alpha-positive cells using a polyclonal antibody was correlated with a histologic degeneration score. RESULTS: Tumor necrosis factor alpha is expressed substantially in (nonsymptomatic) autopsy material in fetal/infantile and older adult nucleus pulposus, whereas it is sparsely expressed in adolescent and young adult nucleus pulposus. In the anulus fibrosus, tumor necrosis factor alpha is not found in young adults (<25 years), but then significantly increases in extent. In contrast, symptomatic nucleus pulposus and anulus fibrosus (surgical material) contain substantially more tumor necrosis factor alpha-positive cells. A significant positive correlation of tumor necrosis factor alpha expression and disc degeneration (histologic degeneration score) was found for the anulus fibrosus in both sample groups. In the surgical material, an additional significant positive correlation was identified for nuclear tumor necrosis factor alpha, disc degeneration, and age. CONCLUSIONS: Tumor necrosis factor alpha is substantially expressed in disc material of symptomatic patients (surgical specimens) in comparison to samples taken at autopsy. The expression of tumor necrosis factor alpha in early fetal/infantile nucleus pulposus may indicate 'physiologic' tissue disarrangement with closure of the blood vessel canals. The expression of tumor necrosis factor alpha in adult discs, in contrast, is statistically associated with disc degeneration. Its occurrence in adults of more advanced age suggests that tumor necrosis factor alpha is not involved in the initiation of disc degeneration, but may be associated with further promotion of degenerative disarrangement and pain induction.

Adolescent↗
PubMed1984

Endoscopic control of upper gastrointestinal hemorrhage with a bipolar coagulation device.

It has been difficult to determine the real efficacy of endoscopic treatment for upper gastrointestinal tract bleeding sites for several reasons. First, since 80 per cent of an unselected group are expected to stop bleeding spontaneously, it is important to focus upon those individuals who continue to bleed instead of a group in whom bleeding would have stopped spontaneously in the majority. Second, it is difficult, if not impossible, to have comparable groups of patients with similar lesions and similar rates of bleeding who can be randomized into different treatment groups. This report describes the use of a bipolar endoscopic coagulation device in 28 patients with active massive upper gastrointestinal tract hemorrhage who represent 10 per cent of the patients with hemorrhage during a one year interval. Endoscopic treatment controlled bleeding initially in 23 of these patients. Another eight patients with recent hemorrhage who were at high risk for recurrent bleeding (visible vessels) had endoscopic coagulation without subsequent hemorrhage. Immediate operations were required in five of the 28 and delayed operations in another four. Mortality in the patients treated by endoscopic or surgical therapy was comparable (20 per cent), but no patient died of hemorrhage. The high mortality in this group of patients is explained by associated illnesses. B-C is as effective as other endoscopic treatments for nonvariceal sources of upper gastrointestinal tract hemorrhage. This modality is relatively cheap compared with other devices, is theoretically less complicated and has minimal risk to the individual patient. Because of these considerations, it is a technique which deserves wider application and may become the endoscopic treatment of choice for control of upper gastrointestinal tract hemorrhage. Patients with endoscopic control of upper gastrointestinal tract bleeding avoid perioperative morbidity, have a lower transfusion requirement and may have a shorter hospital stay than comparable individuals who require operative control of bleeding sites.

Clinical Trials as Topic↗
PubMed1994

Ileitis hyperplastica follicularis Golden: surgical or conservative treatment?

The authors report on four cases of Golden's syndrome, a rare disease with unknown etiology and controversial therapy. The first two 7-year-old boys had gastrointestinal bleeding; their hemoglobin levels were 7.0 g% and 7.3 g%, respectively. A blood transfusion was required. Both patients underwent gastroscopy and rectoscopy, and no source of bleeding was found. Biopsies were taken during laparotomy, after terminal ileotomy in case one and coecotomy in the other. Bowel resection was not necessary in either case. The third and fourth boys (5 and 6 years old, respectively) were treated conservatively with parenteral nutrition; blood transfusion was not necessary. All four patients recovered within several days. Control colonoscopies 6 months later showed normal mucosa. The authors discuss their diagnostic and therapeutical regime, stressing that in their experience, this rare disease does not require surgical intervention.

Child↗
PubMed1997

Vascular intervention in the thorax: bronchial artery embolization for haemoptysis.

Massive haemoptysis is defined as the expectoration of more than 600 mls of blood in 48 h. Many patients are not surgical candidates because of the presence of severe bilateral pulmonary disease and these individuals are best managed by bronchial artery embolization. Occlusion of both the bronchial arteries and hypertrophied non-bronchial systemic arteries is essential if bleeding is to be controlled. A pulmonary arterial source of haemorrhage is uncommon but should always be considered in a patient who has further haemoptyses shortly after a technically successful embolization of bronchial and non-bronchial systemic arteries. The immediate control of haemorrhage is achieved in the majority of patients although subsequent rebleeding on longterm follow-up is not uncommon.

Bronchial Arteries↗
PubMed1995

Modification of intensity distributions from large aperture ultrasound sources.

The Fresnel-Kirchhoff diffraction theory has been used to model the acoustic fields produced by a variety of apodizations of large aperture, axially symmetric ultrasound sources. The forms of resulting intensity maxima and their resulting suitability for surgical lesioning of tissues are compared, through a "lesioning capability" and a "focal efficiency." Although only modest changes in intensity distribution are possible, some may have applications in making arrays of lesions for control of focal cancer and other pathologies.

Acoustics↗
PubMed2001

Salvage surgery.

Salvage surgery is an essential method in the armamentarium of the surgeon caring for the severely injured patient. The patient in unstable condition with multiple abdominal injuries is a challenge, even to the most experienced trauma surgeon. The first priority should be to control major vascular injuries and other sources of bleeding that are immediately life-threatening. Often after massive blood loss, the deadly triad of hypothermia, acidosis, and coagulopathy is present. Additional time in the operating room often worsens these physiologic parameters and patient outcome. Once surgically correctable bleeding has been addressed, such patients are best served by cessation of the operation, packing of the abdomen, and transfer to the intensive care unit. Resuscitative steps should then be taken. Once the physiologic derangement has been corrected, the patient can undergo definitive operative procedures.

Abdominal Injuries↗
PubMed2002

[Antibiotic prophylaxis in surgery: news and controversies].

Preoperative administration of antibiotics to prevent possible post-surgical infections represents a cornerstone of modern medicine. Although the general principles of surgical prophylaxis have been quite clearly defined during the last few decades, advenaces in surgical techniques, the changes in bacterial ecology in hospital, the spread of bacterial resistance and the substantial increase in the surgical population at risk, suggest that several aspects of surgical prophylaxis should be reviewed and new controlled studies should be carried on. The American guidelines for surgical prophylaxis, worked out recently by the CDC, have not modified their general structure, and have strongly influenced the protocols and the prescriptive behaviour of other countries, including Italy. The following points suggest that these guidelines are probably no longer adeguate for the situation in question: evidence from several sources would extend the advisability of antibiotic prophylaxis to other clean surgeries; the current classification of surgical procedures does not consider the "new" population of risk patients; the duration of prophylaxis and its role in preventing post-surgical infections "at a distance" infections has not been carefully defined; the evolution of bacterial epidemiology and bacterial resistance and the contemporary availability of new antibiotics has moved the fear of a post-antibiotic era In the clinical practice, according to these considerations and whilst awaiting the results of new clinical trials, in some cases and for some at risk patients it would appear justified to use third generation cephalosporins and especially ceftriaxone that, because of its peculiar pharmacokinetcs characteristics, guarantees with a single dose the same efficacy of three doses of other cephalosporins.

Anti-Bacterial Agents↗
PubMed1979

Feedback-controlled dextrose infusion during surgical management of insulinomas.

Through the use of a feedback-controlled dextrose infusion system, we obtained continuous monitoring of the blood glucose level in a patient undergoing surgery for multiple pancreatic beta-cell tumors. In addition, this device infused dextrose at variable rates to maintain a predetermined euglycemic level of 90 mg/dl. Before locating the source of excessive insulin production, the maximum dextrose infusion rate of 400 mg/min was required; but after extirpation of multiple insulinomas, the dextrose-infusion rate declined whereas the blood glucose level rose above the preselected level. These results emphasize the usefulness of a monitoring and infusion system not only in protecting the patient from the hazard of hypoglycemia under anesthesia but also as an aid in determining whether all insulin-secreting tumors have been removed.

Adenoma, Islet Cell↗
PubMed1978

Influence of the use of a surgical isolator on the rate of infection in the treatment of hydrocephalus.

Two series of patients treated for hydrocephalus (101 original shunt insertions, 81 revisions and 35 reinsertions after infections) have been operated on in the same location, 146 with a surgical isolator (SI), 71 without a SI. Due to temporary poor technical conditions, the use of a SI was decided because, the overall rate of acute postoperative infections had suddenly increased from 9 to 19.7%. Then, although these technical conditions remained unchanged, the use of the SI immediately reduced the overall rate of acute postoperative infections from 19.7 to 7.4%. In original shunt insertions, this rate decreased from 24.9 to 5.8% and in revisions from 10.7 to 5.5%. In reinsertions after infection, it only fell from 27.2 to 16.6%. With the SI, the rate of peroperative contamination is almost nil. If postoperative contaminations due to wound disruption or scalp necrosis, and shunt reinsertions after infection are not taken into account, the rate of acute postoperative infection is 0.8%. The data presented indicate the efficiency of the SI. This results from elimination by the SI of airborne contamination and errors in aseptic technique. These two factors are probably the main sources of infection in shunt insertions for hydrocephalus.

Cerebrospinal Fluid Shunts↗
PubMed1999

Effect of photodynamic therapy on the critical primary ischemic time of fasciocutaneous flaps.

BACKGROUND: Photodynamic therapy (PDT) may be used as an adjuvant intraoperative therapy to improve locoregional control. PDT has been shown to delay wound healing. This raises concern about PDTs effect on survival of fasciocutaneous flaps. OBJECTIVE: Evaluate the effect of 1) PDT on the critical ischemic time in a rat fasciocutaneous flap model and 2) photosensitizer activation by the surgical light source. DESIGN: A fasciocutaneous flap, based on the left inferior epigastric vessels, was used. Ischemic times of 2, 4, 6, 8, 10, and 12 hours were induced by clamping the vascular pedicle. Animals were randomly divided into five groups: ischemia only, group I; light treatment to wound bed, group II; Photofrin before surgery with the flap elevated without a fiber optic head light, group III, or with a headlight, group IV; Photofrin prior to surgery with light treatment to the wound bed, group V. Flap survival was assessed on postoperative day 7. RESULTS: The critical primary ischemic time of group V (PDT) was significantly less (P < .05) than groups I, II, III, and IV. There was no statistical difference in the critical primary ischemic time when a fiber optic headlight was used (group III vs. group IV). CONCLUSION: Intraoperative PDT significantly reduces the critical primary ischemic time of the rat fasciocutaneous flap. White light illumination of the operative field does not result in photosensitizer activation and has no effect on the critical primary ischemic time.

Animals↗
PubMedDate not supplied

Endogenous benzodiazepine activity in the peripheral and portal blood of dogs with congenital portosystemic shunts.

OBJECTIVE: The purpose of this study was to determine whether an endogenous benzodiazepine receptor ligand (EBZ) was present in the arterial and portal blood of dogs with congenital portosystemic shunts (CPSS). STUDY DESIGN: The presence or absence of an EBZ was determined by the collection of systemic and portal blood from dogs with CPSS. ANIMALS: Fifteen client-owned dogs with a confirmed CPSS. All dogs had historical signs compatible with hepatic encephalopathy. Eight healthy dogs were used as controls. METHODS: In all dogs, systemic blood samples were collected after they were anesthetized. Portal blood samples were collected intraoperatively. EBZ was measured by radioreceptor assay. RESULTS: In 10 of 15 dogs, the portal blood concentration of EBZ was significantly elevated compared with normal dogs (mean, 13.2 +/- 18.55 ng/mL). Five dogs had elevated systemic blood EBZ levels (mean, 8.2 +/- 16.08 ng/mL). Eleven of 15 dogs had a higher portal than systemic blood concentration of EBZ. In contrast, control dogs had extremely low EBZ concentrations detected in their portal blood (mean, 0.16 +/- 0.3 ng/mL) and systemic blood (0 ng/mL). The mean portal and systemic blood concentrations in dogs with CPSS were significantly greater than in control dogs (P < .05). CONCLUSIONS: Elevated blood levels of EBZ were found in dogs with CPSS. The portosystemic gradient noted in 11 dogs suggests the gastrointestinal tract as a possible source for the endogenous ligand. CLINICAL RELEVANCE: Generalized motor seizures have been reported in dogs after surgical correction of CPSS. If the presence of a CPSS results in stimulation of brain receptors for benzodiazepines, post-CPSS ligation seizures may result from a withdrawal of EBZ after ligation of the portosystemic shunt.

Animals↗
PubMed1989

The role of gastrin in the development of the gastrointestinal tract in fetal sheep.

We have investigated the role of gastrin in the development of the gastrointestinal tract during the latter part of gestation in fetal sheep. We surgically removed the major source of gastrin, the gastric (abomasal) antrum, from five fetuses at 90 days of gestation. The remaining abomasum was anastomosed to the pylorus allowing unobstructed flow of luminal contents. Another five fetuses, subjected to sham-antrectomies at 90 days, served as controls. Further surgery was performed in all fetuses at 120 days for the placement of vascular catheters to permit measurement of plasma gastrin concentrations. The fetuses were infused with [3H]thymidine to study villus cell migration rates. At 135 days of gestation samples of gastric (abomasal) fundus, and proximal and distal small intestine, were processed for histology and morphometric analysis. The antrectomized fetuses had significantly lowered plasma gastrin concentrations (P less than 0.025) between 120 and 135 days. At 135 days, the mean body weight, crown-rump length, total gut weight and small intestinal weight and length were not significantly different between the two groups. Similarly, there were no significant differences between groups in the mean thicknesses of the gut wall, mucosa and muscularis externa, or in the mean villus height and crypt depth in the proximal or distal parts of the small intestine. Villus cell migration rate in the proximal and distal small intestine was not affected by antrectomy. No simple relationship could be demonstrated between any of these parameters and plasma gastrin concentration. In the antrectomized fetuses, the mean crypt density and crypt-to-villus ratio were significantly reduced in the proximal small intestine (P less than 0.05), while only the density of villi was reduced in the distal small intestine (P less than 0.05). In the antrectomized fetuses there were significant correlations between plasma gastrin and the fraction of fundic mucosa occupied by gland and pit (P less than 0.005), and between plasma gastrin concentration and villus density (P less than 0.01) and crypt-to-villus ratio (P less than 0.025) in the proximal small intestine. In the sham group these correlations were absent. We conclude that the removal of the gastric antrum in fetal sheep results in decreased plasma gastrin concentration, and that gastrin appears to have a regulatory or trophic role on the gut mucosa in these circumstances.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1989

Quality control in an in-vitro fertilization laboratory: use of human sperm survival studies.

A bioassay procedure is described for quality control testing of various disposable items used in routine IVF procedures. This bioassay is performed over 4 days and uses the survival of human sperm in vitro at room temperature to assess which products are suitable for use. New products were tested for cytotoxicity using a general screening method and subsequent batches of every suitable item tested to detect interbatch variation. Products were considered suitable or unsuitable for use depending upon a calculated sperm survival index. Two main types of product were found to be cytotoxic, namely certain brands of syringe and surgical gloves, the common feature of both being the presence of rubber components. The bioassay was also used to investigate further the cytotoxic effect of the powdered and starch-free surgical gloves. The cytotoxic substances from both types of surgical glove were readily transferred to an embryo replacement catheter by touch, and washing of the gloves reduced this effect only moderately. The bioassay has proved inexpensive and convenient but more importantly it has been invaluable for detecting potential sources of cytotoxicity before they are introduced into a standard IVF protocol.

Cell Survival↗
PubMed1975

Endobronchial tamponade therapy for intractable hemoptysis.

The management of intractable hemoptysis, short of surgery, is poorly defined. A technique is described utilizing a bronchofiberscope and a Fogarty catheter that not only provides visualization of the source of bleeding, but also furnishes a means of controlling the bleeding. This technique can also be used through a rigid bronchoscope.

Bronchoscopy↗
PubMed1977

Possible source and control of trauma-induced glucagonemia in dogs.

Plasma concentrations of glucose, insulin, and glucagon were studied in 10 adult mongrel dogs given (intravenous administration) a large dose of glucose (1g/kg of body weight) both before and after partial (50%) pancreatectomy. A proportional decrease in plasma immunoreactive insulin was observed in partial pancreatectomized dogs. Peak insulin response decreased from presurgery concentrations of 71 +/- 14 muU/ml (mean +/- standard error of the mean) in the dogs before surgical operation (presurgical value) to 52 +/- 6 muU/ml 1 or 4 days after surgical operation. Partial pancreatectomized dogs also showed a reduced plasma glucose removal rate. Fasting plasma concentrations of glucagon, on the other hand, increased by about 80%, from 253 +/- 25 pg/ml to 460 +/- 43 pg/ml 24 hours after operation. Despite an increased glucagon concentration in the dogs after partial pancreatectomy, plasma concentrations of glucagon responded (decreased) to large gulcose dosage administration. Plasma glucagon concentration returned to presurgical value by the 4th postsurgical day.

Animals↗
PubMed2006

Enteral nutrition versus glucose-based or lipid-based parenteral nutrition and tight glycaemic control in critically ill patients.

OBJECTIVE: Early administration of nutrition and attention to tight glycaemic control are both associated with improved outcomes in critically ill patients. We hypothesized that blood glucose control would be better achieved in patients receiving enteral rather than parenteral nutrition and, in the latter group, would be better achieved using a "balanced" glucose plus lipid solution than a dextrose-based solution as calorie source. METHODS: We conducted a retrospective interrogation of the intensive care database as part of a clinical audit of a 12-bed mixed medical and surgical ICU in a tertiary referral teaching hospital between September 2003 and March 2004. Patients expected to stay in the ICU for longer than 48 hours were treated according to an intensive insulin therapy protocol. They received enteral nutrition (EN) or, if EN was not tolerated, parenteral nutrition (PN) or combined EN and PN. PN comprised a glucose-based solution (GluPN) during the first 3 months of the study and a balanced glucose plus lipid solution (LipPN) during the second 3 months. RESULTS: 96 patients were treated according to the protocol. Patients receiving PN (n = 26) had significantly longer ICU length of stay and greater daily caloric intake than did those receiving EN (n = 70) during both study periods. Mean blood glucose, percentage of blood glucose measurements within the target range, and daily insulin dose did not differ significantly between patients receiving EN and PN or GluPN and LipPN. CONCLUSION: When used in association with a tight glycaemic control regimen, PN is not associated with poorer glycaemic control in critically ill patients than EN.

Aged↗