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At least 37 records · Page 2Linked to original sources
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↗
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↗
PubMed1979

Airflow effects in surgery.

Accumulated evidence of the last decade has emphasized the multifaceted nature of wound infection control. Clean air is definitely one of the facets in the complex, but its place in the hierachy of precautions against wound infection has not been established, nor has the method of achieving acceptably clean air been universally agreed on. The surgical team and the patient are the prime sources of contamination during an operation, as evidenced by the good matches between bacteria of infected wounds and those of the team or the patient and by the poor matches between bacteria of infected wounds and airborne bacteria. Therefore, special air-handling systems, despite their ability to lower ambient bioparticulate counts, cannot be credited with being a highly relevant factor in the reduction of wound infection rates.

Air↗
PubMed1979

Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization.

A case of severe postpartum hemorrhage is reported. Three separate surgical procedures failed to reveal the source of bleeding, and standard surgical techniques, including bilateral ligation of the hypogastric arteries, were unsuccessful in producing hemostasis. However, angiography successfully identified the specific bleeding vessel, and transcatheter embolization with Gelfoam fragments quickly and effectively stopped the hemorrhage. The authors consider angiographic embolization to be an effective alternative approach to the control of pelvic hemorrhage and recommend that the technique be considered prior to surgical intervention.

Adult↗
PubMed2026

Hypervirulent Klebsiella pneumoniae ST23 causing pyogenic liver abscess and metastatic endogenous endophthalmitis in Europe: a case report.

INTRODUCTION AND IMPORTANCE: Pyogenic liver abscess (PLA) has traditionally been considered prevalent in Asia. However, its incidence is increasing in Europe. Klebsiella pneumoniae (Kp) has emerged as the leading causative pathogen, and hypervirulent strains pose a higher risk of invasive disease and metastatic complications, such as endogenous endophthalmitis (EE). CASE PRESENTATION: The case describes a 77-year-old woman who presented with fever and right upper quadrant abdominal pain. She was diagnosed with a second episode of PLA within 3 months, caused by Kp. Despite prompt antimicrobial therapy and percutaneous transhepatic drainage, the patient developed acute vision loss in the left eye during hospitalization. Ophthalmologic assessment confirmed EE secondary to bacteremia. Whole-genome sequencing identified the isolate as hypervirulent Kp (hvKp) sequence type 23 (ST23). While the liver abscess resolved following treatment, the patient sustained permanent loss of vision in the affected eye despite aggressive medical and surgical management. CLINICAL DISCUSSION: This case illustrates the invasive nature of hvKp and its potential for recurrence and metastatic complications. Improved recognition through targeted virulence testing is essential to avoid underdiagnosis. CONCLUSION: This case highlights the aggressive nature of hvKp. Early recognition of systemic and ocular symptoms, prompt ophthalmologic evaluation, and timely source control are essential. Optimal management requires multidisciplinary collaboration and the use of molecular diagnostics, including whole-genome sequencing, to identify hypervirulent lineages and support surveillance.

Klebsiella pneumoniae↗
PubMed1979

Studies in burns, XVI: The effect of surgical trauma on metabolic heat production.

As part of an ongoing study of the naturally-occurring skin lipid ethyl linoleate as an adjunct for reducing post-burn hypermetabolism and hyperevaporation, we have conducted a series of evaluations of metabolic heat production (M) using a clinical partitional calorimeter. In this article, we describe the metabolic chamber and its use in evaluating the change in M in pre- and postoperative patients. We determined that dry heat losses (radiation and convection) comprise the major components of heat loss in the "normal" and traumatized individual with intact skin. In the post-operative state, metabolic heat production increases significantly above the preoperative levels, the percentage of change being accurately described by a first order exponential equation. In the postoperative patient, possibly because of a physiologic shift in source of metabolic substrate, stored heat increases significantly. These data may be useful in allowing approximate correction of the metabolic heat equation when studying the burn patient where no "control" is attainable and where some approximation of the contribution of "pure" trauma must be made.

Adult↗
PubMed1977

[Hemorrhage complications of acute pancreatitis (author's transl)].

The authors report 11 cases of hemorrhage due to vascular ulcerations arising early or late in the course of acute pancreatitis. The seriousness of these hemorrhages, the difficulties of their therapy are pointed out. In all cases, bleeding should be controlled by surgery. Therefore, attention is drawn to the need for prompt laparotomy in all the shocked patients who failed to respond to conservative measures, for in such cases, a fatal outcome may rapidly occur. The respective advantages and inconveniences of the 2 main surgical treatments, ligation of bleeding vessels or pancreatectomy removing the source of bleeding, are discussed, basing on the presently reported cases and the data of the literature.

Acute Disease↗
PubMed1976

Body temperature of the lizard (Anolis carolinensis): effect of parietalectomy.

Thermal behavior of parietalectomized, sham-parietalectomized or intact lizards (Anolis carolinensis) was recorded in a test chamber containing moving photothermal gradients. Following parietalectomy, animals chose significantly higher temperatures than sham-parietalectomized or intact control animals, which chose lower and statistically identical temperatures. When pre-surgical and post-surgical means are compared within groups, the eccritic temperature was 2.10 degrees C higher following parietalectomy, 0.72 degrees C higher following sham-parietalectomy, and 0.31 degrees C higher in intact controls during the post-operative measurements. The effects of parietalectomy indicate that the parietalpineal complex may be involved in behavioral thermoregulation by precisely regulating exposure to heat sources (e.g. sunlight).

Animals↗
PubMed1978

Angiography in determining the cause and treatment of gastrointestinal bleeding.

Angiography is useful in the diagnosis of active gastrointestinal bleeding if the rate is greater than 0.5 mL/min. For upper gastrointestinal bleeding, endoscopy is the preferred initial investigation and angiography is used for diagnosis only if the site of bleeding is still obscure. Angiography is the preferred method for investigation of massive lower gastrointestinal bleeding if results of sigmoidoscopy are negative. Vasopressin infusion is most useful for control of bleeding from esophageal varices, erosive gastritis and diverticular disease of the colon. Embolization with Gelfoam or clot is possible for massive hemorrhage from a single source in poor-risk patients. This is most successful for gastric or duodenal bleeding since the collateral blood supply prevents infarction. Some of the methods and complications of embolization are discussed and examples are given. Standard surgical principles should still apply in most cases.

Adult↗
PubMed1976

Multiple arterial occlusions and hypertension probably caused by an oral contraceptive: a patient in whom the development of renovascular hypertension has been followed.

An 18-year-old woman taking an oral contraceptive was admitted to hospital because of a stroke due to occlusion of three branches of the right middle cerebral artery. She later developed renovascular hypertension due to occlusion of one of two renal arteries on the right side. Occlusion of the ceoliac artery was also found. The circumstances suggest that the occlusions were caused by multiple emboli, the source of which could not be identified. The kidney with the circulatory disturbance was shown to have a persistent abnormal renin secretion three and six months after the stroke, but the peripheral renin level was lower at the second investigation. Cardiac function studies revealed an alarming degree of left ventricular hypertrophy, and satisfactory blood pressure control could not be maintained despite increasing antihypertensive therapy. Surgical corrrction of the circulatory disturbance promptly led to normotension without drugs, and the patient has remained normotensive during the postoperative observation period of twelve months. The oral contraceptive was probably responsible for precipitating the vascular occlusions, but no predisposing factors or warning symptoms were present to identify this patient as being at risk.

Adolescent↗
PubMed1979

Adjuvant radiation therapy in colon cancer.

The overall five year survival of patients with colorectal cancer is excellent compared with other major visceral malignancies. This is attributable to effect surgical treatment, yet the death rate per 100,000 population has improved little in recent decades, stimulating a search for adjuvant treatment modalities until a better understanding of etiology and pathogenesis results in prevention of earlier diagnosis. Combination of the known cancerocidal effect of ionizing radiation and surgical excision has been used sporadically for over six decades, but only recently has this combined modality therapy been studied in a scientific manner. Numerous variables such as source of radiation, total tumor dose, dose-time factors, location of portals of treatment, size and shape of radiation fields, and the radiation-surgery sequence are now being studied. Current information leaves little doubt of the effectiveness of this combined modality therapy in selected patients. Controlled clinical trials must continue in order to obtain more solid data, which hopefully will eventually result in substantially improved survival.

Adenocarcinoma↗
PubMed1977

Intravenous amino acids as the sole nutritional substrate. Utilization and metabolism in fasting normal human subjects.

The fasting normal human volunteer subject provides an ideal experimental setting for the initial investigation of foodstuffs whose use is proposed for the acutely ill surgical patient. In the normal human subject many variables can be controlled; the achievement of an ideal body fuel economy is quite simple; if a favorable utilization of injected foodstuffs cannot be achieved in this setting, it is unlikely, and remains to be proven, that utilization will be satisfactory under the challenges of acute surgical trauma. In this experimental model, employing four normal human volunteer subjects, nutrition has been provided by the intravenous infusion of isotonic amino acids (FreAmine(R) II) at a 3.4% concentration. No other source of calories or nutrients was provided. In this setting, utilization was very poor; the subjects were in negative nitrogen balance throughout. The nitrogen excretion was significantly greater than the total of infused nitrogen. The changes in protein, fat and carbohydrate intermediates, as well as the alteration in hormone concentrations, suggest the following endocrine governance of fuel economy in this setting: a sharp rise in glucagon with maintenance of insulin concentration; rapid gluconeogenesis at the expense of both injected and endogenous amino acids; a progressive ketosis without any associated improvement in protein economy; fat oxidation to meet caloric need. The changes in plasma amino acid concentrations are of outstanding interest. They demonstrate changes appropriate to the infusion gradient with the exception of three amino acids whose concentrations did not respond to high infusate levels (serine, lysine, and alanine); likewise, by the fact that methionine rose remarkably though present in only low concentrations in the infusion. These data, taken with other information reported in the literature, as well as continuing studies in these laboratories, strongly suggest that the utilization of infused amino acids for protein synthesis is favored by the provision of an additional caloric source such as glucose.

Adult↗
PubMed2026

The use of 3-dimensional (3D) printing in teaching musculoskeletal oncology for medical undergraduates.

INTRODUCTION: The approach to integrating relevant anatomy in the medical curriculum has been debated for many years. Current literature has explored the broad impact of 3D printing in medical education. However, there is little evidence on 3D printing for the teaching of musculoskeletal oncology (MSO). This is a self-controlled case series (SCCS) study that aims to analyse the effectiveness of 3D printed models in MSO in enhancing the learning experience, engagement and understanding of clinical and surgical anatomy for medical students. METHOD: A cross-sectional cohort study involving 75 clinical year medical students across 3 years from 2 medical schools that rotated through a single teaching hospital's orthopaedic department. Participants first viewed a set of computed-tomography (CT) images of a large pelvic osteosarcoma from a free open-source database, the Cancer Genome Atlas Sarcoma Collection (TCGA-SARC). A standardised 10-minute pre-intervention questionnaire which comprised 15 questions categorised by: 4 questions in 'anatomical knowledge', 7 questions in 'spatial awareness', 4 questions in 'surgical planning and complications', was administered to assess the baseline knowledge in their interpretation of the pathology via CT images only. Next, a 3D-printed model of the pelvic osteosarcoma, which included colour-coded adjacent structures, was provided as an adjunct to answer the same questionnaire. This concluded with a 5-point Likert scale feedback survey to gauge their perspectives and experience. RESULTS: The mean scores comparing their pre- and post-intervention assessment questionnaire increased by +1.34 from 8.15 (SD = 1.85) to 9.49 (SD = 1.7) (p < 0.001). The final year students had the greatest improvement of +1.54 from 8.00 (SD = 1.89) to 9.54 (SD = 1.59) (p = 0.004). There was no significant difference between the scores amongst the 2 medical schools. 91% of students agreed that the 3D model had helped them further their understanding of the anatomy of the sarcoma and 87% would want 3D printing models to augment their learning in anatomy. Baseline weaker students demonstrated significantly greater improvement in scores compared with baseline stronger students (mean difference +2.04 vs +0.30, p < 0.001). CONCLUSION: 3D printing is an effective teaching adjunct for musculoskeletal oncology surgical anatomy for medical undergraduates and could be used to enhance their understanding and learning experience. 3D models could be integrated in the teaching curriculum of surgical anatomy for undergraduate students.

Humans↗
PubMed1976

Neurosurgical materials and devices. Report on regulatory agencies and advisory groups.

The current status of voluntary consensus standards writing procedures in neurosurgery and the current progress of government efforts to regulate materials and devices are described. A survey of the national and international standards writing bodies is presented, along with an introduction to related organizations and agencies and nomenclature. The intent of this review is to provide the neurosurgeon with a reference source regarding past and present neurosurgical activities in the materials and devices field. When President Ford signed the 1976 Medical Device Amendments on May 28, 1976, the Food and Drug Administration assumed direct legal authority to control medical devices and potentially assumed the power to regulate those professionals using them.

Government Agencies↗
PubMed1979

Primary postoperative wound infection due to Staphylococcus pyogenes.

Using S. pyogenes as a tracer organism, an examination of the importance of air-borne infection of clean wounds in the modern, plenum-ventilated operating room has been made. It appears that, for most surgical procedures, additional ultra-clean air installations are not necessary. It has been shown that even if the air is sterile, the skin remains a possible source of infection. This is especially so as far as the patient's skin is concerned. It will remain so, since the skin cannot be sterilized. Indeed, until the ecology of the skin is better understood, rigorous efforts directed toward its disinfection may compromise its inherent defense mechanisms and its protective bacterial flora. It will be argued by some that operating rooms with ultraclean air should be afforded for certain specialized procedures in sugery; for example, those in which prosthetic materials are being implanted or in which the patient's immune mechanisms are depressed. Although not disagreeing with this, I wish to note that the only controlled trial on this aspect of surgery that exists to date shows no advantage for patients randomly apportioned to have hip arthroplasty, either in an isolator or in the same modern operating room but without the isolator. From this experience, I believe that any further trial of this nature, if it is to be controlled to a similar high level, will require very large numbers of patients to show even a marginal advantage for ultraclean air or isolator installations over the modern, plenum-ventilated and meticulously managed operating suite. The verdict on the need to install ultraclean air plant for operating rooms must, therefore, be couched in the third alternative that exists under Scots Law-- "not proved." I suggest the money could be better spent on devising methods to keep skin pathogens out of surgical wounds. Perhaps more urgently, there is a need to discover how to increase the defense mechanisms of the wound milieu to implanted harmful bacteria. There is also a pressing need to improve the ward environment with the aim of diminishing secondary infections of surgical wounds.

Air Microbiology↗
PubMed1978

The bacteriology of primary wound sepsis in potentially contaminated abdominal operations: the effect of irrigation, povidone-iodine and cephaloridine on the sepsis rate assessed in a clinical trial.

Two hundred and nine potentially contaminated abdominal operations were randomly allocated to prophylaxis with a single dose of 1 g cephaloridine intraincisionally, irrigation of the wound at the end of the operation with saline or spraying of the wound with povidone-iodine. In high risk operations (ileocolorectal or those in obese patients) the rate of major wound sepsis in those protected by cephaloridine was 3.8% compared with 13.2% in the irrigation and 16.7% in the povidone-iodine groups. In low risk operations no significant differences in sepsis rates were found. Bacteriological studies of incised organs, subcutaneous fat and pus showed that the majority of wound infections arose from endogenous sources. The outstanding problem remains that of prevention of contamination of the abdominal wall during surgery.

Abdomen↗
PubMed1978

Control of acute gastroduodenal hemorrhage with cimetidine.

Thirty-four patients with acute gastroduodenal hemorrhage were treated with intravenous Cimetidine. Preliminary endoscopy was done at the onset of bleeding to determine the source of bleeding and to rule out the presence of a brisk arterial bleeding site that would require immediate operation for control. Sixteen of the patients had primary peptic ulcer disease and 18 patients had "stress ulcer" syndrome. The bleeding stopped following Cimetidine administration in 14 of the 16 peptic ulcer patients (88%) and in 13 of 18 stress ulcer patients (72%). There was no subsequent rebleeding. The data suggest that Cimetidine is of value in the immediate nonoperative management of acute gastroduodenal hemorrhage. Further, the availability of Cimetidine for postoperative use may modify the surgical approach to stress ulcer bleeding.

Adult↗
PubMed1976

[Acute hemorrhage of the upper digestive tract with special reference to stress ulcer. Prevention and surgical therapy].

For the surgical therapy of an acute stress-ulcer bleeding there are three methods to someones disposal: 1.) the local care of a bleeding source 2.) the partial gastrectomy and 3.) vagotomy with pyloroplasty and local care of a bleeding source and as prophylaxis of an acute stomach bleeding the highly selective vagotomy with or without pyloroplasty. On judging the success of these methods, some has to consider the basal illness with its letality, because it is to differ, wether a patient died postoperative on his basal disease, or on the effect of the operation, or out of deficient control of the situation. Considering such points it comes out clear, that today the vagotomy with a drainage operation is the method of choice, because: 1.) through this intervention patients are tainted less as for instance through a partial gastrectomy, 2.) through a technical faultless done operation, especially through a vagotomy a success concerning a relapse bleeding is guaranteed. Beside that, the highly selective vagotomy without drainage operation presents itself as prophylactic measure, to prevent an acute stomach bleeding in a number of transplanted patients (kidney transplantation). The first experiences with this method show, that a improvement of the results is to be expected.

Acute Disease↗