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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↗
PubMed2003

Prolonged candidemia in infants following surgery for congenital heart disease.

OBJECTIVES: To describe a group of infants with complex congenital heart disease (CCHD) who had candidemia postoperatively and to perform a case-control study of risk factors. DESIGN: Descriptive and case-control study. SETTING: Tertiary-care medical centers. PATIENTS: Infants with CCHD who underwent cardiac surgery and developed candidemia. Controls were matched for congenital heart disease lesions, age, and postoperative hospital stay. RESULTS: Of 95 infants younger than 6 months with CCHD who underwent cardiac surgery between January 1999 and April 2001, 6 (6.3%) developed candidemia with 5 different species. The candidemia was prolonged (range, 12 to 32 days; median, 17 days). The interval between cardiac surgery and onset of candidemia was 12 to 57 days (median, 24 days). All had a central venous catheter inserted 8 to 50 days prior to the onset of candidemia. The mortality rate was 83%, compared with 13% for the group without candidemia. A univariate analysis of the potential risk factors revealed that duration of total parenteral nutrition (TPN), duration of antibiotics, intraoperative cardiopulmonary bypass time, and documentation of an intravascular thrombus were associated with candidemia. In multivariate analysis, long duration of TPN and documentation of a thrombus were associated with candidemia. CONCLUSIONS: Candidemia following cardiac surgery for infants with CCHD was persistent and associated with high mortality. The variety of species indicates that this was not a common-source outbreak. Risk factors associated with candidemia were duration of TPN and documentation of an intravascular thrombus.

Candida↗
PubMed1989

Severe hemorrhage associated with pancreatic pseudocysts: report of two cases.

Severe hemorrhage from pancreatic pseudocysts is a rare condition that poses a diagnostic and therapeutic challenge. Two cases of preoperative intracystic bleeding and massive postoperative gastrointestinal hemorrhage observed during the last year form the basis of the present report. In the first patient, transcystic suture ligation of the bleeding vessel was necessary to control this life-threatening and dramatic condition--External drainage of the cyst was followed by an uneventful postoperative course. In the second patient, massive gastrointestinal bleeding occurred after cysto-gastrostomy, and neither endoscopy nor arteriography was able to identify the source. Despite aggressive medical and surgical therapy, the patient died. Massive intracystic or gastrointestinal hemorrhage caused by rupture of pseudoaneurysms into pancreatic pseudocysts still remains a rare but severe condition, difficult to treat and affected by high mortality rates. Angiography should be performed routinely in the preoperative assessment of pancreatic pseudocysts, even when the other diagnostic techniques do not raise the suspicion of pseudoaneurysm formation. After internal drainage procedures early surgery is recommended whenever GI bleeding occurs in the postoperative course.

Acute Disease↗
PubMed1991

Nutrient modulation of inflammatory and immune function.

The metabolic response to injury occurs after a diverse group of surgical injuries including major surgical intervention, shock, infection, and sources of inflammation such as pancreatitis. The response is mediated by the macroendocrine system, the autonomic nervous system, and the cell-cell communication system. The clinical manifestations include now well-described clinical, physiologic, and metabolic characteristics. The approach of aggressive source control, invasive circulatory resuscitation, and nutrition/metabolic support has been associated with an overall reduction in morbidity and mortality. In those patients who do not respond to this approach, the disease process progresses to multiple organ failure syndrome with its associated high mortality. Altering the route of feeding, preventing single nutrient and generalized nutrient deficiency, and reducing nosocomial infections with selective gut decontamination have not significantly altered the course or outcome of the disease process in this latter group of patients with persistent hypermetabolism. The available data support the position that this persistent hypermetabolism represents abnormal metabolic regulation resulting in persistence of the inflammatory response with associated suppression of the immune defenses. A number of research approaches are being taken to understand and modulate this abnormal state of regulation. Because of the role of specific nutrients in these regulatory processes, beyond their role in classic nutrition support, nutrients such as arginine n-3 polyunsaturated fatty acids, and RNA are being evaluated for their ability to modulate inflammation and to improve immune function. Preliminary results are encouraging.

Arginine↗
PubMed1992

Resident research award: tumor necrosis factor alpha selectively enhances growth and cytotoxic activity of tumor infiltrating lymphocytes from human colorectal cancer.

Adoptive immunotherapy with tumor-infiltrating lymphocytes (TIL) and interleukin-2 (IL2) can induce regression of tumor metastases in animal models and in human metastatic malignant melanoma. We investigated the potential of colorectal cancer TIL as a source of killer cells and the effect of tumor necrosis factor alpha (TNF alpha) in combination with IL2 on their cytotoxic activity. Tumor-infiltrating lymphocytes were isolated from surgical specimens using a mechanical and enzymatic dissociation process. Autologous lamina propria mononuclear cells (LPMC) were used as control. Tumor-infiltrating lymphocytes and LPMC were cultured in the presence of IL2 with/without TNF alpha (1000 U/ml each) for 5 to 8 weeks. Cytotoxicity (% lysis) was tested against Daudi target cells in a 4-hr 51Cr-release assay. The combination of IL2 and TNF alpha resulted in a significantly greater-fold expansion of TIL than IL2 alone (P less than 0.01). Lamina propria mononuclear cells expanded less than TIL, and TNF alpha had an inhibitory effect on their growth (P less than 0.05). Tumor-infiltrating lymphocytes and LPMC showed comparable cytotoxicity when cultured with IL2 alone. However, the addition of TNF alpha augmented the killer activity of TIL while inhibiting that of LPMC (P = 0.035). These results indicate that TNF alpha selectively increases the IL2-induced growth and cytotoxic function of colorectal cancer TIL, but not those of gut mucosal lymphoid cells, suggesting that TIL and LMPC differ in their response to TNF alpha. Therefore, this combination of cytokines may hold more promise than single agents for the immunotherapy of colorectal cancers with TIL.

Aged↗
PubMed2002

Biocompatibility of anionic collagen matrix as scaffold for bone healing.

The basic approach to the treatment of bone defects involves the use of scaffolds to favor tissue growth. Although several bioscaffolds have been proposed for this purpose, the search for new and enhanced materials continues in an attempt to address the drawbacks of the present ones. Modifying current materials can be a fast and cheap way to develop new ones. Among them, type I collagen allows its structure to be modified using relatively simple techniques. By means of an alkaline treatment, anionic collagen with enhanced piezoelectric properties can be obtained through hydrolysis of carboxyamides groups of asparagine and glutamine residues from collagen in carboxylic. The process applied to a raw source of collagen, bovine pericardium, provided a sponge-like structure, with heterogeneous pore size, and, moreover, the complete removal of interstitial cells. For the evaluation of the biocompatibility of such matrices, they were implanted in surgically created bone defects in rat tibias. Empty defects served as controls. This experimental model allowed a preliminary evaluation of the osteoconductiveness of the matrices. The histological results presented a low inflammatory response and bone formation within a short period of time, similar to that of controls. The low cost of production associated to the biocompatibility and osteoconductivity performance make the anionic collagen matrices promising alternatives for bone defects treatment.

Animals↗
PubMed2006

Effect of a novel pancreatic stent design on short-term pancreatic injury in a canine model.

BACKGROUND AND STUDY AIMS: Attempts to address the problem of injury to the pancreas by indwelling pancreatic stents are limited by our lack of knowledge of the pathogenesis of stent-induced injury and its relationship to stent morphology and the duration of stenting. The aim of our study was to evaluate pancreatic injury induced by 1 week of stenting with a 5F indwelling pancreatic stent of novel design, the "wing stent." METHODS: Pancreatic stents (5F) were placed surgically in eight dogs; wing stents (WS-5F) were used in four dogs and conventional stents (CS-5F) in another four. Two dogs underwent duodenotomy without stent placement (controls). The pancreas was harvested for microscopy at 1 week. A pathologist who was unaware of the source of the specimens graded the pancreatic injury. RESULTS: Although pancreatic injury was observed in both the CS-5F and WS-5F groups after 1 week of indwelling pancreatic stenting, it was considerably less severe in the WS-5F group compared with the CS-5F group (1.01 +/- 0.10 vs. 1.63 +/- 0.14, P < 0.01). All components of pancreatic injury were affected, with the most dramatic differences noted in inflammation, fibrosis, and edema. The differences were most marked in the stented segment ( P < 0.001) and in the upstream segment of the pancreas ( P < 0.05). CONCLUSIONS: Indwelling conventional pancreatic stents can cause significant pancreatic injury even when left in place for only 1 week. A wing design can significantly ameliorate stent-induced changes.

Animals↗
PubMed1993

[Contribution of endoscopy of the cerebellopontine angle by retrosigmoid approach. Neuroma and vasculo-nervous compression].

An endoscopic approach to the cerebellopontine angle has been suggested by several authors over the last 20 years but it is only recently that the technical and operative conditions for successful endoscopy could be met. The retrosigmoid approach provides simple and direct access to the cerebellopontine zone. The endoscope, with its distal light source, provides excellent illumination of a wide visual field within an anatomical site particularly rich in neurovascular structures. Endoscopic and microsurgical techniques may be combined for the surgical management of acoustic neuroma with the advantage of assuring better exposure of structures adjacent to the tumor and better control of the quality of dissection of the fundus of the internal auditory canal. The addition of endoscopic techniques, during surgery for trigeminal neuralgia or unilateral facial spasm, makes it possible to accurately locate the site of neurovascular compression without either retraction of the cerebellum or unnecessary dissection.

Arteries↗
PubMed1975

Evaluation and optimum use of directed horizontal filtered air flow for surgeries.

Airborne micro-organisms, a suspected cause of surgical wound infection, are significantly reduced by the use of filtered unidirectional air flow (UAF) in operating rooms. A horizontal UAF system was installed at UCLA for evaluation and to determine procedures which would optimize its use. Major findings are listed: though the air flow was found to be somewhat turbulent and non-uniform in velocity downstream from the filter-bank entrance, the gross flow direction was maintained throughout the protected region; airborne particles were swept downstream with little vertical drop and no large scale recirculation; proper orientation and placement of objects in the clean air stream maximized its purging effect; correlation of non-viable with viable particle counts was not possible; better control of sources of contamination, particularly the operating team, would further reduce the potential for airborne infection; as yet there is no definitive proof that the addition of filtered UAF in a modern operating room reduces occurrences of deep wound sepsis.

Air Microbiology↗
PubMed2002

A cross sectional study of water quality from dental unit water lines in dental practices in the West of Scotland.

OBJECTIVE: To determine the microbiological quality of water from dental units in a general practice setting and current practice for disinfection of units. DESIGN: A cross-sectional study of the water quality from 40 dental units in 39 general practices and a questionnaire of the disinfection protocols used in those practices. SETTING: NHS practices in primarydental care. SUBJECTS: Thirty-nine general practices from the West of Scotland. METHODS: Water samples were collected on two separate occasions from dental units and analysed for microbiological quality by the total viable count (TVC) method. Water specimens were collected from the triple syringe, high speed outlet, cup filler and surgery tap. Each participating practitioner was asked to complete a questionnaire. Results Microbial contamination was highest from the high speed outlet followed by the triple syringe and cup filler. On average, the TVC counts from the high speed water lines at 37 degrees C and for the high speed lines, triple syringe and cup filler at 22 degrees C were significantly higher than that from the control tap water specimens. The study included units from 11 different manufacturers with ages ranging from under one year to over eight years. The age of the dental unit analysed did not appear to influence the level of microbial contamination. Five of the practices surveyed used disinfectants to clean the dental units but these had no significant effect on the microbiological quality of the water. The majority of dental units (25 out of 40) were never flushed with water between patients. A number of different non-sterile irrigants were used for surgical procedures. CONCLUSION: The microbiological quality of water from dental units in general dental practice is poor compared with that from drinking water sources. Suitable sterile irrigants should be used for surgical procedures in dental practice. Further work is required for pragmatic decontamination regimens of dental unit water lines in a general dental practice setting

Colony Count, Microbial↗
PubMed2007

Long-term stability of Class III treatment: rapid palatal expansion and protraction facemask vs LeFort I maxillary advancement osteotomy.

INTRODUCTION: The aim of this retrospective cephalometric study was 3-fold: (1) to compare the effects and long-term stability of protraction facemask treatment with untreated Class III controls, (2) to compare the long-term stability of early protraction facemask treatment with later surgical maxillary advancement with LeFort I osteotomy, and (3) to determine whether early intervention with protraction facemask is an effective treatment modality or whether surgical treatment after cessation of growth should be advocated. MATERIALS: The sample consisted of 34 consecutively treated white patients with Class III malocclusions characterized by maxillary deficiency. The protraction sample consisted of 17 children (8 boys, 9 girls). The surgical sample consisted of 17 adults (10 men, 7 women). The protraction group was also compared with a control group of white subjects with untreated Class III malocclusions. Lateral cephalograms were taken at T1 (initial records), T2 (end of functional appliance treatment or 2 weeks postsurgery), and T3 (7 years 6 months postprotraction or 1 year 5 months postsurgery). Means and standard deviations were calculated for descriptive cephalometric measurements. ANOVA was used to assess the differences between and within the protraction and surgery groups at T1, T2, and T3. The Tukey studentized range test was performed to determine the source of the difference. In addition, paired t tests were used to compare the differences between the protraction group and the matched controls as well as between the surgery group and the matched controls. RESULTS: In the protraction group, there was continued favorable growth of the maxilla, even after the removal of the protraction facemask. From T2 to T3, the maxilla continued to move anteriorly in the protraction patients more so than in the control groups, which had decreases in the intermaxillary measurements (ANB angle and Wits appraisal) over time. The surgical group remained stable from T2 to T3 in all measurements studied. CONCLUSIONS: The most striking findings of this study were the general similarity between the protraction and the surgical groups at T3 and the overall stability of both treatment modalities over time.

Adult↗
PubMed1994

Nosocomial transmission of Serratia odorifera biogroup. 2: Case report demonstration by macrorestriction analysis of chromosomal DNA using pulsed-field gel electrophoresis.

OBJECTIVES: To investigate a cluster of Serratia odorifera in a cardiothoracic surgery unit (CTSU) and to evaluate the applicability of three typing methods for this species. DESIGN: During a surveillance surgical wound study, S odorifera was isolated from two patients in the CTSU. The patients' hospital charts were reviewed for the details of surgery and for common personnel, procedures, or medications. Cultures were obtained of water, soap, and unit dose medications from the CTSU, the operating room, and the surgical intensive care unit. The isolates' antibiograms, biotypes (Vitek identification card and API 20E), and patterns of chromosomal DNA (chrDNA) by pulsed-field gel electrophoresis (PFGE) were examined. S odorifera isolates from our organism collection were used as controls. SETTING: A 900-bed university hospital with a 22-bed CTSU. RESULTS: ChrDNA patterns of isolates from the two patients were identical, suggesting a possible nosocomial source. However, no source of organisms or mode of transmission was identified. Neither biotype nor antibiogram were useful for epidemiologically typing S odorifera, and PFGE was necessary to discriminate among isolates. CONCLUSIONS: Although rarely isolated, S odorifera and other non-marcescens Serratia species may cause nosocomial outbreaks. PFGE of chrDNA seems to be a reliable method for epidemiologically typing this species.

Aged↗
PubMed2004

Mycobacterium chelonae infections associated with face lifts--New Jersey, 2002-2003.

In March 2003, the New Jersey Department of Health and Senior Services (NJDHSS) was notified about three patients who acquired surgical-site infections caused by Mycobacterium chelonae after having face lifts (i.e., rhytidectomies) performed at an outpatient surgical center. NJDHSS learned subsequently of another patient with M. chelonae infection who had a rhytidectomy performed at a second surgical center. The four patients received diagnoses of M. chelonae infection during March 2002-February 2003. NJDHSS conducted an epidemiologic, environmental, and microbiologic investigation. This report summarizes the results of that investigation, which identified contaminated methylene blue used as a tissue-marking agent as the source of infection. Surgeons should use only sterile, single-use, tissue-marking agents during procedures that require aseptic technique, and clinicians should consider M. chelonae when evaluating surgical-site infections.

Adult↗
PubMedDate not supplied

[Apparatus for draining the operative field during ophthalmological surgery].

A vacuum apparatus is offered for drying the surgery field during ophthalmological operations. In fact, this is an aspirator consisting of a vacuum source--vacuum pump, collecting cup and the patients' tube with a holder of suction tip (syringe needles). The pedal with a valved device is attached to control unsealing of the pneumosystem.

Humans↗
PubMed2005

A prospective, randomized, double-blind study evaluating the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after spinal arthrodesis.

STUDY DESIGN: Parallel design, prospective, double-blind, randomized, controlled trial composed of two independent groups treated with a continuous infusion catheter (saline vs. Marcaine) placed into the iliac crest bone graft (ICBG) site. OBJECTIVE: To determine the effects of postoperative continuous local anesthetic agent infusion at the ICBG harvest site in reducing pain, narcotic demand and usage, and improving early postoperative function after spinal fusion. SUMMARY OF BACKGROUND DATA: Harvesting iliac crest bone has been shown to be a source of pain and morbidity. Long-term patient complaints may be more closely associated with the procurement of the iliac crest graft rather than the primary surgical site. METHODS: Thirty-seven patients were enrolled in a prospective, randomized, double-blind parallel-designed study after informed consent and IRB approval was obtained. Twenty-eight patients had ICBG harvested for lumbar arthrodesis and nine for cervical arthrodesis. During spinal arthrodesis surgery, patients were randomly assigned to receive 96 mL (2 mL/hr x 48 hours) of either normal saline (control group, n = 22) or 0.5% Marcaine (treatment group, n = 15) delivered via a continuous infusion catheter placed at the ICBG harvest site. All patients received Dilaudid PCA after surgery. Pain scores, narcotic use/frequency, activity level, and length of stay (LOS) were recorded. Physicians, patients, nursing staff, and statisticians were blinded to the treatment. RESULTS: Mean patient age was 60 years and similar between groups. Narcotic dosage, demand frequency, and mean VAS pain score were significantly less in the treatment (Marcaine) group at 24 and 48 hours (P < 0.05). The average LOS was 4.1 days with no difference between Marcaine or control groups. No complications were attributed to the infusion-catheter system. CONCLUSIONS: Continuous infusion of 0.5% Marcaine at the ICBG harvest site reduced postoperative parenteral narcotic usage by 50% and decreased overall pain scores. No complications were attributed to the infusion-catheter system. The use of continuous local anesthetic infusion at the iliac crest may help in alleviating acute graft-related pain, hastening patient recovery and improving short-term satisfaction.

Adult↗
PubMed2005

Endoscopic therapy for gastroesophageal reflux disease.

Within the last 15 years, novel endoscopic therapies have been developed as options for patients who have gastroesophageal reflux disease (GERD). These approaches can provide long-term relief of GERD, or can be used to "bridge" patients to future therapy, because undergoing treatment does not preclude one from future medical or surgical therapy. These therapies continue to bean active source of research and investigation. Although they are undergoing rapid development, there are only a few peer-reviewed articles detailing original studies with short-term follow-up. Future success in this arena will depend on sham-controlled trials, long-term outcome studies, and cost-effectiveness analyses. This article describes available endoscopic therapies, discusses their effectiveness and duration of response, and reviews their failures and complications.

Biocompatible Materials↗
PubMed1982

The hemostatic effect of conjugated water-soluble estrogens in rats.

Estrogenic steroids have been used as hemostatic agents in various surgical procedures in humans. Their use to reduce bleeding has been based mainly on clinical observation. The present study was carried out to test experimentally whether intravenously administered Premarin reduces capillary bleeding. Skin-graft donor sites in rats served as the standard capillary bleeding source in this controlled double-blind experiment, in which Premarin was found to appreciably reduce capillary bleeding.

Animals↗