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At least 433 records · Page 24Linked to original sources
PubMed2004

Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model.

PURPOSE: To preserve sexual function following radical prostatectomy, one must avoid injury to the neurovascular bundles (NVBs). In the conventional open surgical technique, the use of energy sources for hemostasis is avoided to prevent damage to the cavernous nerves. In contrast, during laparoscopic radical prostatectomy, electrosurgical and ultrasonic energy sources are frequently used for hemostasis during dissection of the prostate. In this study, we evaluated the acute and chronic physiological effects of various hemostatic energy sources on cavernous nerve function in the canine model. MATERIALS AND METHODS: A total of 12 dogs were divided into 4 groups based on the type of energy source used for hemostasis during unilateral dissection of the NVB. The groups included conventional dissection with suture ligatures (group 1), monopolar (group 2) or bipolar (group 3) electrosurgery and ultrasonic shears (group 4). The contralateral NVB was left undissected as a control. Erectile function was assessed acutely and after 2 weeks of survival by measuring peak intracavernous pressures in response to cavernous nerve stimulation. RESULTS: Following conventional techniques of nerve sparing, the erectile response to nerve stimulation was unaffected. In contrast, the use of energy sources in proximity to the NVB during nerve preservation was associated with a substantial decrease in erectile response both acutely (74% to 91% decrease compared to controls) and after 2 weeks (93% to 96% decrease). CONCLUSIONS: In the chronic canine model, use of hemostatic energy sources in proximity to the prostate during dissection of the neurovascular bundle is associated with a significantly decreased erectile response to cavernous nerve stimulation.

Animals↗
PubMedDate not supplied

Axial pattern flap based on the superficial temporal artery in cats: an experimental study.

OBJECTIVE: The purpose of this study was to determine the surgical guidelines for and the survivability of an axial pattern flap based on the superficial temporal artery in cats. STUDY DESIGN: The mean survival length and mean percentage area of survival of flaps after 7 days in control and experimental groups, are assessed and compared. ANIMALS: Ten mature, domestic shorthair cats. METHODS: The superficial temporal artery and vein were incorporated in the flaps of the experimental group (n = 5) and were ligated in the control group (n = 5). Seven days postoperatively, the length of tissue that remained viable in each flap was determined by measurement of the length of the grossly devitalized tissue and subtracting this from total flap length. RESULTS: Mean width and length of all flaps was 2.0 x 7.0 cm, respectively. Mean survival length (+/- SD) of experimental and control flaps was 6.9 (0.2) cm and 4.4 (2.2) cm, respectively. Necrosis occurred in all control flaps, resulting in a mean percentage area of survival of 62.8 (11.7)%, compared with 98.6 (3.2)% for experimental flaps. Results were significantly different (P < .05) between the experimental and control groups. CONCLUSIONS: A flap based on the superficial temporal artery may be a source of skin for reconstructive procedures of the maxillofacial region in cats. CLINICAL RELEVANCE: Knowledge of the anatomic landmarks and survivability of an axial pattern flap are essential considerations when planning a reconstructive technique.

Animals↗
PubMed2002

Involvement of the mural thrombus as a site of protease release and activation in human aortic aneurysms.

Acquired abdominal aortic aneurysms are usually associated with a mural thrombus through which blood continues to flow. Some early data suggest that aneurysmal evolution correlates with the biological activity of the thrombus. Our hypothesis was therefore that the thrombus could adsorb blood components and store, release, and participate in the activation of proteases involved in aneurysmal evolution. For this purpose, we have explored both the metalloproteinase and fibrinolytic systems in the thrombus and the wall of human aneurysms. We have first investigated blood clot formation and lysis in vitro. Spontaneous clotting induces a release of promatrix metalloproteinase (pro-MMP)-9 into the serum that was fourfold higher than in paired control plasma (P < 0.001). Fibrinolysis progressively released more MMP-9 in a time-dependent manner (P < 0.01). After selective isolation, we demonstrated that polymorphonuclear leukocytes are the main source of MMP-9 release during clot formation. Protease content was then analyzed in 35 mural thrombi and walls of human abdominal aortic aneurysms sampled during surgical repair. In 15 aneurysms, the liquid phase at the interface between the thrombus and the wall was sampled separately. Both thrombus and wall contained MMP-2 and MMP-9 but the ratio MMP-9/MMP-2 was higher in the thrombus than in the wall. The liquid interface also contained active MMP-9. Immunohistochemistry of the thrombus confirmed these findings, showing the presence of polymorphonuclear leukocytes at the luminal pole of the thrombus, co-localizing with MMP-9 storage. In contrast, MMP-3 and MMP-7 were only present in the aneurysmal wall. Plasminogen was present in the mural thrombus but plasmin activity was present in both thrombus and wall. In the liquid interface, plasmin-alpha(2)-anti-plasmin complexes were detected demonstrating in vivo the activation of plasminogen. In contrast, u-PA and t-PA were detectable only in the wall, suggesting that plasminogen present in the thrombus could be activated by factors secreted by the arterial wall. This was demonstrated in vitro, in which co-incubation of thrombus and wall extracts generated plasmin in the presence of a fibrin matrix and activated MMPs. In conclusion, our study strongly suggests that the mural thrombus, by trapping polymorphonuclear leukocytes and adsorbing plasma components could act as a source of proteases in aneurysms that may play a critical role in enlargement and rupture.

Abdominal Wall↗
PubMed2003

Acute wound healing: the biology of acute wound failure.

Acute wound healing failure is an important source of morbidity and mortality for surgical patients. Many incisional hernias, gastrointestinal anastomotic leaks, and vascular pseudoaneurysms occur despite patient optimization and standardized surgical technique. Modern surgical experience suggests that biologic and mechanical pathways overlap during "normal" acute wound healing. The cellular and molecular processes activated to repair tissue from the moment of injury are under the control of biologic and mechanical signals. Successful acute wound healing occurs when a dynamic balance is met between the loads placed across a provisional matrix and the feedback and feed-forward responses of repair cells.

Acute Disease↗
PubMed2004

Randomised clinical trial of elective re-siting of intravenous cannulae.

INTRODUCTION: Peripheral venous thrombophlebitis (PVT) represents a considerable source of iatrogenic morbidity, occurring in about 20% of hospital in-patients. The aim of this prospective randomised study was to investigate the effect of elective change of intravenous cannulae on the incidence of PVT in hospital in-patients. PATIENTS AND METHODS: General medical and surgical inpatients requiring intravenous therapy were randomised into control (n = 26) or study (n = 21) groups. Cannulae in the control group were only removed if the site became painful, the cannula dislodged, or there were signs of PVT. Cannulae in the study group were changed electively every 48 h. All patients were examined daily for signs of PVT. RESULTS: Peripheral venous thrombophlebitis developed in 11/26 patients in the control group and 1/21 patients in the study group (P = 0.003). Elective change of cannulae did not significantly increase the total number of cannulae sited (41 cannulae in the control group versus 43 in the study group). CONCLUSIONS: Elective change of cannulae resulted in a significant reduction in the incidence of infusion phlebitis. The authors recommend that elective re-siting of intravenous cannulae becomes standard practice for all patients requiring intravenous therapy.

Adult↗
PubMed1998

The nose: an underestimated source of Staphylococcus aureus causing wound infection.

For the last fifty years, the nose has been intermittently recognized and targeted as a source of Staphylococcus aureus causing surgical site infection. In London in 1959, Williams and co-workers established for the first time that nasal carriers had increased rates of surgical sepsis compared with non-carriers. For half of these patients, the source was the patient's own nose. Post-admission acquisition of tetracycline-resistant strains was associated with even higher rates of infection. The increasing appearance of epidemic methicillin-resistant S. aureus (MRSA) in the 1980s rekindled interest in these (largely overlooked) studies, when the elimination of nasal carriage by topical mupirocin proved pivotal for the control of MRSA in Northern Europe and elsewhere. In the late 1980s and 1990s, Boelaert, Holton and others, appreciating the work performed forty years previously, used nasal mupirocin for the successful prevention of sepsis with S. aureus in patients on haemodialysis and continuous ambulatory peritoneal dialysis without incurring problems with mupirocin resistance. In 1995, Kluytmans and colleagues demonstrated that nasal carriage of S. aureus is a significant risk factor for wound infection after cardiac surgery. Towards the year 2000, the use of prophylactic nasal mupirocin for the prevention of serious sepsis in major clean surgery is emerging as a plausible and exciting new strategy.

Anti-Bacterial Agents↗
PubMed1992

Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis.

Fracture of the hip typically occurs in older women. These patients usually have serious accompanying chronic illnesses. There is a difference of opinion as to the choice of regional versus general anesthesia for surgery in these patients. This meta-analysis compared survival of patients with traumatic femoral neck fractures undergoing operative repair during regional or general anesthesia. The data sources were articles comparing regional and general anesthesia from peer reviewed journals. Thirteen randomized controlled trials were found. Besides 1-month mortality, variables used were estimated operative blood loss and the incidence of deep venous thrombosis. For dichotomous outcomes, two effect measures were calculated: the difference in probabilities and the odds ratio. For blood loss, a continuous variable, the effect measure was the mean difference in blood loss. A random-effects Bayesian meta-analysis was used to combine study data, estimate parameters and create 95% confidence intervals. Only the incidence of deep venous thrombosis was clearly greater for patients receiving general anesthesia, being 31 percentage points higher than for patients receiving regional anesthesia. By the odds ratio, deep venous thrombosis was almost four times more likely following general anesthesia. There was no difference in estimated operative blood loss. By probability difference, mortality was a non-significant 2.7 percentage points less following regional anesthesia. By odds ratio effect measure, death was 1.5 times more likely following general anesthesia, but the lower bound of the 95% confidence interval was close to 1. Meta-analysis does not allow a conclusion that important differences in mortality exist between regional and general anesthesia for traumatic hip fracture surgery.

Aged↗
PubMedDate not supplied

Seminal antioxidant capacity in pre- and postoperative varicocele.

In order to explore the impact of surgical treatment on antioxidant defense system in varicocele (VAR), we evaluated seminal total antioxidant capacity (TAC) in 25 patients affected by VAR, in 14 patients studied 10-24 months after varicocelectomy (post-VAR) and separated into normo- and oligospermic groups, and in 24 non-VAR control patients with seminal parameters matched to patients with VAR in the oligo- and normospermic groups (7 subjects with idiopathic oligospermia and 17 normal fertile subjects). TAC was measured in seminal plasma with the system H(2)O(2)-metamyoglobin as a source of radicals, which interact with a chromogen 2,2',-azinobis (3-ethylbenzothiazoline-6-sulphonate) (ABTS), generating a radical cation spectroscopically detectable. The presence of antioxidants induces a lag time in the production of ABTS cation proportional to the concentration of antioxidant compounds. When whole groups of patients were analyzed, lag values were significantly higher in VAR vs non-VAR controls (mean +/- SEM, 106.6 +/- 8.8 seconds vs 78.7 +/- 8.8 seconds) but were not modified by surgery (mean +/- SEM, 105.8 +/- 8.6 seconds). In groups separated according to seminal parameters, oligospermic VAR presented significantly higher lag values than oligospermic controls. Finally, when exploring a possible association of TAC with seminal parameters, we found a significant correlation between lag and sperm motility only in patients with VAR who were in the normospermic group (r = 0.65, P <.01). This correlation was not yet manifest post-VAR. In conclusion, surgical treatment does not seem to modify absolute values of TAC but influences its fine regulation and relationships with sperm motility.

Adult↗
PubMed1991

Anaphylactic reactions during general anesthesia among pediatric patients--United States, January 1990-January 1991.

From March 1990 through January 1991, nine patients at one children's hospital in Wisconsin (hospital A) had onset of anaphylactic reactions (ARs) within 30 minutes following the start of general anesthesia; no patient had had a surgical incision at the time of their reaction. Eight of these patients required admission to the intensive care unit for supportive care. To determine the extent and potential source of the problem, an epidemiologic investigation was conducted at hospital A.

Adolescent↗
PubMed1995

Enterocolitis associated with Hirschsprung's disease: a clinical histopathological correlative study.

Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of > or = II (> or = 2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of > or = III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally thought, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD.

Abscess↗
PubMed1990

Neurophysiologic monitoring during surgery of peripheral and cranial nerves, and in selective dorsal rhizotomy.

Physiologic monitoring may warn of impending neural damage and intraoperative assessment may provide critical information used to direct the surgical procedure itself. Intraoperative techniques utilize methods modified from the diagnostic neurophysiologic laboratory. Simultaneous multimodality recording of different signal sources is of particular value for several types of procedures. Intraoperative studies must be tailored to each patient's clinical condition and to the specific surgical risks. Since studies have supported the benefits of intraoperative monitoring for peripheral nerve and cranial nerve surgery, monitoring is not likely to be subjected to the rigors of a randomized controlled study for these procedures.

Action Potentials↗
PubMed1996

A clinical trial on the prevention of catheter-related sepsis using a new hub model.

BACKGROUND: Catheter hub contamination is being increasingly recognized as a source of catheter-related sepsis. The authors have investigated the efficacy of a new hub design in preventing endoluminal catheter contamination and catheter-related sepsis arising at the hub. METHODS: Adult surgical and intensive care patients requiring a subclavian catheter for at least 1 week were randomly assigned to receive catheters with standard connectors (control group, n=73) or equipped with a new hub model (new hub group, n=78). Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or because of suspicion of sepsis, in which case peripheral blood cultures were taken. RESULTS: Of the 151 patients included, 15 (10%) developed catheter-related sepsis. Catheters were more often withdrawn because suspicion of infection in the control group (42 vs. 19%, p<0.005). Catheter sepsis rate was higher in the control group (16 vs. 4%, p<0.01) because of the low rate of catheter sepsis arising at the hub observed in the new hub group (1 vs. 11%, p<0.01). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (18 vs. 5%, P<0.03). CONCLUSIONS: A new catheter hub has proved to be useful in preventing endoluminal bacterial colonization and catheter-related sepsis in subclavian lines inserted for a mean of 2 weeks.

Adult↗
PubMedDate not supplied

Health services utilization after induced abortions in Ontario: a comparison between community clinics and hospitals.

The purpose of this study was to compare postabortion health services utilization of hospital abortion patients with community clinic abortion patients using administrative databases. The study was a retrospective cohort study. The study group consisted of patients with induced abortions (n = 41,039) performed in hospitals or community clinics recorded in the 1995 Ontario Health Insurance Plan claims (OHIP) database. An age-matched cohort of 39,220 women who did not undergo induced abortions was selected from the same data source to serve as controls. The main outcome measures were health services utilization indicators constructed from OHIP data within 3 months postabortion from office consultations, emergency room consultations, and hospital admissions. Hospitalization indicators were constructed from Canadian Institute for Health Information hospital discharge data within 3 months postabortion and included data on hospitalizations for infection, certain surgical events, or psychiatric problems. Postabortion health services utilization and hospitalization were higher in the patient population, regardless of service location, than in the age-matched cohort. Within the abortion patient population, hospital day-surgery patients had higher rates of postabortion utilization and hospitalization than did community clinic patients. Multivariate analysis revealed that hospital day surgery patients had a higher risk of subsequent post-abortion hospitalizations for infections (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.23-2.28), surgical events (OR 1.70, 95% CI 1.30-3.24) and psychiatric problems (OR 2.65, 95% CI 1.77-3.98) than community clinic patients. The rates of postabortion health services utilization and risk of hospitalization were lower in community clinic abortion patients than in hospital day-surgery patients. However, it is not possible to fully control for important confounding variables when using these administrative data.

Abortion, Induced↗
PubMed1975

Involvement of adenylate cyclase in mechanisms of denervation supersensitivity following surgical denervation of the dog heart.

Following surgical disruption (4-16 weeks) of the nerves supplying the dog heart, catecholamine (norepinephrine and epinephrine) levels in the atria and ventricles were markedly reduced. Using the 10,000 g particulate fraction as an enzyme source, the activation of adenylate cyclase by norepinephrine was considerably greater in the denervated myocardial preparations (atria and ventricles) than in control hearts. Moreover, in the denervated ventricular preparation fluoride (5 and 10mM) elicited a significantly greater stimulation of the enzyme than that observed in the controls.

Adenylyl Cyclases↗
PubMed2005

PFGE-based epidemiological study of an outbreak of Candida tropicalis candiduria: the importance of medical waste as a reservoir of nosocomial infection.

Between November 2002 and March 2003, an outbreak of candiduria occurred in the surgical intensive care unit (SICU) of a university-affiliated hospital in South Korea. This outbreak affected 34 patients and was caused by Candida tropicalis. To determine the source of the epidemic and the risk factors, surveillance cultures from the SICU, genotyping of Candida isolates by pulsed-field gel electrophoresis (PFGE), and a case-control study were performed. The surveillance cultures revealed that 6 environmental samples related to the urine disposal route were positive for C. tropicalis. The PFGE analysis of genomic DNA demonstrated identical band patterns for all of the C. tropicalis isolates obtained from SICU patients and the 6 environmental samples during the outbreak period, while epidemiologically unrelated strains showed unique PFGE band patterns. Although no risk factors were identified by the case-control study, this epidemiological investigation involving the use of molecular techniques suggests that improper disposal of infectious medical waste led to the cross-transmission of a single clone that was responsible for the outbreak of C. tropicalis candiduria in this SICU. After implementing a better urine disposal system and thorough hand washing procedures, no further clusters of candiduria were detected in the SICU.

Candida tropicalis↗
PubMed1989

Factors women take into account when deciding upon type of surgery for breast cancer.

For women with stage I or II breast cancer, randomized trials have demonstrated no significant difference in survival rates between women receiving modified radical mastectomy (MRM) and women receiving breast conserving (BC) surgery. Therefore, many women are now in a position of having a choice between these two options. Twenty-two women who met the surgical criteria for having this choice were interviewed 1 to 2 weeks postsurgery to determine factors they had considered when deciding between MRM and BC, how much they wished to participate in decision-making, and the sources of information they used. The sample was purposefully limited to women attending one clinic in order to insure control over variables such as the information to which patients are exposed. When asked why they had chosen a given surgery, two factors, concerns about radiotherapy (p = 0.003) and body integrity (p = 0.04), emerged as significantly different for women choosing BC vs. MRM. Furthermore, women reported that participation in decision-making was important to them and that they had had sufficient participation in the decision-making process. Finally, they rated "people" sources of information as more important than written or visual materials, suggesting that nurses and other care providers are important in supporting women through the decision-making process.

Adult↗
PubMed2002

[Changing surgical therapy because of clinical studies?].

The randomised controlled clinical trial (RCT) is a powerful instrument to evaluate different therapeutic regimens. In a survey among 115 physicians visiting the 25th annual meeting of the Surgical Society of Berlin and Brandenburg, the RCT was judged to be very important when changes of therapeutic strategies are discussed. 90 % of all participants claimed to use data from RCTs in the clinical routine and 89 % would participate in such a trial. In official (e. g. discussions during coffee breaks at scientific meetings) or non-medical (e. g. non-scientific press or media) sources of information were assessed as irrelevant for decisions regarding therapeutic strategies. However, in contrast to this view laparoscopic cholecystectomy was introduced into clinical practice rapidly because patients informed by external (non-medical) sources preferred to be operated on with the "modern" technique. Clinical trials with a high level of evidence had no relevant influence on the rapid distribution of laparoscopic cholecystectomy. Controversial discussions concerning the extent of lymphadenectomy with gastric resection for carcinoma demonstrate that the value of excellent clinical RCTs is low if their results challenge a stable paradigma of the surgical scientific society. To allow a rational judgement, new surgical technologies should undergo a scientific gradual evaluation in agreement with the principles of evidence based medicine.

Attitude of Health Personnel↗
PubMed1997

National survey of MRSA: Ireland, 1995.

The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.

Adolescent↗