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PubMed2004

[Limitations of orthognathic model surgery: theoretical and practical implications].

Orthognathic model surgery is a classical technique used to simulate orthognathic surgical cases. However, a detailed analysis of this technique demonstrates that theoretical errors and inaccuracies can occur in routine practice. 2D and 3D cephalometric analysis is the first source of inaccuracies. Then, during the occlusal plane transfer from the patient to the semi-adjustable dental articulator, errors can occur by inaccurate manipulation of the facial bow. Simulating the operation on the plaster cast is difficult due to the lack of a real link between the cephalometric analysis and the model surgery. Rotation and translation movements of the plaster casts are insufficiently controlled during the model surgery stage. Finally, the splint, which transfers the final relative position of maxilla to the mandible, summates all of the errors of the previous stages.

Cephalometry↗

PubMedDate not supplied

Functionality of cultured human hepatocytes from elective samples, cadaveric grafts and hepatectomies.

The major possible sources of human liver for hepatocyte isolation are elective liver biopsies, cadaveric liver grafts and therapeutic liver resections. The suitability in terms of metabolic-competent hepatocyte cultures and risk/benefit of these resources has been comparatively studied. To this end, viability of isolated hepatocytes, yield of isolation procedure, hepatocyte survival during culture and CYP activities were the parameters analysed. The best results were found in hepatocytes prepared from elective biopsies, whereas a marked reduction in viability and functional competence was seen in hepatocytes from hepatectomy samples. Metabolic differences were observed in total CYP oxidative metabolism (7-ethoxycoumarin O-deethylation, total testosterone hydroxylation), as well as in CYP3A4, CYP2C9 or CYP2C19 activities (testosterone oxidations at 6beta-, 16beta- and 17-positions, respectively). Vascular control during the hepatectomy procedure influenced hepatocyte functionality: higher CYP activities were found in hepatocytes isolated from samples obtained under non-ischemic conditions or continuous vascular clamping than in those obtained under intermittent vascular clamping. In addition to cellular functionality, other criteria such as sample availability or ethical aspects should be considered. Elective biopsies have low, but not absent, surgical risk. However, the better functionality and the higher accessibility of elective liver samples in comparison to the other groups suggest this source of liver tissue as the most appropriate for cell harvesting purposes.

Bayes Theorem↗

PubMed1975

Deafferentation slows the growth of specific dendrites of identified giant interneurons.

The effect deafferentation has on the morphology of giant interneurons was studied in the abdominal nervous system of crickets (Acheta domesticus). The morphology of four uniquely identified giant interneurons was exxamined by iontophoresing cobalt chloride into the neurons of interest. A major source of afferents for these interneurons consists of mechanoreceptors located on paired abdominal sensory appendages -- the cerci. Partial deafferentation of the giant interneurons was obtained by pinching off the cercus at hatching and maintaing the specimen in this deprived condition until adulthood. The interneurons of three groups of animals were examined; control specimens which were not treated surgically, unilaterally treated specimens which had a single cercus removed and bilaterally treated specimens which had both cerci removed. Two types of morphological changes were detected. (1) Chronic removal of a cercus was correlated with a reduction in length of dendrites ipsilateral to the ablated cercus; however, the general form of the dendritic branching pattern remained constant and recognizable. Two dendrites of a single neuron could be influenced independently if they were innervated by separate cerci. Thus deprivation did not have a generalized effect on growth of a neuron, rather it specifically influenced the dendrites deprived of afferents. (2) It was also observed that the projection of cercal sensory fibers in specimens reared with a single cercus differed from normal in that scattered fibers cross the midline in regions of the ganglion where none usually exist. It is suggested that modifications in the response properties of these deprived neurons are based on these two changes in morphology.

Animals↗

PubMed2003

The continuing challenge of intra-abdominal infection.

Intra-abdominal infection is common and frequently seen by the surgeon. Mortality is related to disease acuity and organ failure. This report, based on medical literature and personal experience, is a brief review of this subject, highlighting important historical milestones and recent advances in surgical and antibiotic therapy. Peritonitis remains a clinical challenge. Aggressive resuscitation, diagnostic imaging, and surgical treatment are the mainstays of appropriate therapy. Percutaneous drainage of intra-abdominal collections has increased over time and is particularly helpful in certain postoperative patients. Adjunctive antibiotic therapy against gram-negative aerobes and anaerobes should be limited to a 7- to 10-day course, except in selected patients, such as those with inadequate source controls.

Abdominal Cavity↗

PubMed2003

[Initial diagnosis of intra-abdominal hemorrhage caused by isolated splenic injury in blunt abdominal trauma].

Diagnosis of intraabdominal bleeding caused by spleen injury must be performed in the shortest possible period of time, with little risk for the patient, and with high preciseness. By its simple performance, high preciseness and little risk for the patient, DPL imposes as the predominant method in initial diagnostic of intraabdominal bleeding. Control and monitoring of lavage may duly signalize degree of bleeding. Preciseness of this diagnostic in our series ranges up to 93.3%. DPL method is especially important in a combined neurotrauma. Ultrasonography is a sovereign method in diagnostic of bleeding source as well as in monitoring of bleeding that from the very beginning does not require urgent surgical intervention. Its importance is in monitoring both intrasplenic and subcapsulary hematomas. It is not appliable in disturbed and haemodynamically unstable patients. It is in particular important in children where a maximum conservative attitude with respect to operative treatment has been assumed. CT takes the leading place with respect to preciseness of bleeding area, and the combined thoracoabdominal trauma. Preciseness of CT in our series comes up to 96.6%, but can be applied only in haemodynamically stable patients. Same as US of abdomen so the CT of abdomen represents a prominent method in monitoring of both intrasplenic and subcapsular hematomas, which do not require urgent surgical intervention.

Abdominal Injuries↗

PubMed2005

Radiofrequency ablation in lung cancer: promising results in safety and efficacy.

Only about 15% of patients diagnosed with lung carcinoma each year are surgical candidates, either due to advanced disease or comorbidities. The past decade has seen the emergence of minimally invasive therapies using thermal energy sources: radiofrequency, cryoablation, focused ultrasound, laser, and microwave; radiofrequency ablation (RFA) is the best developed of these. Radiofrequency ablation is safe and technically highly successful in terms of initial ablation. Long-term local control or complete necrosis rates drop considerably when tumors are larger than 3 cm, although repeat ablations can be performed. Patients with lung metastases tend to fare better with RF lung ablation than those with primary lung carcinoma in terms of local control, but it is unclear if this is related to smaller tumor size at time of treatment, lesion size uniformity, and sphericity with lung metastases, or to differences in patterns of pathologic spread of disease. The effects of RFA on quality of life, particularly dyspnea and pain, as well as long-term outcome studies are generally lacking. Even so, the results regarding RF lung ablation are comparable to other therapies currently available, particularlyfor the conventionally unresectable or high-risk lung cancer population. With refinements in technology, patient selection, clinical applications, and methods of follow-up, RFA will continue to flourish as a potentially viable stand-alone or complementary therapy for both primary and secondary lung malignancies in standard and high-risk populations.

Adenocarcinoma↗

PubMedDate not supplied

Nosocomial tuberculosis in the AIDS era: strategies for interrupting transmission in developed countries.

In developed countries where tuberculosis is increasing in association with HIV infection, nosocomial transmission among patients and from patients to health care workers is being increasingly reported. Nosocomial tuberculosis among HIV-infected patients is difficult to prevent by conventional control measures because the clinical presentation of the disease may be atypical and confused with other respiratory infections, because the tuberculin skin test is less reliable, because cough generating procedures may increase the probability of transmission, because HIV-infected patients may progress rapidly from infection to disease, and because the organisms are increasingly drug resistant, making preventive therapy difficult. Substandard ventilation and the recirculation of air in many contemporary buildings has also been implicated in widespread nosocomial transmission. Source control through isolation and effective treatment of known or suspected cases remains the most effective strategy for preventing transmission. Dilution of infectious droplet nuclei through ventilation with outside air is important, but incompletely protective. Like ventilation with outside air, filtration of recirculated air may reduce the chance of infection by dilution, but it is expensive. Traditional surgical masks offer the wearer little or no protection. Finally, ultraviolet air disinfection may augment ventilation by inactivating organisms in the upper room air, or in ventilation ducts.

Communicable Disease Control↗

PubMed1998

[Vacuum sealing as carrier system for controlled local drug administration in wound infection].

Between 1.4.96 and 1.3.97 27 patients with acute infections of bone and soft tissues (n = 13), chronic osteomyelitis (n = 8), and chronic wounds (n = 6) were treated by using Instillation-Vacuum-Sealing. Polyvinylalcohol sponges with drainage tubes were used to cover the internal or external wound surfaces which resulted from surgical debridement. Having hermetically covered the wound with a transparent film dressing a vacuum source generated a partial vacuum in the sponge which was modified according to the type of wound between 20 and 80 kPa. Several times daily, the vacuum line was blocked and, in an alternating fashion, antiseptic or antibiotic solution instilled for 30 minutes. Then, the vacuum was reestablished and the fluids drained from the wound. Seven days later, intermittent drug instillation was stopped and there was either immediate or delayed wound closure by secondary suturing (n = 22), skin grafting (n = 3) or spontaneous epithelialization (n = 2). During a follow-up from the beginning of the instillation treatment of 4.2 (3-14) months there was one recurrency of infection in a patient with chronic osteomyelitis.

Adolescent↗

PubMed1999

All Wales surveillance of methicillin-resistant Staphylococcus aureus (MRSA): the first year's results.

Over the last five years, hospitals in Wales have experienced difficulties with increasing numbers of isolates of methicillin-resistant Staphylococcus aureus (MRSA). Continuous total population surveillance of MRSA was introduced with the objectives of gaining an understanding of the extent and variation in time and place of its occurrence, the burden of disease and possible risk factors associated with its isolation and resistance to other antibiotics. All first isolates of MRSA from both hospital and community settings and all isolates of methicillin-sensitive Staphylococcus aureus (MSSA) associated with bacteraemia and cerebrospinal fluid (CSF) isolates detected in medical microbiology laboratories in Wales were collected via CoSurv, a set of interconnected data-base modules for communicable disease control. A data set was collected on each isolate and the patient associated with that isolate and compiled centrally at CDSC (Wales) for all-Wales analysis of the MRSA situation. Surveillance started in January 1996 and at the end of the first year, 2700 new isolates of MRSA had been reported from hospital and community settings, giving a rate of 92.43/100,000 population. The incidence of MRSA from bacteraemias and CSF was 5.20/100,000 compared with 12.70/100,000 for MSSA. MRSA from bacteraemia and CSF was significantly more commonly associated with male patients than MSSA. MRSA patients were significantly older. For all MRSA isolates, the highest reporting rate was in men aged 75+ (647.21/100,000). The highest incidence of invasive disease was also in men aged 75+ (45.69/100,000). Isolates from post-surgical patients were more likely to be involved in invasive disease (OR = 2.59), P < 0.001) than strains from other sources. The majority of isolates were resistant to at least two antibiotics in addition to methicillin, most frequently erythromycin and the fluoroquinolones. Very little resistance to fusidic acid, mupirocin or rifampicin was reported. Continuous total population surveillance has provided a minimum incidence of MRSA in Wales and has allowed a simple and intelligible picture of the problem to be determined, which has been fed back to hospitals to assist decisions on control.

Adolescent↗

PubMedDate not supplied

Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100beta protein levels.

PURPOSE: Despite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100beta protein and neuropsychological tests after coronary artery bypass grafting (CABG). METHODS: Twenty patients undergoing CABG, randomly allocated into two groups, were enrolled in this prospective, controlled, preliminary study. Isoflurane was used in group I and propofol in group P. Neurological examination and a neuropsychologic test battery consisting of the mini mental state examination (MMSET) and the visual aural digit span test (VADST) were obtained preoperatively and on the third and sixth postoperative days. Blood samples for analysis of S-100beta protein were collected before anesthesia (T1), after heparinization (T2), 15 min into CPB (T3), after CPB (T4) and at the 24(th) hr postoperatively (T5). RESULTS: Postoperative neurological examinations of the patients were normal. VADST performance declined significantly on the third day (P < 0.05) in both groups, and there were no significant differences on VADST and MMSET scores between the two groups. In group P, S-100beta protein levels increased significantly at T3 and T4 compared to preoperative and isoflurane levels (P < 0.05). CONCLUSIONS: Despite reports about the neuroprotective effects of propofol, S-100beta protein levels were significantly elevated in group P. Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients.

Anesthetics, Inhalation↗

PubMed1997

Plasminogen in proliferative vitreoretinal disorders.

OBJECTIVE: Intravitreal fibrin formation is a frequent observation after vitrectomy performed for a variety of vitreoretinal disorders including proliferative vitreoretinopathy (PVR), proliferative diabetic retinopathy (PDR), and endophthalmitis. Plasminogen activators (PA) have been used for the management of this postoperative complication. This approach requires the presence of plasminogen, the substrate for PA mediated fibrinolysis, in the vitreal cavity. METHODS: Quantification of plasminogen in the vitreous of 60 patients with PVR, PDR, and macular pucker was performed by streptokinase mediated activation using a chromogenic substrate. The presence of immunoreactive plasminogen was confirmed by immunoblot analysis of vitreal proteins and immunocytochemistry of surgically removed epiretinal membranes. RESULTS: Plasminogen levels were dramatically increased in the vitreous of PVR and PDR patients compared with macular pucker patients and normal controls. Staining for plasminogen in epiretinal membranes was confined to the extracellular matrix. Predominant staining of perivascular areas in PDR specimens indicated that breakdown of the blood-retinal barrier is an important source of intravitreal plasminogen in that condition. CONCLUSION: Plasminogen may play a role in traction membrane formation in PVR and PDR. Our biochemical analysis of presurgical vitreous indicates that there may be abundant substrate for PA mediated fibrinolysis in the vitreous cavity after vitrectomy.

Eye Diseases↗

PubMedDate not supplied

[Cytokines in the treatment of a generalized surgical infection].

A novel approach to the treatment of surgical sepsis has been tried: cytokine-based immunotherapy. Human recombinant interleukin-2 (IL-2) and a mixture of native cytokines obtained by arteriovenous perfusion of xenospleen were used as a source of proinflammatory cytokines. Extracorporeal immunotherapy of 62 patients with surgical sepsis with mononuclear cells treated by autologous IL-2 resulted in a significant decrease of endotoxicosis and effective immunocorrection. Cytokine-based immunotherapy notably decreased the mortality of patients with generalized surgical infection--to 14.6%, which was lower than the expected mortality (35%) and the mortality in the control group (34.5%).

Acute Disease↗

PubMed1987

Nosocomial Legionnaires' disease.

Members of the family Legionellaceae have emerged as important nosocomial pathogens. Bronchopneumonia is the typical illness and mimics other nosocomial pneumonias. On rare occasion, surgical wound infections may be due to legionellae. Legionella pneumophila is the species causing most human illness, but other species may predominate in individual institutions. Pneumonia is acquired by inhalation of environmental aerosols from water sources contaminated by Legionella sp. In the hospital setting contaminated water sources include potable water, heat-exchange systems, and cooling towers. Water temperature control and maintenance programs may prevent colonization of water systems. Should clinical cases and water colonization occur, aggressive suppression/eradication programs--by chlorination or heat/flush--must be instituted. Surveillance of pneumonias in high-risk patient groups is essential for early detection of a nosocomial outbreak. There has been no evidence of person-to-person transmission. Familiarity with diagnostic techniques and their pitfalls will permit institution of effective antimicrobial therapy.

Cross Infection↗

PubMed1997

Results of hospital cancer registry surveys by the American College of Surgeons: outcomes of prostate cancer treatment by radical prostatectomy.

BACKGROUND: The number of prostate cancer patients treated by radical prostatectomy has increased. Different data sources have yielded various estimates of the outcomes of this treatment and the need for additional therapy. To provide additional perspective on these issues, the American College of Surgeons conducted surveys of cancer registries and reviewed related data. METHODS: In 1993, in the first phase of the study, hospital cancer registries and programs were sent survey forms and instructions requesting data on up to 5 patients treated by radical prostatectomy at their institutions in 1990. In 1996, in the second phase of the study, additional data were requested on treatment administered to the 1990 patients up to 5 years after surgery, and hospitals were also invited to submit new data on patients diagnosed in 1993. Responses were received from 482 hospitals concerning 2122 patients for 1990, and 265 hospitals provided data on 1304 patients diagnosed in 1993. Follow-up data on 1076 of the 1990 patients were provided by 258 hospitals. Kaplan-Meier survival curves were calculated to determine the probability of additional treatment after radical prostatectomy. RESULTS: Similar surgical pathology outcomes were reported for the 1990 and 1993 patients. For 1990 and 1993, respectively, it was reported that 27.5% and 29.7% of patients maintained erectile function adequate for intercourse after surgery. For 1990 and 1993, respectively, complete control or only occasional urinary incontinence requiring no pads was reported for 81.3% and 79.8% of patients. The surgical mortality rates were less than 1% for both the 1990 and the 1993 patients. The 5-year cumulative probability of any additional treatment after radical prostatectomy was 10.5%. Seminal vesicle involvement, positive surgical margins, lymph node involvement, capsular penetration, high Gleason score, and high prostate specific antigen were significantly associated with greater probability of additional treatment. CONCLUSIONS: Hospital cancer registries are valuable sources of data on patterns of care and outcome for prostate cancer patients. Continuing evaluation of the outcomes of prostate cancer treatments is needed to reconcile the differences in outcomes reported from different data sources.

Erectile Dysfunction↗

PubMed2005

Spontaneous supratentorial intracerebral hemorrhage: the role of surgical management.

Spontaneous supratentorial intracerebral hemorrhage is a vexing clinical problem. Without established guidelines, clinicians are often forced to make case-by-case decisions, based on their own interpretation of relevant studies and experience. A number of randomized studies and several meta-analyses have been unable to provide a clear indication for surgery for this condition. Data from both experimental and clinical studies suggest that early surgical evacuation in some circumstances may be beneficial. This may include a subset of patients with moderate sized hemorrhages and associated moderate neurological deficits; specifically those patients that are likely to survive the primary bleed but with significant permanent neurological deficits. Minimal access surgical techniques may offer advantages over standard large craniotomies, although a role for stereotactic aspirations has not yet been established. The timing of any surgery may also be important with theoretical advantages associated with early and thorough clot evacuation. Future surgical advances will require techniques or adjuvant medical treatment to reduce the occurrence of clot expansion and rebleeding, that have been identified as a source of early deteration and post-operative condition. We review the randomized clinical trials, experimental evidence and management options related to surgical treatment of spontaneous supratentorial intracerebral hemorrhage.

Cerebral Hemorrhage↗

PubMed1980

Determination of incidence and partial characterization of tumor-associated antigens found in the urine of patients bearing solid tumors.

Urine samples from patients with solid tumors and from donors without malignant disease were concentrated and tested for the presence of tumor-associated antigens. In the complement-fixation assay using serum from a source autologous with the source of the urine, 87.4% of cancer patients were positive, while only 6.9% of control donors were positive. When serum from an allogenic source was used, 94.7% of cancer patients and 35.1% of control donors were positive. Absorption of a cancer patient's serum with autologous tumor cells removed antibody activity to autologous and allogeneic urine samples. Normal lymphocytes, skin, or muscle-cell suspensions were ineffective as absorbents. The excretion of antigen into urine is dependent upon the presence of tumor. Surgical removal of tumor resulted in cessation of antigen excretion. The urine remained antigen-negative as long as the patient remained disease-free. The antigenic activity was heat-stable and comprised molecules of greater than 1,000,000 daltons which could be dissociated into smaller molecular weight active fractions by treatment with 6 M urea.

Adolescent↗

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↗

PubMed1992

Soluble interleukin 2 and CD8 and CD4 receptors in inflammatory bowel disease.

Serum levels of soluble interleukin 2 receptor (sIL-2R) have been proposed as a clinical marker of inflammatory bowel disease. The source of sIL-2R in patients with Crohn's disease and ulcerative colitis is unknown, and other soluble receptors have not been investigated. In the present study, sIL-2R and soluble CD8 and CD4 levels were measured in plasma and culture supernatants of peripheral blood and intestinal mucosal mononuclear cells from patients with inflammatory bowel disease, surgical controls, and healthy subjects. Level of plasma sIL-2R was significantly higher in patients with Crohn's disease and ulcerative colitis than in healthy volunteers. Intestinal cells always produced more sIL-2R than peripheral cells. Spontaneous sIL-2R production by mucosal cells was significantly elevated in Crohn's disease but not in ulcerative colitis supernatants compared with levels of surgical controls. Soluble CD8 and CD4 were poor indicators of systemic or mucosal immunity. A positive correlation was found between plasma sIL-2R and spontaneous production by intestinal cells of patients with Crohn's disease and surgical control patients, whereas ulcerative colitis plasma sIL-2R correlated with spontaneous production by peripheral cells. The association of plasma or spontaneous sIL-2R levels with the degree of intestinal inflammation was weak, and there was a wide overlap with control values. Therefore, caution should be used before considering sIL-2R an accurate marker of inflammatory bowel disease activity.

Aged↗