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At least 739 records · Page 41Linked to original sources
PubMed1995

Laparoscopic laser lumbar diskectomy. Operative technique and case report.

Approximately 300,000 patients each year in the United States undergo laminectomy for disabling lumbar disc herniation. Post-laminectomy hospitalization is 3-7 days and convalescence may be prolonged. As an alternative to laminectomy, we have developed a technique for performing L5-S1 lumbar diskectomy laparoscopically. Using an anterior approach, the intervertebral disc space is opened and the diskectomy is performed under direct videolaparoscopic imaging. After pneumoperitoneum is established, the patient is placed in a steep Trendelenburg position. The small bowel is retracted cephalad and the colon is moved to the left. The iliac vessels are identified visually and by Doppler probe, and the presacral space is dissected in the midline to expose the L5-S1 disc. In the case presented, the disc annulus was opened with the Nd:YAG contact laser, and diskectomy was performed under direct videolaparoscopic vision using standard neurosurgical instruments modified for laparoscopy. The posterior longitudinal ligament can be visualized directly to define the posterior limits of the completed diskectomy. In the case described, pain relief was confirmed immediately after the procedure. The patient was discharged after 2 hospital days, and returned to normal activity in 8 days.

Adult↗
PubMedDate not supplied

Prevalence of antibodies against HEp-2 cell antigen in infants and children hospitalized with respiratory syncytial virus infection.

Infants with respiratory syncytial virus (RSV) infection were shown to have antibodies against HEp-2 cell antigen present in RSV-antigen preparation used for immunoblot analysis. The prevalence of anti HEp-2 cell antibodies was examined in infants hospitalized for RSV infection (n = 49, median age 121 days) compared to rotavirus infected children (n = 30, median age 114 days) and to healthy controls (n = 20, median age 150 days). The immunoblot analysis with RSV-infected and non-infected HEp-2 cells as antigen revealed the expected age-dependent low prevalence of G protein antibodies and clear seroconversion of N and P protein antibodies. HEp-2 antibody prevalence was higher in RSV antigen-positive infants (33/49) than in rotavirus antigen-positive (5/30) and RSV antigen-negative infants (4/20), respectively (p < 0.001). Anti HEp-2 antibodies were mostly directed against 47, 46, 33, 30 kD antigens. A multiple regression analysis found the following correlations (odds ratio; 95% confidence interval): 42 kD RSV antibodies (N protein) with pneumonia (7.58; 1.43-40), 94 kD RSV antibodies (G protein) with bronchiolitis (0.064; 0.006-0.686). This study shows repeated well-known features of humoral immunity in RSV infection. The data on anti HEp-2 antibodies point to a role for these pre-existing autoreactive antibodies in the pathogenesis of RSV infection.

Acute Disease↗
PubMed2003

[Prospective multicenter study of adverse drug reactions in hospitalized elderly patients].

BACKGROUND AND OBJECTIVE: The incidence of adverse drug reactions (ADRs) in hospitalized elderly patients is an important clinical problem. The purpose of this study was to determine the incidence of ADRs in elderly in-patients, to analyze the factors involved in their presentation and to evaluate the reactions detected. PATIENTS AND METHOD: Prospective multicenter study in patients older than 65 years during their stay in hospital or nursing home. The assessment consisted of a complete geriatric evaluation and a protocol for collecting information on suspected ADRs during hospitalization or nursing home stay. A multivariate analysis by multiple logistic regression was performed. RESULTS: The study included 865 patients: 185 (21%) from 5 hospital units; 325 (38%) from 8 convalescent centers; and 355 (41%) from 8 long-term centers. The incidence of ADRs was 9%. In acute units the incidence was 15%; in post-acute units, 5%; and in long-term centers, 10% (p < 0.004). In the global multivariate analysis, the risk of experiencing an ADR was associated with a greater use of medications (OR = 1.15; 1.07 1.23 for each additional drug), the presentation of delirium (OR = 3.6; 1.95-6.85) and the type of unit (acute OR = 2.6; 1.16-6.01; long-term OR = 3.3; 1.62-7.05). Fifty type A ADRs were detected (65%). With regard to severity, 36 (47%) were moderate, 27 (35%) were mild, and 14 (18%) were severe. Causality: 58 (76%) probable and 17 (20%) possible. Potential avoidability: 39 (51%) were unavoidable and 38 (49%) were totally or partially avoidable; of these, 15 (39%) were the result of an interaction with another drug. CONCLUSIONS: The incidence of ADRs in our study was close to 10%. ADRs were associated with the frequency of use, presence of delirium and type of unit, and occurred most frequently in acute and long-term units. ADRs were principally type A, moderate severity, probable causality and partially avoidable.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

Laparoscopic splenectomy in patients with refractory or relapsing thrombotic thrombocytopenic purpura.

HYPOTHESIS: Thrombotic thrombocytopenic purpura (TTP) is a rare and serious hematological disease. First-line therapy is plasma exchange, often used in combination with corticosteroids, vincristine, aspirin, and dipyridamole. The role of splenectomy for patients resistant to or dependent on plasma therapy and for the prevention of TTP relapses is not yet determined. Laparoscopic splenectomy (LS) is effective and safe for the treatment of the chronic relapsing form of TTP. INTERVENTION: We performed LS in 8 patients with refractory or relapsing TTP. The operative as well as the early and late postoperative course and complications were recorded. RESULTS: The mean duration of LS was 70 minutes (range, 35-180 minutes). There were no serious bleeding complications during or after surgery. Convalescence was rapid, and the mean hospital stay was 2.5 days (range, 1-9 days). Patients were followed up for a mean of 32 months (range, 19-54 months). Seven patients are in remission with no relapse of TTP. One patient with familial TTP had multiple relapses before and after surgery. CONCLUSIONS: Laparoscopic splenectomy for refractory or relapsing TTP is safe and associated with low morbidity and fast recovery. It is effective in the long-term prevention of TTP relapses in most patients, and it should probably be considered early in the course of chronic, relapsing TTP.

Adolescent↗
PubMed2000

Laparoscopic splenectomies for idiopathic thrombocytopenic purpura: experience of sixty cases.

We performed a laparoscopic splenectomy (LS) in 60 patients (age 9-83, 45 females) with idiopathic thrombocytopenic purpura (ITP) who did not achieve sustained remission on steroid therapy. Using a modified procedure, the mean duration of LS was 78 min (range 25-240 min) and surgery was associated with only 5% major and 5% minor complications. Ten patients had a platelet count less than 50 x 10(9)/l during surgery despite the administration of immune globulin (0.4 g/kg x 3-5 days) or pulsed oral dexamethasone (40 mg/day x 4 days). Three patients were refractory to these therapies and underwent LS with a platelet count less than 5 x 10(9)/l. Bleeding complications during or after surgery were rare (5%). Accessory spleens were removed in eight patients. Convalescence was rapid and the mean hospital stay was 2.3 days (range 1-7 days). The patients were followed for a mean of 16 months (range 1-36 months), and 49 patients (84%) are in complete remission. Seven patients (12.5%) relapsed despite an initial good response in 6 of them. Two patients underwent laparoscopic removal of accessory spleens with excellent response. We conclude that LS for ITP is safe and effective and associated with low morbidity and fast recovery. Thus, LS may be considered earlier in the course of ITP.

Adolescent↗
PubMed1996

[Laparoscopic lymphadenectomy in prostate carcinoma. Experiences with 120 patients].

Laparoscopic pelvic lymph node dissection was performed in 120 patients scheduled to undergo either radical perineal prostatectomy or radiation therapy. On average 13 lymph nodes were resected in each patient, and 21 patients were found to have metastatic disease in 1-9 lymph nodes. After an initial learning curve, mean operative time was reduced significantly, allowing laparoscopic lymph node dissection and radical prostatectomy to be performed as a one-stage procedure. The overall complication rate was 10%; open revisions were necessary in only 2 of 120 patients. Postoperative hospital stay was 2 days in patients undergoing laparoscopic lymph node dissection only. This minimally invasive procedure is particularly beneficial to patients with lymph node metastases not undergoing radical prostatectomy, as well as to patients planned to be treated by radiation therapy. The combination of laparoscopic lymph node dissection and radical perineal prostatectomy avoids an abdominal incision and thus shortens both the hospital stay and the period of convalescence.

Adenocarcinoma↗
PubMed2006

Traumatic retropharyngeal hematoma: case report.

Traumatic retropharyngeal hematoma is a rare but potentially life-threatening condition that requires an early diagnosis. Isolated retropharyngeal hematoma without an associated cervical fracture is a relatively rare condition. The treatment of retropharyngeal hematoma is conservative in most cases, with close observation. The indications for surgical evacuation of hematomas are large size, difficult with mechanical ventilation and failure to improve with medical therapy. We present the case of a 50-year-old man with retropharyngeal hematoma with a compromised airway due to minor contusion of the neck, which required surgical intervention. The patient underwent emergent surgical debridement and tracheostomy. Postoperative course was uneventful. The patient was discharged 9 days later. Early surgical intervention can reduce the hospital stay, resulting in a rapid convalescence.

Adult↗
PubMed1993

Laparoscopic versus open cholecystectomy: the Canadian experience. The McGill Gallstone Treatment Group.

Numerous uncontrolled trials have suggested that laparoscopic cholecystectomy (LC) is a major improvement over open cholecystectomy (OC). In an effort to objectively document the benefits of LC, two Canadian studies are reviewed. The first is a matched time series based on prospective data from a single surgeon's practice in which patients are closely matched for baseline characteristics. The groups consist of 121 patients from each of 3 time periods: 1989, prior to the introduction of LC; 1990, when LC was being introduced; and 1991, when LC had become the preferred method of cholecystectomy. The second study is a randomized trial, in which LC is compared with mini-cholecystectomy. In both studies, the superior efficacy of LC is demonstrated with respect to the duration of hospitalization and the duration of postoperative convalescence. The incidence of complications as well as their severity is also less in LC patients. Although quality of life improves after any type of cholecystectomy, LC patients improve faster and seem to accept the operation better. These studies support the widespread dispersion of LC in Canada, although comparative efficacy with nonsurgical alternatives has not been addressed.

Adult↗
PubMed1988

Changing surgical aspects of urinary stone disease.

Surgical management of urinary calculous disease has changed dramatically in the past decade. The development of percutaneous nephrostomy techniques has allowed new access to upper tract stones. Percutaneous removal of large calculi was made possible by the development of ultrasonic and electrohydraulic lithotripsy. All upper tract calculi can now be removed in 70 to 100 per cent of cases with minimal complications. Nephrostolithotomy has reduced transfusion rates and hospitalization costs and has markedly shortened convalescence periods compared with open surgery. Ureteroscopy followed nephrostolithotomy as advanced fiberoptic technology allowed the development of the small-caliber instruments required for this procedure. With experience, successful stone retrieval has occurred in 90 per cent or more of cases, again with minimal complications. As nephrostolithotomy and ureteroscopy have become available, the subspecialty of endourology has emerged and significantly changed the management of urinary tract calculi. Perhaps the most significant advance in stone therapy has been the design and implementation of extracorporeal shock wave lithotripsy. With this noninvasive technique, most renal and proximal ureteral calculi can be effectively treated with minimal morbidity and convalescence. Research in lithotripter design is continuing, with more advanced and effective machines on the horizon. The applicability of extracorporeal therapy for the treatment of biliary tract calculi is currently under investigation. Finally, one should not disparage medical therapy for recurrent nephrolithiasis. A comprehensive metabolic evaluation combined with selective medical therapy provides almost complete relief from recurrent stone formation and makes medical therapy an integral component of treating the patient with renal or ureteral calculi.

Endoscopy↗
PubMed2003

The process of adult living liver donation.

OBJECTIVE: To evaluate both the opinion that living liver donors have of the process and the psychological, economic, and social consequences of donation. MATERIAL AND METHODS: Six months after the donation, an anonymous survey was sent to 22 donors of the right liver lobe between March 2000 and December 2002. RESULTS: 15 surveys were returned with all of the questions answered. Almost all the donors had no prior knowledge of living donation. When they were considered to be suitable donors, all of them felt happy, 21% were scared and 15% felt joy and insecurity. The information provided was well understood and accurately described the experiences of 93% of donors. All donors understood the vital risk, and 93% understood that transplantation is not always completely successful. All donors would repeat the experience. Mean hospital stay was 12.6 days. Mean convalescence was 50.6 days. Salaried donors were on sick leave for a mean of 96.4 days (21-150 days), causing financial problems in six cases (36%), due to no financial compensation and compulsory redundancy in one case. All donors had completely recovered at six months after donation. DISCUSSION: Adult living donation of the right liver lobe is an accepted therapeutic alternative. In order to regulate medical and economic protection to avoid additional disturbances after donation, the public, patients, and physicians require more complete information about living donation.

Adult↗
PubMed1994

[Peri- and postoperative quality of life in pelviscopy and laparotomy].

In 298 patients we evaluated criteria of peri- and post-operative quality of life. 222 patients underwent pelviscopic surgery and 76 patients underwent laparotomy. The parameters of convalescence used were: the duration of hospital stay and disablement, the duration and intensity of post-operative discomfort, and the number of consultations in a physician's office after discharge from hospital. Our results show, that minimal access endoscopic surgery can reduce the impairment in the peri- and post-operative quality of life.

Adolescent↗
PubMed1999

[Imported Anopheles: in the luggage or from the airplane? A case of severe autochthonous malaria tropica near an airport].

HISTORY AND ADMISSION FINDINGS: A 67-year-old woman was admitted with pyrexia of unknown cause preceded by transitory peripheral pareses. She had not been to any malaria-infested regions. Within 4 days a "sepsis syndrome" developed with acute respiratory and renal failure. INVESTIGATIONS: Initially there were no pointers to organ involvement, either clinically or by ultrasound, in the electrocardiogram, radiographically or by computed tomography. Haematological and other laboratory tests indicated a bacterial infection. But 6 days after starting intensive treatment a blood smear revealed Plasmodium falciparum. TREATMENT AND COURSE: Administration of mefloquine and quinine quickly reduced the parasite count (from 10% to 1%), no parasite being found in the blood smear on the 5th day. But severe complications developed: perforation of a duodenal ulcer, exudative pancreatitis, cholangitis, diffuse bleeding into the large intestine and a chronic capillary leakage syndrome. But the patient was finally cured and discharged to a convalescent home after 160 days in hospital, 135 of them in intensive care. CONCLUSION: The source of the malaria could not be identified. "Baggage malaria" is more likely than the bite of a mosquito expelled from the "plane's undercarriage" well as it approached Frankfurt airport (the patient lived under one of the approach sectors, 30 km from the airport). As there are no screening procedures, imported malaria should be thought of in case of fever of unknown cause without history of foreign travel; a blood smear should be done.

Acute Disease↗
PubMedDate not supplied

Presidential Address-1976. Social support as a moderator of life stress.

Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations. The evidence that supportive interactions among people are protective against the health consequences of life stress is reviewed. It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome. Furthermore, social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimens.

Affective Symptoms↗
PubMed1986

Antibody response in group B meningococcal disease determined by enzyme-linked immunosorbent assay with serotype 15 outer membrane antigen.

To elucidate pathogenic aspects and serodiagnostic possibilities for meningococcal disease, we investigated levels of specific antimeningococcal immunoglobulin G (IgG), IgA, and IgM in serum by using an enzyme-linked immunosorbent assay with outer membrane antigen prepared from a Neisseria meningitidis B:15:P1.16 strain. Serum samples were drawn on hospital admission as well as during convalescence from patients suspected of purulent meningitis or meningococcal septicemia, and single samples were drawn from population controls. A total of 637 samples were examined blindly. On admission, the average antimeningococcal immunoglobulin levels were about the same in the meningococcal disease patients as in the population controls. Septicemic patients, however, had significantly lower values. During one week the mean specific immunoglobulin levels in meningococcal-disease patients increased 6 times for IgG, 14 times for IgA, and 5 times for IgM. Children younger than 1 year showed a modest and more slowly developing antibody response. There were no statistically significant differences in average antibody responses among patients infected with meningococci of different serotypes. At 100% specificity, the increase in IgG, IgA, and IgM yielded diagnostic sensitivities for meningococcal disease of 84, 52, and 66%, respectively. One of seven serum pairs from the patient control group with unknown etiology was positive for meningococcal disease in this assay. The patients with meningococcal disease originally diagnosed only by clinical signs and symptoms showed a slightly lower rate of seroconversion than the patients in whom the diagnosis was supported by test results showing a systemic Neisseria meningitidis isolate.

Adolescent↗
PubMedDate not supplied

Meal-induced oxygen desaturation and dyspnea in chronic obstructive pulmonary disease.

OBJECTIVE: To study arterial oxygen saturation (SpO2) obtained by pulse oximetry and dyspnea during active eating (AE) and passive eating (PE) in patients with severe chronic obstructive pulmonary disease (COPD). DESIGN: Patients were studied on two consecutive days with AE and PE, which occurred in random order. SpO2 was recorded for 20 mins before and during eating, and dyspnea was recorded by the patient using a 10 cm visual analogue scale before and upon completion of eating. SETTING: Subjects were in-patients at an intermediate care facility who were hospitalized for pulmonary rehabilitation or for convalescence after an exacerbation of COPD. POPULATION STUDIED: Thirty-five patients with severe COPD (forced expiratory volume in 1 s [FEV1] less than 50% predicted, FEV1 to forced vital capacity ratio less than 65%) were studied. Mean age was 70.5 7.1 years. MAIN RESULTS: Mean SpO2 decreased significantly (P<0.05) from 91.7 3.4% to 90.1 4.0% during AE, and 91.7 3.2% to 90. 8 3.6% during PE. Mean lowest SpO2 was lower and percentage of time with SpO2 less than 90% was greater during eating compared with corresponding control periods during both AE and PE. Dyspnea increased significantly (P<0.05) from 1.4 1.2 to 3.3 2.3 cm during AE, and from 1.5 1.5 to 2.4 2.2 cm during PE. The increase in dyspnea was significantly greater during AE than PE. CONCLUSIONS: Eating is an activity that can adversely affect SpO2 and increase dyspnea in patients with severe COPD. Oxygen desaturation and particularly increased dyspnea may at least in part relate to the recruitment of upper extremity muscles during eating.

Aged↗