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PubMed1999

Real-time measurement of radiation exposure to patients during diagnostic coronary angiography and percutaneous interventional procedures.

OBJECTIVES: The aim of this study was to accurately assess the radiation exposure received by patients during cardiac catheterization in a large sample representative of the current state of practice in cardiac angiography. BACKGROUND: Radiation exposure to patients and laboratory staff has been recognized as a necessary hazard in coronary angiography. The effects on x-ray exposure of the increased complexity of coronary angiographic procedures and, in particular, the increasing use of coronary artery stenting, have not been adequately addressed in previous studies. METHODS: X-ray exposure measurements were performed on a consecutive series of 972 patients undergoing 992 diagnostic and interventional studies in the Mayo Clinic catheterization laboratory within an eight week period in late 1997. Data were acquired from 706 diagnostic procedures and 286 interventional procedures using a real-time exposure measurement system to continuously calculate and record the exposure rate and total exposure, reflecting all parameters relevant to the specific patient and procedure situation. RESULTS: The median exposure for all 992 procedures was 41.8 mC/kg (162.1 R); the corresponding values for diagnostic and interventional procedures were 34.9 and 95.6 mC/kg, respectively (135.3 vs. 370.5 R). There were significant differences in the fluoroscopy exposure time between diagnostic and interventional procedures: 4.7 min vs. 21.0 min. Heavier patients (>83 kg) received x-ray exposures at a significantly higher rate than did lighter patients (<83 kg) during both fluoroscopy and cine; 44.9 mC/kg/min (173.9 R/min) vs. 27.9 mC/kg/min (108.3 R/min) for cine exposure rate and 2.3 mC/kg/min (8.8 R/min) vs. 1.5 mC/kg/min (5.8 R/min) for fluoroscopy exposure rate. CONCLUSIONS: Changes in practice have led to higher values for patient x-ray radiation exposures during cardiac catheterization procedures. The real-time display and recording of x-ray exposure facilitates the reduction of exposure in the catheterization laboratory.

Aged↗

PubMed2002

Comparison of four techniques to estimate radiation dose to skin during angiographic and interventional radiology procedures.

PURPOSE: Four techniques used to estimate radiation risk were compared to determine whether commonly used dosimetry measurements permit reliable estimates of skin dose. Peak skin dose (PSD) is known to be the most reliable estimate of risk to skin. The purpose of this study is to determine peak skin dose with use of real-time software measurements and to correlate other measures of dose with PSD. MATERIALS AND METHODS: Two hundred twelve patients undergoing arch aortography and bilateral carotid arteriography (referred to as "carotid"), abdominal aortography and bilateral lower extremity runoff ("runoff"), or tunneled chest wall port placement ("port") were studied. Fluoroscopy time, dose-area product (DAP), and cumulative dose at the interventional reference point were recorded for all procedures; PSD was recorded for a subset of 105 procedures. The dose index, defined as the ratio between PSD and cumulative dose, was also determined. RESULTS: In general, correlation values for comparisons between fluoroscopy time and the other measures of dose (r =.29 to.78) were lower than values for comparisons among DAP, cumulative dose, and PSD (r =.52 to.94). For all procedures, pair-wise correlations between DAP, cumulative skin dose, and PSD were statistically significant (P <.01) The ratio between PSD and cumulative skin dose (dose index) was significantly different for ports versus other procedures (carotid, Z = 4.62, P <.001; runoff, Z = 4.52, P <.001), but carotid and runoff procedures did not differ significantly in this regard (Z = 0.746, P =.22). Within each individual procedure type, the range of values for the dose index varied 156.7-fold for carotid arteriography, 3.2-fold for chest ports, and 175-fold for aortography and runoff. CONCLUSION: Fluoroscopy time is a poor predictor of risk because it does not correlate well with PSD. Cumulative dose and DAP are not good analogues of PSD because of weak correlations for some procedures and because of wide variations in the dose index for all procedures.

Computer Systems↗

PubMed2000

Role of the martius procedure in the management of urinary-vaginal fistulas.

BACKGROUND: Urinary-vaginal fistula is one of the most common and dreaded complications of obstetric trauma in developing countries. Management of these fistulas is complicated by the presence of substantial urethral loss and the tendency of the repair to break down. STUDY DESIGN: We retrospectively studied 46 patients with urinary-vaginal fistulas operated on in our institution over 5 years. Most of the patients had obstetric trauma as the causative factor. Twelve patients had urethrovaginal and 34 had vesicovaginal fistulas. Of the 12 patients with urethrovaginal fistulas, 8 underwent a Martius procedure and 4 were treated with simple anatomic repair. Of the 34 patients with vesicovaginal fistulas, 13 underwent a Martius procedure and 21 were treated with anatomic repair. Nineteen patients had recurrent fistulas and 17 had multiple fistulas. RESULTS: Only one patient with a urethrovaginal fistula treated with a Martius procedure had recurrence, compared with three of four of the patients having anatomic repair. None of the patients with vesicovaginal fistulas treated with a Martius flap had recurrence, compared with 4 of 21 in the anatomic-repair group (19.05%). Thirteen patients with single fistulas (7 urethrovaginal and 6 vesicovaginal) treated with a Martius procedure healed well without failure, compared with 1 failure among 16 fistulas (1 urethrovaginal and 15 vesicovaginal) in the anatomic-repair group. In the group of patients with multiple fistulas, the Martius flap also showed a definite advantage. Eight patients with multiple fistulas were offered the Martius flap. The procedures were successful in all but one, compared with six failures out of nine treated with anatomic repair. None of the patients having primary treatment with the Martius flap had postoperative recurrence, compared with 3 of 18 having anatomic repair (16.67%). Only 1 of 12 patients with recurrent fistulas undergoing Martius flap repair had failure (8.33%), compared with 4 of 7 undergoing anatomic repair (57.14%). None of the patients treated with the Martius procedure experienced dyspareunia postoperatively, compared with 33.33% of the patients treated with anatomic repair. CONCLUSIONS: The overall success rate was far better and the complication rate (especially incontinence and dyspareunia) was considerably less with the Martius procedure. We recommend the Martius procedure for urethrovaginal and vesicovaginal fistulas, especially those that are recurrent or multiple.

Adolescent↗

PubMed2002

Premenarchal vaginal discharge: findings of procedures to rule out foreign bodies.

STUDY OBJECTIVE: Vaginal discharge in children is a common gynecologic complaint and may be resistant to symptomatic and/or antibiotic treatment. In recurrent or unresponsive patients, an evaluation to rule out a foreign body is traditionally recommended. The objective of this study is to review cases of vaginal discharge referred to our institution and assess outcome and diagnosis in those who required irrigation or vaginoscopy to rule out a foreign body.A retrospective chart review was performed on all premenarchal girls identified through the University of Michigan Pediatric and Adolescent Gynecology Clinic database who were seen for evaluation of vaginal discharge between June 1996 and December 2001. The records were reviewed for age, length of time of discharge, aspects of discharge, procedures done to rule out foreign bodies, and findings of such procedures. SETTING: The study was performed in a tertiary care university hospital. PARTICIPANTS: Forty-one premenarchal girls were evaluated for vaginal discharge. The average age was 6.0 yr (range 3 months-11 yr). RESULTS: The average duration of vaginal discharge prior to presentation was 13.7 months (range 1-42 months). Of the 41 girls, 18 girls underwent 1 procedure each, 2 girls underwent 2 procedures each, and 1 girl underwent 5 procedures. Ten vaginal irrigations in clinic were performed in 7 girls, 3 by the referring physician and 7 by us. These irrigations removed a foreign body (tissue paper) in 4 of 10 (40%) cases, 3 at our institution and 1 at an outside institution. In the three irrigation cases with foreign bodies performed at our institution, the foreign body was visible on genital examination prior to the irrigation. Seventeen vaginoscopies under anesthesia were performed in 16 girls, 5 by the referring physician and 12 by us. In the girls who underwent a vaginoscopy under anesthesia a foreign body was found in 3 of 17 (17.6%). The other findings of the vaginoscopies included: biopsy-proven severe dermatitis with no infection in 1 patient, lymphatic duct chylous drainage in 1 patient, nonspecific vulvovaginitis in 11 patients, and normal exam with eventual diagnosis of malingering in 1 patient. In all cases where a foreign body was identified, the patient presented with bloody or brown discharge. CONCLUSIONS: Foreign bodies as a cause of persistent vaginal discharge in a tertiary care referral clinic were identified in 4 of 41 girls (9.8%) and 7 of 27 procedures (25.9%). One child had recurrent foreign bodies removed during 4 of 5 procedures for discharge. In children with persistent vaginal discharge, vaginal irrigation was feasible in older children (average age 7.7 yr). However, no foreign bodies were removed by irrigation that had not already been visually identified prior to the procedure. Exam under anesthesia and vaginoscopy allowed the identification of foreign bodies, and it facilitated the diagnosis of other unusual conditions.

Child↗

PubMed2003

Medial-sided bony procedures: why, what, and how?

The adult acquired flat foot deformity is a common clinical entity; rupture or incompetence of the posterior tibial tendon is a frequent cause. The natural history is characterized by progressively worsening deformity and early recognition is important. Nonoperative treatment can alleviate symptoms and control progression in nearly all stages of the disease. Should this fail to control symptoms or prevent progression of deformity, operative intervention should be considered. In stage I disease, exploration and debridement, with or without FDL tendon transfer, is a viable option. In stage II disease, the PTT becomes elongated and the medial soft tissues become attenuated. Exploration and debridement of the PTT is performed, but frequently a FDL tendon transfer or side-to-side anastomosis is required. It has been shown that soft tissue procedures alone may fail to correct deformity and this can lead to deterioration of results over time. Combined procedures, including soft tissue reconstructions to restore PTT function and bony procedures to correct deformity, have become popular. When the PTT is intact and degeneration or elongation is minimal, as in stage I or early stage II disease, reconstruction of the medial column with advancement of an osteoperiosteal flap based on the PTT insertion, combined with selective arthrodeses of the medial column, may be considered. These procedures have been well described for the treatment of symptomatic flexible flat foot in children and adolescents but experience in adults is lacking. Although it may be theoretically possible to passively correct hindfoot valgus with these procedures, it seems prudent to limit the indications to patients who have early disease accompanied by an isolated midfoot sag. In more advanced stage II disease, correction of deformity with a tendon transfer combined with a medial displacement calcaneal osteotomy or a lateral column lengthening is currently recommended. This allows for correction of deformity while sparing the hindfoot joints, which may be particularly important in young or active patients. Short-term studies showed excellent results, but long-term results are lacking. In stage III disease, in which the deformity is fixed, arthrodesis is the procedure of choice. Isolated talonavicular arthrodesis has been shown to correct nearly all aspects of the deformity with long-lasting results. This procedure results in nearly complete lack of hindfoot motion and may predispose the patient to adjacent joint arthrosis. In a patient who has stage III disease with arthrosis confined to the talonavicular joint, isolated talonavicular arthrodesis may be considered. This clinical situation is rare, and, in most patients, a triple arthrodesis is probably preferred. If residual deformity is present after these procedures, it must be addressed. Residual medial column instability may be addressed by adding a selective arthrodesis of the naviculo-cuneiform or first metatarsocuneiform joint, whereas residual forefoot varus or supination may be addressed with selected midfoot fusions with or without a cuneiform osteotomy.

Adolescent↗

PubMed2006

Safety of a new transobturator suburethral synthetic sling (TVT-O) procedure during the training phase.

OBJECTIVE: The TVT-O (Ethicon, Somerville, NJ) is a new transobturator suburethral synthetic sling used in the treatment of female stress urinary incontinence (SUI). This study aimed to evaluate the complication rates and procedural times associated with performing this procedure during a period of transition from the retropubic tension-free vaginal tape (TVT) procedure to the transobturator TVT-O procedure. METHODS: We performed a retrospective analysis of the first 50 patients to undergo the TVT-O procedure in one gynaecologist's practice. All patients had SUI or mixed urinary incontinence. Operative times and intraoperative and perioperative complications were recorded. At the two-week and six- to eight-week postoperative reviews, a urogenital history and examination were performed. RESULTS: The only complications encountered were two cases (4%) of urinary tract infection and one case (2%) of superficial wound infection. There were no cases of postoperative voiding difficulty, hemorrhage, hematoma, persistent groin pain, or vascular or visceral injuries. The mean procedural time was 21 minutes. CONCLUSION: These preliminary results indicate that the TVT-O procedure is a safe treatment for female SUI even during the training phase. In light of the safety and the ease of transition to this technique, this finding is encouraging for surgeons who are making the transition from other surgical procedures for female SUI to the transobturator TVT-O.

Adult↗

PubMed1986

Evaluation of procedures for hygienic hand-disinfection: controlled parallel experiments on the Vienna test model.

Controlled parallel experiments were performed on the Vienna test model for the evaluation of procedures for hygienic hand-disinfection in three laboratories (Vienna, Mainz, Birmingham). The degerming activity of four procedures, each taking 1 min, was assessed repeatedly and compared with that of a standard disinfection procedure (ST) using isopropanol 60% (v/v). The mean log reductions (mean log RF) for each procedure were as follows: n-propanol 50% (v/v) 4.85 and 5.14 in Vienna (V) and Mainz (M) respectively, ethanol 70% (v/v) + chlorhexidine-gluconate 0.5% (w/v), 4.01 (V), 3.76 (M) and 4.00 in Birmingham (B). Washing procedures were less effective, mean log RF's of 3.19 (V), 3.49 (M) and 3.04 (B) were obtained with povidone-iodine soap, and 2.91 (V), 3.37 (M) and 3.27 (B) with a liquid phenolic soap. Analysis of variance on the data from Vienna and Mainz revealed significant differences of means not only between procedures ('preparations') but also on repeat testing. To compensate for the influence of variables such as test subjects, laboratory and day, the Vienna test model provides a method of standardization by testing a ST in parallel with the test procedure (P). Standardization of the results was obtained by pair-wise substraction, log RFPi-log RFSTi. Analysis of variance on the resulting values demonstrated that comparability of the results between laboratories and on repeat testing was achieved. The relative variation of the measurements within the laboratories ranged from 0.9 to 4.2%. As assessed by power-analysis, a disinfection procedure will be detected as significantly (P = 0.1) inferior to the standard processes in 95 of 100 experiments if it produces a mean log RF that is at least 0.55-0.65 log units smaller than that of the standard.

Austria↗

PubMed2001

Comparative studies on the certification of reference materials by ICPMS and TIMS using isotope dilution procedures.

A comparison of different isotope dilution mass spectrometric (IDMS) procedures using inductively coupled plasma mass spectrometry (ICPMS) and thermal ionization mass spectrometry (TIMS) was carried out to examine the degree of equivalence between the used procedures in terms of requirements for reference material certification. The comparison was based on the measurement results and their uncertainties. The sample used in this study is a pure zinc metal to be certified by the Bureau Communie de Référence (BCR) for amount contents of different trace elements. This study focuses on cadmium and thallium. The TIMS values contributed to the certified values. To guarantee identical conditions as far as possible for the procedures under investigation, the samples were split into subsamples after spiking and digestion took place. Thus, every IDMS procedure started with an identical set of samples. In total, four different IDMS procedures and one external calibration procedure using internal standardization as an example of routine analysis were applied. The IDMS procedures divide in a group with and a group without trace/matrix separation. Multicollector TIMS (TI-MC-MS) and multicollector ICPMS (ICP-MC-MS) were used in combination with trace/matrix separation, whereas quadrupole ICPMS (ICP-QMS) and ICP-MC-MS were also applied to nonseparated samples. All IDMS results agree well within their combined uncertainties, while some results from the external calibration procedure do not. IDMS results obtained by ICPMS without separation are comparable to those obtained by TI-MC-MS with separation regarding precision and accuracy. The smallest uncertainties were achieved using ICP-MC-MS in combination with trace/matrix separation.

Journal Article↗

PubMed1996

Effect of step size on clinical and adaptive 2IFC procedures in quiet and in a noise background.

Audibility thresholds for a 1000-Hz sinusoid were measured with a standard clinical (CLIN) procedure and a two-interval, forced-choice (2IFC) adaptive procedure bracketing 79% correct. Both used 2- and 5-dB step sizes in quiet and in a continuous, broadband noise background. Clinical thresholds were from 2 to 4 dB higher than 2IFC thresholds, depending on the condition. Step size had a larger effect on the CLIN thresholds than the 2IFC thresholds. For the CLIN procedure, thresholds with a 2-dB step size were 1.4 dB lower than with a 5-dB step size. For the 2IFC procedure, thresholds with a 2-dB step size were 0.8 dB higher than with a 5-dB step size. Reliability, as measured by the intrasubject standard deviation, was better for the 2IFC than for the CLIN procedure and better in noise than in quiet. Reliability was unaffected by step size. Adding extra trials to the 2IFC adaptive track decreased the variability across threshold estimates, but more for the noise background than the quiet background. The efficiency of the 2IFC procedure was fairly constant across track length in noise, but decreased for longer track lengths in quiet. In both quiet and noise backgrounds, CLIN procedures were much more efficient than 2IFC procedures.

Adult↗

PubMedDate not supplied

Management of complications of endovascular dialysis access procedures.

Endovascular procedures are becoming the standard of care for the management of hemodialysis (HD) vascular access dysfunction. As with any type of medical procedure, these techniques result in procedure-related complications. The expected frequencies are low. The most frequent procedure-related complication seen in association with angioplasty that dictates the need for intervention is tearing of the vein or vein rupture. The clinical significance of this complication is variable, ranging from none to disaster for the access. The difference lies in the severity of the tear. Management depends on the clinical presentation, ranging from symptomatic measures alone to the need to occlude the graft. Since endovascular thrombectomy is a combined procedure including angioplasty, all of the complications of that procedure can occur with this procedure as well. The major unique procedure-related complication requiring interventional therapy is the occurrence of a symptomatic peripheral artery embolus. This complication can generally be managed successfully by mechanical endovascular means. It is essential that the interventionalist be prepared to manage these complications appropriately when they are encountered.

Angioplasty↗

PubMed2000

Differences between generalists and specialists in characteristics of patients receiving gastrointestinal procedures.

BACKGROUND: As a result of market forces and maturing technology, generalists are currently providing services, such as colonoscopy, that in the past were deemed the realm of specialists. OBJECTIVE: To determine whether there were differences in patient characteristics, procedure complexity, and clinical indications when gastrointestinal endoscopic procedures were provided by generalists versus specialists. DESIGN: Retrospective cohort study. PATIENTS: A random 5% sample of aged Medicare beneficiaries who underwent rigid and flexible sigmoidoscopy, colonoscopy, and esophagogastroduodenoscopy (EGD) performed by specialists (gastroenterologists, general surgeons, and colorectal surgeons) or generalists (general practitioners, family practitioners, and general internists). MEASUREMENTS: Characteristics of patients, indications for the procedure, procedural complexity, and place of service were compared between generalists and specialists using descriptive statistics and logistic regression. MAIN RESULTS: Our sample population had 167,347 gastrointestinal endoscopies. Generalists performed 7.7% of the 57, 221 colonoscopies, 8.7% of the 62,469 EGDs, 42.7% of the 38,261 flexible sigmoidoscopies, and 35.2% of the 9,396 rigid sigmoidoscopies. Age and gender of patients were similar between generalists and specialists, but white patients were more likely to receive complex endoscopy from specialists. After adjusting for patient differences in age, race, and gender, generalists were more likely to have provided a simple diagnostic procedure (odds ratio [OR] 4.2; 95% confidence interval [95% CI] 4.0, 4.4), perform the procedure for examination and screening purposes (OR 4.9; 95% CI, 4. 3 to 5.6), and provide these procedures in rural areas (OR 1.5; 95% CI 1.4 to 1.6). CONCLUSIONS: Although generalists perform the full spectrum of gastrointestinal endoscopies, their procedures are often of lower complexity and less likely to have been performed for investigating severe morbidities.

Aged↗

PubMed2003

Residual cell content in plasma produced by three centrifugal apheresis procedures.

BACKGROUND: Understanding the impact of collection procedures on the residual amount of blood cells in plasma for transfusion and for fractionation is of current interest. This prospective work evaluated plasma donations collected on an apheresis machine (PCS 2, Haemonetics) with three different automatic centrifugal apheresis procedures, currently largely used in the US (Revision G) and in Europe (Revision F), and included a new procedure that uses a high-separation core (HSC) that is designed with a second separation chamber to further separate cells from plasma. STUDY DESIGN AND METHODS: A total of 90 collection procedures have been performed from a population of 37 donors, under comprehensively standardized conditions. There were 30 well-matched donors in each group. Plasma aliquots were taken from the plasma units within 30 minutes of the end of the collection procedures and immediately assessed for WBCs, RBCs, PLTs, and supernatant Hb. RESULTS: In Revision F and Revision G plasma donations, the mean numbers of WBCs were 83.1 x 10(4) and 311 x 10(4) per L; PLTs, 5.01 x 10(9) and 20 x 10(9) per L; and RBCs, 58 x 10(6) and 43 x 10(6) per L, respectively [corrected]. Significantly lower values were found with the HSC procedure (mean WBC, RBC, and PLT counts, 3.01 x 10(4)/L [p < 0.05], 9 x 10(6)/L [p < 0.001], and 3.5 x 10(9)/L [p < 0.001], respectively). The amount of free Hb was similar in all three procedures. CONCLUSION: Significant differences in numbers of cells in plasma were found depending on the centrifugal procedures used and the design of the separation bowl. The lowest level of cell contamination was found with the new HSC bowl, which without a filtration step, yielded plasma that met the standard for WBC-reduced plasma. Plasma collectors can select the most appropriate method of plasma collection based on donor criteria, use of plasma (transfusion, viral inactivation, or fractionation), and local or international regulations, when in place.

Blood Cell Count↗

PubMed2000

The difference between ultrasound-guided and stereotactic-guided neurosurgical procedures.

We evaluate two different methods, ultrasound (US) guidance and stereotactic guidance, routinely used in our Department for navigation in various neurosurgical procedures. We have performed 53 US-guided and 101 stereotactic-guided procedures. These procedures were intracranial lesion biopsies, intracranial cysts and abscesses puncture and evacuations, ventricular punctures for hydrocephalus shunt operations, stereotactic-guided microneurosurgical resections, and stereotactic-guided endoscopic operations. Advantages of the US-guided operations are the shortness of the procedure, simplicity (no need for moving patient for additional CT scanning), no irradiation and the possibility of real-time imaging. The disadvantages of the US-guided procedures are worse resolution of the images in deep-seated and small lesions as well as the need for a bigger trepanation because of the transducer's dimensions. Stereotactic procedures are time-consuming but more precise and usually done in local anaesthesia because only a small trepanation is required. Main disadvantage of the stereotactic-guided procedures when compared with the US-guided procedures is a lack of real-time intraoperative control. According to our experience, both methods are complementary and safe and they do not cause any additional complications when used as a navigation tool in microneurosurgical operations. Both methods are highly reliable when used in properly selected patients.

Brain Diseases↗

PubMed2006

Surveillance for surgical site infection after hospital discharge: a surgical procedure-specific perspective.

OBJECTIVE: To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program. DESIGN: Prospective surveillance study. SETTING: A surgical ward at a university teaching hospital in Italy. PATIENTS: A total of 264 surgical patients were included in the study. RESULTS: The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (+/-SD) for patients who acquired a postdischarge SSI was 4.9+/-3.7 days, and SSI was diagnosed a mean duration (+/-SD) of 11.5+/-4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher. CONCLUSIONS: Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.

Aged↗

PubMed1992

Determinants of clean surgical wound infections for breast procedures at an oncology center.

OBJECTIVE: To determine the clean surgical wound infection rate for breast procedures and the risk factors predisposing patients to these infections. DESIGN: A survey study. SETTING: Oncology center. PATIENTS: A consecutive sample of adult female patients who underwent surgical breast procedures for suspected carcinoma of the breast. Patients undergoing excisional biopsy, lumpectomy, or mastectomy from January 1985 to January 1987 were included in the study. INTERVENTION: Clean surgical wound infection rates were derived overall and for each procedure type. The medical records of all patients were then reviewed to extract data on patient characteristics and operative information in order to assess the risk factors for infection. RESULTS: Among the breast procedures performed on 448 patients, the overall clean surgical wound infection rate was 8.7% (39/448). The clean surgical wound infection rate for each procedure type was as follows: biopsy 2.3%, lumpectomy 6.6%, and mastectomy 19%. In addition to the type of procedure, factors significantly (p less than .05) associated with the development of clean surgical wound infection in the univariate analysis included: presence of surgical drains (p less than .01); closed suction drainage (odds ratio [OR] = 16.5, 95% confidence interval [CI95] = 5.0-54.7); location of the drain (OR = 3.3, CI95 = 1.7-6.6); prolonged preoperative stay (OR = 1.2, CI95 = 1.0-1.5); length of surgery (OR = 2.2, CI95 = 1.7-3.0); and greater mean age (OR = 1.6, CI95 = 1.2-2.1). CONCLUSION: Clean surgical wound infections are not uncommon in patients undergoing breast procedures. Factors relating to both the patient and operative techniques contribute to the clean surgical wound infection rate. Further consideration should be given to perioperative antibiotic prophylaxis for selected breast procedures, and the role of surgical drains should be reassessed.

Biopsy↗

PubMed1988

32P-adduct assay: comparative recoveries of structurally diverse DNA adducts in the various enhancement procedures.

A 32P-adduct assay for the measurement of low levels (1 adduct per 10(7) nucleotides) of binding of carcinogens to DNA has been reported previously. In this procedure, DNA is enzymatically hydrolyzed to 3'-monophosphates of normal nucleosides and adducts, which are 5'-32P-labeled by T4 polynucleotide kinase and [gamma-32P]ATP. Labeled adducts are resolved by TLC. Enrichment of adducts by extraction in 1-butanol [Gupta, R.C. (1985) Cancer Res., 45, 5656] or digestion with nuclease P1 [Reddy, M.V. and Randerath, K. (1986) Carcinogenesis, 7, 1543] prior to 32P-labeling, however, increased the sensitivity of detection for many adducts to a level of 1 per 10(9-10) nucleotides, although adduct recovery particularly in the latter assay depended on the chemical nature of adducts. We have now compared recoveries for greater than 70, different carcinogen-DNA adducts of known and unknown chemical nature in the two enrichment procedures as well as in a new procedure in which polynucleotide kinase is substituted for nuclease P1. When compared with the butanol extraction procedure, arylamines (such as 2-aminofluorene, 2-aminophenanthrene, 2-naphthylamine, 4-aminobiphenyl, 4-azoaminobenzene and N'-acetylbenzidine) bound to the C8 position of guanine were lost almost completely (0.2-4% recovery) in the nuclease P1-mediated assay, but the presence of a polar group in the aromatic amine moiety (such as 2-acetylaminofluorene, 2-acetylamino-phenanthrene and methyl-4-azoaminophenyl) rendered similar recovery. In contrast, aromatic amines (2-amino-phenanthrene, 2-acetylaminophenanthrene, 2-acetylaminofluorene and methyl-4-azoaminobenzene) and polycyclic aromatic hydrocarbons (benzo[a]pyrene, bromomethylbenzanthracene and benzanthracene) bound to the exocyclic positions of guanine or adenine showed extensive or as complete recovery in the nuclease P1 procedure as in the extraction procedure. Some of the unknown presumably polar adducts showed a lower recovery (30-70%) in the butanol procedure as compared to the nuclease P1 enrichment. The recovery pattern of most adducts examined in the polynucleotide kinase-enrichment assay was essentially the same as found in nuclease P1-mediated assay, except that overall lower values were obtained. Our data suggest that a given DNA sample should be analyzed by different versions of the 32P-adduct assay, particularly, DNA of specimens of humans exposed to low levels of unknown carcinogens. The observation that chemical structure of an adduct may be detrimental in its recovery in the enzyme- and extraction-mediated enrichment procedures may serve as a probe in the structural characterization of adducts of unknown carcinogens.

Butanols↗

PubMed1998

Intracytoplasmic sperm injection: laboratory set-up and injection procedure.

Intracytoplasmic sperm injection (ICSI) as treatment for male-factor infertility has been introduced worldwide in the past few years in many laboratories using assisted reproduction techniques. Some changes in the existing set-up are necessary before implementing this procedure. The equipment can be divided into two groups: that required for preparation of the microtools and that required for the microinjection procedure itself. A pipette puller, grinder and microforge are necessary for preparation of the microtools. The correct settings and use of these instruments are of crucial importance in preparing a good needle, which in turn is crucial to the injection procedure itself. The microscope has to be equipped with a heated stage, correct optics and manipulators and injectors. The correct settings and use of this equipment also influence the injection procedure and may influence the success rate. Retrospective analysis of the evolution of ICSI in our centre clearly shows a marked improvement following the introduction of some modifications into the procedure. These modifications were (i) reducing the concentration of hyaluronidase used for cumulus and corona radiata removal, (ii) selecting a motile spermatozoon that was immobilized prior to the injection and (iii) aspiration of cytoplasm to ensure rupture of the oocyte membrane. The injection procedure itself can also be influenced by oocyte characteristics. It has been reported that the reaction of the oocyte to the penetration by the pipette has an influence on the success rate. The ICSI procedure has about the same success rate as IVF in cases of non-male infertility. However, work can still be done to improve the success rate of this procedure.

Fertilization in Vitro↗

PubMedDate not supplied

The influence of appraisals in understanding children's experiences with medical procedures.

OBJECTIVE: To examine the influence of cognitive appraisals on anticipatory anxiety, procedural distress, and postprocedural evaluations in 100 children (ages 8-17) undergoing esophagogastroduodenoscopy (EGD). METHOD: Children's knowledge about the procedure, appraisals of the procedure's aversiveness, coping ability, and state anxiety prior to the procedure were assessed by self-report. Distress during the EGD was assessed by observer ratings. Postprocedural evaluations were assessed by self-report 1 hour after the procedure. RESULTS: Structural equation modeling indicated that children who knew more about the EGD appraised it as less threatening, and, in turn, children who appraised the procedure as less threatening experienced less anxiety. Decreased anxiety was associated with decreased distress, which, in turn, was associated with decreased pain, evaluations of less aversiveness, and less negative attitudes toward future procedures. CONCLUSIONS: This study has implications for how children are prepared for EGDs and supports the utility of an appraisal-based model in understanding children's experiences with medical procedures.

Adaptation, Psychological↗