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PubMed1997

Prevalence of positive serology for acute Chlamydia pneumoniae infection in emergency department patients with persistent cough.

OBJECTIVE: To determine the prevalence of acute Chlamydia pneumoniae infection in ED patients presenting with a persistent cough. METHODS: This was a case series consisting of a convenience sample of 65 patients > or = 18 years of age who presented with a chief complaint of a cough lasting > or = 2 weeks. Patients were treated in the ED of an urban university hospital. Patients with immunosuppression, lung disease, pneumonia, or a cough lasting > or = 3 months were excluded. Acute and convalescent sera were assayed for antibody to C. pneumoniae. Subjects with C. pneumoniae antibody titers showing a fourfold rise in either immunoglobin M (IgM) or immunoglobin G (IgG) antibody, an IgM titer of > or = 16, or an IgG titer of > or = 512 were considered to have evidence of acute C. pneumoniae infection. RESULTS: Thirteen (20%; 95% CI, 11% to 32%) of the 65 subjects had serologic evidence of acute C. pneumoniae infection. Except for an increased rate of fever, clinical signs and symptoms and laboratory studies did not differentiate those who had C. pneumoniae from those who did not have the disease. Patients diagnosed as having Bordetella pertussis or Mycoplasma pneumoniae infection did not have serologic evidence of concurrent C. pneumoniae infection. CONCLUSIONS: C. pneumoniae infection appears to be associated with a persistent cough in ED patients. Clinicians should consider this organism when evaluating these patients. It is unclear whether antibiotic therapy is indicated for these patients. If antibiotics are used, a tetracycline or macrolide antibiotic would be most appropriate.

Adolescent↗
PubMed2006

Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis.

BACKGROUND: Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Small-incision cholecystectomy is a less frequently used alternative. Laparoscopic cholecystectomy was introduced in the 1980s. OBJECTIVES: To compare the beneficial and harmful effects of laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis. SEARCH STRATEGY: We searched TheCochrane Hepato-Biliary Group Controlled Trials Register (6 April 2004), The Cochrane Library (Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), Web of Science (1988 to January 2004), and CINAHL (1982 to January 2004) for randomised trials. SELECTION CRITERIA: All published and unpublished randomised trials in patients with symptomatic cholecystolithiasis comparing any kind of laparoscopic cholecystectomy versus small-incision or other kind of minimal incision open cholecystectomy. No language limitations were applied. DATA COLLECTION AND ANALYSIS: Two authors independently performed selection of trials and data extraction. The methodological quality of the generation of the allocation sequence, allocation concealment, blinding, and follow-up was evaluated to assess bias risk. Analyses were based on the intention-to-treat principle. Authors were requested additional information in case of missing data. Sensitivity and subgroup analyses were performed if appropriate. MAIN RESULTS: Thirteen trials randomised 2337 patients. Methodological quality was relatively high considering the four quality criteria. Total complications of laparoscopic and small-incision cholecystectomy are high: 26.6% versus 22.9%. Total complications (risk difference, random-effects -0.01, 95% confidence interval (CI) -0.07 to 0.05), hospital stay (weighted mean difference (WMD), random-effects -0.72 days, 95% CI -1.48 to 0.04), and convalescence were not significantly different. High-quality trials show a quicker operative time for small-incision cholecystectomy (WMD, high-quality trials 'blinding', random-effects 16.4 minutes, 95% CI 8.9 to 23.8) while low-quality trials show no significant difference. AUTHORS' CONCLUSIONS: Laparoscopic and small-incision cholecystectomy seem to be equivalent. No differences could be observed in mortality, complications, and postoperative recovery. Small-incision cholecystectomy has a significantly shorter operative time. Complications in elective cholecystectomy are prevalent.

Cholecystectomy↗
PubMed1990

Three serotypes of Norwalk-like virus demonstrated by solid-phase immune electron microscopy.

Solid phase immune electron microscopy (SPIEM) was used to investigate the serological differences between Norwalk-like virus (NLV) strains from five different outbreaks within the United Kingdom. The existence of two previously demonstrated serotypes, Lewis et al. (Journal of Clinical Microbiology 26:938-942, 1988), was confirmed by the use of whole convalescent sera and purified IgM. A third serotype was found to be the agent of two recent hospital outbreaks and could similarly be typed by use of whole sera or pure IgM. Paired sera were available for two of the three serotypes and demonstrated rising antibody levels. These antibody rises were also specific for the infecting serotype. However, two serum pairs from a later outbreak gave antibody rises to all three serotypes, although much higher counts were produced with the infecting serotype. SPIEM is a useful method for distinguishing NLV serotypes and can also be used to detect specific IgM and to demonstrate seroconversion. Cross-reacting antibodies, possibly anamnestic in origin, can occur after natural infection and could cause confusion in typing virus unless further evidence of the identity of the infecting agent is obtained.

Adult↗
PubMed1984

Nephrolithotony: percutaneous removal of renal calculi.

The development of percutaneous nephrostomy has laid the foundation for a major advance in the treatment of urolithiasis: the percutaneous removal of renal and ureteral calculi (i.e., nephrolithotony). With the use of a variety of instruments, calculi can be either removed intact or, if too large, fragmented in situ and then extracted. The method has wide applicability; more than 90% of all upper urinary tract calculi can be successfully treated. Length of hospitalization and costs are comparable to or less than those for open surgery; however, the period of convalescence is only 2-7 days. Continued advances in fluoroscopic technology and endoscopic instrumentation will enable the urologic surgeon to treat the majority of urinary tract conditions using endourologic techniques.

Dilatation↗
PubMed1984

Prediction of emotional and social outcome after a heart attack.

Data from two prospectively studied series of patients recovering from heart attacks (n = 129 and 100) were analysed to determine the extent to which early findings can predict later psychological and social outcome. Some aspects of early and late outcome can be predicted with modest accuracy by multiple regression analysis of information obtained during the acute hospital admission. More accurate, and therefore clinically more useful, prediction of late outcome is possible in early convalescence. It is suggested that systematic clinical assessment during admission and a few weeks after return home could detect most patients in need of extra specialist rehabilitation.

Convalescence↗
PubMed1999

Acute lower respiratory infections in hospitalized children over a 6 year period in Tokyo.

BACKGROUND: Acute lower respiratory infections are major causes of hospitalization in children and are mainly caused by respiratory viruses. In the present study, we investigated the etiologic agents responsible for acute lower respiratory infections from the period November 1986 to October 1992 in order to determine the seasonal pattern and different characteristics of age distribution of respiratory infectious agents, mainly virus infections. METHODS: A total of 1521 patients with lower respiratory infections was hospitalized in Saiseikai Central Hospital, Tokyo, Japan. Nasopharyngeal secretions were obtained for virus isolation and paired sera in the acute and convalescent phases were obtained for serological examination. RESULTS: Etiological agents were identified in 668 of 1521 patients (43.9%) by serological antibody responses, virus isolation and/or detection of virus antigen: 240 (15.8%) with respiratory syncytial (RS) virus; 62 (4.1%) with influenza virus type A; 26 (1.7%) with influenza virus type B; 86 (5.7%) with adenovirus; 81 (5.3%) with parainfluenza virus; 32 (2.1%) with measles virus; 20 (1.3%) with enteroviruses or Herpes virus other than respiratory viruses; 75 (4.9%) with Mycoplasma pneumoniae; 10 (0.7%) with pertussis; and 36 (2.4%) with mixed infections. In the remaining 853 patients (56.1%), etiologic agents were not identified. Respiratory syncytial (RS) virus was a main causative agent of respiratory infections in patients younger than 3 years of age. Influenza virus and M. pneumoniae were two main causative agents in patients with acute respiratory illness over 5 years of age. Parainfluenza virus type 3 was frequently observed in infants from 9 to 12 months of age. A distinct seasonal pattern of viral infections was consistently observed in each year during the study period; RS and influenza viruses were prevalent in winter, parainfluenza virus was prevalent in spring and M. pneumoniae was prevalent in summer and autumn. However, adenovirus infections were observed in all seasons. Serological responses were poor in patients younger than 1 year of age and they were mainly diagnosed by virus isolation or detection of virus antigen. CONCLUSIONS: Virological epidemiology provides useful information in daily clinical practice for the prediction of etiological agents based on patient age and the seasonal distribution of agents. We should examine virus isolation and the detection of virus antigen, along with serological examinations in patients with respiratory infections, especially in infants younger than 1 year of age because of poor serological responses.

Age Distribution↗
PubMed1999

[Complications after surgery for pilonidal cyst. An introduction to a new debate on a "costly" disease].

The frequency of wound complications following operation for pilonidal disease in our department was compared with results from the literature. The case-records of 88 consecutive patients operated for 100 sinuses (12 recurrences), were evaluated retrospectively, supplemented by a questionnaire. Wound healing problems occurred in 69% of the sutured sinuses. Length of hospitalization was two days in uncomplicated, five days in complicated, and eight days in open treated cases. Convalescence (days off work) took 25 days, 41 days and 26 days, respectively. There was no correlation between previous history of pilonidal disease, wound healing complications, and outcome (recurrence frequency). Relapses occurred in 18%. In conclusion, the closure of pilonidal sinuses had a high frequency of wound healing complications and recurrences.

Adolescent↗
PubMed2000

Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: the Cleveland Clinic experience.

PURPOSE: We report our single institutional experience with retroperitoneal laparoscopic radical nephroureterectomy in patients with upper tract transitional cell carcinoma and compare results to those achieved by the open technique. MATERIALS AND METHODS: A total of 77 patients underwent radical nephroureterectomy for pathologically confirmed upper tract transitional cell carcinoma. Of these patients 42 underwent laparoscopic nephroureterectomy from September 1997 through January 2000 and 35 underwent open surgery. All specimens were extracted intact. Of the laparoscopic group the juxtavesical ureter and bladder cuff were excised by our novel transvesical needlescopic technique in 27 and radical nephrectomy was performed retroperitoneoscopically in all 42. Data were compared retrospectively with 35 patients undergoing open radical nephroureterectomy from February 1991 through December 1999. RESULTS: Laparoscopy was superior in regard to surgical time (3.7 versus 4.7 hours, p = 0.003), blood loss (242 versus 696 cc, p <0. 0001), specimen weight (559 versus 388 gm., p = 0.04), resumption of oral intake (1.6 versus 3.2 days, p = 0.0004), narcotic analgesia requirements (26 versus 228 mg., p <0.0001), hospital stay (2.3 versus 6.6 days, p <0.0001), normal activities (4.7 versus 8.2 weeks, p = 0.002) and convalescence (8 versus 14.1 weeks, p = 0.007). Complications occurred in 5 patients (12%) in the laparoscopic group, including open conversions in 2, and in 10 (29%) in the open group (p = 0.07). Followup was shorter in the laparoscopic group (11.1 versus 34.4 months, p <0.0001). The 2 groups were similar in regard to bladder recurrence (23% versus 37%, p = 0.42), local retroperitoneal or port site recurrence (0% versus 0%) and metastatic disease (8.6% versus 13%, p = 1.00). Mortality occurred in 2 patients (6%) in the laparoscopic group and 9 (30%) in the open group. Cancer specific survival (97% versus 87%) and crude survival (97% versus 94%) were similar between both groups (p = 0.59). CONCLUSIONS: In patients with upper tract transitional cell carcinoma who are candidates for radical nephroureterectomy the retroperitoneal laparoscopic approach satisfactorily duplicates established technical principles of traditional open oncological surgery, while significantly decreasing morbidity from this major procedure. Short-term oncological and survival data of the laparoscopic technique are comparable to open surgery. Although long-term followup data are not yet available, it appears that laparoscopic radical nephroureterectomy may supplant open surgery as the standard of care in patients with muscle invasive or high grade upper tract transitional cell carcinoma.

Aged↗
PubMed1990

[Beta-glucuronidase in blood serum of patients with contagious mononucleosis].

The activity of beta-glucuronidase in blood serum of 12 women and 14 men ill from contagious mononucleosis in the first and third week of hospitalization was determined after the method given by Krawczyński. Moreover, there were determined: the number of leucocytes, percentage of normal lymphocytes including atypical ones, the activity of aminotransferases (asparagine and alanine), as well as Paul-Bunnell-Davidsohn's reaction. It was found that the level of beta-glucuronidase during the first week of hospitalization increased, and it decreased in the third week, which may be one of the indices of convalescence, independently of the sex of the examined persons.

Adolescent↗
PubMed1976

[Preventive and therapeutic effect convalescent zona and varicella sera in high risk children (659 cases)].

Study of 659 cases treated with serum from patients convalescent after herpes zoster and chickenpox over a period of two and a half years in French hospital departments, showed the obvious effectiveness of this type of therapy which seems to be better than that of zoster specific gamma globulin used by other workers since we obtained protection against chickenpox in 90 p. cent of cases, and attenuation of chickenpox in 82 p. cent. It would seem that these results could be improved by increasing the doses used.

Chickenpox↗
PubMed1975

Dengue virus replication in cultures of peripheral blood leukocytes during the course of dengue haemorrhagic fever.

A preliminary study was made of the ability of cultured human peripheral blood leukocytes (PBL) to support dengue 2 infection. Leukocyte donors, children hospitalized with primary (one case) or secondary dengue infections (12 cases), were studied during the acute and convalescent stages of illness. D2 virus replication occurred infrequently in PBL cultures obtained from children before the 10th day after onset of symptoms (2/23 samples), but frequently thereafter (8/13 samples). The absence of virus permissive cells during the acute stage of illness might be explained by several different mechanisms, including the possibility that permissive PBL are exhausted as the result of a severe dengue infection. An unexpected finding was the appearance of dengue hemagglutination-inhibition antibodies in cultures of PBL obtained from children during the acute stage of secondary dengue infections.

Acute Disease↗
PubMed1996

Use of viral cultures and serologic tests for cytomegalovirus infection. Rational or random?

To assess their applied clinical utility, viral cultures and serological tests for cytomegalovirus (CMV) were reviewed at Duke University Medical Center (DUMC), a 1,125-bed tertiary-care hospital. Less than 1% (3 of 1,216) of CMV cultures were positive, and 8% of serum samples (45 of 587) were positive by single sera IgM ELISA. Sixteen percent (32 of 199) of IgG acute to convalescent sera pairs were positive. Four hundred five of 588 (69%) serum samples were positive for the IgM/IgG passive latex agglutination test, consistent with the results for random blood donors. Review of hospital records showed that fewer than 1% of the positive-test patients (excluding the latex test) received treatment for CMV. Comparisons of tests ordered on individual patients did not disclose a coherent diagnostic strategy. The authors conclude that the majority of testing for CMV in their medical center does not yield useful clinical information, but carries a substantial financial burden. A new diagnostic strategy to attempt to diagnose CMV disease is needed.

Acute Disease↗
PubMed1995

Herpes zoster in a normal child after varicella vaccination.

A healthy 5 year old girl developed herpes zoster in the dermatome supplied by the ophthalmic branch of the fifth cranial nerve 40 months after varicella vaccination. She was admitted to our hospital because of high fever and painful vesicular lesions over the left side of her forehead. She was treated successfully with systemic and topical acyclovir without developing herpetic keratoconjunctivitis. Our acute and convalescent phase evaluations showed that non-specific cellular and humoral immunity was normal. This is the fourth case of herpes zoster developing in an immunocompetent child following vaccination. Unlike the previously reported cases, our patient required hospitalization mainly to prevent ocular involvement. The issue concerning whether the universal introduction of varicella vaccination of normal children will reduce the incidence of the subsequent occurrence of herpes zoster must await further studies involving longer follow-up periods.

Chickenpox Vaccine↗
PubMed2002

The contribution of the Hospital Saturday Fund to nursing history: evaluation of a primary source.

The Hospital Saturday Fund was established as a means of providing much-needed contributions to the voluntary hospitals. Subscribing to the Fund ensured the contributor's care, but, additionally, they could sponsor a 'deserving object'. The annual reports of the Fund provide a number of insights in relation to the social, economic and political history of Liverpool. The reports also provide some insights into nursing in the city during the period 1888-1927. Following documentary analysis, the paper discusses some of these findings, namely district nursing, services for women and convalescence, and evaluates how useful this source may be to nursing history.

Economics, Hospital↗
PubMed2004

[Short-term care after hospitalization: influencing factors for discharge to the patient's own home environment].

A special short-term care (KZP) in a nursing home is offered to patients who are not yet able to live independently after hospitalization. It was institutionalized in 1989. But its basic conditions changed in 1996 with the new Pflegeversicherungsgesetz (nursing insurance law): the maximal stay was limited to 4 weeks and cost were turned over to the new insurance system. The paper analyzes the part KZP plays in health care maintenance. It addresses the questions which kind of patients is referred to KZP and what factors influence discharge at home vs admission to end-term nursing homes.A total of 325 patient's records (female: 80.3%) from 5 KZP institutions in the city of Bremen were analyzed (nearly 50% of all clients, who were formerly hospitalized). Patient's mean age was 82.9 years. Hospitalization lasted three weeks with men staying 27.6 days and women staying 20.1 days. Nervous disorders (especially apoplexy) and cardiovascular diseases are very common. After the stay in KZP, 39.1% moved to nursing homes, 36.0% returned home. Predictors for nursing home admission are long-lasting hospitalization, predicted need of long-term care by physicians, and nervous disorders. The results show that short-term care is a useful concept in health care maintenance of patients with special diseases und complicates re-convalescence.

Aged↗
PubMed2006

[The first confirmed human case of avian influenza A (H5N1) in mainland, China].

OBJECTIVE: To ascertain the causation of a family cluster involving two undefined pneumonia cases, a 12-year-old girl and her brother, reported October, 2005 in Xiangtan county, Hunan province. METHODS: Information on epidemiology and clinical manifestation of the cases was collected from interviewing the keyman and referring to related medical records. The environment exposure of the cases to their households and the timeline of the illness were reproduced, using this information. Medical check-up was undergone among the close contacts of the cases and on sick/dead poultry. Throat swab of the cases were collected and tested by both RT-PCR and real-time PCR to detect viral nucleic acids of A/H5N1, and were then inoculated into special pathogen free (SPF) embryonated hens' eggs. Serum of the cases including acute and convalescent phases were also collected and tested by microneutralization and haemagglutination-inhibition (HI) assays to detect H5-specific antibodies. RESULTS: Both the girl and her brother developed fever 2 and 4 days after sudden deaths of chickens being raised in the same house. Both of them had developed pneumonia and the girl died from acute respiratory distress syndrome (ARDS) complicated with multi-organ failure. The boy survived and subsequently discharged from hospital. An eighth-day serum from the girl tested H5 antibody negative, while 4-fold and greater increased in antibody titers were detected in serum from the boy using microneutralization and HI assays in sequential acute and convalescent sera. Of 192 cases, only one doctor who cared for the girl during hospitalization had upper respiratory symptoms but tested negative for H5N1 by microneutralization assay. CONCLUSION: The boy was the first confirmed human case of avian influenza A (H5N1) in the mainland of China and his sister was diagnosed clinically. The most probable explanation of these two cases was that the transmission of H5N1 virus from infected poultry within the same household environment. No evidence of human-to-human transmission was noted in the family cluster.

Animals↗
PubMed2004

Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa.

OBJECTIVE: The current study analyzed the variables related to rehospitalization after total weight recovery in adolescents with anorexia nervosa. METHOD: One hundred and one patients first admitted for inpatient treatment, aged 11-19 years, were followed up for 12 months after discharge. RESULTS: Twenty-five subjects (24.8%) required readmission after complete weight recovery and 76 (75.2%) did not. Duration of disorder, weight loss, body mass index at first admission, and global body image distortion were similar in the two groups. Patients needing readmission had a lower rate of weight gain (p < .001), a lower mean age (p = . 007), a higher mean score on the Eating Attitudes Test (EAT; p = .009), and a higher percentage of hips overestimation (p = .049). In a stepwise logistic regression analysis, these three variables predicted readmission and correctly classified 77.6% of patients. Taken as discrete variables, age younger than 15 years old, EAT score above 55, and a rate of weight gain lower than 150 grams per day were associated with a higher percentage of readmissions. DISCUSSION: The variables most clearly related to readmission were young age, abnormal eating attitudes, and a low rate of weight gain.

Adolescent↗