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PubMed1979

Mononuclear cell analysis of peripheral blood from burn patients.

Mononuclear and polymorphonuclear cells isolated by Ficoll-hypaque density-gradient sedimentation from peripheral blood of 25 burn patients at 3-to 4-day intervals during hospitalization were subjected to morphologic analysis. The aim was to identify all cells isolated and to examine the cell population characterized as B-lymphocytes. Patterns of response comprised of lymphocytes, monocytes, neutrophils, and precursor cells in varying stages of maturity were delineated. Shortly after thermal trauma, isolated cell pools from all patients contained high proportions of immature cells. In surviving patients during convalescence, the cell pools had increasing proportions of mature cells and corresponding declines in immature cell types. Patients who died did not produce large populations of mature cells at any time during their hospitalization. Cells identified morphologically as lymphocytes were accounted for by E-rosette assay (T-lymphocytes). Cells previously identified as B-lymphocytes appeared morphologically to be monocytes, were positive for Fc and complement receptor activity, and were phagocytically active.

B-Lymphocytes↗
PubMed1994

Access to the thorax by incision.

BACKGROUND: For years the standard access to the thorax has been by posterolateral or other muscle cutting thoracotomy incisions. These are accompanied by significant discomfort and often limitation of shoulder girdle movement. To obviate these distressing features, the less traumatic median sternotomy was recommended. In the last ten years, several types of mini or axillary thoracotomies have been described. We believe that the vertical axillary thoracotomy is the best of these incisions as no major muscles are divided, it can be created rapidly, and exposure is excellent. STUDY DESIGN: We compared the operative approaches from the point of view of the duration of postoperative hospitalization, the length of the operating time, the incidence of postoperative atelectasis, and persistence of incisional pain. RESULTS: The vertical axillary thoracotomy showed a definite advantage in all these categories. CONCLUSIONS: These findings suggest that the vertical axillary thoracotomy is the incision of choice for most thoracic procedures as the incision is small and quickly made. Because there is limited division of muscles, the convalescence is smooth and uncomplicated.

Axilla↗
PubMed2002

[Expected and received assistance from informal social support for aged people in heart surgery].

This study describes and compares the importance and availability of expected and received types of assistance, during the convalescence period at home, from the informal social support network, as perceived by older persons undergoing heart surgery. The research design is descriptive and comparative. Barrera's conceptual framework has been integrated to Roy's model of adaptation. The 45 participants, 31 men and 14 women with a mean age of 74 years (SD = 3.37 years), underwent myocardium revascularisation, valve replacement, or a combination of both surgeries. The day before the heart surgery and one month following the hospital discharge, the participants completed a French modified and adapted version of the "Inventory of Socially Supportive Behaviors" (Lepage, 1984) to identify perceived importance and availability of expected and received types of assistance (material, physical, emotional, guidance, and feedback) while at home on convalescence. Repeated-measure MANOVAs result in significant interactions between importance and availability of assistance, and between the day before heart surgery and one month following hospital discharge in three categories of assistance (emotional, p = 0.002; guidance, p = 0.003; feedback, p = 0.001). ANOVAs indicate that older persons perceive, one month after hospital discharge, the received assistance as important as anticipated the day before their surgery, but its availability is less. It is therefore important for nurses to reevaluate and adapt their pre-operative teaching program for older persons, especially as pertaining to the significant 15 types of assistance, and according to available resources from the informal social support network, and to mobilize the formal support network before hospital discharge.

Aged↗
PubMed1982

Blood pressure changes during convalescence after myocardial infarction.

We have retrospectively studied changes in blood pressure from CCU admission to the end of convalescence after myocardial infarction in 72 consecutive patients less than or equal to 70 years, who did not receive hypotensive therapy before or during the period of observation. Besides confirming previous observations of an initial fall and subsequent rise in blood pressure we have, in addition, identified a difference in response after large compared with smaller infarcts. The rise in systolic blood pressure after larger infarcts appears to be delayed and is greater after leaving hospital (23.3 +/- 18.5 mmHg) (3.09 +/- 2.46 kPa) than after small infarcts (14.4 +/- 19.6 mmHg) (1.91 +/- 2.6 kPa), p less than 0.05. The results emphasise the importance of checking blood pressure during convalescence following a myocardial infarction particularly after larger infarcts.

Adult↗
PubMed1998

Timing of recovery of lung function after severe hypoxemic respiratory failure in children.

OBJECTIVE: To describe the timing of recovery of lung function after severe acute hypoxemic respiratory failure (AHRF) in children. DESIGN: A serial observational follow-up study of clinical and lung function measurements up to 53 months after acute illness. SETTING: University pediatric intensive care unit in a national children's hospital. PATIENTS: Five critically ill children aged 5-14 years. INTERVENTIONS: None RESULTS: Clinical recovery: each patient required a 3-5 month convalescence before being able to attend full-time school because of lethargy and dyspnea. All patients developed wheeze 3-12 months after illness and four received long-term bronchodilator therapy. Lung function recovery: for both the forced vital capacity (FVC) and forced vital capacity in the first second (FEV1) four patients had abnormally low values, regaining only 60-70% of predicted values for their height and sex, and all of this improvement had occurred by 6-12 months after illness. Beyond this interval, patients remained on their same FVC and FEV1 centile. FEV1/FVC ratios were consistently within the normal range, indicating a predominantly restrictive defect. Changes in peak expiratory flow exhibited a time course of improvement similar to the other lung function tests. CONCLUSION: In children, pulmonary recovery after severe AHRF may occur for 6-12 months. A 1-year follow-up could offer a rational single point for assessment of outcome and long-term counselling of child and parents.

Adolescent↗
PubMed1993

Successful interferon-gamma therapy in a chronic granulomatous disease (CGD) patient suffering from Staphylococcus aureus hepatic abscess and invasive Candida albicans infection.

A 16-year old boy with an early history of recurrent lower respiratory tract infections exhibited symptoms of prolonged septic fever and liver abscess. Cultures from liver puncture were positive for Staphylococcus aureus, and the patient initially responded to antibacterial therapy. After a period of 4 months, however, the infection relapsed, and further treatment with broad antibacterial, antifungal and tuberculostatic drugs was ineffective. Neither soluble nor particulate stimuli were found to elicit the respiratory burst response in granulocytes from the patient. Spectral analysis of granulocyte cytochrome-b confirmed the diagnosis of chronic granulomatous disease. Since the patient's physical condition deteriorated severely during the prolonged (10-week) septic course, immunosupportive interferon-gamma was added to the anti-microbial therapy. With this regime, the fever subsided and the general condition of the patient improved dramatically. He could be discharged from hospital 9 weeks after the introduction of interferon-gamma and was, at an elective follow-up control 1 month later, convalescing and showed no signs of active infection.

Adolescent↗
PubMed1994

Patterns of neuroendocrine activation at rest and during exercise following acute myocardial infarction.

Previous studies of neurohumoral activation following myocardial infarction have concentrated on the within-hospital phase and have only made measurements at rest. The objectives of this study were to measure neuroendocrine activity in the early convalescent phase of myocardial infarction at rest and during symptom-limited maximal exercise and to study the effects of early drug therapy. We studied 75 patients, mean age 57 (range 37-74) without evidence of overt heart failure, following Q-wave myocardial infarction. Patients were studied a mean of 17 days following myocardial infarction and compared with 11 age-matched control subjects. Plasma noradrenaline, adrenaline, atrial natriuretic peptide and plasma renin activity were measured at rest, at submaximal and symptom-limited maximal treadmill exercise. At the time of study 40 patients were taking beta-blockers, 19 diuretics and 16 no treatment. Atrial natriuretic peptide levels were higher at rest (P = 0.0001) and at symptom-limited exercise (P = 0.002) in the patient group than in the control subjects. Although there were no significant resting differences between the patient subgroups, at symptom-limited exercise plasma atrial natriuretic peptide levels were significantly higher in the patients taking beta-blockers than in the other patient groups (P = 0.001). Plasma renin activity was no different between the patients and the control subjects at rest or during exercise. Those patients taking diuretics had higher values at rest (P = 0.001) and during exercise (P = 0.005) compared with the remaining patients. There were no significant differences in resting or maximal exercise levels of plasma noradrenaline and adrenaline between the patients and the control subjects (all P > 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1990

[Clinical problems in non-A, non-B viral hepatitis. III. The course of non-A, non-B viral hepatitis in the chronic stages].

Investigation of a group of 231 patients with viral hepatitis non-A, non-B (HNANB) revealed that the majority of cases is of the parenteral type (60.17%) and the remainder was without parenteral procedures. The course of HNANB was icteric in the majority (72.55%). On check-up examination one year after the onset of the acute stage the pathological clinical and laboratory finding, i.e. chronic liver disease still persisted in 31.6%. A follow-up of the patients in the course of six years revealed that the ratio of serious sequelae (chronic active hepatitis and cirrhosis of the liver) is significant and increases with time and thus already after two years these serious diagnoses predominate over the number of patients with chronic persistent hepatitis. The chi2 test revealed that there is no sexual difference as regards the development of the chronic stage of HNANB, that the chronic stage develops in both basic types of HNANB (in the parenteral and the epidemic type) but it is significantly more frequent in the parenteral type. The development of the chronic stage is equally frequent after icteric and anicteric forms. In patients who recovered completely within one year (68.39%) the convalescence was protracted and normalization of the clinical and biochemical finding occurred later than in patients with viral hepatitis A and B, hospitalized during the same period.

Chronic Disease↗
PubMed1986

Bacteriology of hospital-acquired pneumonia.

Hospital-acquired pneumonia was studied prospectively for 3 1/2 years in a 549-bed facility with acute medical-surgical care wards, convalescent wards, and a chronic care unit. Bacteriological studies were limited to transtracheal aspirates, pleural fluid, and blood cultures. The predominant isolates in 159 patients were gram-negative bacilli (47%), anaerobic bacteria (35%), Staphylococcus aureus (31%), and Streptococcus pneumoniae (26%). Nearly half of all specimens yielded a polymicrobial flora with more than one potential pathogen. Distribution of pathogens was similar with analysis of all patients, including patients with a monomicrobial infection and patients with bacteremic pneumonia. The prevalence of cases and distribution of bacteria were similar for patients located on acute medical-surgical wards and those in the nursing home care unit. Nosocomial pneumonia was judged directly responsible for lethal outcome in 19% of patients and a contributing factor to death in another 13%.

Bacteriological Techniques↗
PubMed1981

Implementation of a multidisciplinary nutritional assessment program.

Depending on the severity of malnutrition, protein depletion is associated with general debilitation, inanition, slow healing of wounds, delayed convalescence, increased susceptibility to infection, and other pathophysiologic conditions. In an effort to decrease the incidence and severity of these complications, Hermann Hospital and the University of Texas Medical School at Houston have implemented a comprehensive nutritional assessment program to identify clinical and subclinical malnutrition and to implement aggressive, effective therapy. A multidisciplinary team approach to nutritional assessment, therapy, and research can lead to an increased awareness of the importance of nutritional support and optimal nutritional care for the hospitalized patient under all conditions at all times.

Anthropometry↗
PubMed1995

Nursing criteria for patient progression post myocardial infarction.

Nurses play a pivotal role in the evaluation of patients with coronary artery disease, since many symptoms are subtle and arise while carrying out activities. Consistency among nursing staff in interpreting patient readiness for activity is crucial to ensure that patients are progressing steadily or to determine if a delay in their progression is warranted. While there have been studies on patient reaction to myocardial infarction and on the physiological effects of activity and/or nursing interventions on myocardial patients, no studies could be found that have examined the criteria used by nurses to assess when patients are ready to increase, decrease or maintain a level of activity according to specific activity protocols. This descriptive study examined the criteria utilized by experienced staff nurses in determining post myocardial patients' readiness to progress through the institution's designated activity levels. The results indicated that in-depth criteria were utilized by these experienced nurses and that patient situations existed whereby it was difficult to determine patient readiness. Factors were discovered that were perceived to enhance or inhibit patient's progression through designated activity levels. Recommendations from this study support the need to (a) examine the use of current activity protocols for their utility in nursing decision making, (b) consider the experiential base of practicing nurses as well as the working environment in any further development of activity protocols.

Activities of Daily Living↗
PubMed2001

Evaluation of the efficacy and safety of laparoscopic nephrectomy.

PURPOSE: To evaluate the efficacy and safety of laparoscopic nephrectomy. METHODS: From June 1994 to November 1999, 10 patients underwent laparoscopic nephrectomy at Osaka University Medical Hospital and Osaka Rosai Hospital. Laparoscopic nephrectomy was performed either via transperitoneal or retroperitoneal approach under general anesthesia. These 10 cases were reviewed in respect of primary disease of the kidney, operative time, complications and postoperative convalescence. RESULTS: Of the 10 patients, five were preoperatively diagnosed as having a non-functioning kidney with hydronephrosis, two patients were diagnosed as having an atrophic kidney, two had renal cell carcinoma and one had renal pelvic tumor. The average operative time was 374 min (range 270-675 min). The mean blood loss was 330 mL (range 60-800 mL). One patient required transfusion due to postoperative oozing. The average hospital stay after operation was 7 days. No major postoperative complications were observed. CONCLUSION: Laparoscopic nephrectomy is an option in surgically managing renal disorders, including malignancies, although it has a longer operative time compared to conventional open surgery.

Adult↗
PubMed1984

Patients' evaluation of a post-myocardial infarction teaching programme administered by nurses.

Two-hundred and twenty-eight patients admitted to a District General Hospital Coronary Care Unit with a confirmed myocardial infarction were given a detailed information session by nurses. Information included a detailed programme of exercise during convalescence and attitudes toward diet, smoking and sexual intercourse. Patients were asked to assess the value of these sessions using questionnaires administered during convalescence. Between 76% and 91% of patients considered the presentation necessary and there was a significant improvement in their understanding of what an infarction was. More than 80% of patients found a booklet entitled Recovering from your Heart Attack particularly helpful. The great majority of patients believed that more health education should be given at school and that members of the general public should be taught the techniques of cardio-pulmonary resuscitation. The teaching programme appears to have reduced the admitted smoking habits of patients. On admission 56% of patients were smokers. This fell to 7% at the end of 3 weeks, but had risen to 17% at 6 months.

Attitude to Health↗
PubMed1999

Organization of patient care during the Ebola hemorrhagic fever epidemic in Kikwit, Democratic Republic of the Congo, 1995.

In contrast with procedures in previous Ebola outbreaks, patient care during the 1995 outbreak in Kikwit, Democratic Republic of the Congo, was centralized for a large number of patients. On 4 May, before the diagnosis of Ebola hemorrhagic fever (EHF) was confirmed by the Centers for Disease Control and Prevention, an isolation ward was created at Kikwit General Hospital. On 11 May, an international scientific and technical committee established as a priority the improvement of hygienic conditions in the hospital and the protection of health care workers and family members; to this end, protective equipment was distributed and barrier-nursing techniques were implemented. For patients living far from Kikwit, home care was organized. Initially, hospitalized patients were given only oral treatments; however, toward the end of the epidemic, infusions and better nutritional support were given, and 8 patients received blood from convalescent EHF patients. Only 1 of the transfusion patients died (12.5%). It is expected that with improved medical care, the case fatality rate of EHF could be reduced.

Algorithms↗
PubMed1992

Management of acute asthma.

Patients with acute asthma experience increased airway obstruction, increased work of breathing, and ventilation-perfusion mismatch. Careful observation and assessment of the patient are fundamental for successful treatment. Therapy is dictated by the severity of the acute episode. Prevention of subsequent flares of asthma needs to be initiated as the patient convalesces.

Acute Disease↗
PubMed1991

Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers.

OBJECTIVE: To determine the efficacy of ciprofloxacin therapy in eradicating convalescent fecal excretion of salmonellae after acute salmonellosis. DESIGN: Randomized, placebo-controlled, double-blind trial of ciprofloxacin, with prospective follow-up of nonparticipants. SETTING: An acute care community hospital experiencing an outbreak of salmonellosis. PATIENTS: Twenty-eight health care workers developed acute infection with Salmonella java; 15 participated in a placebo-controlled trial of ciprofloxacin, beginning on day 9 after infection. INTERVENTIONS: Eight patients were randomly assigned to receive ciprofloxacin, 750 mg, and 7 patients to receive placebo; both were administered orally twice daily for 14 days. Nonparticipants who received therapy were placed on the same ciprofloxacin regimen. MEASUREMENTS AND MAIN RESULTS: Study participants had follow-up stool cultures every 3 days initially and then weekly for 3 weeks; nonparticipants were followed until three consecutive cultures were negative. All eight ciprofloxacin recipients showed eradication of S. java from stool cultures within 7 days of beginning therapy (compared with 1 of 7 placebo recipients), and their stool cultures remained negative up to 14 days after discontinuing therapy (P less than 0.01). However, 4 of 8 relapsed; their stool cultures became positive between 14 and 21 days after therapy. In addition, 3 of 3 hospitalized patients treated with ciprofloxacin who did not participate in the controlled trial also relapsed. Thus, the total relapse rate was 7 of 11 (64%; 95% CI, 31% to 89%). In 4 of these 7 patients, relapse was associated with a longer duration of fecal excretion of salmonellae than that of the placebo group. Relapse could not be explained on the basis of noncompliance, development of resistance, or presence of biliary disease. CONCLUSIONS: Despite its excellent antimicrobial activity against salmonellae and its favorable pharmacokinetic profile, ciprofloxacin at a dosage of 750 mg orally twice daily had an unacceptably high failure rate in patients with acute salmonellosis and may have prolonged fecal excretion of salmonellae. The late occurrence of relapses indicates the need to obtain stool cultures up to 21 days after therapy to document fecal eradication in acute salmonellosis.

Acute Disease↗