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PubMedDate not supplied

Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance.

The metabolic response to injury and illness as manifested by increases in energy expenditure and nitrogen losses makes it difficult for the clinician to evaluate calorie and protein needs. A method for determining daily calorie needs in hospitalized patients is presented. Average increases in resting metabolic expenditure for a group of patients following elective operation, skeletal trauma, skeletal trauma with head injury, blunt trauma, sepsis and burns were determined by indirect calorimetry and protein need by urinary nitrogen losses over extended time periods. Total daily calorie needs were then calculated, using the Harris-Benedict equation and adjusting this value upward using a previously measured activity and injury factor to arrive at the daily needs. Protein requirements may be determined on periodic 24 hour urine samples analyzed for the urinary urea nitrogen and adjusting this to a total nitrogen or protein equivalent. This approach to estimating the calorie nitrogen needs of the hospitalized patient under various degrees of stress more closely approximates the patient's variable needs at the height of the catabolic response and during convalescence.

Basal Metabolism↗
PubMedDate not supplied

Rhoades Lecture. Effect of infection on nutrient requirements.

All infections, no matter how mild, decrease nutrient intakes and increase nutrient losses even when subclinical. The losses include decreased intestinal absorption, direct loss of nutrients in the gut, internal diversion for metabolic responses to infection and increased basal metabolic rate when fever is present. In this way, infection influences not only protein and energy status but also that of most other nutrients. The clinical importance of these consequences of infection depends on the prior state of the individual, the nature and duration of the infection, and the diet of the individual during the infection, particularly dietary intake during the convalescent period and whether full recovery takes place before another infection occurs. In industrialized countries particular attention must be paid to the nutrition of hospitalized patients inasmuch as they are frequently debilitated by their primary disease, morbidity, and nutritional status. Morbidity and mortality are increased by nosocomial infections to which the poorly nourished individual is more susceptible.

Bacterial Infections↗
PubMed1992

Effect of infection on nutritional status.

All infections no matter how mild decrease nutrient intakes and increase nutrient losses even when subclinical. The losses include decreased intestinal absorption, direct loss of nutrients in the gut, internal diversion for metabolic responses to infection and increased BMR when fever is present. Infection influences in this way not only protein and energy status but also that of most other nutrients. The clinical importance of these consequences of infection depends on the prior state of the individual, the nature and duration of the infection and the diet of the individual during the infection, particularly dietary intake during the convalescent period and whether full recovery takes place before another infection occurs. In industrialized countries particular attention must be paid to the nutrition of hospitalized patients since they are frequently debilitated by their primary disease, morbidity, and their nutritional status. Morbidity and mortality are increased by nosocomial infections to which the poorly nourished individual is more susceptible.

Child↗
PubMed1994

Twenty-four-hour beta-endorphin secretory pattern in stroke patients.

BACKGROUND AND PURPOSE: Abnormalities of hypothalamo-pituitary-adrenocortical axis function have been observed frequently in stroke patients. The aim of this study was to investigate plasma beta-endorphin and cortisol 24-hour secretory patterns in patients early after stroke and in the convalescent period to evaluate a possible influence of brain damage on hormonal circadian pattern. METHODS: Patients (n = 15; age, 46 to 75 years) were evaluated in the first 24 hours and 10 days after hospital admission for ischemic cerebral stroke and compared with 15 age- and sex-matched normal subjects. Blood samples for beta-endorphin and cortisol determination were drawn every 4 hours from 8 AM to 8 PM and every 2 hours from midnight to 6 AM. RESULTS: Mean 24-hour beta-endorphin and cortisol levels, recorded in the acute phase, were significantly (P < .05) higher than those recorded in normal subjects; circadian rhythm was not demonstrable for either hormone. In the convalescent period, plasma cortisol 24-hour mean values and circadian rhythm returned to the normal range, whereas the plasma beta-endorphin 24-hour mean values and circadian rhythm did not. CONCLUSIONS: Cerebral stroke induces abnormalities of beta-endorphin and cortisol circadian secretion. Whereas cortisol abnormalities are transient, those of beta-endorphin last longer. The dissociation between beta-endorphin and cortisol 24-hour secretory patterns might potentially serve as a marker of psychoneurological abnormalities occurring after stroke.

Aged↗
PubMedDate not supplied

Retroperitoneoscopic lumbar sympathectomy for buerger's disease: a novel technique.

BACKGROUND: The conventional lumbar sympathectomy procedure through the extraperitoneal route requires a muscle cutting-splitting incision, which leads to significant postoperative pain and prolonged convalescence. With increasing experience in retroperitoneoscopic procedures, we did a pilot study to explore the role of retroperitoneoscopy in lumbar sympathectomy. We describe herein our technique used for the surgery. METHODS: The patient was placed in a lateral position. A 15-mm incision was made just below the 12th rib, and retroperitoneal space was created using blunt finger dissection. A custom-made, large balloon was inserted and inflated with the equivalent of 750 mL to 1000 mL of saline. The second 10-mm port was placed in line with the first port above the iliac crest. The third and fourth 5-mm ports were placed anterior to the first 2 ports. Peritoneum was retracted anteriorly. The medial border of the psoas muscle was used as a landmark and a chain identified immediately medial to it. Lumbar vessels were ligated on the right side. The first to fourth lumbar sympathetic ganglia were removed with the intervening chain. The port sites were closed without a drain. RESULTS: We attempted and successfully completed this procedure in 8 patients; 6 on the left side and 2 on the right side. The average operating time was 38 minutes. The mean hospital stay was 1.5 days. All patients had symptomatic pain relief and clinical improvement. CONCLUSIONS: Retroperitoneoscopic lumbar sympathectomy is a safe and effective procedure. It has a short convalescent time and minimal morbidity; hence, it is a viable alternative for the open procedure.

Adult↗
PubMed1988

Does isolation of patients with infections induce mental illness?

Forty-one patients admitted into single-bedded isolation cubicles in an infectious diseases unit were assessed for evidence of mental disturbance. By use of the Crown-Crisp Experimental Index as a measure of mental state, the scores for somatic anxiety, free floating anxiety, and the total score were found to be significantly raised on admission, falling towards those found in a control general practice population by the time of discharge from hospital. Higher scores were associated with a past history of mental illness. There was, however, no statistical correlation between the psychological indices and consumption of alcohol, smoking, or patient's sex. Clinically apparent behavioural disturbance, mainly anxiety and agitation, was seen in 12 patients. Overall, patients expressed a preference for single rooms and did not find the isolation rituals disconcerting. The findings indicate that anxiety in patients with acute infections is more related to their illness and referral to hospital than to their imposed isolation. Only those patients with a past psychiatric history are likely to benefit from transfer to an open ward during convalescence.

Adaptation, Psychological↗
PubMed1988

Work of a rehabilitation medicine service.

The results of the work of the Edinburgh Rehabilitation Medicine Service in one year were evaluated. Over 1400 new patients were seen, of whom 525 were in hospital at the time. Patients most often referred were those who had had cardiovascular accidents, back pain, lower limb amputations, and head injuries and those convalescing after heart surgery. Most patients had several problems. Many were referred so that they could obtain wheelchairs or other appliances, or for assessment of their ability to drive. Only 3% of the referrals were considered inappropriate. Of the inpatients, 455 (87%) returned home after treatment, but 13 (2%) did not respond satisfactorily to rehabilitation. Twelve per cent (18% of the inpatients) were referred from other health boards, suggesting a need for similar facilities elsewhere.

Persons with Disabilities↗
PubMed1997

White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children.

We evaluated the applicability of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and absolute neutrophil count (ANC), in the screening of pneumococcal (PNC) pneumonia in children. In 1981-1982, 161 children were treated for radiologically verified community-acquired pneumonia in the hospital during a period of 12 months. The Streptococcus pneumoniae aetiology of infection was studied by antigen, antibody and immune complex assays in acute and convalescent sera. In acute blood samples, CRP was measured by the immunonephelometric method, ESR by the Westergren method, WBC using an automatic cell counter, and thereafter the ANC was calculated after microscopic examination of peripheral smears. CRP and ESR were significantly higher in patients with alveolar (n=53) than in those with interstitial (n=108) pneumonia. CRP, ESR and ANC were significantly higher in PNC (n=29) than in viral (n=23) pneumonia. The values in mixed PNC and viral infections (n=17) were approximately midway between PNC and viral cases. All cases with serologic evidence of S. pneumoniae aetiology were combined (n=46) for calculation of diagnostic parameters. When a cut-off limit of 60 mg x L(-1) was used, CRP had a sensitivity of 26% and a specificity of 83% in the screening of PNC pneumonia. We conclude that C-reactive protein and erythrocyte sedimentation rate have a limited capacity to differentiate between pneumococcal and nonpneumococcal pneumonia. C-reactive protein is recommended as the first-line method of screening, and the value of 60 mg x L(-1) as the cut-off limit.

Adolescent↗
PubMed1983

Original antigenic sin in dengue.

Sequential blood samples were obtained from eight Thai children before, during and 3-5 months after hospitalization for dengue shock syndrome. All patients experienced a secondary-type antibody response as evidenced by hemagglutination-inhibition antibody responses in acute and convalescent sera. Dengue 2 viruses were recovered from two patients. In their pre-illness blood sample, all children had monotypic neutralizing antibodies; five to dengue 1, two to dengue 3 and one to dengue 4. The highest neutralizing antibody titers in acute phase and late convalescent sera were to the initial infecting virus type. This report documents for sequential dengue infections the existence of an original antigenic sin antibody response. It may be possible to apply this phenomenon to identify initial dengue serotype infection in individuals experiencing secondary dengue infections, thus helping to clarify the antecedents to dengue shock syndrome.

Adolescent↗
PubMed2004

[Tension-free laparoscopic versus open inguinal hernia repair].

AIM: During the last decade laparoscopic techniques have been applied to the treatment of inguinal hernia to combine tension-free technique, esthetic, and functional benefits of mini-invasive surgery. Anyway controversy persists regarding the most effective inguinal hernia repair. The aim of this study is to compare the open technique and the laparoscopic approach concerning: complications, recurrences, recovery time and return to usual activity. METHODS: A randomized prospective analysis of 121 consecutive inguinal hernia repairs was performed over a 12-month period. Male well-informed patients with primary monolateral inguinal hernia (ASA I-II) were divided into 2 groups and consecutively treated; group A was treated with laparoscopic transabdominal preperitoneal approach (TAPP) (median age 47+/-7 years, 57 patients), group B with open mesh herniorrhaphy (45+/-6 years, 64 patients). RESULTS: Complication rate was 5.26% for group A (none needed conversion) and 4.68% for group B. All complications were considered minor. No recurrences were observed over a 12-month follow-up in both groups. Post-operative hospital stay and return to activity show statistically significant differences. Median post-hospital stay was 1.7 days for group A while it was longer (2.9 days) for group B. Significant difference was observed in the duration of convalescence too (group A 9.3+/-7.2 days; group B 12.1+/-7. 1 days). CONCLUSION: On the basis of our experience, even if a longer follow-up is needed, the validity of laparoscopic approach to inguinal hernia is confirmed. General anesthesia and higher costs are reasonable compromises for a shorter period of discomfort in patients with a low ASA index and busy job/sport activity.

Adult↗
PubMedDate not supplied

The suprapubic cruciate incision for laparoscopic-assisted microceliotomy.

OBJECTIVES: To introduce cruciate microceliotomy for performing conventional open surgery maneuvers at laparoscopy without conversion to standard laparotomy. METHODS: Retrospective review of all pelvic operations performed by this method by a single surgical team at one institution from 1993 through 1996. RESULTS: We found the cruciate incision to provide excellent exposure for the performance of extensive uterine suture-reconstruction, morcellation, tubal microsurgery, and bowel surgery with excellent cosmetic and convalescent results in a series of 94 patients. No wound-related complications were noted. Postoperative analgesic requirements averaged 4.1 oxycodone/acetaminophen tablets per day, and hospital stay averaged 36 hours. CONCLUSION: In our experience, cruciate microceliotomy represents a useful, minimally-invasive adjunct for the performance of open surgical maneuvers at laparoscopy.

Abdomen↗
PubMed2002

Basic fibroblast growth factor among children with diarrhea-associated hemolytic uremic syndrome.

Diarrhea-associated hemolytic uremic syndrome (D+HUS) is characterized by endothelial injury and activation of inflammatory cytokines. Basic fibroblast growth factor (bFGF) is an angiogenic peptide released in response to vascular damage. The plasma concentrations and urinary excretion of bFGF during the course of D+HUS were determined, in comparison with the levels of various inflammatory cytokines, and changes were correlated with clinical and laboratory features of the disease. Serial plasma and urine samples were collected from 31 children with D+HUS, during the acute (days 1 to 7 of hospitalization) and recovery (through day 60 after discharge from the hospital) phases of the disease. The patients were enrolled in the multicenter trial of SYNSORB Pk (SYNSORB Biotech, Calgary, Alberta, Canada) treatment for D+HUS. bFGF, interleukin-1alpha (IL-1alpha), IL-8, and tumor necrosis factor-alpha levels were determined with enzyme-linked immunosorbent assays. bFGF was detected in urine and plasma samples more frequently than were IL-1alpha, IL-8, and tumor necrosis factor-alpha. There was an acute increase in urinary bFGF excretion, which returned to normal during convalescence. Urinary excretion of bFGF during the acute phase was higher among patients who required dialysis, compared with those who did not (48.9 +/- 15.0 and 28.9 +/- 9.0 pg/ml, respectively; P < 0.05). Plasma bFGF concentrations were persistently elevated throughout the period of hospitalization and the follow-up period among patients with D+HUS. Urinary excretion and plasma levels of bFGF were comparable for the SYNSORB Pk-treated (n = 19) and placebo-treated (n = 12) groups. Measurements of urinary and plasma concentrations of bFGF among patients with D+HUS may be useful indices for assessment of the severity of acute renal disease and the timing and adequacy of the systemic angiogenic process during early convalescence.

Adolescent↗
PubMed1990

Management of institutional outbreaks of Salmonella gastroenteritis.

The number of reports of outbreaks of salmonella gastroenteritis in hospitals has decreased since 1984 but the number of outbreaks in institutions such as old peoples' homes have increased during 1988. Foods, particularly chickens, remain a source of salmonellae and particular attention has to be paid to training and practices in food preparation areas. Staff who are convalescent are very unlikely to be sources of salmonella and do not need to be excluded unless they handle food that receives no further cooking. Outbreaks that do occur can usually be controlled by patient isolation and good control-of-infection measures and an effective Major Outbreak Control Plan is necessary. In some large old hospitals cross infection outbreaks may continue despite good control-of-infection measures. Antibiotics have been contraindicated in the treatment of salmonella gastroenteritis, but the new 4-quinolone antibiotics have demonstrated potential. Ciprofloxacin was used successfully in two outbreaks of salmonella gastroenteritis at a dose of 500 mg bd orally for seven days. Relapses did not occur and resistance did not develop. Ciprofloxacin should be considered as a therapeutic adjunct to control of infection measures in cross infection outbreaks in these situations.

Anti-Bacterial Agents↗
PubMed1996

[The communal hygiene problems of hospital institutions].

The study covers 17 hospitals on the territory of the Capital Community, including their clinics, departments and rooms for treating of social significant and other diseases. The analysis reveals a number of negative aspects: inappropriate situation, insufficiency or lack of green areas, unfavourable aspect of the rooms, overcrowding, insufficient area of the windows, irrational heating regime, lack of ventilation regime, etc. Undesirable parameters of the microclimate are observed in the patients' rooms and this leads to discomfort to the patients and prolonging of the convalescent period. A study on a large scale for the town of Sofia is presented which aims at revision of the current building norms and requirements in respect of their correction and the improving the future building of hospitals in our country.

Adolescent↗
PubMed1991

[Prevalence of Chlamydia pneumoniae infection among pneumonias in a sample of Spanish hospital population].

BACKGROUND: The importance of Chlamydia pneumoniae as a cause of respiratory tract infection in humans has been shown recently. There is no data in Mediterranean countries about C. pneumoniae infection. METHODS: We tested acute and convalescent serum collected from 103 Spanish pneumoniae patients from 1979 to 1987. The microimmunofluorescent test (MIF) with C. pneumoniae and other Chlamydia antigens to exclude cross reactions was used. Serological evidence of current infection was a fourfold rise in IgG antibody titer o titer 1/6 in the IgM serum fraction in the MIF test. RESULTS: The mean age of the patients was 52 years (typical deviation 18, with an age range of 13 to 83) and 75% were male. Serological data of recent infection was found in four of the 103 patients and 59 had antibodies in the IgG fraction indicative of previous infection. CONCLUSIONS: These finding show that C. pneumoniae is associated with pneumonia in Spain and that there is a wide contact with this agent in the patient population with lower respiratory tract infection.

Adolescent↗
PubMed1996

[The assessment of functional status in hospitalized elderly patients: the Plutchik scale].

BACKGROUND: To study the usefulness of the Plutchik Scale to measure functional capacity in daily activities of hospitalized elderly patients. PATIENTS AND METHODS: A sample of 300 patients stratified by age and sex (111 male and 189 female), mean age 81 years, hospitalized in the Geriatric Unit, was selected from all the patients admitted to our Unit along the year 1994 (n = 974, mean length of stay in acute beds 15 days, in convalescent beds 57 days, total 19 days). Scores of patients in the Plutchik Scale, Katz Activities of Daily Living and Barthel ADL Index were obtained. Ninety seven of the subjects were rated by two independent observers. RESULTS: The kappa statistic of interrater reliability in Plutchik Scale scoring was high (0.807). There was a good correlation between the three instruments at cut-points for autonomy/dependence: 0.824 for cut-points 4/5 in Plutchik Scale and 2/3 in Katz Activities of Daily Living; 0.846 for cutpoints 4/5 in Plutchik Scale and 55/60 in Barthel ADL Index (p < 0.01). The coefficient alpha (Cronbach) in Plutchik Scale was 0.876 and the standardized alpha 0.868, which reflect that the Plutchik Scale is internally consistent. By factor analysis one factor was obtained explaining 58% of the variance. The factor showed the highest correlation with "washing/dressing" (0.861) and lowest with "vision" (0.349). CONCLUSIONS: The Plutchik Scale is a good instrument for measuring functional capacity in hospitalized elderly patients.

Activities of Daily Living↗
PubMed1997

What is the role of the pharmacist in home care?

Pharmacists provide a wide range of medications, along with health and convalescent aids, for patients at home. Traditionally community pharmacists have been viewed as providers of prescription and nonprescription medications administered orally. Today pharmacists in community and hospital pharmacies across the country have expanded their services for the homebound patient and provide a variety of sophisticated products and services in the patient's home.

Community Pharmacy Services↗
PubMed1979

Immediate reconstruction of gunshot injuries to the face.

In the past, severe traumatic injuries to the face resulting from shotgun injuries have been managed by primary wound healing followed by little or late reconstruction. This would involve a long period of convalescence by the patient, followed by years of living with his deformity. With recent demands to minimize the patient's suffering and disabilities and to lessen hospitalization costs, a method of immediate reconstruction of such crippling facial injuries using a partially de-epithelialized skin flap has been devised and successfully applied to the patient presented here.

Adult↗