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At least 1,207 records · Page 67Linked to original sources
PubMed1996

[Experience of 143 cases of laparoscopic surgery in urology--clinical outcome in comparison to open surgery].

(BACKGROUND). The clinical outcome of laparoscopic surgery performed in 143 patients, including laparoscopic adrenalecotmy, nephrectomy, pelvic lymph node dissection (PLND) and varicocele ligation is reported. (METHODS). In patients who underwent laparoscopic adrenalectomy (32 cases), laparoscopic nephrectomy (7) or PLND (44), the following parameters were evaluated and compared to those obtained in patients undergoing the same surgeries but by conventional open procedure; operation time, hospital stay, pain killer doses and the time necessitated for ambulation. (RESULTS). The operation was successful in 95.8% (137/143). Open laparotomy was necessitated in 4 patients to control bleeding (two in adrenalectomy and two for PLND) and in one nephrectomy case due to massive adhesion with the descending colon. The major complication occurred in 4.2% of the cases, but without mortality. The laparoscopic adrenalectomy, nephrectomy and PLND had an average operating time of 260, 304 and 139 minutes, respectively, while the open surgery for each procedure required 251, 212 and 128 minutes, respectively (p = 0. 24 approximately 0.82). Likewise, the total dose of pain killer was 0.8, 1.8 and 0.9 for the former, whereas it was 3.2, 6.0 and 3.9 for the latter, respectively (p < 0.01). The average hospital stay for laparoscopic surgery was 4.9, 6.4 and 4.7 days in the same order, whereas open adrenalectomy or nephrectomy required about 14 days (p < 0.001). Convalescence was completed within significantly shorter term in patients with laparoscopic surgery. Potential complications of laparoscopic surgery included not only those unique to pneumoperitoneum (8.1%), but also those which may be encountered during any endoscopic operation such as compartment syndrome in the lower extremities. The physiologic changes accompanying increased intra-abdominal pressure affected renal function, characterized by a significant decrease in urinary output (p < 0.02), which, however, resumed to normal range within several hours after the operation without causing permanent renal dysfunction. (CONCLUSION). These results suggest that the laparoscopic surgery in certain area in urology has less morbidity and equal accuracy compared with conventional open surgery.

Adolescent↗
PubMed1983

Back transport of neonates: improved efficiency of tertiary nursery bed utilization.

Neonatal back transport is defined as the return of previously critically ill neonates from Level III newborn intensive care units to Level II and Level I nurseries for intermediate and/or convalescing care. During 1980, 172 infants (65% of eligible infants) were back transported from a Level III nursery to both Level I and Level II community hospitals. Infants who were returned to Level II hospitals tended to be smaller at the time of transfer, were less frequently nipple fed, and more frequently required oxygen supplementation compared with infants returned to Level I hospitals. Back transport permitted physicians to defer 3,892 days of hospitalization for these infants to community hospitals, an equivalent savings of approximately ten hospital beds at full occupancy. This resulted in a 44% reduction in the need for services in the newborn intensive care unit. Back transport is an efficient means of dealing with overcrowding of Level III nurseries.

Cost-Benefit Analysis↗
PubMed1978

Intermediate coronary care. Observations on the validity of the concept.

Recognition of significant mortality among hospitalized patients with myocardial infarction after dismissal from the coronary care unit (CCU) has led to the introduction of the intermediate coronary care unit (ICCU). It had been hoped that protracted monitoring during the convalescent phase of acute myocardial infarction might prevent sudden death, as in the CCU. Study of patterns of survival among 1,361 patients with acute myocardial infarction included 814 patients treated prior to the establishment of an ICCU and 557 managed in such a unit. Analysis of the two groups (including such high-risk factors as congestive heart failure, tachyarrhythmias, previous infarction, cardiac enlargement, and other unfavorable manifestations) failed to reveal a reduction in mortality after introduction of the ICCU. Thus, the value of the ICCU cannot be demonstrated in terms of mortality. Other benefits of the ICCU are projected, which include more sophisticated evaluation of the patient prior to discharge from the hospital and expanded opportunities for education of patients. A definite role of the ICCU in the total management of the patient with coronary arterial disease is postulated.

Coronary Care Units↗
PubMed2004

[Implementation of a common clinical path for transurethral resection of prostate (TURP) in multiple hospitals].

PURPOSE: To investigate the length of hospitalization and medical charges when a common clinical path for TURP (transurethral resection of prostate) was implemented in multiple hospitals. PATIENTS AND METHODS: This study included 310 patients in 2001 and 298 in 2002, who were diagnosed with benign prostatic hyperplasia and who underwent TURP in seven hospitals in Japan. While the patients were treated according to the managing methods of each hospital in 2001, the patients were managed using a common clinical path in 2002, on which we conferred and established in 2001. We investigated the change of various outcome indicators before and after implementation of the common clinical path. RESULTS: The background of patients and surgical outcome in 2002 were equal to those in 2001, except in incidence of preoperative urinary tract infection, general anesthesia and blood transfusion, and number of surgeons. Implementation of a common clinical path shortened the pre- and postoperative hospital stay, duration of bed rest, administration of antibiotics and Foley catheter indwelling, and reduced the standard deviation of these indicators. The total medical charge decreased from 515,439 to 491,935 yen. However, outcomes were considerably different among the seven hospitals. Multivariate analyses identified the hospitals, cognitive impairment, preoperative indwelling catheter and preoperative variance as the factors affecting preoperative hospital stay, and the hospitals, co-existing disease, blood transfusion, postoperative urinary tract infection and postoperative variance as factors affecting postoperative stay. Based on these analyses, we determined four exclusion criteria against using a common clinical path: 1) patients requiring examination or surgery other than TURP simultaneously, 2) patients whose ADL disturbance, cognitive impairment, past history and/or coexisting disease are expected to affect postoperative convalescence, 3) patients with a preoperative indwelling catheter just before operation, and 4) patients with preoperative urinary tract infection. By excluding 122 (39.4%) and 129 (43.3%) patients fulfilling the above criteria in 2001 and 2002, respectively, there were reduction in the length of pre- and postoperative hospital stay, and the total admission fee. Furthermore, there were decrease in their standard deviations. CONCLUSIONS: A common clinical path was valid for reducing variance of the critical indicators affecting the clinical course of TURP and shortening the pre- and postoperative stay in the multiple hospitals. It is mandatory to establish the standard perioperative management for TURP from the viewpoint of urologists, under the circumstances of the impending introduction of the Diagnosis Procedure Combination (DPC).

Aged↗
PubMed2000

Nd:YAG laser surgery for the excision of pilonidal cysts: a comparison with traditional techniques.

BACKGROUND AND OBJECTIVE: Nd:YAG laser photothermal ablation has been accepted as a treatment modality for hemorrhoidal disease. There is little reported on its use in treating pilonidal disease. We hypothesized that laser would be an excellent tool for pilonidal cystectomy, facilitating improved outcome and patient satisfaction. STUDY DESIGN/MATERIALS AND METHODS: A 5-year retrospective study was performed comparing Nd:YAG laser to the standard surgical technique. A telephone questionnaire addressing the length of time the cyst was debilitating both preoperatively and postoperatively as well as length of convalescent time before return to work was administered. Pain was assessed by using an analog pain scale. RESULTS: Operative time for the traditional pilonidal cystectomy was 20 minutes longer than Nd:YAG laser cystectomy. Postoperative hospital stay was similar. Laser patients returned to work an average of 2.4 days earlier, and their postoperative pain was less than those treated traditionally. CONCLUSION: In an era when the medical consumer makes decisions based on the efficacy of treatment by using criteria such as pain, length of hospitalization, and speed of return to work, Nd:YAG lasers have emerged as a surgical tool that can fulfill these criteria for certain procedures. Patient postoperative satisfaction after laser excision was greater when compared with those who had traditional excisions. Postoperative pain was less, as was the pain experienced during the first week of recovery. Cost for both was comparable.

Absenteeism↗
PubMed2003

Hemodynamic profiles of patients with dengue hemorrhagic fever during toxic stage: an echocardiographic study.

OBJECTIVE: To study left ventricular performance and hemodynamic abnormalities during different stages of dengue hemorrhagic fever (DHF). DESIGN AND SETTING: Observational study in a tertiary medical school hospital. PATIENTS: Twenty-four patients with serologically confirmed diagnosis of dengue virus infection and DHF according to the WHO criteria. METHODS: Echocardiography was performed during toxic, convalescent stages and at least 2 weeks after discharge (recovery). Left ventricular ejection fraction, rate-corrected velocity of circumferential fiber shortening adjusted for end-systolic meridional wall stress (VCFC/ESS) Z score, end-diastolic volume Z score, cardiac index, heart rate, mean arterial pressure, and total systemic vascular resistance (SVR) were compared between different stages of DHF. RESULTS: Ejection fraction and VCFC/ESS were significantly lower during the toxic stage than after recovery. End-diastolic volume was low during toxic stage and returned to normal during convalescence and recovery. Cardiac index was low during the toxic stage due to decreased preload (low end-diastolic volume) and depressed left ventricular ejection fraction. Cardiac index remained subnormal during convalescence due to sinus bradycardia. Wide variation in heart rate during toxic stage resulted in a small, nonsignificant increase compared to recovery. With treatment, heightened SVR resulted in relatively normal mean arterial pressure throughout the course of the illness. CONCLUSIONS: The mechanism of decreased cardiac output during toxic stage of DHF is complex. Decreased preload is accompanied by decreased left ventricular performance, and possibly a subnormal heart rate response in some patients.

Analysis of Variance↗
PubMed1977

Modern approach to the patient with acute myocardial infarction.

This presentation has described the modern approach to the patient presenting with chest pain suspected as acute myocardial infarction. Noninvasive and invasive methods have been applied to estimate the extent of the myocardial damage and to monitor the electrical, hemodynamic and metabolic changes during the acute phase. In addition to the use of standard analgesics and antiarrhythmics, measurement of the determinants of left ventricular function by noninvasive and invasive techniques provides a physiologic basis for administration of available pharmacologic agents that can alter the afterload, contractile state, preload, heart rate, metabolic state and infarct size. Information from the Swan-Ganz catheter can describe hemodynamic categories that can be optimally managed by regulation of the left ventricular filling pressure. Patients managed in this manner can be identified for early hospital discharge at 7-10 days. Other patients less than 50 years of age or those experiencing recurrent arrhythmias, ischemic pain or evidence of left ventricular dysfunction may be candidates for coronary arteriography and left ventricular angiography before hospital discharge.

Blood Pressure↗
PubMed2002

Laparoscopic donor nephrectomy in the elderly patient.

OBJECTIVES: To evaluate retrospectively the outcome of laparoscopic donor nephrectomy in patients aged 65 years or older, because data regarding tolerance profile and renal allograft outcome of laparoscopic donor nephrectomy in the elderly patient are lacking. METHODS: Since February 1995, 6 patients aged 65 years or older underwent laparoscopic donor nephrectomy for living-related renal transplantation. Patient demographic, intraoperative, and postoperative parameters, as well as renal allograft outcome, were evaluated. RESULTS: The median donor age was 69.5 years (range 65 to 74), and the median American Society of Anesthesiologists score was 2 (range 2 to 3). The median operative time was 240 minutes (range 183 to 298), with a median blood loss of 300 mL (range 150 to 400). No intraoperative complications or open conversions occurred. Postoperatively, the median time to resumption of oral intake was 1 day (range 1 to 3), and the median hospital stay was 3 days (range 2 to 4). The median narcotic analgesic requirement was 17 mg (range 11 to 27) morphine sulfate equivalent, and the median convalescence was 2 weeks (range 1 to 4). The 1-year renal allograft survival was 100% (n = 6). CONCLUSIONS: Laparoscopic donor nephrectomy is well tolerated by the elderly patient and provides satisfactory patient and renal allograft outcome. Although our sample size was small, it appears that laparoscopy is an acceptable modality for renal donation in the elderly population.

Adult↗
PubMed2003

Legionella pneumophila serogroup 1 antibody kinetics in patients with Legionnaires' disease: implications for serological diagnosis.

To evaluate current serological criteria for Legionella pneumophila serogroup 1 (Lp1), the antibody response was prospectively studied in all patients hospitalized for Legionnaires' disease in a Swedish county during 11 y (n = 62). A 4-fold or greater rise in antibody titre to > or = 128 (the minimum convalescent antibody level for diagnosis, as recommended by the Centers for Disease Control and Prevention), using the indirect immunofluorescence antibody test, was found in 21/52 (40%) of tested patients. By referring to the titre levels in healthy residents from the local population (World Health Organization criteria), 45/52 (87%) cases were confirmed serologically. In 21 patients followed longitudinally for 10 y, the median antibody titre fell from 256 (range 32-1024) to 16 (range 2-128) in 3 y. No booster reactions were observed in any patient. After 10 y, the geometric mean titre of this clinical cohort had reached the same level as observed in the background population 5 y earlier. Titre levels in subjects exposed to Legionella from a municipal water system indicate that only 1 out of 10 of all infections are identified clinically. Indirect immunofluorescent antibody testing with local reference sera is a sensitive method for laboratory confirmation of Lp1 in an unselected pneumonia population.

Antibodies, Bacterial↗
PubMed2006

Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired pneumonia in Istanbul, Turkey.

BACKGROUND: To investigate the role of Mycoplasma pneumoniae and Chlamydia pneumoniae infection in pediatric pneumonia, in Istanbul, Turkey, we conducted a prospective study covering all the children between 2 months and 15 years hospitalized for community-acquired pneumonia. METHODS: A total of 140 children (85 males, median age 2.5 years) with community-acquired pneumonia were enrolled. Acute and convalescent sera were tested for IgM and IgG antibodies to M. pneumoniae (enzyme-linked immunosorbent assay, Serion ELISA classic) and for IgM and IgG antibodies to C. pneumoniae (microimmunofluorescence, Savyon, Israel). RESULTS: Mycoplasma pneumoniae infection was diagnosed in 38 patients (27%) and C. pneumoniae infection in 7 (5%). In 2 children M. pneumoniae and C. pneumoniae co infection was observed. The average age of the M. pneumoniae cases was 5.3 years and that of the C. pneumoniae was 1.5 years. The average age of pneumonia cases caused by other pathogens was 3.4 years (p<0.05). No significant difference was observed in clinical onset, signs, symptoms and laboratory parameters in children with M. pneumoniae and C. pneumoniae infection and in those without M. pneumoniae and C. pneumoniae infection. CONCLUSIONS: The results of this study suggest a remarkable role for M. pneumoniae and C. pneumoniae in childhood community-acquired pneumonia, and the knowledge of the true prevalence of these two types of infections discovered in the community might lead to modifications in the present empirical treatment of bacterial pneumonia.

Adolescent↗
PubMed1981

Rubella outbreak among hospital employees.

A rubella outbreak among medical staff on the obstetric service of a large Los Angeles hospital was studied. Fifteen cases of suspected rubella were reported among hospital personnel during a 2-month period in 1978. Of these, 4 were confirmed, 2 by viral isolation and serology and 2 by serologic study alone. A fifth case, the index, had a convalescent-phase serum with an elevated rubella hemagglutination inhibition (HAI) antibody titer. A list of 231 pregnant women who may have been exposed to any of the 15 suspect cases was assembled. The authors succeeded in contacting and obtaining postexposure sera for only 140 (61%) of the exposed women. Thirty-five (25%) of these women were without detectable rubella HAI antibody. A second serum sample was obtained from 93 women 2 to 3 weeks after the first, and no fourfold rises in titer were observed. To evaluate those with suspicious high stationary titers, 60 specimens were selected for immunoglobulin M (IgM) testing. Only 1 was positive for IgM antibody. A postexposure illness survey revealed that 20 (15%) of 130 women reported various rash-like illnesses after their visit to the hospital. There were no reports of affected offspring in any of the exposed women. Four hundred ten staff members submitted sera for antibody testing; 76 (19.2%) were without detectable rubella HAI antibody. This outbreak is discussed in light of recent changes in rubella epidemiology, and several recommendations for hospital policy are proposed.

California↗
PubMed1980

Increased renal perfusion and kidney size in convalescent burn patients.

Renal blood flow was elevated in convalescent burn patients shortly before discharge (992 +/- 112 mL/min/sq m in burn patients vs 551 +/- 37 mL/min/sq m in normal subjects; mean +/- SE). Autopsy studies demonstrated that renal enlargement was a constant feature of patients after a prolonged hospital course; the kidneys of 28 patients who died after 60 days of hospitalization weighed 241 +/- 10 g vs 153 +/- 8 g in control subjects. The increase in renal weight was primarily related to cellular hypertrophy and hyperplasia. These physiological and morphological findings in thermally injured patients may be a form of renal work hypertrophy following increased protein catabolism accompanying severe injury.

Adult↗
PubMed1990

[The incidence of exacerbations in chronic diseases in patients hospitalized with influenza and para-influenza].

A retrospective analysis was made of the case reports of 829 patients admitted to the infectious department with a diagnosis of influenza (592) and parainfluenza (237). In all the patients, the diagnosis was supported serologically with the aid of the hemagglutination inhibition test, with the antibody titer in the serum rising 4-fold and more. In part of the patients the indicated test was used in combination with the immunofluorescence test in studying nasopharyngeal smears, whereas in part of the patients, it was coupled with virological tests. It has been revealed that in addition to the most frequently occurring complications on the part of the bronchopulmonary system and ENT organs caused by the pneumococcal and streptococcal flora, there were complications on the part of the endocrine, urogenital, nervous and gastrointestinal systems, equally in patients with influenza and parainfluenza. In patients with postinfarction cardiosclerosis, influenza B and mixed influenza run the most unfavourable course, provoking deterioration of coronary heart disease in every other patient. In 66.6% of cases, exacerbation of coronary heart disease fell within the period of early convalescence of patients with influenza and parainfluenza.

Adolescent↗
PubMed1990

Limited lateral thoracotomy. Improved postoperative pulmonary function.

A prospective randomized controlled study was designed to determine differences in early postoperative pulmonary function, pain, and complications between patients undergoing limited lateral muscle-sparing thoracotomy. Fifteen patients underwent standard thoracotomy and 13 underwent limited incision with the same anesthetic technique. During the first 24 hours after operation, there were large decreases in the results of spirometric tests of pulmonary reserve (forced expiratory volume in 1 second and forced vital capacity), but these decrements were consistently significantly smaller in the limited-incision group. Other tests of pulmonary function (mid-expiratory phase forced expiratory flow, alveolar-arterial oxygen gradient, and PaCO2), however, demonstrated similar postoperative changes in both groups. Similarly, there were no differences in pain scores, postoperative morphine requirements, complications, or length of hospital stay. Use of the limited muscle-sparing incision resulted in improved postoperative pulmonary reserve, but this did not translate into differences in other measures of postoperative convalescence.

Female↗
PubMed1986

Extraperitoneal approach for aortoiliac reconstruction of the abdominal aorta.

The extraperitoneal approach is not usually used for reconstruction of the abdominal aorta; however, herein we have made an attempt to influence vascular surgeons to modify this practice. The results in 200 patients approached extraperitoneally have been compared with those of 70 patients explored by the traditional transperitoneal route. The expeditious technique of extraperitoneal exploration described results in significantly less postoperative morbidity due to the pulmonary complications of atelectasis and pneumonia. Intestinal ileus is uniformly brief, and rarely requires nasogastric suction. Patients explored extraperitoneally have demonstrably less pain and were discharged from the hospital sooner. Furthermore, prosthetic graft patency and mortality were comparable in both groups. Thus, the retroperitoneal approach should be the preferred method of aortoiliac reconstruction since the postoperative convalescence period is smoother and shorter.

Aged↗
PubMed1990

Homotypic serum antibody responses to rotavirus proteins following primary infection of young children with serotype 1 rotavirus.

The class-specific antibody responses to serotype 1 rotavirus structural proteins were examined by immunoblotting with sera obtained from young children hospitalized with acute rotavirus diarrhea caused by serotype 1. All were believed to be primary infections. Three consecutive samples were obtained from 16 patients during the acute and convalescent phases of the disease and then approximately 4 months later. Immunoglobulin G (IgG)-class antibody responses to two inner capsid proteins (VP2 and VP6) and to the major homologous outer capsid protein (VP7) were detected in all patients. Antibody responses to VP6 were rapid, increased in intensity during 20 to 40 days after the onset of symptoms, and persisted for more than 4 months. Responses to VP2 and VP7 were more delayed, were maximal in convalescent-phase sera, and decreased markedly in intensity 4 months after the onset of symptoms in the majority of children. Two patients with evidence of mixed infection showed persisting high levels of antibody to VP7. Responses to the outer capsid protein VP4 were detected in 67% of patients, peaked at 20 to 40 days after the onset of symptoms, and were no longer detected at 4 months in the majority of patients. It is likely that the immunoblotting technique underestimated responses to VP4. Acute- and convalescent-phase sera (known to contain antirotavirus IgM or IgA measured by enzyme immunoassay) were also examined by immunoblotting. IgM- and IgA-class antibody responses to viral proteins VP2, VP4, and VP7 appeared to be qualitatively identical to those observed for IgG in the same serum samples.

Antibodies, Viral↗
PubMed2003

[Isolation and identification of SARS-coronavirus in nasal and throat swabs collected from clinically diagnosed SARS patients].

OBJECTIVE: To isolate and identify SARS-coronavirus in nasal and throat swabs collected from clinically diagnosed severe acute respiratory syndrome (SARS) patients. METHODS: Nasal and throat swab specimens were inoculated onto well of 24-well plate containing confluent monolayers of Vero and MRC-5 cells. Isolates were identified with serology, electron microscopy and genome sequence. RESULTS: One hundred and fifty-eight nasal and throat swabs specimens from 79 SARS patients in Peking Union Medical College Hospital between April and May, 2003 were cultured for SARS-coronavirus. Cytopathic effect (CPE) was found in three nasal swab specimens inoculated in Vero cells. Acute and convalescent phase serum specimens collected from SARS patients were found with seroconversions and/or a fourfold or greater rises in indirect fluorescence antibodies (IgG and IgM) titers when the 3 isolates (infected Vero cells) were used as antigen. Coronavirus was observed in the culture supernatant by negative-stain electron microscopy. Genome sequence confirmed the isolates were SARS-coronavirus. CONCLUSIONS: The 3 isolates from nasal and throat swabs samples collected from 79 clinically diagnosed SARS patients were SARS coronavirus.

Adolescent↗