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PubMed2002

Comparison of hand assisted and standard laparoscopic radical nephroureterectomy for the management of localized transitional cell carcinoma.

PURPOSE: Hand assisted laparoscopy affords the surgeon tactile sensation and blunt dissection, which are currently limited using the standard laparoscopic technique. Therefore, we compared standard and hand assisted laparoscopic radical nephroureterectomy for localized upper tract transitional cell carcinoma. MATERIALS AND METHODS: The medical records of 27 patients who underwent standard (11) or hand assisted (16) laparoscopic radical nephroureterectomy between April 1998 and January 2001 were retrospectively reviewed. The parameters of efficacy, efficiency, safety and convalescence were compared. RESULTS: Mean patient age was 64 and 66 years (p = 0.72) in the standard and hand assisted groups, and the mean American Society of Anesthesiologists score was 2.5 and 2.7 (p = 0.64), respectively. All standard and 15 of the 16 hand assisted (94%) procedures were successfully completed via laparoscopy. Total operative time was more than 1 hour shorter for hand assisted than for laparoscopic radical nephroureterectomy (4.9 versus 6.1 hours, p = 0.055). Mean estimated blood loss was similar in the standard and hand assisted groups (190 and 201 ml., p = 0.78). In each group 1 patient required blood transfusion. Mean specimen weight was significantly higher in hand assisted cases (576 versus 335 gm., p = 0.036). Mean time to oral intake was similar in patients who underwent standard and hand assisted laparoscopic radical nephroureterectomy (13 and 20 hours, respectively, p = 0.45). The mean analgesic requirement was also similar (29 and 33 mg. morphine sulfate, respectively, p = 0.83). Mean hospital stay in uncomplicated cases was similar for standard and hand assisted surgery (2.9 and 2.5 days, respectively). Overall hospital stay in the 2 cohorts was also similar (3.3 and 4.5 days, respectively, p = 0.59). Four patients per group experienced postoperative complications. There were no deaths in the standard group but 1 patient (6%) in the hand assisted group died postoperatively. Mean time to partial and complete convalescence in the standard and hand assisted groups was 2.4 and 5.2, and 3.5 and 8.0 weeks, while mean followup was 27.4 and 9.6 months, respectively. CONCLUSIONS: Compared with standard laparoscopy hand assisted laparoscopy decreases operative time without significantly altering short-term parameters of convalescence. However, long-term convalescence after hand assisted laparoscopic radical nephroureterectomy is 1 to 3 weeks longer (p = 0.27). Longer followup in the hand assisted cohort is necessary to determine whether there are any differences in the 2 methods in regard to cancer control.

Aged↗
PubMed1986

Prognostic significance of the treadmill exercise test performance 6 months after myocardial infarction.

A submaximal treadmill exercise test performed before hospital discharge after an uncomplicated myocardial infarction is often utilized to estimate prognosis and guide management, but there is little experience with a maximal exercise test performed 6 months after infarction to identify prognosis later in the convalescent period. The performance characteristics during an exercise test 6 months after myocardial infarction were related to the development of death, recurrent nonfatal myocardial infarction and coronary artery bypass surgery in the subsequent 12 months (that is, 6 to 18 months after infarction) in 473 patients. Mortality was significantly greater in patients who exhibited any of the following: inability to perform the exercise test because of cardiac limitations, the development of ST segment elevation of 1 mm or greater during the exercise test, an inadequate blood pressure response during exercise, the development of any ventricular premature depolarizations during exercise or the recovery period and inability to exercise beyond stage I of the modified Bruce protocol. By utilizing a combination of four high risk prognostic features from the exercise test, it was possible to stratify patients in terms of risk of mortality, from 1% if none of these features were present to 17% if three or four were present. Recurrent nonfatal myocardial infarction was predicted by an inability to perform the exercise test because of cardiac limitations, but not by any characteristics of exercise test performance. Coronary artery bypass surgery was associated with the development of ST segment depression of 1 mm or greater during the exercise test. Although clinical evidence of angina and heart failure 6 months after infarction was predictive of subsequent mortality among all survivors, among the low risk group without severely limiting cardiac disease, the exercise test provided unique prognostic information not available from clinical assessment alone. Therefore, a maximal exercise test performed 6 months after myocardial infarction is a valuable, noninvasive tool to evaluate prognosis. It provides information that is independent of and additive to clinical evaluation performed at the same time.

Adrenergic beta-Antagonists↗
PubMed1996

Chlamydia pneumoniae as a cause of community-acquired pneumonia in hospitalized patients in Berlin.

The incidence of community-acquired pneumonia due to Chlamydia pneumoniae was evaluated in a 1-year prospective study of 236 hospitalized patients with 237 manifestations of pneumonia. The microbiological diagnosis was based on results of cultures of blood and sputum or bronchoalveolar lavage fluid and results of complement fixation tests and indirect immunofluorescence of acute- and convalescent-phase sera for C. pneumoniae, Mycoplasma pneumoniae, Legionella species, Coxiella burnetii, and respiratory viruses. Diagnosis of acute C. pneumoniae infection was made on the basis of the results of microimmunofluorescence of paired serum samples. A microbiological diagnosis was obtained in 160 cases (67.5%). C. pneumoniae was the causative agent in 27 patients (11.4%). The following organisms were the other etiologic agents of pneumonia: Streptococcus pneumoniae, 30 cases (12.7%) (bacteremia occurred in 53.3%); Mycoplasma pneumoniae, 22 (9.3%); respiratory viruses, 22 (9.3%); and Enterobacteriaceae, 18 (7.6%). The prevalence of C. pneumoniae antibody in our study population was 47.5%. As has been increasingly reported in recent years and confirmed by this study, C. pneumoniae appears to be a common etiologic agent of community-acquired pneumonia and upper respiratory tract infection in Germany.

Adolescent↗
PubMed2001

How parents of premature infants gather information and obtain support.

PURPOSE: To identify the process by which parents of premature infants seek information, the kinds of information they seek, and the resources they use to meet their educational and support needs. DESIGN/SAMPLE: Descriptive study using 19 parent interviews and 64 questionnaires. MAIN OUTCOME VARIABLE; The process parents use to obtain information and support. RESULTS: Parents of premature infants make a transition from being passive recipients of information to actively seeking it. They spend 10-20 hours a week gathering information during the first month of the baby's hospitalization. They desire more information than is provided, particularly in the areas of infant health, infant care, and coping. Family is the primary source of support prior to birth and after discharge, but during the infant's convalescence, nurses are the main source of support and help for parents in understanding and adapting to their baby. Many parents would use a computer-based resource for information if it were available to them.

Adaptation, Psychological↗
PubMed1988

A comparison of laparoscopy and laparotomy for the treatment of ectopic pregnancy.

A case-control method was used to examine differences in outcome between laparoscopy and laparotomy for the treatment of ectopic pregnancy. Cases and controls, 25 each, were matched by criteria selected to minimize differences in preoperative morbidity and technical difficulty. Patients treated laparoscopically had significantly shorter hospital stays (1.34 +/- 0.8 versus 3.92 +/- 1.1 days; mean +/- SD; P less than .01) and less operating time (77.5 +/- 26.1 versus 103.6 +/- 26.7 minutes; P less than .05). In addition, a laparoscopic approach resulted in a shorter convalescence (8.7 +/- 7.8 versus 25.7 +/- 16.2 days; P less than .01) and reduced postoperative analgesia requirements (0.84 +/- 2.3 versus 4.64 +/- 2.9 doses; P less than .01). We conclude that laparoscopic treatment of ectopic pregnancy is well tolerated by patients and, in comparison with laparotomy, requires fewer medical resources, thereby significantly reducing cost.

Convalescence↗
PubMed2001

Retroperitoneal laparoscopic versus open pyeloplasty with a minimal incision: comparison of two surgical approaches.

OBJECTIVES: To compare the complications, hospital stay, and functional results of retroperitoneal laparoscopic (RL) pyeloplasty versus open pyeloplasty (OP) with a minimal subcostal incision. METHODS: From October 1997 to January 2000, 53 consecutive nonrandomized patients underwent 26 RL pyeloplasties, of which 1 was bilateral (group 1), and 28 OP (group 2). The decision between the two techniques depended on the patient's anesthetic ability to tolerate RL, previous ureteropelvic junction surgery, associated renal pathologic findings, and the surgeon's laparoscopic experience. Subjective outcomes as to postoperative pain and convalescence and objective findings on intravenous urography were assessed at 3 months postoperatively in both groups. RESULTS: The mean operating time (165 versus 145 minutes) and mean blood loss (92 versus 84 mL) were similar in both groups. No intraoperative complications occurred in either group; in group 1, 1 patient required open conversion. Postoperative complications occurred in 11.5% of group 1 and 14.3% of group 2. The mean hospital stay was 4.5 days for group 1 and 5.5 days for group 2. At 3 months, 23 patients (92%) in group 1 and 25 (89.2%) in group 2 were pain-free or improved. Intravenous urography showed a patent ureteropelvic junction in all cases and improvement of hydronephrosis in 88.5% of group 1 and 89.3% of group 2. CONCLUSIONS: The incidence of complications, hospital stay, and functional results were equivalent for RL pyeloplasty and OP with a minimal incision, but the return to painless activity was more rapid with laparoscopy in younger patients.

Adolescent↗
PubMed1979

Hepatitis types A, B, and non A--non B in childhood.

199 children with acute hepatitis hospitalized between 1968 and 1978 were tested for serological markers of hepatitis A and B infection. In 24 out of 28 HBsAg-positive patients, hepatitis B infection was diagnosed because of the disappearance of the antigen during convalescence. The histories of the 171 HBsAg-negative children suggested acute hepatitis A infection in 69% of the patients. This diagnosis could be confirmed in 110 of the 116 tested cases (95%) by a more than fourfold increase in the anti-HAV titer or by detection of anti-HAV of the IgM class. In the 55 HBsAg-negative patients without epidemiological clues as to the type of hepatitis, 40 children exhibited anti-HAV which could be related to acute A infection in 21 out of 22 tested cases. At least 11 patients had to be classified as having nonn A--non B infection. The results indicate that a combination of evaluation of the patient's history and selected serological tests will permit a fast preliminary diagnosis. This is important in the clinical management of patients and protection of contacts with immunoglobulin.

Age Factors↗
PubMed1980

Elevated CSF cyclic AMP concentrations in patients with inflammatory diseases of cerebral and extracerebral origin.

Cyclic 3'-5' adenosine monophosphate (c-AMP) concentrations were measured in cerebrospinal fluid (CSF) from children admitted to the hospital because of suspected meningitis. c-AMP levels were found to be markedly elevated (P < 0.001) during the acute phase of most of the purulent meningitis patients, as well as in patients with acute aseptic meningitis. In convalescent patients after purulent meningitis mean c-AMP concentrations remained elevated (P < 0.01) beyond the normalization of the routine parameters in CSF. In addition, a variety of febrile inflammatory conditions of extracerebral origin produced elevations (P < 0.001) of c-AMP although CSF by routine criteria was normal. The results suggest that c-AMP might serve as a sensitive indicator of transient cellular metabolic disturbance in the brain.

Adolescent↗
PubMed1997

Predicting patients' deterioration and recovery.

The purpose of this study was to identify patient cues that expert nurses identify as a patient moves to/from deterioration and/or recovery. The sample of 33 nurses was drawn from a medical intensive care unit (MICU). Data were collected through interviews regarding nurses' knowledge about caring for patients with acute gastrointestinal bleeding, heart failure/post-myocardial infarction, and pulmonary edema. Using the constant comparative technique, cues were identified and grouped into early, imminent, and late patterns for deterioration and into categories of early, midway, and complete for recovery. Rationales for the nurses' decisions included memories of patients with similar cues, using multiple not single cues, and clustering both physiological and psychological cues together. This study is a beginning effort toward validating nurses' intuitiveness and provides knowledge about expert practice that can be taught to novice practitioners and incorporated into protocols for care.

Adult↗
PubMed2001

Retroperitoneal laparoscopic access in children using a direct vision technique.

PURPOSE: Retroperitoneal procedures were initiated in 1992 by balloon dissection of the retroperitoneum. More recently a new type of retroperitoneal access has been obtained by directly entering the retroperitoneum using the Visiport visual trocar. We present our initial experience with direct visual access to the retroperitoneum in the pediatric population. MATERIALS AND METHODS: A total of 31 children underwent retroperitoneal laparoscopy, including renal biopsy in 22, varicocelectomy in 5, renal cyst ablation in 3 and pyelolithotomy for a staghorn stone in 1. Patients were placed in the full flank position. A maximum of 3 ports was used and the initial trocar was placed under direct vision. The laparoscope was then used to dissect bluntly a working space in the retroperitoneum. RESULTS: All procedures were successful. Blood loss was minimal. Operative time was 4 hours for pyelolithotomy and less than 1 for the other procedures. Mean hospital stay was 1.5 days and all patients returned to normal activity at a mean of 6 days. Two minor complications developed. The peritoneum was inadvertently entered in 1 case, in which no further treatment was necessary and convalescence was uneventful and short. In another case severe arrhythmia developed, resulting in an aborted procedure. CONCLUSIONS: This technique is simple, safe and does not require extensive laparoscopic experience.

Adolescent↗
PubMed2002

Comparison of hand assisted versus standard laparoscopic radical nephrectomy for suspected renal cell carcinoma.

PURPOSE: We compared standard and hand assisted laparoscopic radical nephrectomy for suspected renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed 22 hand assisted and 16 standard laparoscopic radical nephrectomies performed for suspected renal cell carcinoma. Operative and recovery data were collected prospectively and from medical records as part of an institutional review board approved protocol. Patients completed pain, activity and the 12-item short form health related quality of life surveys preoperatively and postoperatively. RESULTS: Although patients undergoing hand assisted laparoscopic nephrectomy had larger tumors (mean 6.3 versus 4.1 cm., p = 0.009), tended toward greater corrected mean specimen weight (658 versus 482 gm., p = 0.111) and had greater medical co-morbidity (p = 0.0228), mean operative time for hand assisted laparoscopic procedures was significantly shorter (205 versus 270 minutes, p = 0.0004). With experience mean operative time decreased for standard but not for hand assisted laparoscopy (293 to 232 minutes, p = 0.0445, versus 206 to 204, p = 0.6162). Procedure type, surgeon experience and adrenal sparing were the only significant predictors of operative time. There was no difference in the groups in terms of the complication rate, hospital cost or stay, return to activity or overall pain score, or in the difference in preoperative and postoperative 12-item short form scores. Hand assisted laparoscopic nephrectomy tended to be associated with more abdominal pain early in convalescence and more wound complications but not significantly so. CONCLUSIONS: Hand assisted laparoscopic radical nephrectomy offers recovery, morbidity and cost that are comparable to those of standard laparoscopy. The benefits of the technique include shorter operative times, no need for specimen morcellation and direct manual control of the operative field. It is particularly useful early in surgeon experience, for large specimens or when patient co-morbidities require a rapid procedure.

Adult↗
PubMed2003

[Changes of cerebral vascular hemodynamics from normal population to stroke].

OBJECTIVE: To probe into changes of cerebral vascular hemodynamics indexes (CVHI) from normal population to different clinical stage before and after occurring of stroke. METHODS: Participants were selected from 25,355 stroke cohort study population aged 35 years and over in Northeast of China and 55 acute stroke patients were selected from Fuzhou PLA General Hospital. CVHI indexes were checked during baseline investigation or within one week after acute stroke. Participant enlisted in the study were divided into following 5 groups, normal population, high risk population, individuals before stroke, acute stroke patients and convalescence stroke patients. Characteristics of CVHI indexes in different population were analyzed and compared. RESULTS: V(min) of cerebral vascular in previous defined 5 group participants were 11.39 +/- 3.27, 9.66 +/- 3.18, 6.71 +/- 3.30, 4.13 +/- 1.27, 6.78 +/- 3.09, respectively. V(mean) and V(max) were with the same decreasing trends as V(min). However, RV in 5 group participants were 62.35 +/- 21.11, 82.32 +/- 31.16, 122.72 +/- 52.73, 137.46 +/- 49.56 and 115.89 +/- 55.51, respectively. Zcv, WV, DR and CP were also with the same increasing trends as RV. Abnormal rate of CVHI score (< 75 points) from normal population to convalescence stroke patients were 13.3%, 34.7%, 74.1%, 100% and 66.7%, respectively. CONCLUSION: From normal population to clinical stage of stroke, cerebral vascular velocity showed decreasing trends while other indexes, such as RV, Zcv, WV, DR and CP were increasing.

Brain↗
PubMedDate not supplied

[Prostatic electrovaporization, a new treatment for prostatic hyperplasia].

TUR remains the choice technique for the surgical management of bph BUT, though effective, is not entirely free of morbidity. Over the last few years, new techniques have been developed trying to decrease morbidity, of which laser procedures are the most successful ones. We report here the prostate electrovaporization technique and our preliminary results in 75 patients seen over a 5-month period. The efficacy of the system is evaluated using the IPSS score and peak flow values; safety was assessed through the complications arisen, vesical catheter time and operating time. Mean hospital stay was 2 days, length of operation 32 minutes and post-operative vesical catheter time 48 hs; at 3 months, mean peak flow was 19.2 ml/seg and mean IPSS 7. Based en our preliminary results, quick convalescence, decreased cost and casiness of the technique, we consider prostate electrovaporization a likely alternative to conventional TUR, although further longer-term studies are warranted in order to evaluate the histological changes caused by this procedure on the prostate tissue.

Aged↗
PubMed1979

Etiology of pediatric gastroenteritis in Rochester, Minnesota.

The cause of diarrhea in a Rochester, Minnesota, pediatric population was studied by examining specimens for the presence of enterotoxigenic strains of Escherichia coli and reovirus-like agents, in addition to parasites and other bacteria and viruses. Reovirus-like agents were detected by electron microscopy in the feces of 11 of 31 patients, but none was found from specimens collected during convalescence or from 16 asymptomatic matched controls (P less than 0.01). Infection due to reovirus-like agents occurred significantly more often during the winter months in patients 6 to 18 months of age. Vomiting and diarrhea most often occurred simultaneously. All patients recovered without significant complications or sequelae, although one child was hospitalized for 3 days. Mean duration of illness was 9 days. No enterotoxigenic strains of E. coli were detected from symptomatic or control groups. Our results show that of the 16 organisms detected in stool specimens (11 reovirus-like agents, 3 salmonellae, and single isolates of adenovirus and enterovirus), the reovirus-like agent was the most frequent (69%) and was the probable etiologic agent in 35% of the cases of diarrhea in Rochester children.

Child, Preschool↗
PubMed1989

Anesthetic technique and surgical convalescence.

This brief review presents an update of studies on postoperative fatigue and convalescence and the way in which they are affected by anesthetic technique. Development of postoperative fatigue is related to the degree of surgical trauma, but not to general anesthesia, and it cannot be predicted from age, sex, duration of surgery, or preoperative assessment of various nutritional parameters. Postoperative fatigue correlates with deterioration in nutritional status and impaired adaptability of heart rate to orthostatic stress and bicycle exercise. Decreases in muscle performance and endurance are associated with postoperative fatigue, but psychological factors such as preoperative degree of anxiety do not appear to be important factors. Pain relief with regional anesthetics does not improve postoperative fatigue after abdominal surgery; however, no studies are available that evaluate the effects of regional analgesia with concomitant inhibition of the stress response. Controlled studies suggest that the use of regional anesthesia with local anesthetics reduces duration of hospitalization and time to ambulation. Further studies are needed to define the relative roles of immobilization, impaired nutritional intake, and surgical stress response in the pathogenesis of postoperative fatigue.

Anesthesia, Conduction↗
PubMed2006

Nurses' meaning of caring with patients in acute psychiatric hospital settings: a grounded theory study.

BACKGROUND: The concept of caring is described as intangible, abstract, and invisible in nursing practice. This has translated into a view of caring as a personal choice or natural obligation rather than a deliberate process. While there has been movement to delineate caring within nursing in general, the psychiatric nurse's perspective on caring has been absent from theoretical works and measures constructed to describe nurse's work. OBJECTIVES: To develop a substantive grounded theory of caring from the perspective of Registered Nurses working with patients in three Canadian acute psychiatric hospital settings. DESIGN: The qualitative research design of grounded theory methodology was used to develop a theory of caring. SETTINGS: Three urban, acute psychiatric hospital settings in Canada. Two were general hospitals and one was a psychiatric hospital. PARTICIPANTS: Registered Nurses (N=17) licensed with the College of Nurses of Ontario. METHOD: In-depth interviews with Registered Nurses were conducted using theoretical sampling. The data were analysed using constant comparative analysis. RESULTS: Protective empowering is the basic social psychological process that represents Registered Nurses' caring with patients in acute psychiatric hospital settings. Nurses accomplish protective empowering through six main categories of: (1) respecting the patient; (2) not taking the patient's behaviour personally; (3) keeping the patient safe; (4) encouraging the patient's health; (5) authentic relating; and (6) interactive teaching. The six main categories were accomplished through 27 subcategories. In the theory of protective empowering, the goal is to help patients participate in activities contributing to convalescence, health, and/or quality of life. CONCLUSIONS: The theory of protective empowering provides six main categories and 27 subcategories that can be transferred to funding formulas, patient health record documentation systems, nurse orientation and education programs, nurse role descriptions, and used in guiding discussions about organizational values of patient-centred care within a collaborative multidisciplinary context.

Hospitals, Psychiatric↗
PubMed1990

Psychiatric inpatient rehabilitation: is there a future?

A review of 105 consecutive admissions to a Hospital Rehabilitation Unit (HRU) over two years showed that only a small minority were still the 'traditional' long stay [new or old]. The Unit has diversified and now also treats patients with acute psychosis transferred from admission wards at a relatively early stage in their convalescence, and patients with chronic psychosis admitted directly from the community. Despite the small proportion of long stay referrals to the HRU, the overall number of inpatients under 65 has fallen substantially, without evidence of the HRU being bypassed. It is concluded that a major part of the decline in numbers occurs independently of patients being discharged. Most patients were admitted to the Unit for sound clinical reasons, despite rather than in default of follow up, and after consideration and sometimes trial of community alternatives. A substantial minority of admissions from the community, however, might have been avoided by increased provision of long term highly supported accommodation. The pattern of use of our HRU suggests that HRUs can continue to play a pivotal role if they retain their primary emphasis on rehabilitation, but extend their remit to include those patients who would previously have become long stay (many of whom are now likely to lose out in the everyday pressures of acute ward psychiatry).

Adult↗