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PubMed2002

[Evolution of the use of antibiotics in a hospital long-term care center in Catalonia].

INTRODUCTION: Advanced age, together with immune system changes, malnutrition, chronic disease, and the institutional environment, all contribute to a higher risk of acquiring infection in the elderly. Antibiotics are widely used in geriatric centers, but often their use is not optimal. MATERIAL AND METHODS: Study carried out during the period 1992-1999 in Centro Sociosanitario Albada (Sabadell, Spain). Data were taken from the Pharmacy Department's unidose registry. We determined the most frequently used antibiotics, the hospital units with highest consumption, the variation in these factors over time, and related costs. RESULTS: A progressive increase in overall antibiotic consumption was observed during the first 5 years of the study with subsequent stabilization. The units showing highest consumption were the Moderate and Highly-Dependent Chronic Unit, the Palliative Care Unit and the Convalescence and Rehabilitation Unit, with significant increases in the Palliative Care Unit in the last two years of the study. Amoxicillin-clavulanate, ciprofloxacin and norfloxacin were the most extensively used antibiotics. Cost increases were seen in the last three years despite the stabilization of antibiotic use. CONCLUSION: We observed a change in the consumption and profile of the antimicrobial agents used in our setting, probably related to changes in the population, increases in parenteral treatment and changes in the criteria for treatment of terminal patients. The establishment of controls for antibiotic use in long-term care centers would lead to improvements in the quality of the care provided.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2003

Rotavirus-specific subclass antibody and cytokine responses in Bangladeshi children with rotavirus diarrhoea.

Rotavirus-specific subclass antibody responses and cytokines, tumour necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-8 (IL-8), and IL-10, were measured in children 7-24 months of age with rotavirus diarrhoea (n = 29); the responses were compared with children with watery diarrhoea from whom no enteric pathogens were isolated (controls; n = 11). All children had diarrhoea for < 5 days and were enrolled from the Dhaka Hospital of the Centre for Health and Population Research. Samples of blood and stools were collected on the day of enrollment and 18-21 days after the onset of diarrhoea. Children showing a > or = 4-fold rise in antibody titre between the acute and convalescent stages were considered to have a response. The numbers of children with rotavirus-specific IgA and IgA1 responses in stool were similar in the two groups of children. In the plasma, more children with rotavirus diarrhoea had rotavirus-specific IgA, IgA1, IgG, IgG1, and IgG3 responses than did control children (P = 0.049, 0.007, 0.001, 0.002, and 0.012, respectively). IgA2 was not detectable. Among cytokines measured in supernatants from peripheral blood mononuclear cells (PBMCs) cultured for 6 and 24 hr, IFN-gamma was the only cytokine that was higher in children with rotavirus diarrhoea compared with controls (P = 0.013). Severity of illness did not correlate with nutritional status or antibody titres, but severity did correlate with TNF-alpha during the acute stage of illness. IFN-gamma correlated positively with IgG1 titres. These findings suggest a role for IFN-gamma in the pathogenesis of rotavirus infection, but this needs confirmation by other studies. The immune responses described are relevant to future vaccine trials, as immune responses in vaccinees should mimic those in natural infection.

Antibodies, Viral↗
PubMed1981

Endoscopic papillotomy in the treatment of biliary tract disease: 258 procedures and results.

Endoscopic papillotomy has been successfully performed in 258 of 267 patients (96.6%) presenting with common duct stones, papillary stenosis, or ampullary adenocarcinoma. A low morbidity was experienced (5%) while mortality was 0.77% (2 deaths). Surgical intervention was necessary in 2 patients. The mean age of the group is 66.4 years (range 26-95 years), while the mean hospital stay remains low at 3 days (range 1-12) days. The procedure has proven to be safe and effective, creating a permanent biliary enteric fistula comparable to standard surgical procedures, but does not require a laparotomy/duodenotomy. Eliminating the latter reduces morbidity, immobility, and convalescence. Papillotomy is not a procedure to be performed by inexperienced endoscopists as it is the only endoscopic procedure with predictable morbidity and mortality. In order to maintain the progress achieved to date, papillotomy should be performed by those with extensive endoscopic experience in the diagnostic area before embarking onto the therapeutic procedure.

Adenocarcinoma↗
PubMed1987

Management of the post-myocardial infarction patient. Essential considerations.

Management of patients who survive acute myocardial infarction (MI) demands the physician's awareness of certain essential considerations. Risk stratification, a useful prognostic indicator of mortality, should be done early in convalescence. If present, postinfarction angina or postinfarction syndrome warrants appropriate therapy. Low-level exercise testing should be under-taken within three weeks of acute MI, and left ventricular function should be assessed and arrhythmias delineated before the patient's discharge from the hospital. Findings may indicate the need for coronary bypass surgery or angioplasty, antiarrhythmic drug therapy, or permanent pacing. Digitalis should be used for treating congestive heart failure only if deemed absolutely necessary. If there are no contraindications, all postinfarction patients should receive beta blockers for at least two years after MI. Control of coronary risk factors is essential. Aspirin can be used prophylactically in patients at risk for recurrent MI; routine use of anticoagulants is not indicated.

Angina Pectoris↗
PubMed1988

Seroconversion patterns to four human rotavirus serotypes in hospitalized infants with acute rotavirus gastroenteritis.

We studied rotavirus-specific antibodies in paired sera from 71 hospitalized infants with acute rotavirus gastroenteritis. Most of the infants were less than six months old. Infants with serological evidence of a secondary rotavirus infection were excluded. With an enzyme-linked immunosorbent assay, 46% of the 71 infants studied showed specific IgM in convalescent sera. Titers of specific IgG and IgA increased in 7% and 2% of the infants, respectively. The presence of specific IgM correlated positively with age and severity of clinical symptoms. With a neutralization test, 59% of the infants showed a seroconversion: 20% to a single serotype (7% to serotype 1, 7% to serotype 3, and 6% to serotype 4), 21% seroconverted to two serotypes (nearly exclusively to serotypes 1 and 3), and 18% seroconverted to three serotypes (exclusively to serotypes 1, 3, and 4). No infant seroconverted to serotype 2 or to the heterologous (bovine) serotype 6.

Age Factors↗
PubMed2005

The laparoscopic nephrectomy learning curve: a single centre's development of a de novo practice.

OBJECTIVE: There has been a dramatic increase in the interest and practice of laparoscopic urology, with nephrectomy having become the commonest laparoscopic urological procedure. Compared with open nephrectomy, it results in reduced morbidity and shorter convalescence times while maintaining oncological safety. However, while these results predominately stem from institutions with well developed laparoscopic programmes, little is known about the results in centres that have newly adopted this technique. The introduction of a laparoscopic urological service at the Royal Hallamshire Hospital provided an opportunity to study these factors. METHODS: Since the appointment in October 2000 of a urological surgeon (N Oakley) to develop the laparoscopic service, there have been over 200 laparoscopic procedures including 121 nephrectomies performed at this centre. Full details were collected for each of these cases, and in addition, compared with retrospective data for 50 open nephrectomies performed during the same time period. RESULTS: With increased operator experience the median operative duration, complication, transfusion, and conversion rates significantly improved. While a learning curve was evident, the overall operative complication (9%) and conversion rates (6%) were low, in addition to patient morbidity (16.5%) and mortality (0%) rates, showing that this learning curve had no deleterious effects upon patient care. The median hospital stay was four days, which reduced to three with experience and was significantly shorter than for open nephrectomy at this institution (p = 0.001). CONCLUSIONS: The development of a successful laparoscopic programme can be achieved with a comparatively short learning curve and without detriment to the patient provided the necessary steps are observed.

Carcinoma, Renal Cell↗
PubMed1976

Shock syndrome in primary dengue infections.

During 1974, 114 patients with dengue hemorrhagic fever were studied at the Bankok Children's Hospital. Over 40% of the patients had dengue shock syndrome. Five fatal cases were included in the study. Primary dengue infections were identified by absent or low titered antibodies in acute sera and the sequential development of IgM antibodies followed by IgG antibodies during convalescence. Three patients, aged 4,8, and 12 years, had primary dengue infections with shock. Although no convalescent sera could be tested two other patients, aged 7 to 12 years, with fatal disease also appeared to have primary infections. At the time of shock patients with primary infections had subnormal concentrations of complement factor 3. The data show that in older children dengue shock syndrome associated with complement depression can occur during primary as well as secondary infections.

Antibodies, Viral↗
PubMed2002

[Detection of acute infection due to legionella pneumophila in patient with community acquired pneumonia in Buenos Aires city].

Community-acquired pneumonia (CAP) is caused by different microorganisms, their frequency varying in each community. Legionella pneumophila has been reported as etiologic agent of CAP. The aim of our study was to determine the incidence of acute infection due to Legionella pneumophila in a group of adult patients in Buenos Aires city. Adults of both sexes with CAP diagnosis were included and two serum samples, acute and convalescence (2-4 weeks apart from each other), were tested to detect antibodies against Legionella pneumophila by indirect immunofluorescence (IFI) (Organon Teknica, NC, USA). Ninety-two of the enrolled patients were evaluable, average age 56 years, 55% men (males), 52.2% did not require hospitalization. Three patients (3.3%) fulfilled the serologic diagnostic criteria for Legionella pneumophila acute infection. None of them were confirmed by microorganism isolation. The actual incidence of CAP caused by Legionella pneumophila in Argentina has not yet been established. It will require studies including larger numbers of patients and the use of simple and sensitive tests, such as Legionella pneumophila urinary antigen detection, to establish the exact role of this pathogen in our community.

Adolescent↗
PubMed1991

Use it or lose it--the hazards of bed rest and inactivity.

Professional experience and lay wisdom teach us the benefits of exercise and the hazards of idleness. Yet the myth persists that "bed rest is good for you" when ill or convalescing. Abundant scientific evidence in the past 50 years has demonstrated the specific damage done to each of the body's organ systems by inactivity. Both aging and inactivity lead to strikingly similar kinds of deterioration. I summarize the data from military and veterans' hospitals, rehabilitation experience, aerospace research, and gerontology and review the physiologic and metabolic changes of aging and inactivity, along with strategies to help prevent the iatrogenic complications of bed rest.

Aged↗
PubMed1996

[Two days' hospital stay after laparoscopic colon resection].

In order to reduce surgical stress-induced dysfunction and morbidity in the postoperative period after colon cancer surgery in old people, we performed the operations laparoscopically and optimized the postoperative regime especially as regards to treatment of pain, early oral intake and mobilisation. The patients were treated with continuous epidural infusion of local anaesthetic for 48 hours postoperatively. Morphine was avoided. Normal oral intake was allowed immediately after operation and active mobilisation was ensured. Twenty patients with a median age of 81 years (71-92 years), who preoperatively were able to take care of themselves at home, entered the study. In four the operation was converted to open surgery due mainly to growth of the cancer into neighbouring organs. One patient had to have an open reoperation due to small bowel strangulation. Fifteen followed the scheduled programme. They all had normal bowel function on day one or two and were mobilised for eight hours on day two and 12 hours on day three. Accordingly postoperative hospital stay was only two days (median), and the high level of activity continued at home after discharge. The combination of laparoscopic mini-invasive surgical technique and a postoperative regime that optimized pain treatment, early oral intake and active mobilisation considerably reduced postoperative convalescence after colon cancer surgery in old patients.

Aged↗
PubMed1998

Serum cortisol levels in patients with uncomplicated and cerebral malaria.

Ten patients with uncomplicated malaria, ten with cerebral malaria and 37 controls (blood donors from blood bank) were included in the study. The serum cortisol levels of the patients were determined daily for 7 days while they were at the hospital. A radio-immunoassay method was used for quantitative measurement of cortisol in human serum. The mean serum cortisol level of patients with uncomplicated malaria was 528.2 +/- 123.9 nmol/l, with cerebral malaria was 516.0 +/- 80.5 nmol/l, and in controls was 393.8 +/- 141.0 nmol/l. There was a significant rise of serum cortisol levels in patients with malaria when compared to controls at the day of admission to hospital. There was no significant difference between uncomplicated malaria patients and those with cerebral malaria. There was also no significant difference between the different days of treatment up till day 7. We found no cortisol insufficiency in cases with falciparum malaria during acute and convalescent stages of illness.

Adolescent↗
PubMed2003

Correlation between increased platelet-associated IgG and thrombocytopenia in secondary dengue virus infections.

Although the public health impact of dengue is increasing rapidly, the mechanism of thrombocytopenia in this disease remains unknown. To elucidate this mechanism, the relationship between platelet-associated IgG (PAIgG) and platelet count in 53 patients in the acute phase of secondary dengue virus infection was investigated in a prospective-hospital-based study. A significant inverse correlation between the two parameters was found in these patients, while no correlation was observed in healthy volunteers. The low baseline platelet counts during the acute phase in 12 patients with secondary dengue virus infection significantly increased during the convalescent phase, while the increased PAIgG levels during the acute phase in these patients significantly decreased during the convalescent phase. Anti-platelet IgG autoantibody was detected rarely in the plasma of 53 patients with secondary dengue infection. The involvement of anti-dengue virus IgG was also shown in platelets from all of 8 patients in the acute phase of secondary dengue virus infection. These findings suggest that PAIgG formation involving anti-dengue virus IgG plays a pivotal role in the induction of transient thrombocytopenia during the acute phase of secondary dengue virus infection.

Acute Disease↗
PubMed2000

West Nile virus investigations in South Moravia, Czechland.

Seven virus isolates were obtained from 11,334 mosquitoes after the 1997 Morava River flooding in South Moravia (Czech Republic): 6 strains of Tahyna bunyavirus, California antigenic group (5 from Aedes vexans, 1 from Ae. cinereus), and 1 strain of West Nile flavivirus (WNV) from Culex pipiens. In 1999, one isolate of Tahyna virus from Ae. vexans and one isolate of WNV from Cx. pipiens were recovered from a total of 14,354 mosquitoes examined in the same area, whereas no virus was detected there in 1,179 overwintering mosquitoes (mostly Cx. pipiens) in March 2000. The infection rate of mosquitoes with arboviruses was significantly higher in 1997, the year of the flood and an enormously high population density of mosquitoes. Antibodies neutralizing WNV were detected in 13 of 619 (2.1%) hospitalized patients or persons seeking outpatient clinics of the area in 1997. Five of the seroreactors revealed clinical symptoms compatible with West Nile fever: in 2 of them (children), recent infection with WNV was confirmed by a significant increase of antibody titer between acute and convalescent serum samples.

Adolescent↗
PubMed2002

Experience with laparoscopic management of solitary symptomatic splenic cysts.

Aggressive laparoscopic procedures can be used to manage pathologic lesions of solid organs. We attempted laparoscopic management of solitary symptomatic splenic cysts in four patients--two men and two women--ranging in age from 19 to 63 years (mean, 35 years). The cysts involved the whole spleen in one case, the upper pole in one, and the lower pole in two. We performed laparoscopic splenectomy in one case and laparoscopic unroofing of the cyst wall in three. In two procedures we successfully used needlescopic instruments. The duration of surgery and the volume of intraoperative bleeding were 300 minutes and 200 mL, respectively, for the splenectomy, and an average of 170 minutes (range, 120-240) and minimum volume, respectively, for the unroofing. There were no intra- or postoperative complications related to the laparoscopic procedures. The postoperative hospital stay was 9 days for the patient who underwent splenectomy and an average of 5.6 days (range, 5-7) for the patients who underwent unroofing. Laparoscopic management of splenic cysts is technically feasible and safe and has the advantages of reduced postoperative pain, shortened convalescence, and improved cosmesis.

Adult↗
PubMed1998

Simultaneous repair of bilateral groin hernias: open or laparoscopic approach?

A persistent problem in hernia surgery concerns the repair of bilateral inguinal hernias. A retrospective analysis of 78 patients with bilateral inguinal hernias was performed. Hernia repair was performed either by an open anterior access (modified Shouldice repair) or a laparoscopic posterior approach (TAPP repair). The two patient groups were similar with regard to ASA classification, age, and sex. The intraoperative complication rate was low (2.6% to 7.8%), whereas postoperative complications occurred more frequently (7.7% to 15.4%). The recurrence rate was low in both groups: 5.1% for the open group and 1.3% for the laparoscopic group. The mean hospital stay was 4 days for both groups, and the mean off-work times were 56.4 days and 17.9 days for the open and laparoscopic group, respectively (p < 0.05). Both procedures gave satisfactory results. The main advantages of the laparoscopic approach are the shorter convalescence time and quicker return to work.

Adolescent↗
PubMed2004

Serum cytochrome c level as a prognostic indicator in patients with systemic inflammatory response syndrome.

BACKGROUND: Apoptosis may play an important role in the development of systemic inflammatory response syndrome (SIRS) and progression to multiple organ dysfunction syndrome (MODS). To quantify the extent of apoptosis in these morbidities, we developed a sandwich ELISA system to measure serum cytochrome c (cyt-c) levels and we investigated the prognostic significance of cyt-c concentration in SIRS/MODS patients. METHODS: Cyt-c concentrations in patients with SIRS (n=53) with or at risk for MODS were measured and compared with those of control subjects (n=14). RESULTS: Cyt-c concentrations in SIRS/MODS patients increased (0.24-210 ng/ml), whereas those in control subjects were under detection limits (0.1 ng/ml). Cyt-c concentrations in non-survivors increased significantly compared with those in survivors both on the day of admission and on the fifth hospital day. A significant positive correlation was found between cyt-c concentration and two representative organ dysfunction scores, APACHE II and multi-organ failure (MOF) score. Cyt-c concentrations increased earlier than MOF score during the exacerbation phase and rapidly decreased during the convalescence phase in a survivor, but the level continued to be high in a non-survivor. CONCLUSIONS: Determination of serum cyt-c concentrations may be useful to assess the severity of organ dysfunction and to predict the prognosis of SIRS/MODS patients.

Adolescent↗
PubMed1995

Comparison of open and endourologic approaches to the obstructed ureteropelvic junction.

OBJECTIVES: To compare open pyeloplasty with three minimally invasive modalities: antegrade endopyelotomy, Acucise endopyelotomy (Applied Medical, Laguna Hills, Calif), and laparoscopic pyeloplasty. METHODS: Forty-five adult patients with ureteropelvic junction obstruction were managed by one of the above four techniques. Success rates, analgesic use, length of hospital stay, recovery time, and complications were compared between each of the four groups. RESULTS: Successful relief of obstruction was achieved in 100% of patients undergoing open and laparoscopic dismembered pyeloplasty, 78% undergoing Acucise endopyelotomy, and 77% undergoing antegrade percutaneous endopyelotomy. Acucise endopyelotomy results in shorter convalescence (1 week) than antegrade endopyelotomy (4.7 weeks), laparoscopic pyeloplasty (2.3 weeks) or open pyeloplasty (10.3 weeks). Complication rates appear to be similar among all groups. CONCLUSIONS: Our limited data imply that Acucise endopyelotomy offers low morbidity with success rates comparable to antegrade pyeloplasty, whereas laparoscopic pyeloplasty is as effective as open pyeloplasty with diminished morbidity.

Adult↗
PubMed2000

Cost and quality-of-life issues associated with different surgical therapies for the treatment of abnormal uterine bleeding.

Abnormal uterine bleeding is a common problem among women of reproductive age and can be treated medically or surgically. When medical therapy fails to cure menorrhagia, many women undergo hysterectomy. Over the past 15 years, operative laparoscopy and hysteroscopy increasingly have replaced traditional surgery (i.e., abdominal and vaginal hysterectomy). An endoscopic approach such as LAVH has been added to the therapeutic choices of patient and physician. Additionally, hysterectomy alternatives such as endometrial resection and ablation and myomectomy have been offered to women with significant menorrhagia. This article reviewed the cost and quality-of-life issues of endoscopic treatment versus traditional surgical methods. Vaginal hysterectomy is the least costly of all hysterectomy techniques. Studies have shown that for LAVH, direct costs are higher that abdominal hysterectomy. However, this difference decreases with additional operator experience and with the use of nondisposable instrumentation. The indirect cost of LAVH is significantly less than abdominal hysterectomy because of the more rapid convalescence. With endometrial resection and ablation, direct and indirect costs are significantly less than those of hysterectomy even when high failure rates are factored. Women choose this procedure over hysterectomy because it avoids major surgery, allows for a fast return to normal functioning, and entails short hospitalization. Hysterectomy can lead to many psychologic and physical changes for a woman. It continues to provide a high satisfaction rate because it is a guaranteed cure for abnormal bleeding.

Costs and Cost Analysis↗