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At least 1,369 records · Page 76Linked to original sources
PubMed2002

Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implications.

OBJECTIVES: We analyzed the clinical characteristics and outcomes of 47 patients with severe pulmonary hypertension (PHT) and severe aortic valve stenosis (AS) from 1987 to 1999. BACKGROUND: The prognostic implications of severe pulmonary hypertension in patients with severe AS are poorly understood. METHODS: The mean age of patients was 78 years (range 47 to 91 years), and 37 patients (79%) were in New York Heart Association (NYHA) functional class III or IV. Aortic valve replacement (AVR) was performed in 37 patients (79%) and 10 patients (21%) were treated conservatively. RESULTS: In the group that had AVR, there were six perioperative deaths (16%) and nine late deaths, resulting in a total mortality of 32%. In the conservatively treated group, there were eight deaths (80%) on follow-up. Severe PHT was an independent predictor of perioperative mortality. However, perioperative mortality was independent of the severity of left ventricular systolic dysfunction or concomitant coronary artery bypass grafting. Aortic valve replacement was associated with significant improvement in left ventricular ejection fraction, the severity of PHT and NYHA functional class. The difference between long-term survival of the operative survivors and the expected survival from life tables was not statistically significant. CONCLUSIONS: The prognosis for patients with AS and severe PHT treated conservatively without AVR is dismal. Although AVR is associated with higher than usual mortality, the potential benefits outweigh the risk of surgery.

Aged↗
PubMedDate not supplied

The most stable class of benzenoid hydrocarbons-new topological correlations of strain-free total resonant sextet benzenoids.

While briefly reviewing how the concepts of strictly pericondensed, strain-free, Clar's aromatic sextet, and symmetry are interconnected in the topological correspondence between strictly pericondensed and total resonant sextet (TRS) benzenoid hydrocarbons, new structural correlations in isomer numbers, symmetry distributions, and empty rings between various strain-free TRS benzenoids made up of only fused hexagonal rings are presented. These correlations are made evident by the Formula Periodic Table for Total Resonant Sextet Benzenoid Hydrocarbons [Table PAH6(sextet)] and application of the leapfrog operation. A new perimeter topology relationship for fused strain-free TRS benzenoids is derived. This work represents a contribution toward understanding formula/structure relationships of benzenoid hydrocarbons.

Journal Article↗
PubMed2006

Intraoperative computed tomography in otorhinolaryngology.

CONCLUSIONS: Intraoperative CT surgery provides the surgeon with additional information about the altered surgical site in difficult anatomical situations. The skull base and lamina papyracea may be revealed by means of intraoperative CT, which may be beneficial in endonasal sinus surgery involving difficult surgical sites, although individual ethmoid cells cannot be assessed owing to blood artefacts. This provides the surgeon with valuable information that may facilitate the procedure considerably. In soft-tissue surgery it is advisable to apply a contrast agent in order to achieve good soft-tissue contrast, thus allowing the tumour to be adequately distinguished from benign tissue. The intraoperative application of CT is a fairly time-consuming procedure, partly owing to the preparation time (set-up of the appliance; 10-min warming-up phase) and partly due to the length of time required to calculate each image (15 s). OBJECTIVE: CT is a well-established imaging method for the assessment of osseous and soft-tissue structures in the head and neck region. Saving information and transferring it to the intraoperative site may, however, be problematic. Computer-assisted navigation systems are now able to assist difficult surgical procedures in the field of otolaryngology. To investigate the indications for intraoperative CT, we used it in various surgical procedures in the head and neck region. MATERIAL AND METHODS: Intraoperative CT was applied using the Tomoscan M in 46 cases in order to demonstrate the surgical benefit of the following procedures: endonasal surgical procedures on the paranasal sinuses (maxillary and ethmoidal sinusitis, anterior fracture of the sphenoidal sinus); tumour removal by means of laser surgery (carcinomas of the hypopharynx and larynx); and cochlear implantation (to verify the electrode position). After positioning the patient on the CT table, the workstation was set up in the operating theatre. If necessary, the gantry could be moved over the patient's head without repositioning the patient. RESULTS: Intraoperative CT was used to assist in the exposure of the skull base and lamina papyracea in endonasal surgery of the paranasal sinuses. Individual ethmoidal sinuses could not be evaluated owing to blood artefacts. Intraoperative imaging proved particularly helpful in revision surgery for chronic sinusitis in cases with missing anatomical landmarks owing to previous surgeries, where there is an increased risk of inflicting damage to the skull base or orbita. The resection margins can be determined in craniofacial resections. In soft-tissue procedures, such as tumour removal by means of laser surgery, it proved possible to visualize the resection borders of malignant tumours. Assessment of the electrode position in cochlear implantation is particularly useful in revision cases and in cases of cochlear obliteration.

Cochlear Implantation↗
PubMed1994

The design of an emergency operating procedure in process control systems: a case study of a refrigeration system in an ammonia plant.

The purpose of this study was to develop a method to aid and support human operators in emergency operations. A conceptual model of system performance was constructed in order to observe the constraints of human capabilities under emergency conditions. Then the influence of emergent events and the applicable condition of procedural design principles were discussed. In order to help operators in handling the emergent event, a decision table support and a computer support were developed according to historical data and principles of procedural design. In order to verify the effects of above methods, a simulated experiment of handling the emergent event in the refrigeration system of an ammonia plant was performed. As shown by the experimental results, the support methods successfully improved the response speed of the subject, but did not improve accuracy. The results also revealed that the decision table support had a better effect on simple error type, whereas the 16-breadth computer support had a better effect on both the simple error type and complex error type.

Adult↗
PubMed2006

Planning and task management in older adults: cooking breakfast.

The article describes a simulated "cooking breakfast" task in which participants must remember to start and stop cooking five foods so that all the foods are "ready" at the same time. In between starting and stopping operations, the participants also carried out a "table-setting" task as a filler activity. The breakfast task yields various measures of multitasking and executive control. Groups of younger and older adults performed the task; half of the participants in each group were bilinguals and the other half were monolinguals. The results showed substantial age-related decrements in most measures of executive control. Additionally, older bilinguals showed some advantages in task management over their monolingual peers.

Activities of Daily Living↗
PubMed1988

Marketing in the HMO industry: an analysis of spending patterns and enrollment growth results.

The purpose of this paper is to assess the level of marketing spending in the HMO industry and the enrollment growth HMOs have achieved in return for their marketing dollars. This study identifies industry norms that are designed to assist HMOs in the evaluation of their marketing performance. The study is based on data from 1985 to 1986 covering approximately half the HMOs in the country and comprising a substantial proportion of industry-wide enrollment (Table 1). The analyses are designed to allow operational HMOs to compare their marketing efforts, enrollment growth, and marketing costs per new member with industry norms within similar age, model type, enrollment level, and geographic categories. The marketing expenses provided by each HMO are an aggregate figure including sales staff salaries, benefits and commissions, advertising, costs for the production and printing of marketing materials, and all other expenses directly related to the marketing effort. Components of the aggregate marketing expenses, such as the amount spent on advertising versus sales staff compensation, were not available.

Cost Allocation↗
PubMed2003

Reducing exposure to laboratory animal allergens.

Laboratory animal allergy is a serious health problem. We examined several possible allergen-reducing strategies that might be effective in the working mouse room. Ambient allergen concentrations were measured when mice were maintained under several conditions: conventional housing versus ventilated cage racks operated under negative or positive pressure. We found that housing mice in ventilated cages operated under negative pressure and using ventilated changing tables reduced ambient mouse allergen (Mus m 1) concentrations tenfold, compared with values when mice were housed in conventional caging and using a conventional (non-ventilated) changing table. Housing mice in positively pressurized cages versus conventional cages did not reduce ambient allergen values. Cleaning mouse rooms at an accelerated frequency also did not reduce ambient Mus m 1 concentration. We also quantified ambient allergen values in several areas of The Jackson Laboratory. A facility-wide survey of Mus m 1 concentrations indicated that allergen concentrations were undetectable in control areas, but ranged from a mean (+/- SEM) 0.11 +/- 0.02 ng/m3 to 5.40 +/- 0.30 ng/m3 in mouse rooms with different cage types. The percentage of animal caretakers reporting allergy symptoms correlated significantly with ambient allergen concentrations: 12.9% reported symptoms in the rooms with the lowest allergen concentration (0.14 +/- 0.02 ng/m3), but 45.9% reported symptoms in rooms with the highest concentration (2.3 +/- 0.4 ng/m3). These data indicate that existing technology can significantly reduce exposure to laboratory animal allergens and improve the health of animal caretakers.

Air Pollution, Indoor↗
PubMed2005

A stake in the business.

When Chris Sullivan and three friends opened the first Outback Steakhouse in March 1988, in Tampa, Florida, they were hoping it would be successful enough to spawn a few more and maybe some other kinds of restaurants as well. Since then, their chain of Australia-themed restaurants has grown to some 900 locations and counting-plus another 300 or so "concept" restaurants that operate from under Outback's corporate umbrella. Growth like that doesn't happen accidentally, Sullivan says, but it certainly wasn't part of the original plan. In this first-person account, Outback's chairman describes the organization's formula for growth and development, which is consciously rooted in the founders' belief in putting people first. They've created an organizational model in which field managers make most of the decisions, garner the rewards, and live with the consequences. Specifically, the founders believe that the most effective way to make customers happy is to first take care of the people who cook for them, serve them, and supervise operations at the restaurants. Outback servers have fewer tables to worry about than those at other restaurant chains; the cooks have bigger, cooler, better-equipped kitchens; and the supervisors work their way up the ranks toward an equity stake in the restaurant or region they run. There are no administrative layers between field managers and the executives at headquarters. Giving employees good working conditions and the chance to become owners has proved to be good business: Turnover among hourly employees is low, and Outback and its subsidiaries opened 120 restaurants last year, increasing sales by 20.1%. The company must grow in order to keep offering career opportunities to its workers; in turn, those opportunities ensure that Outbackers remain committed to making customers happy and the company successful.

Career Mobility↗
PubMed1978

[Modern therapy and after-care in urogenital tuberculosis].

The present therapy of the urogenital tuberculosis is based on the effective medicaments (rifampizin, isonicotinic acid hydrazid, streptomycin, and ethambutol). It rests on an optimum dosage in connection with a best suited combination, taking into consideration the relations of sensitiveness and side effects as well as consequent long-term treatment. It is referred to the possibility of additional administrations of corticosteroid preparations and it is taken notice to the necessity also to treat unspecific mixed infections. Under the modern chemotherapy with bactericidal effect a stable negativation practically always develops within 3 months. Actual recidivations were not seen during the last 12 years. Apart from a compilation of the indications to nephrectomy references to possibilities of plastic surgical corrections of the urinary system are given. Two tables give information about the patients who were operatively treated during the last 15 years. A close collaboration of the various therapeutic institutions with a consulting urologist -- particularly in problematic and advanced cases of the disease -- nearly always saves the patient with urogenital tuberculosis from invalidism.

Adrenal Cortex Hormones↗
PubMed1983

Role of resection in the management of metastases to the liver.

The results of 22 hepatic resections for metastatic disease are reviewed. There were no operative deaths and survival was encouraging. Life-table analysis of all 22 patients predicted a 5-year survival of 56.4%, and if 16 patients who had primary colorectal tumours are considered separately, the expected 42-month survival was 42.2%. Patients with a single metastasis generally lived longer, and there was no difference in survival between hepatic metastases resected synchronously or metachronously. The authors recommend an aggressive approach to the treatment of hepatic metastases.

Actuarial Analysis↗
PubMed1997

Gonioscopic laser sclerostomy versus filtration surgery in a rabbit model.

In a prospective and randomised study, we compared the course of pulsed dye laser ab interno sclerostomy with the course of posterior lip sclerectomy in 25 rabbits. One eye of each rabbit was randomly selected to be treated with laser; the fellow eye underwent posterior lip sclerectomy. Intraocular pressure (IOP) determinations and slit lamp examinations were recorded pre-operatively, then every other day for 3 weeks on 21 of the rabbits. Histological examination was performed on the eyes of 3 randomly selected rabbits that were killed 72 hours post-operatively. Laser sclerostomy resulted in an average maximal drop in IOP of 9.5 mmHg on post-operative day 1, and posterior lip sclerectomy resulted in a similar drop of 10.5 mmHg (p = 0.43, t-test). By life-table analysis, 88% of eyes returned to within 2 mmHg of pre-operative IOP values within 7 days following either laser internal sclerostomy or posterior lip sclerectomy. There was no significant difference between laser internal sclerostomy and posterior lip sclerectomy eyes with respect to the number of days needed to return to within 2 mmHg of preoperative IOP values (p = 0.26, sign test of the life-table analysis). Pulsed dye laser internal sclerostomy appears to be as effective as posterior lip sclerectomy in lowering IOP in the rabbit model.

Animals↗
PubMed1995

Operative mortality and long-term relative survival of patients operated on for asymptomatic abdominal aortic aneurysm.

OBJECTIVE: Assessment of mortality and long-term relative survival following repair of asymptomatic abdominal aortic aneurysms. DESIGN: Retrospective review. SETTING: University Hospital. MATERIALS: Three hundred and twenty seven patients with a median age of 68 years and male to female proportion of 10:1. CHIEF OUTCOME MEASURES: Operative mortality and long-term mortality obtained from Norwegian Registrar's Office. Demographically matched expected survival calculated from death rate tables published by the Norwegian Central Bureau of Statistics. MAIN RESULTS: The overall operative mortality was 5.2%. Ten-year survival rate for all the patients was 38% compared to the expected of 52%. The standard mortality rate was 1.30, indicating a 30% higher mortality compared to a demographically matched population. Older patients and patients with known cardiac disease had significantly increased operative mortality. These patients also had the lowest long-term survival. Patients with cardiac disease suffered a postoperative mortality more than two times expected. CONCLUSIONS: Further studies are needed to define subgroups unsuitable for elective surgery.

Age Factors↗
PubMed1996

[Study of surgical instruments contamination by bacteria from air during the operation].

Routinely sterilized surgical instruments were divided into two groups and put on the same instrument table, one group was covered with dressing and the other was exposed to the air. The samples were collected at 30 min, 60 min, and 90 min respectively after operation began and bacterium culture was done. The results showed that the general air contamination rate of the exposed group was 1.18 times higher than that of the covered one. The exposure time had a positive correlation with bacterium contamination rate. This study gave the laboratory evidence for controlling the infection in the operation room.

Air Microbiology↗
PubMed2003

Intraoperative computerized tomography for improved accuracy of spinal navigation in pedicle screw placement of the thoracic spine.

We report on our experiences with the use of intraoperative CT imaging in surgery of the thoracic spine and on our results of pedicle screw insertion using spinal navigation and implantable fiducial markers. For our operations we used the Tomoscan M-EG and the EasyGuideSpine (Philips Medical Systems). During the operation the patient was positioned on the mobile CT table. Following dorsal preparation, small titanium screws were implanted in the vertebrae so as to serve as fiducial markers. Image data were obtained by performing a spiral CT scan. Ventilation was suspended for the duration of the CT scan. Screw insertion as well as vertebral biopsies were performed using spinal navigation. Intraoperative CT scans were obtained to confirm the position of the implants and to assess the amount of bony decompression as well as the realignment. Since 1998, 112 patients with various disorders of the thoracic spine have been operated on using the described technique. 365 screws were inserted in the area of T1 to T12. There were 23 (6.3%) misplacements of pedicle screws. In 42 cases (11.5%) we observed a minimal lateral perforation (<2 mm) of the pedicle wall. No neurological, cardiovascular, or pulmonary injury occurred. Intraoperative CT imaging influenced surgical decisions as well as the final result of surgery. Despite the use of intraoperative imaging and accurate spinal navigation, pedicle screw placement in the thoracic spine remains extremely challenging.

Bone Screws↗
PubMedDate not supplied

[The diagnosis of cancer and nodular formations of the thyroid by using a mathematical table].

It is especially difficult of recognize thyroid cancer (TC) at early stages when it develops as a nodule. Cancer is often regarded as a nodular goiter, chronic thyroiditis is sometimes regarded as cancer. The authors propose for screening a mathematical table of symptoms (in points) permitting differentiation between "cancer" and "no cancer". The table is the result of computerized processing of clinical data of 417 case records of patients operated on for thyroid nodulations (cancer--in 128 patients, adenoma--in 214, chronic thyroiditis--in 75). The table is simple to use. Cancer is diagnosed with the number of symptoms being +15. This disease can be diagnosed with the help of the table in 71% of cases.

Adenoma↗
PubMed1981

Semi-elective portal systemic shunts for variceal bleeding.

Between June 1977 and November 1980, we performed portal systemic shunt operations on eight patients for esophageal bleeding secondary to portal venous hypertension. One patient had operation as an emergency and the other seven semi-electively during the same hospitalization as admission. The patient operated upon as an emergency was the only hospital death. Life table analysis on this small group of patients indicates that semi-elective portal systemic shunt surgery after hemodynamic stabilization, nutritional support, and improvement of hepatic function is a viable alternative to emergency operation that can be done effectively in a community hospital.

Adult↗
PubMed2006

Study of the oxygen transfer in a disposable flexible bioreactor with surface aeration in vibrated medium.

The oxygen mass transfer is a critical design parameter for most bioreactors. It can be described and analyzed by means of the volumetric mass transfer coefficient K(L)a. This coefficient is affected by many factors such as geometrical and operational characteristics of the vessels, type, media composition, rheology and microorganism's morphology and concentration. In this study, we aim to develop and characterize a new culture system based on the surface aeration of a flexible, single-used bioreactor fixed on a vibrating table. In this context, the K(L)a was evaluated using a large domain of operating variables such as vibration frequency of the table, overpressure inside the pouch and viscosity of the liquid. A novel method for K(L)a determination based on the equilibrium state between oxygen uptake rate and oxygen transfer rate of the system at given conditions was also developed using resting cells of baker's fresh yeast with a measured oxygen uptake rate of 21 mg g(-1) h(-1) (at 30 degrees C). The effect of the vibration frequency on the oxygen transfer performance was studied for frequencies ranging from 15 to 30 Hz, and a maximal K(L)a of 80 h(-1) was recorded at 30 Hz. A rheological study of the medium added with carboxymethylcellulose at different concentrations and the effect of the liquid viscosity on K(L)a were determined. Finally, the mixing time of the system was also measured using the pH method.

Bioreactors↗
PubMed1995

Seventy-two pulmonary retransplantations for obliterative bronchiolitis: predictors of survival.

BACKGROUND: Obliterative bronchiolitis (OB) occurs in up to 40% of patients in the intermediate term after lung transplantation. In recent years an increasing number of recipients with end-stage OB have been treated with retransplantation. METHODS: Seventy-two patients with OB underwent retransplantation at 26 North American and European centers a median of 590 days after their first transplant operation. The predictors of survival were determined using life table and Cox proportional hazards methods, and the recurrence rate of OB was determined in survivors. RESULTS: The actuarial survival rate was 71% +/- 5% at 1 month, 43% +/- 6% at 1 year, and 35% +/- 6% at 2 years; nonetheless, of the 90-day postoperative survivors, 63% +/- 7% were alive 2 years after retransplantation. Institutional experience with more than three pulmonary retransplantations (p = 0.008), reoperation in Europe (p = 0.013), donor-recipient ABO blood group identity (p = 0.018), and more recent year of retransplantation (p = 0.03) were associated with survival. On multivariate analysis, reoperation after 1989 (p < 0.001), retransplantation performed in Europe (p = 0.017), and being ambulatory immediately before reoperation (p = 0.022) were found to be predictive of a positive outcome. Pulmonary function test analyses confirmed that the forced expiratory volume in 1 second decreased from postoperative baseline values by 11% +/- 9% at 1 year and 27% +/- 10% at 2 years (p = 0.02; year 2 versus baseline). Fourteen percent of patients were in stage 3 of the bronchiolitis obliterans syndrome at 1 year postoperatively, with 33% affected at 2 years. CONCLUSIONS: The results of pulmonary retransplantation for OB are improving. Current evidence indicates that OB does not recur in an accelerated manner after retransplantation, although pulmonary function does worsen again by 2 years. Pulmonary retransplantation is appropriate only in selected patients with OB who are ambulatory and are operated on at experienced centers.

Adolescent↗