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PubMed2003

Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases.

OBJECTIVES/HYPOTHESIS: Several reports since the early 1990s have advocated a minimally invasive technique, endoscopic staple diverticulostomy (ESD), to treat Zenker's diverticulum. However, long-term results and comparisons with the reported experience with external or other endoscopic approaches have been lacking in the literature. We present follow-up on our experience with ESD since 1995 and compare it with the results obtained by other endoscopic or external techniques for treatment of Zenker's diverticulum. STUDY DESIGN: Retrospective review of 159 consecutive ESD procedures performed on 150 unique patients with Zenker's diverticulum between March 1995 and August 2002. Telephone interviews of patients were conducted to assess long-term treatment outcome. Review of the literature was performed by Ovid MEDLINE search for all reports on the surgical treatment of Zenker's diverticulum in the English language between January 1990 and August 2002. METHODS: Data were retrospectively reviewed and information was tabulated for age, sex, size of diverticulum, symptoms, duration of symptoms, operative time, length of hospital stay, time before oral intake, complications, and relief of symptoms at first postoperative visit. Follow-up interviews of patients were conducted to assess current status of symptoms and, if any symptoms returned, how many months after the procedure they recurred. All case series in the literature in the English language since 1990 that were found in the Ovid MEDLINE database and referenced from identified articles were also tabulated for the same information. RESULTS: At the time of initial follow-up after ESD, 98% of patients reported complete or improved symptoms. Average hospital stay was 0.76 days, with a diet started on postoperative day 0.25. There was a 2.0% significant complication rate without mortality. Further follow-up (average, 32.2 mo) identified a recurrence rate of 11.8%. On review of the literature, patients who underwent ESD had shorter perioperative courses, quicker return to diet, and lower complication and mortality rates compared with external procedures. ESD had comparable operative times and mortality rates, but fewer complications and more rapid convalescent times compared with other endoscopic procedures. Recurrence rates were found to be variable. CONCLUSIONS: Overall, ESD is an outpatient procedure with few complications. The technique has a faster operative and convalescence period with fewer complication rates compared with other endoscopic or external transcervical approaches. The results in the present study and those reported in the English language literature advocate that ESD be the initial preferred treatment for Zenker's diverticulum.

Adult↗
PubMed1997

[Gastrografin for mechanical partial, small bowel obstruction due to adhesions].

The therapeutic effect of gastrografin is occasionally mentioned in the literature. However, this effect has not been objectively evaluated. We studied prospectively the effect of Gastrografin in cases of adhesive, simple, partial, small bowel obstruction (SBO) compared to conventional management. During 3 years, a total of 137 episodes of simple, partial SBO in 127 patients (10 recurrent episodes) were treated. The episodes were randomized into a control group (80 episodes), treated conventionally, and a trial group (77 episodes), which received in addition 100 ml of Gastrografin administered through the nasogastric tube. The two groups were well-matched with regard to age, gender, weight, medical and surgical background and duration of complaints before admission. Time to first stool and resolution of obstruction, complications, need for surgery, and hospital stay were noted. Mean time to first stool was significantly shorter in the trial group: 6.2 +/- 3.9 hours vs 23.5 +/- 12.7 (p < .0001). Mean hospital stay for unoperated patients was also shorter in the trial group: 2.7 +/- 2 days vs 5.5 +/- 2 days, (p < .0001). In addition, significantly fewer episodes in the trial group required operation, 10.4 vs 26.7% (p < 0.013). 1 patient in each group dies following operation. There were no Gastrografin-related complications and it was effective and safe for adhesive, partial, simple SBO. It significantly speeds resolution of obstruction, reduces the need for operation, and shortens convalescence.

Contrast Media↗
PubMed2005

Influence of a decisional tree on the route of hysterectomy for benign disease in Italy: personal experience.

BACKGROUND: Mainly to report our experience in the route of hysterectomy after introducing specific guidelines according to the Society of Pelvic Reconstructive Surgeons and to record all hysterectomy-related complications after abdominal and vaginal hysterectomies. METHODS: The records of 22 patients who underwent abdominal hysterectomy and 59 who underwent vaginal hysterectomy for benign disease were reviewed. Complications related to hysterectomy were recorded during surgery, postoperative hospital stay and a period of six weeks. Statistical methods used were t-tests and chi square analysis. RESULTS: Operation time was shorter with the vaginal route. Patients operated on via the vaginal route had less blood loss and shorter hospital stay. CONCLUSIONS: The main standard to select the route for hysterectomy is the severity of the clinical status. Decreasing the ratio between the abdominal and vaginal route is possible, but it is crucial to make the indications clear, based on scientific evidence.

Age Factors↗
PubMed2001

Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a prospective, randomized, single-blind study.

OBJECTIVE: To analyze outcomes after open small-incision surgery (minilaparotomy) and laparoscopic surgery for gallstone disease in general surgical practice. METHODS: This study was a randomized, single-blind, multicenter trial comparing laparoscopic cholecystectomy (LC) to minilaparotomy cholecystectomy (MC). Both elective and acute patients were eligible for inclusion. All surgeons normally performing cholecystectomy, both trainees under supervision and consultants, operated on randomized patients. LC was a routine procedure at participating hospitals, whereas MC was introduced after a short training period. All nonrandomized cholecystectomies at participating units during the study period were also recorded to analyze the external validity of trial results. The randomization period was from March 1, 1997, to April 30, 1999. RESULTS: Of 1,705 cholecystectomies performed at participating units during the randomization period, 724 entered the trial and 362 patients were randomized to each of the procedures. The groups were well matched for age and sex, but there were fewer acute operations in the LC group than the MC group. In the LC group 264 and in the MC group 150 operations were performed by surgeons who had done more than 25 operations of that type. Median operating times were 100 and 85 minutes for LC and MC, respectively. Median hospital stay was 2 days in each group, but in a nonparametric test it was significantly shorter after LC. Median sick leave and time for return to normal recreational activities were shorter after LC than MC. Intraoperative complications were less frequent in the MC group, but there was no difference in the postoperative complication rate between the groups. There was one serious bile duct injury in each group, but no deaths. CONCLUSIONS: Operating time was longer and convalescence was smoother for LC compared with MC. Further analyses of LC versus MC are necessary regarding surgical training, surgical outcome, and health economy.

Bile Ducts↗
PubMedDate not supplied

Surveillance of Kawasaki disease in Taiwan and review of the literature.

BACKGROUND: Kawasaki disease affects mainly children younger than five years, leading to coronary artery lesions, even to life-threatening myocardial infarctions. Since 1976, Kawasaki disease has occurred in thousands of children in Taiwan; some of them died. METHODS: Questionnaire forms for the survey of epidemiological features of Kawasaki disease were designed and sent to the hospitals of 100 or more beds in Taiwan, in 1987, 1992, 1994, and 2001, for retrospective reviews of their patients with Kawasaki disease encountered during 1976-2000. A school-based mass survey, on the prevalence of children with history of Kawasaki disease was conducted every year from 1990 to 2000. RESULTS: Since 1976, the number of Kawasaki disease patients increased, totaling to 8,267 patients in 2000. The ratio of the incidence increased by 1.15 times annually (Poisson regression), reaching the highest incidence of 54.9 per 100,000 children <5 years of age in 1998. Of them, 85.1% were under 5 years of age. The male-to-female ratio was 1.6. Coronary artery lesions were noted during acute, subacute and convalescent stages in 25.8% of the patients. The fatality rate decreased from 0.4% to 0.06%. There was no student with history of Kawasaki disease among students surveyed in 1990. Subsequent school surveys showed the prevalence was 24.6 in 1991, 74.6 in 1996, then reached to 103.9 per 100,000 school children in 2000, with an annual increase of 1.24 times (Poisson regression). CONCLUSIONS: In Taiwan, Kawasaki disease, first diagnosed in 1976, continued to occur with several outbreaks reaching to a peak incidence of 54.9 per 100,000 population less than 5 years of age in 1998. Epidemiological features of Kawasaki disease in Taiwan were similar to the Japanese experiences and the incidence was, next only to Japan, the second highest in the world.

Child↗
PubMed1985

Investigation of the effectiveness of measles vaccination in children in Kenya.

Laboratory studies were performed on 128 children clinically diagnosed as measles when seen at the Infectious Diseases Hospital, Kenyatta National Hospital (IDH), Nairobi (86 cases) and the Rural Health Training Centre, Maragua, Central Province (42 cases) between 9 July and 31 August 1984. A concurrent measles infection was confirmed in 95% of the children seen at IDH and in 85% of those seen at Maragua, with similar proportions of confirmations in children who had, and who had not, received measles vaccine. No differences in the number of sero-conversions nor in the absolute levels of acute or convalescent HI antibody titres could be detected between vaccinated and unvaccinated children. Analysis of the cases seen at Maragua indicates that about two thirds of the children who had received vaccine were protected. A pilot study of vaccinating children at 8 months and again at 12-13 months is suggested in an attempt to eradicate measles.

Age Factors↗
PubMed1980

Laboratory diagnosis of Rocky Mountain spotted fever.

To examine the use of the laboratory in the diagnosis of Rocky Mountain spotted fever and to determine the specificity and sensitivity of the Weil-Felix test, hemagglutination, complement fixation, and skin biopsy immunofluorescence in the hospital, we reviewed our experience during th year 1978. Sera were submitted from 142 patients and skin biopsies from 16 patients suspected of having RMSF. Sensitivity rates of methods in the acute phase were skin biopsy, 70%; Proteus OX-19 agglutination, 65%; hemagglutination, 19%; Proteus OX-2 agglutination, 18%; and CF, 0%. Overall specificity rates were skin biopsy, 100%; hemagglutination, 99%; and agglutination of Proteus OX-2 96% and OX-19 78%. Major problems were failure to submit convalescent serum and nonspecificity of Weil-Felix titer of 1:160. Two cases illustrate the importance of skin biopsy and serologic results. Immunofluorescent examination of skin biopsies for Rickettsia rickettsii is the best procedure currently available for early diagnosis.

Adolescent↗
PubMed1999

Initial experience with laparoscopic live donor nephrectomy.

BACKGROUND: Advances in laparoscopic instruments and video technology have made laparoscopic donor nephrectomy (LDN) feasible. We report our initial experience with this technique. METHODS: A retrospective review of 30 open donor nephrectomies and our first 30 LDNs was performed to assess donor and recipient outcome and resource usage. RESULTS: LDN was successfully completed in 26 donors (87%). The increased operative time and costs were balanced by less postoperative pain, earlier discharge, earlier return to normal activity and work, fewer incision problems, and less personal financial loss. Recipient outcome was not affected. CONCLUSION: LDN is technically feasible and safe, and recipient graft outcomes are equivalent. Convalescence is shortened, and there is less personal financial loss. LDN offers significant benefit to the donor and may result in increased organ donation.

Adult↗
PubMed2001

[Diagnosis and approaches to therapy of emotional disorders in patients with infectious diseases].

AIM: To examine psychological and emotional disorders in patients with infectious diseases, to specify indications for their pharmacological correction. MATERIAL AND METHODS: Clinicopsychological, clinicofunctional and laboratory tests were made to examine 30 patients with infectious mononucleosis (19 females and 11 males) and 30 patients with serous meningitis (16 females and 14 males) aged 16-35 admitted to hospital on the disease day 2-14. RESULTS: Shmishek's questionnaire revealed various types of personality accentuations with dominating hyperthymic (30%) and cyclothymic (20%). According to the data of the clinical scale SCL-90, the greatest number of cases with values over normal was in patients with serous meningitis. Beck's questionnaire revealed clinical depression in 12 patients (40%) with acute serous meningitis, subdepression in 14(46.7%) patients, severe depression in 6(20%) patients with infectious mononucleosis. In convalescence, emotional disorders persisted in 4 patients with serous meningitis. CONCLUSION: Affective disorders in the above patients require consultation of the psychiatrist to decide on psychopharmacotherapy inclusion in combined treatment of infectious diseases to prevent lingering course.

Acute Disease↗
PubMed2002

[A case of renal cell carcinoma in a horseshoe kidney].

A-50-year-old patient visited our hospital to have further examination for left renal mass. Drip infusion pyelography revealed a cluster of calculi in the upper pole of the left kidney. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass on the left side of a horseshoe kidney. Left nephrectomy was performed through an abdominal transperitoneal approach. An operation for dividing isthmus was simultaneously done using a microwave tissue coagulator. Histopathological findings showed grade 1 > 2, pT1aN0M0, clear cell subtype, renal cell carcinoma. Convalescence was uneventful and the patient was free of tumor at one year postoperatively.

Carcinoma, Renal Cell↗
PubMed1996

The one-stop coronary cholesterol clinic: a multidisciplinary approach to implementing evidence-based treatment.

We describe a 'one-stop' cholesterol clinic implementing a regime based on the Scandinavian Simvastatin Survival Study (4S) in patients with established coronary heart disease in a district general hospital. The clinic has been established in collaboration with the cardiac rehabilitation centre. It was commissioned as an audit project by the purchasing authority, Walsall Health, a need having been shown in a previous audit. In the new clinic, audit is inbuilt, rather than being carried out as a separate retrospective exercise, and undertaken prospectively for all patients. Central to this is a database, used for routine correspondence and administration, as well as monitoring outcome. This application of information technology has improved clinical practice. Attendance at the clinic has been excellent. Half the consultations have resulted in therapeutic interventions, many of which may otherwise have been missed. Over 50% of patients were eligible for lipid-lowering medication under the protocol. Cholesterol targets based on 4S were achieved but with much lower drug doses, which may have major cost implications. Cholesterol levels measured within 24 hours of admission for myocardial infarction were poor predictors of results obtained after convalescence. After the clinic visit, most patients were taking aspirin plus one or two other secondary prevention treatments. Guidelines have been issued to primary care. Future plans for audit links with general practitioners, integration of the metabolic and cardiological assessment of survivors of myocardial infarction, and for long-term monitoring of clinical events in treated patients are discussed.

Aged↗
PubMedDate not supplied

The pituitary-thyroid axis in severe falciparum malaria: evidence for depressed thyrotroph and thyroid gland function.

Abnormal thyroid function is strongly associated with mortality in severe non-thyroidal illness. We have assessed the pituitary-thyroid axis serially in 18 Thai adults with severe falciparum malaria and in 18 matched controls. The admission total serum thyroxine (T4) concentrations of the patients (median [range]: 64 nmol/litre [less than 30-91]) were significantly lower than those of controls (81 nmol/litre [61-133]; 2P less than 0.01), and remained depressed until after fever and parasite clearance. Two patients who died in hospital had admission serum T4 concentrations less than 35 nmol/litre. The admission basal serum thyrotropin (TSH) levels of the patients (0.9 mU/litre [less than 0.2-3.1]) were similar to those of controls (1.3 mU/litre [less than 0.2-3.7], 2P greater than 0.1) and remained normal throughout fever and parasitaemia. Thirty-minute TSH increments during a thyrotropin-releasing hormone test on admission were reduced in 13 patients with severe malaria (4.1 mU/litre [0.7-8.1]) relative to those in convalescence (7.1 mU/litre [1.7-14.4], n = 10, 2P less than 0.01) and controls (5.6 mU/litre [3.3-12.9], n = 9, 2P less than 0.05). These findings suggest that thyrotroph and thyroid gland function are depressed during acute, severe malaria. As these changes may be an adaptation to accelerated catabolism, the role of thyroid replacement in such patients is uncertain.

Adolescent↗
PubMed1992

Outcomes of skilled cardiopulmonary resuscitation in a long-term-care facility: futile therapy?

OBJECTIVE: To assess whether cardiopulmonary resuscitation performed by in-house physicians is effective for long-term-care residents. DESIGN: Retrospective chart review. SETTING: Long-term-care facility with an intermediate care unit, skilled care unit, and a convalescent and assessment unit at a retirement community for veterans. PARTICIPANTS: All residents resuscitated from April 1987 to August 1990. All participants were male. The mean age was 75 years +/- 7.3 (range 42-93 years). MAIN OUTCOME MEASUREMENTS: Charts were abstracted for demographics, advanced directives information, information about the arrest, and post-resuscitation course. RESULTS: Forty-five elderly residents underwent resuscitation during this period. Nine residents (20%) were successfully resuscitated, with seven dying within 24 hours of hospitalization. No residents survived to return to long-term care (95% CI, 0-7%). The diagnoses were consistent with age-related chronic disease. Seventeen (38%) arrests were witnessed. The predominant rhythm at onset of resuscitation was asystole. CONCLUSION: We conclude that cardiopulmonary resuscitation, even when performed by a trained and experienced physician and team, has limited benefit for elderly long-term-care populations.

Adult↗
PubMed1999

[Rehabilitation and the socio-occupational reintegration of workers who have had a myocardial infarct: a pilot study].

OBJECTIVE: To evaluate in a pilot study some psychosocial impacts of a multidisciplinary rehabilitation program on work reintegration of postmyocardial infarction (MI) patients. PATIENTS AND METHODS: Two groups of 19 workers among public and governmental enterprises of the greater Quebec city area admitted to hospital for uncomplicated MI where recruited for the study. One group received multidisciplinary cardiac rehabilitation intervention and a structured return to work program. The second group received the usual care post-MI (no organized rehabilitation program). Over a period of 15 months, the following variables were measured patients' perception of their loss of autonomy, and loss of capacity to manage their emotions, physical work capacity and their capacity to meet work requirements. The impact of the intervention on convalescence time and patients' stability at work were also evaluated. RESULTS: The rehabilitation group showed a better development than the usual care group of capacity to manage emotions (P=0.004) and of capacity to return to work (P=0.006). Furthermore, the patients in the intervention group reintegrated their work environment following a convalescence of 84.32+/-35.39 days compared with 151.39 +/-75.53 days for the usual care patients (P=0.0007). CONCLUSION: A multidisciplinary rehabilitation program and a structured return to work program are beneficial for sociovocational reintegration of post-MI patients.

Adaptation, Psychological↗
PubMed1994

Viral, mycoplasmal and chlamydial lower respiratory tract infections in Hong Kong: cost and diagnostic value of serology.

A hospital virology laboratory in Hong Kong tested 10,852 sera by complement fixation (CF) for antibodies against agents of respiratory disease between 1 July 1986 and 31 December 1991. Ten commercially supplied antigens were used: influenza virus types A and B, parainfluenza virus types 1, 2 and 3, adenovirus, respiratory syncytial virus (RSV), Mycoplasma pneumoniae, Chlamydia species and Coxiella burnetii. Single sera comprised 69% of the total, including sera from 7488 patients investigated for LRTI with paired acute and convalescent samples. A total of 167 pairs (21.6%) showed rising CF titres, 82 of them against M. pneumoniae. Of the 809 patients, 365 were children under 11 years of age: 115 (31.5%) showed rising titres, including 51 with antibodies against M. pneumoniae, 21 against RSV, 17 against adenovirus and 10 against parainfluenza type 3. Viral antigen detection by immunofluorescence and virus isolation were also used: these methods yielded more positive findings than did CF test serology for the corresponding agents. The cost of the tests performed is discussed in relation to their contribution to the aetiological diagnosis of LRTI, and changes in the service to be offered are outlined.

Adolescent↗
PubMed1996

[Unilateral and synchronous occurrence of renal cell carcinoma and ureteral tumor: a case report].

An 81-year-old woman was admitted to our hospital with left flank pain. Excretory urography revealed left hydronephrosis. Abdominal computed tomography (CT) revealed a large heterogenous tumor in the upper pole and marked hydronephrosis and hydroureter in the lower portion of the left kidney. Left total nephroureterectomy was performed under the diagnosis of renal pelvic and ureter tumor. The pathological diagnosis was of renal cell carcinoma (spindle type, grade 3) in the kidney and transitional cell carcinoma (grade 2) in the ureter. Postoperative chemotherapy was not given. Convalescence was uneventful and fifteen months after the operation she is alive with no recurrence or metastasis.

Aged↗
PubMedDate not supplied

Laparoscopic management of tubal ectopic pregnancies--the Irish experience.

Ectopic pregnancies are being dealt with increasingly via the laparoscope on account of several advantages over conventional surgery. We commenced a Laparoscopic Ectopic service at the National Maternity Hospital in November 1995. This paper reviews the first 8 months of the service and is the first series of its kind in Ireland. All confirmed Ectopic pregnancies (EPs) between November 1995 and June 1996 are included in the study. Demographic details, diagnosis, operative details, analgesic requirements and outcome are reviewed. There were 56 tubal EPs giving an incidence of 1 per 81 live births. 35 were managed laparoscopically and were noted to have lower morbidity, analgesic requirement, reduced convalescence, shorter inpatient stay and thus lower cost. We have shown that EPs can be managed successfully via minimal access surgery in an Irish setting. In fact 22 of the last 24 cases of EPs were managed via the laparoscope.

Female↗
PubMed1992

Once-daily ceftriaxone to complete therapy of uncomplicated group B streptococcal infection in neonates. A preliminary report.

Newborn infants minimally symptomatic with non-central nervous system (CNS) infections due to Streptococcus agalactiae (group B streptococcus [GBS]) and other pathogens may not require skilled nursing care during the entire course of parenteral antibiotic therapy. In 1985, treatment guidelines were made available to private practitioners in Oregon for therapy of newborn infants at low risk of complications from their infections. In 1988, patient data were collected and analyzed retrospectively. Outpatient management during convalescence of 51 infants (21 with culture-positive infections due to GBS) was accomplished with once-daily physician follow-up examinations and IM injection of ceftriaxone. Long-term (greater than or equal to two months) follow-up data were available for 67% of GBS-infected infants, with no complication of infection or significant complication of therapy reported. Outpatient parenteral antibiotic management of selected, low-risk infants may offer the clinician an alternative to hospitalization for a portion of the duration of parenteral antibiotic therapy.

Ceftriaxone↗