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PubMed1999

Clinical virology of Ebola hemorrhagic fever (EHF): virus, virus antigen, and IgG and IgM antibody findings among EHF patients in Kikwit, Democratic Republic of the Congo, 1995.

Ebola hemorrhagic fever (EHF) patients treated at Kikwit General Hospital during the 1995 outbreak were tested for viral antigen, IgG and IgM antibody, and infectious virus. Viral antigen could be detected in virtually all patients during the acute phase of illness, while antibody was not always detectable before death. Virus was also isolated from patients during the course of their febrile illness, but attempts to quantify virus in Vero E6 cells by standard plaque assay were often unsuccessful. IgG and IgM antibody appeared at approximately the same time after disease onset (8-10 days), but IgM persisted for a much shorter period among the surviving convalescent patients. IgG antibody was detectable in surviving patients through about 2 years after onset, the latest time that samples were obtained. Detection of Ebola virus antigens or virus isolation appears to be the most reliable means of diagnosis for patients with suspected acute EHF, since patients with this often-fatal disease (80% mortality) may not develop detectable antibodies before death.

Animals↗
PubMed2005

Laparoscopic partial nephrectomy: comparison of transperitoneal and retroperitoneal approaches.

PURPOSE: Laparoscopic partial nephrectomy has become an effective alternative for small renal tumors. Previous reports include transperitoneal and retroperitoneal approaches but to our knowledge the indications for when to apply the techniques have not been defined. We report our experience with comparing the 2 techniques. MATERIALS AND METHODS: A retrospective review of 51 laparoscopic partial nephrectomies was performed. Patients were analyzed based on the surgical approach, operative parameters and postoperative recovery. The 2 approaches used similar operative techniques to control parenchymal bleeding and collecting system entry. RESULTS: There were 32 retroperitoneal and 19 transperitoneal partial nephrectomies. Mean operative time (3.5 vs 5.4 hours, p = 0.000001) and blood loss (192 vs 403 cc, p = 0.002) was significantly less for the retroperitoneal approach. Renal vessel clamping was performed in 81% of retroperitoneal and 63% of transperitoneal operations. Warm ischemia time was not significantly different between the groups. Patients undergoing the retroperitoneal approach had a statistically significant decrease in time to tolerating a regular diet (1.2 vs 1.7 days, p = 0.02), catheter removal (1.4 vs 2.5 days, p = 0.004) and discharge home (2.3 vs 3.6 days, p = 0.0008). CONCLUSIONS: Based on tumor location as the selection criteria the retroperitoneal approach was associated with shorter operative time, less blood loss, more rapid return of bowel function and shorter hospitalization compared with those in patients selected for the transperitoneal technique. Based on our experience we believe that the decision on the approach should be based on the tumor location on the kidney surface. For polar or posterolateral masses the retroperitoneal approach is preferred. The transperitoneal approach is best suited to anterior and medial lesions.

Blood Loss, Surgical↗
PubMed1990

Aortico--left ventricular communication: report of a case.

An 11-month-old male infant whose condition had been followed since birth was referred to the National Taiwan University Hospital for management of a congenital heart disease. On admission, this infant was noted to have a systolic and diastolic precordial thrill and a grade 4/6 systolic and diastolic murmur. Echocardiography, cardiac catheterization and cineangiogram revealed aortic stenosis, aortic regurgitation and dilatation of the aortic root. Surgical repair was performed to correct this congenital anomaly due to the progressive congestive heart failure. Intraoperatively, a breach between the aortic valve and the edge of the sinus of Valsalva along the aortic annulus was found. This congenital defect was repaired with a Teflon patch successfully. Postoperatively, this patient convalesced steadily and was discharged. We report this unique case with aortico-left ventricular communication which we believe to be the ninth case in the English-language literature and the first in the Republic of China.

Aortic Aneurysm↗
PubMed1983

Untreated meningococcemia in two siblings.

In September 1982 two siblings were admitted to hospital within a few days of each other, with almost identical symptoms of meningococcemia. One of them had been discharged from hospital four days previously, fully treated to meningococcal meningitis. Two systemic meningococcal isolates and nasopharyngeal meningococci from patient No 1 were B:15:P1. 16 strains as well as one nasopharyngeal isolate from patient No 2. One nasopharyngeal isolate from the father was a non-encapsulated 15:P1. 16 strain. The two systemic isolates were clearly different with respect to the class 5 outer membrane protein(s); the second closely resembled the various nasopharyngeal isolates, all of which were identical. Only the two patients mounted detectable bactericidal antibody activity as measured by using human complement. Convalescent serum from patient No 1 after the second episode was bactericidal against the first but not the second isolate. No differences among patients and parents were found by measuring opsonizing activity. The clinical picture and the laboratory results seem to indicate that both children, one after a treated meningitis episode, had benign meningococcemia which subsequently ran its course untreated and without complications.

Adult↗
PubMed1997

CT scan abnormalities in a series of patients with hemorrhagic shock and encephalopathy syndrome.

BACKGROUND: Hemorrhagic shock and encephalopathy syndrome (HSES) affects children under 1 year of age and is characterized by seizures, shock and certain laboratory abnormalities, including coagulation abnormalities. It has a high mortality and many of the survivors are neurologically abnormal. OBJECTIVE: To describe abnormalities observed on initial and follow-up CT scans in a group of patients suffering from HSES. MATERIALS AND METHODS: Retrospective review of records and CT scans of ten patients with HSES who were admitted to the intensive care unit of the Children's Hospital and Medical Center, Seattle. RESULTS: Cerebral edema was seen in all cases when the CT scan was obtained between 1 and 7 days after onset of HSES. The basal ganglia and cerebellum were relatively spared, and no hemorrhage was seen. Patients with moderate or marked cerebral edema usually had a poor prognosis. All survivors had significant neurologic sequelae. CT scans obtained after 7 days often showed encephalomalacia with ex vacuo ventricular enlargement. CT scans obtained between 24 h and 4 days after onset will show the acute changes of HSES. CT scans during the initial and convalescent stages of HSES can provide useful information about cerebral edema and encephalomalacia, which occur frequently with this illness.

Brain↗
PubMed1993

Nonparallel changes in global left ventricular chamber volume and muscle mass during the first year after transmural myocardial infarction in humans.

OBJECTIVES: This study was designed to serially assess time-dependent changes in both chamber volume and myocardial muscle mass after infarction in humans. BACKGROUND: Dilation of the left ventricular chamber has been previously described after transmural myocardial infarction. METHODS: Global left ventricular chamber volumes and muscle mass were quantified by using cine computed tomographic scanning in 18 patients at hospital discharge and 6 weeks, 6 months and 1 year after an initial transmural myocardial infarction (12 anterior and 6 inferior). No patient had heart failure during the initial hospital stay or on any subsequent follow-up visit. RESULTS: The patients with anterior myocardial infarction (estimated infarct extent 27 +/- 2% of left ventricle) demonstrated a progressive increase in left ventricular end-diastolic volume from 148 +/- 9 ml (mean +/- SEM) at hospital discharge to 180 +/- 9 ml at 1 year after infarction (p < 0.001). However, global left ventricular muscle mass decreased significantly during the 1st 6 weeks after infarction but returned by 1 year to nearly the value determined at hospital discharge (177 +/- 13 vs. 165 +/- 10 g, p = NS). The changes in global muscle mass did not parallel the steady and progressive increases in chamber end-diastolic volume. The end-diastolic chamber volume to muscle mass ratio, an index of global left ventricular wall tension, increased steadily after hospital discharge but remained level by 1 year after infarction. The time course of changes in global end-systolic chamber volume was roughly proportional to the concomitant changes in end-diastolic volume. During this same time period, left ventricular stroke volume remained constant or improved from that determined at baseline. Global left ventricular end-diastolic and end-systolic volumes remained relatively static during the 1st year in the patient subgroup with inferior wall myocardial infarction (estimated infarct extent 10 +/- 1% of left ventricle), but global muscle (myocardial) mass initially decreased and then increased in a pattern similar, although of smaller magnitude, to that observed in patients with anterior wall myocardial infarction. CONCLUSIONS: Overall, left ventricular end-diastolic and end-systolic chamber volumes increase progressively from hospital discharge to 1 year after an initial transmural myocardial infarction in patients with a moderately large anterior wall infarction but remain stable in patients with a small inferior wall infarction. Concurrently, total left ventricular muscle mass decreases significantly during the initial 6 weeks after infarction (presumed largely secondary to changes in the necrotic segments) but then returns to the hospital discharge baseline values by 1 year. These data are consistent with the late development of, at most, limited ventricular hypertrophy in the noninfarcted myocardium that occurs well after the early and progressive left ventricular chamber dilation observed in patients with a moderate to large myocardial infarction. These data, in particular as applied to patients with anterior infarction, suggest that ventricular wall tension is significantly elevated at least during the 1st year after an initial transmural myocardial infarction. These observations may explain the potential utility of agents aimed at reducing afterload or ventricular wall tension during the early convalescent phase after myocardial infarction.

Female↗
PubMed1982

Delayed recovery of vision after blindness caused by methanol poisoning.

Total blindness developed in an adult Melanesian man 36 hours after he drank 100 mL of 100% methanol. On admission to hospital, he had a blood methanol level of 0.5 g/L and severe acidosis. Peritoneal dialysis was carried out, and he was treated with sodium bicarbonate and ethanol for one week. After 12 days of blindness, he regained some light perception. Progressive improvement in vision occurred. Twelve weeks after the methanol poisoning, his visual acuity was: right eye, able to see hand movements at one metre; left eye, 6/12. However, a right central scotoma persisted, and bilateral optic atrophy was present. No reason for the exceptional delay before recovery and degree of recovery could be deduced, although throughout his convalescence he frequently chewed betel nut. We recommend further studies to determine if any of the constituents of betel nut diminish the toxic effects of methanol on the eye.

Adult↗
PubMed1979

[Nutritional requirements and parenteral feeding].

1. The nutritional needs of man are governed by the law of the minimum (structural and protective substances) and the isodynamic rule (exchangeability of various energy carriers) There is a tendency to abandon the traditional concept of requirement as an absolute value (g or mg/day) and replace it by 3 graded parameters (minimal - lowest acceptable - desirable supply). Today nutrient density is of utmost importance in the planning and evaluation of food formulas, i.e. the content per 1000 kcal or per MJ = mega-Joule. 2. The metabolism of nutrients proceeds (simplified) in 3 phases: a) digestion (comminution); b) coordination and conversion in intermediary metabolism; c) direct use in synthetic or oxidation processes. This creates problems of balance, of co-ordination and regulation. In the phases b and c the same conformities apply for oral and parenteral feeding. 3. Particular features of parenteral feeding: Exclusion of intestinal flora, limited capacity of uptake by the circulation and, especially, the lowered capacity of biochemical regulatory mechanisms (homeostasis) in patients requiring parenteral feeding necessitate optimal coordination of supply and effective needs. Attempts to comply are made by continuous infusions, diversification of the substrate supply and optimisation of the different components. In principle, priority is given to those nutritional factors which promote anabolism (tissue formation) and counteract catabolism (tissue breakdown). 4. Example: protein needs. --Recapitulation of quantitative and qualitative requirements regarding protein and amino acid supply. --Discussion of the different recommendations and guidelines. --Discussion of the criteria for evaluation and the composition of an optimal amino acid mixture (nitrogen balance and growth as criteria). 5. Conclusions for parenteral feeding. The supply of amino acids should be on the generous side because there is an increased requirement in the "acute phase" and in convalescence. The amino acid composition should correspond to the pattern of a high quality food protein. The E/T ratio (essential AS versus total AS supply) is an indicator. The value proposed as a guideline is E/T approximately 3. However, an exaggerated amino acid cosmetic is not recommended. 6. Diagnostic problems. In the interest of optimal results of treatment, foremost attention should be given to the detection of latent deficiency states and the improvement of nutrition at large. The list of indicators given in the figures should be consulted whenever there is evidence of undersupply. The so-called "hospital malnutrition", as described in recent studies, should obviously not occur.

Amino Acids↗
PubMed1993

Clinical survey of natural varicella compared with breakthrough varicella after immunization with live attenuated Oka/Merck varicella vaccine.

OBJECTIVE: To prospectively characterize varicella occurring in children previously immunized with a live attenuated varicella vaccine (breakthrough varicella) through daily observation by medical personnel and to compare it with natural varicella followed in the same manner. DESIGN: A blinded clinical survey. SETTING: Four pediatric practices (two private; two hospital-based). PARTICIPANTS: Healthy 12-month-old through 17-year-old children with chickenpox were studied; 92 had natural varicella and 58 had breakthrough varicella. SELECTION PROCEDURES AND INTERVENTIONS: Study personnel, unaware of vaccination status, documented the clinical characteristics of each patient in the office or at the patient's home each day from enrollment until the day after the total number of lesions increased less than 10%. A standard form documenting number and description of lesions, temperature, duration of illness, and associated clinical complaints was completed each day by the same study personnel. Acute and convalescent sera were obtained on breakthrough cases. MEASUREMENTS AND RESULTS: Antibody to varicella-zoster virus was measured by the glycoprotein-based enzyme-linked immunosorbent assay. Of those with sera available, 85% were serologically confirmed. Eighty-seven percent of enrollees had a known exposure to chickenpox, with at least two thirds of each group having a greater than 4-hour or a household exposure. The numbers of total and vesicular lesions were significantly higher in the natural varicella group, regardless of exposure status (P = .021 to < .001). The group with breakthrough varicella had a significantly lower incidence of fever (P < .001) and a significantly shorter duration of illness (P < .001). Other associated constitutional complaints and complications were not significantly different between groups. CONCLUSION: Varicella in vaccine recipients is clinically modified and significantly less severe than natural disease.

Adolescent↗
PubMedDate not supplied

Effect of misoprostol on the course of viral hepatitis B.

BACKGROUND/AIMS: Some prostaglandins revealed hepatoprotective effects, that was confirmed mostly in experimental liver injury. The aim of the study was to determine the effects of misoprostol on the course of viral hepatitis B and associated gastric mucosal injury. METHODOLOGY: Fifty two male patients with viral hepatitis B were assigned at random to receive either misoprostol (800 micrograms/day), silymarin (210 mg/day) or no drug treatment at all (control group). Biochemical indices of liver injury were measured once a week, and HBsAg clearance was analysed 6 months later. Moreover serum levels of endogenous prostaglandins (PGE2, PGI2) and stomach mucosal injury (scored endoscopically) were evaluated before and after treatment. RESULTS: Decrease of serum concentration of bilirubin, activities of transaminases and alkaline phosphatase as well as hepatomegaly reduction were significantly faster in misoprostol treated patients, that resulted in significantly shorter time of hospitalization. The best effect of misoprostol treatment on liver injury was observed in patients suffering from a severe course of the disease. HBV elimination, evaluated 6 months after the disease onset, was similar in both groups. Misoprostol treatment had a significant effect on the improvement of stomach mucosal injury. Serum concentrations of main endogenous prostaglandins produced by the liver (PGE2 and PGI2), were not affected by exogenous administration of misoprostol. There were no side effects related to misoprostol or silymarin treatment. CONCLUSIONS: Our data demonstrates the beneficial effect of misoprostol treatment in patients with viral hepatitis B. Faster convalescence related to normalization of biochemical indices of liver injury and healing of associated stomach mucosal lesions was also observed.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

Randomized comparison of conventional and gasless laparoscopic cholecystectomy: operative technique, postoperative course, and recovery.

The positive CO2 pneumoperitoneum needed to create the working space for laparoscopic surgery induces cardiovascular, neuroendocrine, and renal changes. Concern about these pathophysiologic changes has led to the introduction of a gasless technique. Fifty consecutive patients with symptomatic gallstones were randomized to conventional (CLC) or gasless laparoscopic cholecystectomy (GLC), with special reference to overall patient satisfaction, technical difficulties, duration of surgery, postoperative pain, and recovery. The overall exposure of the operative field was extremely poor in the GLC group, whereas the duration of surgery, steps involved in the cholecystectomy technique, length of hospital stay, and postoperative pain score did not differ significantly. After discharge, the median time to complete relief of pain tended to be shorter in the gasless group (5 days [range 1 to 15]) vs. the conventional group (8 days [range 1 to 15]). The period to return to normal activity was shorter in the GLC group (6 days [range 1 to 15]) compared to the CLC group (8.5 days [range 1 to 15]) (P = 0.031). No differences were found in terms of fatigue, dizziness and nausea, and overall satisfaction with the outcome. This study demonstrates a significantly shorter convalescence after laparoscopic cholecystectomy by means of the gasless technique compared to the conventional CO2 technique. Exposure of the operative field was less than optimal using the gasless technique.

Adult↗
PubMed1967

Concurrent isolation from patient of two arboviruses, Chikungunya and dengue type 2.

Chikungunya virus and dengue type 2 virus were isolated from a single blood specimen taken from a patient in the acute phase of a dengue-like illness seen at Christian Medical College Hospital, Vellore, South India, in October 1964. In serial blood specimens collected from this patient there was an increase in antibody to these same two viruses. The technique for unmasking an agent (such as dengue) with a long incubation period in mice in the presence of an agent with a short incubation period is described.

Animals↗
PubMed1977

[Bilateral direct injury of oculomotor nerves in craniocerebral trauma-report of a case (author's transl)].

A 46-year-old housewife was admitted to the Kawasaki Hospital soon after traffic accident. She was struck in the right forehead. She was very slightly drowsy but well oriented. Both eyeballs were extremely abducted without any motility. The pupils were bilaterally dilated and equal in size with no response to light. There was a pronounced blephaloptosis on both sides. Another neurological abnormality was a slight right facial weakness. On skull films, a linear fracture in the right temporobasal region was noted but the views of the orbits were normal. A lumbal tap showed a mild subarachnoidal hemorrhage. Three weeks after the trauma, pneumoencephalography showed no abnormal finding. Throughout convalescence, no special treatment was given beyond medication. She improved steadily. Three years after injury, re-examination disclosed that lateral gaze was almost full to either side but upward and downward movements of both eyeballs were limited. In our opinion, the most likely cause of the disability in this case was bilateral direct damage of the oculomotor nerves near the petroclinoid ligament (Grüber).

Brain Injuries↗
PubMed1975

Reduction of prehospital, ambulance and community coronary death rates by the community-wide emergency cardiac care system.

Initiation of quick prehospital cardiopulmonary resuscitation and emergency cardiac care completed the total system needed to provide emergency and convalescent coronary care for a community. Subsequently, annual community rates for coronary death during ambulance transport fell by 62 per cent and for prehospital coronary death by 26 per cent in people under 70 years of age. In cardiac arrest due to acute myocardial infarction, prompt successful prehospital correction of ventricular fibrillation and asystole yielded long-term survival in two thirds of cases. This 66 per cent success rate of prehospital cardiopulmonary resuscitation and emergency cardiac care is identical to contemporary international experience. Precordial thump-version with the fist and precordial fist pacing appeared logical additions to prehospital cardiopulmonary resuscitation and emergency cardiac care technics. Community lives saved yearly were 15.2/100,000 people aged 30 to 69 years and 6.4/100,000 total population. Simultaneously, annual community rates for coronary death as a cause of death and coronary death per 1,000 people fell significantly by 15 and 17 per cent, respectively. Unquantifiable influences included prehospital relief of ischemic chest pain; prehospital correction of acute dysautonomia; prehospital abolition of otherwise prefatal dysrhythmias; similar treatment for acute myocardial infarction in the emergency department, in the inhospital mobile coronary care unit and in the progressive intermediate coronary convalescent unit; and general community education through the media of newspapers, radio and television. The present frequency of coronary death during ambulance transport, 9 to 22 per cent of prehospital coronary deaths in this and other surveys, suggests that the prehospital cardiopulmonary resuscitation and emergency cardiac care component needs improvement in many communities. By reducing prehospital and ambulance coronary death rates, prehospital cardiopulmonary resuscitation and emergency cardiac care for acute myocardial infarction constitutes an essential component of the total system approach to emergency coronary care. Since prehospital cardiopulmonary resuscitation and emergency cardiac care have cheaply and effectively expedited and abbreviated hospitalization for acute myocardial infarction, and lowered community death rates from coronary artery disease, its adoption throughout the United States and the western world seems justified.

Ambulances↗
PubMed1993

Changes in lipid profile observed in children over the course of infectious disease.

Lipid profile was evaluated prospectively in 23 consecutive children, aged 3.2-14.9 years, admitted to the hospital with a febrile illness (pneumonia, upper respiratory tract infection, diarrhea, pyelonephritis, mononucleosis, appendicitis). The degree of dyslipidemia associated with fever was assessed using each child as his/her own control and by comparison with 93 non-febrile children who had no evidence of fever during the past six months. Total cholesterol decreased during the symptomatic phase of the disease. The magnitude and duration of its decrease appeared to be related to the degree and duration of fever. Low HDL-cholesterol and hypertriglyceridemia were observed during the late stage of the febrile disease and were still detected in the convalescent phase. This study suggests that in children, transient and sometimes prolonged lipid changes may occur in association with an infectious febrile disease. This effect is important for defining the appropriate timing for screening for dyslipidemias.

Adolescent↗
PubMed2004

Nutritional care of Danish medical inpatients: effect on dietary intake and the occupational groups' perspectives of intervention.

BACKGROUND: Many patients do not eat and drink sufficiently during hospitalisation. The clinical consequences of this under nutrition include lassitude, an increased risk of complications and prolonged convalescence. The aim of the study was 1) to introduce intervention targeting nutritional care for medical inpatients, 2) to investigate the effect of this intervention, and 3) to investigate the occupational groups' attitudes towards nutritional intervention and nutritional care in general. METHODS: The design was to determinate the extent to which the protein and energy requirements of medical inpatients were met before and after intervention. Dietary protein and energy intakes were assessed by 72-hour weighed food records. A total number of 108 medical patients at four bed sections and occupational groups in the two intervention bed sections, Aarhus University Hospital, Denmark participated. The intervention included introduction and implementation of nursing procedures targeting nutritional care during a five-month investigation period using standard food produced at the hospital. The effect of intervention for independent groups of patients were tested by one-way analysis of variance. After the intervention occupational groups were interviewed in focus groups. RESULTS: Before the intervention hospital food on average met 72% of the patients' protein requirement and 85% of their energy requirement. After intervention hospital food satisfied 85% of the protein and 103% of the energy requirements of 14 patients in one intervention section and 56% of the protein and 76% of the energy requirement of 17 patients in the other intervention section. Hospital food satisfied 61% of the protein and 75% of the energy requirement in a total of 29 controls. From the occupational groups' point of view lack of time, lack of access to food, and lack of knowledge of nutritional care for patients were identified as barriers to better integration of nutritional care into the overall care provision. CONCLUSION: There was ample room for improving the extent to which standard hospital food satisfies patients' protein and energy requirements, but implementation of procedures addressing nutritional care were difficult, especially at bed sections with a large staff turnover.

Journal Article↗
PubMed1998

Limitations on life: women's lived experiences of angina.

The purpose of this study was to build on the notion of nursing as a human science by using the approach of phenomenology and grounded theory to explore and describe the lived experience of women suffering with angina. Eight women aged between 50 and 70 years old were asked to participate for a 2-month period. The women were selected soon after admission to a hospital in southern England. They were interviewed on two occasions and were asked to keep a diary of events. From the analysis of the transcribed data and the diary records it is possible to detect a clear adjustment process that emerged as the women recovered and dealt with the limitations on their lives.

Activities of Daily Living↗
PubMed2003

[Assessment of health-related quality of life in cured SARS patients].

OBJECTIVE: To assess the quality of life in cured patients with severe acute respiratory syndrome (SARS). METHODS: One hundred and nineteen SARS outpatients, including 64 men and 55 women, with mean age (34.1 +/- 11.4) years and average days of discharge from hospital (28.0 +/- 12.8) days, were assessed by the St George's respiratory questionnaire (SGRQ), and 72 patients with spirometry test. RESULTS: The patients had a moderately degree physiological impairment and increased SGRQ score. Scores of all four part of SGRQ correlated significantly with diffuse capacity of the lung for carbon monoxide/pre (DLco%). The correlation coefficients between the activation, impaction, total score, and diffuse capacity of the lung for carbon monoxide/alveolar ventilation/pre (DLco/Va%) were resembled (r = 0.47-0.54, P < 0.01). There was a significant relationship between the score of SGRQ and patients age, and gender. The time leaving hospital only had a significant relationship with the symptom score of SGRQ. CONCLUSIONS: SGRQ is a sensitive tool for assessing quality of life in cured SARS patients. The cured SARS patients' quality of life decrease moderately.

Adolescent↗