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PubMed2002

Strategy of control of nosocomial infections: application of disinfectants such as povidone-iodine.

At Morioka Yuai Hospital, the Infection Control Division was set up 5 years ago, and it has made efforts to actively control infections. In particular, the division succeeded in increasing the frequency of general round table discussions for patients with infections. We strongly recommend to frequently gargle with Isodine at operations. Recently, we have followed up patients with infections caused by MRSA, Pseudomonas aeruginosa and Serratia or carriers of these bacteria, and determined the drug sensitivities of clinical isolates. In addition, because of the current highly aged society, a high percentage of inpatients has various underlying diseases. In particular, there are quite a few cases in which pneumonia occurs as an opportunistic infection. From studies in these patients and patients of the dental department, it has been shown that oral microorganisms clearly decrease in count by careful tooth brushing and gargling with Isodine, with prevention of pneumonitis caused by oral microorganisms. As we consider that antisepsis with povidone-iodine is useful for the prevention of nosocomial and opportunistic infections, we would like to report the findings of our study currently under way.

Anti-Infective Agents, Local↗
PubMed2004

Determinants of antithrombin consumption in cardiac operations requiring cardiopulmonary bypass.

Antithrombin (AT) is a natural anticoagulant that is consumed during cardiac operations with cardiopulmonary bypass (CPB). This study is an observational trial aimed at identifying the factors determining the magnitude of the AT consumption during cardiac operations. Two hundred and fifty consecutive adult patients undergoing cardiac operations with CPB were admitted to the study. Preoperative and intraoperative variables were tested with respect to their role in determining AT activity at the end of the operation. At a univariate analysis, eight predictors of AT activity at the end of the operation have been identified: preoperative AT activity; age; diabetes on medication; preoperative haematocrit value; preoperative dialysis; combined operation; CPB duration; lowest temperature on CPB. A multivariate predictive model was created, and five factors remained as independent predictors of AT activity at the end of the operation: preoperative AT activity (p = 0.001); age (p = 0.015); combined operation (p = 0.014); diabetes (p = 0.013) and CPB duration (p = 0.001). On this basis, predictive tables of AT consumption have been established for different combinations of risk factors.

Aged↗
PubMedDate not supplied

[Autologous transfusion technique application table].

The authors make a survey on the reasons leading to the application of different methods of autologous transfusion. They underline, incidentally, the important role played by the issues encountered in dealing with Jehovah's Witnesses as well as the discovery and spread of new transfusion transmitted diseases like AIDS and hepatitis C. They explain their experience, from which they have produced a Best Autologous Transfusion Technique Application Table (Scheda di Applicazione Ottimale delle Metodiche di Autotrasfusione, SAOMA), specific for every type, of operation, through the analysis of many parameters (surgeon, anaesthetist, transfusionist, general conditions of the patients, type of surgical operation). Moreover the authors evaluate advantages and disadvantages of the different autologous transfusion methods, including their cost efficiency aspects, and how they can be combined depending on the type of surgical operation. As a conclusion they attribute great importance to SAOMA to minimize homologous blood transfusion risks, even though at times the clinical aspect is made to prevail over the economic one.

Blood Transfusion, Autologous↗
PubMed1975

Long-term survival following coronary bypass surgery in patients with significant impairment of left ventricular function.

To assess the influence of coronary revascularization on the long-term survival of patients with debilitating angina and significant impairment of left ventricular function, analysis was done of 62 consecutive patients with severe angina and hypokinetic left ventricles (LVED larger than or equal to 20) undergoing coronary bypass at N.Y.U. Medical Center between January, 1971 and May 1974. Follow-up was 98% complete, range 4 to 41 months with a mean of 23 months. Multiple bypasses were done in 94% of the group; a left-ventricular scar was excised in 16%. There were six operative deaths (mortality 9.7%) and three late deaths, all within eight months after operation. Angina was either absent or substantially improved in 90% of surviving patients. Life-table analysis shows a two-year survival of 85%, very similar to the survival rate for patients with good ventricular function. Hence, with current techniques impaired ventricular function is not a major contraindication to bypass grafting.

Adult↗
PubMed2001

[Multimodality therapy concept in stage I-IIIA small cell bronchial carcinoma. Case follow-up over 15 years].

We analysed our results of multimodal therapy including chemotherapy, radiotherapy and surgery in 150 consecutive patients with SCLC stage I-IIIa operated on in our hospital between 1983 and 2000. Median age: 58 years, stages see Table 2. Patients with proven SCLC had induction chemotherapy prior to surgery. All patients received three cycles of adjuvant chemotherapy, some with additional radiotherapy. Perioperative mortality: 2%. Median survival: 22.4 months. R0 resection was possible in 84% of all patients. Pre- and post-surgery staging differed in the majority of the patients. Rotes of 1-, 2- and 5-year survival were 79%, 47%, and 32%, respectively. A median survival of 22.4 months in multimodally treated LD-SCLC, most of them stage IIb/IIIa appears promising. Randomized studies based on clinical staging procedures are not recommended. Survival data are promising.

Carcinoma, Bronchogenic↗
PubMed1990

The frequency of bacterial pathogens in infections potentially preventable by antimicrobial prophylaxis.

Bacterial pathogen frequency was analyzed over a fourteen year period at the University of Utah Medical Center. Isolation techniques and identification procedures have remained essentially the same during this period, allowing for a valid comparison of this frequency. For most organisms the frequency of overall isolation had remained relatively stable. Differences were seen in the frequency of Pseudomonas aeruginosa and in the isolation rate of Staphylococcus aureus. Escherichia coli became proportionately less frequent, almost as an adjustment to the increase in Pseudomonas aeruginosa. A table is presented of these same pathogens and their likelihood to occur in post-operative patients categorized by surgery type in order to define their role in such infections potentially preventable by antimicrobial prophylaxis.

Anti-Bacterial Agents↗
PubMed1990

Cholesterol analyzers.

We evaluated eight cholesterol analyzers from eight manufacturers, basing our ratings on the accuracy of the cholesterol results (from both fingerstick and venous samples) compared with the national reference method for cholesterol; repeatability (precision) of the cholesterol results; human factors design; suitability for off-site testing; sample analysis time and throughput; and the effects of sample interferences and electrical disturbances on cholesterol test results. Although many of the units perform additional tests, we did not evaluate performance for these tests; our ratings are based solely on the cholesterol tests performed in this evaluation. We rated seven units Acceptable. We rated one unit Unacceptable because it provided inaccurate and imprecise cholesterol results; also, its reagent system has inherent problems that contribute to human error and, thus, erroneous results. The manufacturer is no longer marketing this unit but is supporting the reagents. We found advantages and disadvantages for each Acceptable unit. To help users choose the appropriate unit for specific applications, we developed a Selection Factors table based on features and applications; this table is presented in the Discussion section. We recommend that all of these units be operated by qualified personnel to minimize the potential for human error. [See "Improved Regulations for Clinical Laboratory Tests."] For further discussion of related issues, see the Clinical Perspective, "Cardiovascular Disease: Reducing the Risk through Cholesterol Screening"; "Cholesterol Readers"; and "The Discontinued Johnson & Johnson CLA 200" in this issue.

Blood Chemical Analysis↗
PubMed1989

[Excision of condylar osteochondroma by vertical ramisection with immediate TMJ reconstruction].

In literature, excision of condylar osteochondroma is usually performed by preauricular incision. In Oct 1984 according to the experience of "Z" form osteotomy and bone graft to reconstruct the TMJ, a new method for excision of condylar osteochondroma was used by the first author, i.e. (1) making a vertical ramisection by subauricular incision; (2) excising the condylar osteochondroma with the posterior part of the ramus; (3) excising the condyle with osteochondroma on the surgical table, and (4) immediately reconstructing the TMJ with the surplus bone fragment at the same operation. Since 1984-1987, 7 cases have been performed by this method with excellent results. The details of the operation were described and discussed.

Adult↗
PubMed1981

Severe aortic stenosis in patients 60 years of age or older: left ventricular function and 10-year survival after valve replacement.

From 1962-1977, 99 patients, mean age 65 +/- 0.5 years (range 60-81 years) underwent valve replacement for severe calcific aortic valve stenosis. Ninety-three percent of the patients were in New York Heart Association functional class III or IV. The aortic valve gradient was 76 +/- 3 mm Hg and the aortic valve area index was 0.34 +/- 0.01 cm2/m2. Left ventricular systolic pressure was 207 +/- 4 mm Hg, cardiac index was 2.5 +/- 0.1 l/min/m2, left ventricular ejection fraction was 0.57 +/- 0.02 and left ventricular end-diastolic volume index was 108 +/- 60 ml/m2; left ventricular ejection fraction and end-diastolic volume were normal in 63% of the patients. The operative mortality was 16%. Mean follow-up is 55 +/- 4 months. Using life-table analysis, the 10-year survival, excluding cardiac deaths, is 57.5 +/- 7%. Ninety-one percent of the survivors are in functional class I or II. We conclude that the left ventricular function is normal in two-thirds of elderly patients with severe aortic valve stenosis. After valve replacement, the 10-year survival is most encouraging and most of the survivors are functionally improved.

Aged↗
PubMed1997

[Surgical treatment of aortic valve regurgitation due to nonpenetrating trauma of the chest--a case report and review of the literature in Japan].

A case report and a literature review of the patients in Japan who underwent surgical treatment of an aortic valve regurgitation due to nonpenetrating chest trauma are presented. A 70-year-old man was admitted to our hospital with multiple trauma, including fracture of sternum, caused by traffic accident. After treatment of respiratory and circulatory failure, he was found to have aortic regurgitation and subsequent congestive heart failure. The aortic valve replacement was performed and his postoperative course was good. The tear of aortic valve was detected in the noncoronary cusp, and the size of the tear was 4 mm. The aortic valve was not recognized the findings of inflammatory or rheumatic changes. Before this case, 15 cases were operated in Japan with the diagnosis of traumatic aortic regurgitation. We reviewed them in the table.

Accidents, Traffic↗
PubMed1989

False aneurysms after prosthetic reconstructions for aortoiliac obstructive disease.

Several aspects of false aneurysm development after prosthetic resconstruction for aortoiliac obstructive disease were studied. For this purpose the long-term results (up to 20 years of follow-up) of 518 patients with implanted arterial prostheses in the aortoiliofemoral tract were retrospectively evaluated. Completeness of follow-up data was 83.2% 15 years after operation. A total of 101 false aneurysms (21 aortic, 53 iliac, and 27 femoral) were detected in 69 patients and verified by operation. The incidence per patient was 69 of 518 patients (13.3%). The incidences per anastomosis were: aortic, 21 of 438 anastomoses (4.8%); iliac, 53 of 835 anastomoses (6.3%); and femoral, 27 of 198 anastomoses (13.6%). Almost one half (47.5%) of all the false aneurysms were asymptomatic and were detected by angiography or ultrasonography. Chances for late survivors to develop a false aneurysm during follow-up were calculated by the life-table method. The chance to be free of a false aneurysm at any site was 77.2% 15 years after operation. These chances were 92.3%, 84.5%, and 76.2% for aortic, iliac, and femoral anastomoses, respectively. Analyses of subgroups showed that the development of a false aneurysm was significantly correlated with the presence of hypertension, multilevel disease, the type of suture material, and the type of anastomosis. These results indicate unexpectedly high chances for the development of false aneurysms in long-term survivors after aortoiliac or aortofemoral prosthetic reconstructions. We advocate the use of a life-long follow-up schedule with periodic angiography and ultrasonography for these patients.

Anastomosis, Surgical↗
PubMed1996

Financial perspectives for the perioperative nurse.

This article describes the preparation of the operating room budget and identifies six components that contribute to cost per case. The successful budget can be achieved by following a six-step budgetary process. The budget process is shown by sample tables.

Budgets↗
PubMed1976

Veterinary information: the current situation and future trends.

Veterinary science is well supplied with abstracting and indexing hournals. Both experience and an investigation undertaken for the Food and Agriculture Organisation indicate that they are comprehensive in scope and subject coverage. Computer operation of information services is now routine, and mechanised alerting and retrospective services are available. A veterinary round table was set up in 1973 by the Commission of the European Communities to attempt to improve veterinary information. The round table is conducting a detailed study of the value of the available machine information systems to veterinarians and is compiling a multi-lingual thesaurus. In addition, it is investigating the need for a new review journal, methods of recording animal disease incidence and variations in the needs of the different types of veterinarians for information. The use of machine information systems is expected to become more widespread in the near future. Many will be available on-line, a method of working which offers great advantages in speed and flexibility of operation.

Abstracting and Indexing↗
PubMed2000

[Inflammatory abdominal aortic aneurysm. Role of corticosteroid therapy].

For more than 20 years it has been generally acknowledged that operation for inflammatory abdominal aortic aneurysm (IAAA) using the common in-lay-graft procedure will induce the regression of peri-aortic fibrosis. However in prospective studies, after a 2 years follow-up, no regression appeared in approximated 8% of the cases (table I). Moreover in some IAAA a corticosteroid treatment (CS) was prescribed and it produced a regression of fibrosis and therefore facilitated the operation. Nevertheless the usefulness of the CS remains debated. We report 4 new cases of IAAA with CS. Based on our cases and an analysis of the literature we conclude that when there is no urgency to operate (diameter inferior to 50 mm) CS is the best option in IAAA with either severe inflammation or ureter involvement. Due to the regression of the fibrosis it can facilitate the surgical procedure. However it needs to be conducted with an adequate dose and duration. Finally the CS is the only possibility when the inflammation persist following the treatment of the IAAA.

Adrenal Cortex Hormones↗
PubMed1986

Surgical management of infected abdominal aortic grafts: review of a 25-year experience.

Eighty-four patients with infected abdominal aortic grafts managed from 1961 through February 1985 were reviewed. Thirty-three patients had associated aortoenteric fistula formation. Twenty-eight infections (33%) and 13 aortoenteric fistulas (39%) originated at The Cleveland Clinic, yielding an incidence of aortic graft infection of 0.77% (28 of 3652 grafts) and aortoenteric fistula formation of 0.36% (13 of 3652 grafts) at this center. Staphylococcus organisms alone or in combination with other organisms were isolated from 34% of the series. Management consisted of graft removal and extra-anatomic bypass in 54 patients (64%), graft removal alone in 14 (17%) patients, partial graft removal and extra-anatomic bypass in seven (8%) patients, and miscellaneous operations in nine (11%) patients. Twenty-three patients (27%) required major amputations, nine of which were bilateral. Life-table analysis yielded 30-day and 1-year survival rates of 72% and 42%, respectively. Thirty-day survival of the aortoenteric fistula subset (49%) was less than that (86%) of the nonaortoenteric fistula subset (p = 0.003). One-year survival of patients treated since 1980 (54%) was superior to that of patients treated before 1980 (31%, p = 0.035). No difference in operative or 1-year survival was demonstrated between the group treated with extra-anatomic bypass and subsequent graft removal and another in which both procedures were performed simultaneously, although the staged group experienced substantially fewer (p = 0.04) amputations (7%) than the combined group (41%).

Actuarial Analysis↗
PubMed1979

Dental operating lights and illumination of the dental surgery.

The requirements laid down in national and international standards and draft standards provide helpful guidelines for optimum illumination (Fig. 1, Table I). General room illumination with 500 lx and illumination of the working area with 1000 lx are best achieved with a larger number of fluorescent lamps on the ceiling above and in front of the dental chair. Daylight white lamps with good colour rendering (e.g. Osram colour 19 or Philips colour 47) are a good combination with changing daylight and the colour of light of the operating light. The colour of external skin, mucous membrane and teeth appears natural. The eight surgical lights examined differ in quality (Figs. 2-9). The maximum illuminance is between 9000 and 21 000 lx and is thus sufficiently high. The evenness of light distribution within an ellipse 9 cm and 18 cm in diameter is between 1 : 4 and 1 : 15 (Figs. 10 and 11). Illuminance can be adjusted to the work in hand by means of controls. If the patient looks into the operating lights (Figs. 2c and 9c), maximum luminances of 5 cd/cm2-20 cd/cm2 occur 8 cm above the illuminance maximum in six operating lights. Luminances of more than 20 cd/cm2 cause squinting and running eyes. A light fitting with more than 200 cd/cm2 should not be used. A sharp fall in illuminance (distinct light/dark threshold) and low luminances to the patient's eyes can be achieved with very directed light. Very directed light leads to very heavy shadows. Similarly, less specifically directed light leads to softer shadows so that objects in the oral cavity can be discerned easily, but the patient is no longer dazzled. The following operating lights can be recommended if the patient is to suffer as little glare as possible: Den-Tel-Ez Daray, and Belmont Type 040, Faro Sunlight S 70, Ritter Super Starlite; as well as: Chirana Fax, Siemens Sirolux. The following can be recommended for good illumination of the oral cavity: Belmont Type 040, Chirana Fax, Emda Top Spot, Faro Sunlight S 70, Pelton and Crane Light Fantastic Plus, Ritter Super Starlite, Siemens Sirolux. The colour temperature, heat radiation, easy handling, stability and price are also important for qualitative assessment.

Color↗
PubMed1982

Femoropopliteal bypass: saphenous vein and expanded polytetrafluoroethylene grafts.

The patency of 181 saphenous vein and expanded polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts was assessed during a follow-up that ranged from 1 to 53 months after operation. Significantly better patency (P less than 0.05) was noted with saphenous vein (70%) than with PTFE (56%). Life-table analysis at 30 months demonstrated a cumulative patency of 50% for saphenous vein grafts versus 39% for PTFE, while at 53 months the rates were 46% and 33% respectively. The PTFE grafts tended to occlude earlier than saphenous vein grafts but after the initial year, both types of graft failed at a rate of about 5% a year. Patency was similar in both groups when operation was performed for claudication, but for limb salvage operations saphenous vein patency was superior to PTFE. Although the groups were similar in constitution, a higher percentage of patients in the PTFE group had undergone previous vascular operations.

Adult↗
PubMed1991

Simultaneous operative repair of multilevel lower extremity occlusive disease.

Sixty-two patients (39 men (63%), 23 women (27%), mean age 68 years) with multilevel lower extremity arterial occlusive disease underwent simultaneous inflow and outflow operative arterial repair consisting of aortofemoral bypass in 22 (35%), axillofemoral bypass in 17 (28%), femorofemoral bypass in 15 (24%), iliac endarterectomy in 7 (11%), and unilateral aortoiliac bypass in 1 (2%), combined with 69 outflow procedures (unilateral in 55 patients, 89%), including above-knee femoropopliteal in 12 (17%), below-knee femoropopliteal in 35 (51%), femoroinfrapopliteal in 20 (29%), popliteal tibial in 1 (1%), and femoropedal bypass in 1 (1%). Multiple criteria were used to identify patients with multilevel disease likely to benefit from multilevel procedures. The operations were performed by two operating teams in a median time of 240 minutes. Prosthetic grafts were used for eight (13%) distal bypasses, the remainder were autogenous vein. There was one operative death (1.8%). The mortality rate, morbidity rate, and operative time were not significantly different from a group of patients who underwent concurrent, isolated inflow operations (aortofemoral, axillobifemoral, femorofemoral bypass or iliac endarterectomy). Mean follow-up was 14.9 months (range, 0 to 120). The life-table primary patency for the inflow procedures was 92.6% at 24 months, the outflow was 94.9% at 24 months. Cumulative limb salvage was 90.9% at 48-month follow-up. All patients with claudication were relieved of their symptoms. We conclude that complete correction of multilevel disease can be accomplished with operative time, morbidity rate, and patency equal to that of single level repair. Multilevel procedures provide complete relief of symptoms in a higher percentage of patients than has been reported after single level repair.

Adult↗