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At least 1,729 records · Page 96Linked to original sources
PubMed1987

Pelvic exenteration: prognostic significance of regional lymph node metastasis.

The members of the Felix Rutledge Society were surveyed to determine their policies concerning pelvic exenteration when regional lymph node metastasis is discovered at the outset of an operation and the resulting survival data. Survival data from the responding members are presented in a summary table. A series of 448 exenterations performed at The University of Texas M. D. Anderson Hospital and Tumor Institute from 1955 to 1984 was reviewed, and the medical records of patients with positive nodes were analyzed for factors that might influence prognosis, such as anatomical site of cancer, histologic type, and location and number of positive nodes. Of the 407 patients whose lymph nodes were studied histologically, 44 had nodal metastasis. Death from recurrent gynecologic cancer and death from all causes were used as end points, and survival rates were calculated according to primary treatment, treatment of recurrent cancer, cancer of the cervix, location of positive nodes, and number of positive nodes. For patients with positive nodes, 36.2% avoided death from recurrent cancer for 3 years, and 26.3% survived for 5 years. We conclude that although the prognosis for patients with positive nodes is poor, some longterm survivals can be achieved. The goal of pelvic exenteration is cure; however, for selected patients, the operation may be justified when it improves the quality of life and extends life.

Female↗
PubMed1993

A stimulator for studies of mechanical nociception based upon a commercially available translation table.

We have developed a mechanical stimulator that can be used for studies of sensory physiology, psychophysics and tissue mechanics. The stimulator operates in either displacement or force-servo modes. It surpasses other available stimulators in respect to displacement range, measurement sensitivity and cost, and it can be easily assembled from parts that are commercially available.

Animals↗
PubMed2026

RSHash: a fast and space-efficient hash table for k-mers.

SUMMARY: Large genomic data collections can be viewed as a continuous string of DNA characters. The essential operations for data structures indexing the k-mer content of such a string are lookup and locate. Lookup determines whether a query k-mer q exists in the string and locate returns all locations in the string where q is present. High-throughput DNA sequencing generates very many k-mer sets of size exceeding billions of characters. In such scenarios, memory consumption and query efficiency pose significant challenges to a data structure supporting the above mentioned queries. To address this problem, we describe a simple, compressed, static data structure for k-mers that answers lookup and can be extended for supporting locate. The general scheme follows the use of minimizers like the state-of-the art SSHash. However, instead of using minimum perfect hash functions our solution (RSHash for Rank-Select Hash) relies on bitvectors with rank and select support, a multiple layered minimizer scheme, and a clever buffering strategy. We can show that RSHash is on average 40% and in some cases up to two times faster than SSHash while having the same memory requirements. Indeed we can go as low as 8 bits per canonical 31-mer on a human dataset. AVAILABILITY: https://github.com/jonsmcode/rshash.

Sequence Analysis, DNA↗
PubMed1993

[Anesthetic gas consumption and costs in a closed system with the PhysioFlex anesthesia equipment].

A marked decrease in both personal and environmental pollution with anaesthetic gases as well as in costs is possible with anaesthesia machines which can be run with a low fresh gas flow (FGF) [9]. Low-flow anaesthesia can be performed with appropriately equipped circle systems, although strongly reduced FGF minimises the control of depth of anaesthesia and gas concentrations. Microprocessor-controlled feedback systems allow the utilisation of closed-circuit systems throughout the whole duration of anaesthesia, maintaining full anaesthetic control [3,5]. The aim of this investigation was to determine the costs resulting from gas consumption and clinical suitability of the recently marketed PhysioFlex anaesthesia machine. METHODS. We used a PhysioFlex (Physio, Hoofdorpp, Netherlands) in a series of 15 routine otorhinolaryngological interventions. After induction with thiopentone and suxamethonium, general anaesthesia was maintained with nitrous oxide in 30% oxygen and isoflurane and supplemented with fentanyl and atracurium. The expenditure of anaesthetic gases was recorded during a total of 61 h and 27 min and differentiated into its components. Anaesthetic gas uptake and costs were compared with different breathing systems (low-flow anaesthesia, semiclosed system and non-rebreathing system) under similar clinical conditions. RESULTS. The average minute volume was 6.84 (+/- 1.17) l and the expiratory isoflurane concentration was 0.91% (+/- 0.14%) (Table 1). These settings resulted in an oxygen expenditure of 27.9 (+/- 8.46) l/h with total costs of SFr. 0.04, nitrous oxide 11.9 (+/- 5.4) l/h and 0.27, isoflurane 3.9 ml/h and SFr. 5.42. In contrast, other breathing systems in analogous settings resulted in greater costs by a factor of 0.77 for low-flow anaesthesia (FGF 1 l/min), 2.47 for a semiclosed system (FGF 3 l/min) and 5.63 for a valve-controlled non-rebreathing system (FGF 6.84 l/min) (Table 2). DISCUSSION. The emission of anaesthetic gases can be lowered by measures that avoid unintended gas fallout, the application of filters, scavenging systems and efficient air circulation in operation and recovery rooms [8]. Above all, the use of the lowest possible FGF is advantageous for the patient insofar as better conditioned breathing gases are available, and economic and environmental effects are more significant (Table 3). With the method of quantitative anaesthesia as performed by the PhysioFlex, it is now possible to reduce gas expenditure according to the requirements of the patient as well as maintaining full control of anaesthesia depth. Simultaneously, multiple secured feedback control systems guarantee adequate monitoring and storage of respiratory and metabolic parameters. The duration of nitrous oxide wash-out can be a problem, in particular, when a changeover to O2/air is required.

Anesthesia, Closed-Circuit↗
PubMed1985

Comparison of axillounifemoral and axillobifemoral bypass operations.

Routine use of axillobifemoral (ABF) bypass has been advocated because this operation is thought to achieve better patency than the axillounifemoral (AUF) procedure. In 5 years we performed 34 AUF and 22 ABF bypass operations for limb salvage in high-risk patients using 6 mm polytetrafluoroethylene grafts. Five-year cumulative life table patency rates for AUF bypasses were 71% with reoperation (secondary patency) and 44% without reoperation (primary patency). These values were not significantly different (p greater than 0.5) from those for ABF bypasses (77% and 50%, respectively). Five-year limb salvage results (AUF 73%; ABF 89%) were also not significantly different (p greater than 0.1). Correlation of arterial outflow characteristics with graft patency revealed that 78% of the patients who never had graft occlusion had occluded superficial femoral arteries (SFA) demonstrated at the first operation, while 79% of the patients who experienced graft closure had comparable SFA occlusions. Our aggressive approach to graft thrombosis included angiographic study of the inflow arterial system. This revealed that 16% of the failed grafts were associated with hemodynamically significant stenosis of the donor subclavian artery. Our results indicate that AUF bypass is the procedure of choice for unilateral limb ischemia in high-risk patients who require an axillary source and that patency of the SFA does not affect outcome. These results also emphasize the need to obtain angiographic evaluation of the inflow system.

Aged↗
PubMed1990

[Epidemiologic aspects of polyarterial pathology].

UNLABELLED: With the considerable technical progress in vascular investigations made in the last decade, evaluation of multifocal ischemic pathology (MIP) has become easier and allows better assessment of strategy for reperfusion. In vascular surgery, 50% of post-operative mortality and morbidity are related to coronary heart disease (CHD). Epidemiologic data, not biased by specific recruitment of medical and surgical departments, are needed to assessing the real incidence of MIP. Different clinical date have already shown the problem of MIP: the post-operative cardiac mortality rate in vascular surgery has been evaluated at between 0.9% and 3.5% for abdominal aortic aneurysms and 0.3% and 3.2% for peripheral vascular disease (PVD) according to recent statistics (2, 7, 10, 12, 21) (Table I). The total cardiac mortality rate is between 1% and 2% for vascular surgery and is 0.2% for general surgery (8). Thus, though early post-operative over-risk in vascular surgery is not very high, the long term-prognosis is far more impaired: 25% to 55% of patients will die within 10 years after vascular surgery (4, 10, 13, 20). Hertzer, using systematic pre-operative coronary angiograms, found significant coronary stenosis in 57% of patients referred for vascular surgery (11). POPULATION AND METHODS: This study was performed in a representative sample taken from an ongoing prospective survey of 10,446 council employees in Marseille (5,177 men (M.), 5,269 women (W.)). This sample of 1,883 M. and 1,212 W. (mean age: 42.3 +/- 9 for M., 44.9 +/- 11 for W., range 25-65 years) was submitted to a detailed questionnaire on personal and family history of CHD, risk factors and symptoms of CHD (22), and to a physical examination including height, weight and blood pressure measurements. Every subject underwent an ECG recording and a dietetic (5) and psychologic (1) interview, and a blood sample was taken for plasma glucose, total cholesterol and lipoprotein assay. According to epidemiologic data, the prevalence of MIP appears to be lower as compared to clinical data. Undoubtedly, clinical data from surgical departments overestimate the true prevalence of MIP since patients referred for surgical therapy are usually suffering from more advanced pathology. Epidemiology, mainly based on non invasive data probably underestimates the prevalence of MIP but confirms the highest prevalence of CHD as compared to prevalence of other localisations of atherosclerosis and shows CHD as being the earliest localisation of vascular ischemic lesions in most cases. When unifocal ischemic pathology (UIP) and MIP are compared, risk factors are the same, although different proportions of patients are concerned with some of them: in MIP, age is still the major risk factor, whereas smoking in M. and overweight in W. seem to be more frequent than in UIP. RESULTS: Sixty-eight cases (5%) of ischemic pathology were found in men and 47 cases (4%) in women, with 4.1% cases of unifocal ischemic pathology (UIP) in M. and 3.3% in W...

Adult↗
PubMed2002

Carotid endarterectomy in high risk patients.

We elected to compare the clinical outcomes of carotid endarterectomy (CEA) patients who were thought to be at increased risk for peri-operative complications because of advanced age (> 79 years), medical comorbidities and contralateral internal carotid artery occlusion to patients without these risk factors. A prospective series of 875 CEAs done using regional anesthesia were analyzed. All patients were operated upon under the direction of one neurosurgeon (REH). Clinical outcomes measures evaluated were any stroke, death or myocardial infarction within 30 days of operation. All patients were followed to a clinical endpoint and/or six weeks post-operatively. The incidence of adverse clinical outcomes in the suspected high risk patients was compared to the incidence in the entire series using contingency table analysis (Chi-square and Fisher's exact test). Twenty strokes (2.3%), four myocardial infarctions (0.5%) and three deaths (0.3%) occurred within 30 days of CEA. None of the suspected risk factors was associated with a significantly (p < 0.05) increased risk of peri-operative morbidity or mortality. CEA using regional anesthesia can be performed in patients with advanced age, diabetes mellitus, atherosclerotic coronary vascular disease and contralateral ICA occlusion with acceptably low peri-operative morbidity.

Age Factors↗
PubMed1975

Contamination of the operative wound.

A study of the bacteriologic environment of the conventional operating rooms in the hospitals used by the Mayo Clinic orthopedic surgical section revealed several areas of potential contamination of the surgical wound. Such areas included the back table and the unsterile suction receptacle. Use of an impermeable hood with a large mask diminished contamination of the instruments and the wound originating in direct fallout from members of the surgical team. Irrigation of the operative wound with 0.1 per cent neomycin solution for brief periods was not as effective as previously thought. The level of airborne bacterial contamination in the operating room can be reduced by limiting the traffic and controlling the activity and the number of operating room personnel. Although none of these factors could be directly related to operative wound sepsis in any of our studies, their potential was obvious. They can be controlled by the methods we have described.

Air Pollution↗
PubMed2005

Creating an emergency general surgery service enhances the productivity of trauma surgeons, general surgeons and the hospital.

BACKGROUND: Several models that integrate trauma and emergency general surgery (EGS) have been proposed to provide a diverse and challenging operative practice for trauma surgeons and improve recruitment. In July 2002, our institution established a 24/7 EGS consult service, staffed primarily by critical care/trauma surgeons (CCTS). The objective of this report was to evaluate the impact of this new service on CCTS, general surgeons (GS) and the hospital. METHODS: All admissions to CCTS and GS from July 1, 2000 to June 30, 2003 were reviewed by querying hospital and physician databases for demographics, diagnoses, operative intervention(s), and resource utilization. Data were analyzed using nonparametric methods. RESULTS: [See ]. 9,405 admissions were identified, with GS and EGS admissions increasing over time. In July 2002, EGS became a separate service and captured 26% of GS admissions. Hospital-wide trauma admissions remained stable despite a slight decrease in trauma admissions to CCTS. A decrease in trauma operations by CCTS was offset by an increased EGS operative volume. EGS included "bread and butter" GS procedures including appendectomies and cholecystectomies and complex surgical procedures. EGS patients were often sicker with more than 50% requiring ICU admission compared with GS admissions of which only 10% required ICU care.(Table is included in full-text article.) CONCLUSIONS: Departmental restructuring to include an EGS service: 1) increased CCTS volume despite decreased CCTS trauma admissions and operations; 2) increased elective GS volume; 3) generated increased use of ICU and operating room resources; and 4) demonstrated that CCTS with broad operative GS backgrounds and critical care knowledge can effectively staff an EGS service.

Delivery of Health Care, Integrated↗
PubMed1993

Tibial bypass grafting for limb salvage with ringed polytetrafluoroethylene prostheses: results of primary and secondary procedures.

PURPOSE: In advanced peripheral ischemia, tibial artery prosthetic bypass grafting is virtually the last chance for limb salvage when conservative treatment and other methods of revascularization have failed. METHODS: For this study we reviewed our 7 years of experience with below-popliteal artery polytetrafluoroethylene grafts implanted for limb salvage. RESULTS: All results regarding graft patency and limb salvage were computed by actuarial methods and were presented in the form of life-table analysis. There were 211 grafts in 184 patients (195 limbs). Two and 5 years after the operation, primary patency rates were 37% and 23% and secondary patency rates were 45% and 25%, respectively. The main negative predictive factors for patency rate were an occluded primary plantar arch artery and poor vessel runoff. Primary bypass procedures had markedly better success rates than secondary (repeat) procedures, with primary patency rates of 52% at 2 years and 42% at 4 years, whereas the corresponding rates for secondary procedures were 22% and 14%, respectively. The 5-year cumulative limb salvage rate was 51% for the total series. CONCLUSIONS: Although the patency of prosthetic grafts is not as satisfactory as that of autologous vein grafts, the limb salvage rate justifies an aggressive approach to infrapopliteal bypass grafting with polytetrafluoroethylene prostheses when the limb is threatened and vein is not available.

Aged↗
PubMedDate not supplied

Operative versus nonoperative management of asymptomatic high-grade internal carotid artery stenosis: improved results with endarterectomy.

In a 4-year period, 129 asymptomatic high-grade (80-99%) internal carotid artery stenoses were identified in 115 patients. Because we previously demonstrated a strong relation between degree of carotid stenosis and subsequent development of ipsilateral related events (stroke, transient ischemic attack, and carotid occlusion), we changed our previous policy and began to offer carotid endarterectomy to good surgical risk patients referred to us with asymptomatic high-grade carotid stenosis. A total of 56 carotid endarterectomies were performed while 73 lesions were followed nonoperatively. Operated and nonoperated groups were similar with regard to age, prevalence of hypertension, cardiac disease, diabetes, and aspirin use. Life table analysis to 24 months revealed a higher rate of stroke (19 vs. 4%, p = 0.08), transient focal neurologic deficits (28 vs. 5%, p = 0.008), and carotid occlusion (29 vs. 0%, p = 0.003) in the nonoperated group. Eight of the 9 strokes in the nonoperated group occurred within 9 months of diagnosis of the high-grade lesion; none were preceded by a transient ischemic attack. There was 1 perioperative stroke (1.8%) but no in-hospital operative deaths and no difference in the late death rates of the two groups. This suggests that the preservation of neurologic status in patients with asymptomatic high-grade internal carotid artery stenosis can be improved by carotid endarterectomy.

Actuarial Analysis↗
PubMed1994

Isolated bypass to the superior mesenteric artery for intestinal ischemia.

OBJECTIVE: A number of reports indicate revascularization for intestinal ischemia should include the superior mesenteric artery (SMA) and the celiac artery. However, no controlled or randomized studies have proven this approach superior to SMA bypass alone. We report our results using bypass to only the SMA for intestinal ischemia. DESIGN: Retrospective review with mean follow-up of 40 months (range, 2 to 110 months). SETTING: University medical center and Veterans Affairs hospital. PATIENTS/METHODS: The records of patients who underwent intestinal revascularization of the SMA alone from 1982 through 1993 were reviewed. Patients were assessed for indication for operation, operative technique, perioperative mortality, and long-term outcome. The SMA grafts were examined for patency within the last 6 months using duplex scanning or arteriography. Patient survival and graft patency rates were calculated using life-table methods. RESULTS: Twenty-nine bypasses to only the SMA were performed in 26 patients (16 female and 10 male; mean age, 59 years; age range, 13 to 81 years). Indication for operation was symptomatic chronic mesenteric ischemia in 23 cases and acute intestinal ischemia in five cases. One bypass was performed for asymptomatic SMA occlusion. There were three perioperative deaths (10% mortality rate), all in patients with acute intestinal ischemia and previous mesenteric arterial surgery. Life-table 4-year primary graft patency and patient survival rates were 89% and 82%, respectively. Symptomatic improvement was maintained in all patients available for follow-up. CONCLUSION: Revascularization of only the SMA for intestinal ischemia provides excellent graft patency with acceptable perioperative mortality and long-term patient survival. The SMA bypass alone for intestinal ischemia appears as successful as bypasses to multiple visceral vessels.

Adolescent↗
PubMed1992

[Surgical treatment of carcinoma of the middle and lower rectum. Report of 949 cases].

Carcinoma of the rectum in 949 cases (484 cases of middle rectum and 465 cases of lower rectum) was resected from 1954 to 1986. There were 296 (31.99%) cases of sphincter-saving resection (SSR). The results of SSR before 1980 were compared with those after 1980. The operative mortality of curative resection decreased from 1.52% to 0.34%. The overall survival rate was 74.20 +/- 2.16% (life table method), for abdominoperineal resection (A-P resection) was 61.67 +/- 3.62% and for SSR was 84.12 +/- 2.40% Respectively. The local recurrence after curative resection in all cases was 14.02%, after A-P resection-15.44%, and after SSR-10.92%. The local recurrence after SSR before 1980 was just the same as after 1980. The results in this series showed the rationality of SSR in the treatment of carcinoma of the middle and lower rectum.

Adenocarcinoma↗
PubMedDate not supplied

Maximization of production of secreted recombinant proteins in Pichia pastoris fed-batch fermentation.

Pontryagin's Maximum Principle has been applied for optimization of secreted proteins from Pichia pastoris fed-batch fermentation. The objective of this work is to maximize the total accumulated product per unit operation time under different given conditions and system constraints. To obtain optimal solutions, an automated curve-fitting software, Table Curve 2D, was employed to construct the necessary mathematical models and solve the complicated functions. In the solution processes, the end of the glycerol batch phase was defined as the initial state of the system, the end of the methanol fed-batch phase as the final state, the cell mass produced along with product accumulated as state variables, and the specific growth rate (mu) as the control variable. Initially, a relationship between the specific production rate (rho) and mu was established. Then, according to Pontryagin's Maximum Principle, the admissible range of mu and its trajectories for the optimal operations were determined. Four representative cases with different combinations of the operation time along with the initial and final states were evaluated. A close correlation was obtained between the predicted values of the model equation with the experimental results from the Pichia pastoris fed-batch fermentations producing secreted alpha-galactosidase. The approaches proposed here greatly simplify the computational processes and validate the optimization strategy as a generalized approach to maximize the yield from fed-batch fermentations.

Fermentation↗