Biomedical subjects

A Bach

Publications and source records attributed to A Bach.

At least 19 recordsLinked to original sources

PubMed2006

Increasing the amount of n-3 fatty acid in meat from young Holstein bulls through nutrition.

Fifty-four Holstein bulls were blocked by initial BW (301 +/- 7.4 kg) and randomly assigned to 6 treatments following a 3 x 2 factorial arrangement, with 3 concentrate lipid levels (5, 8, and 11% of DM) and 2 lipid sources (whole canola seed and whole linseed), with the objective of evaluating the possibility of increasing the content of n-3 fatty acids in meat. Concentrates (mostly corn meal) were isonitrogenous and isocaloric. Concentrate and straw were both fed ad libitum. Animal BW was recorded every 2 wk, and feed consumption was recorded weekly. Ruminal pH and VFA concentrations were determined monthly. Bulls were transported to the slaughterhouse when they achieved the target slaughter weight of 443 kg (after 105 +/- 4 d of fattening). After slaughter, a sample of LM from the sixth to the eighth ribs was dissected and analyzed for intramuscular fat content and fatty acid profile. Dietary lipid source did not affect overall animal performance, rumen fermentation, or carcass quality. Rumen pH was >6.0 despite consumption by the bulls of large amounts of concentrate. In bulls fed linseed, the percentage of n-3 fatty acids in LM increased linearly with lipid level, whereas in bulls fed canola seed it remained constant. The ratio of n-6:n-3 fatty acids was lower (P < 0.01) in the LM of bulls fed linseed (10.0) than in those fed canola seed (26.0). The content of cis-9, trans-11-CLA in the LM tended (P = 0.06) to be greater in the bulls fed linseed than in those fed canola seed (62.9 vs. 49.2 mg/kg of LM, respectively). Concentration of n-3 fatty acids in meat of bulls fed high-concentrate diets can be enhanced by whole linseed supplementation without affecting animal performance, ruminal fermentation, or carcass quality.

Animal Feed↗

PubMed2006

Performance and feeding behavior of primiparous cows loose housed alone or together with multiparous cows.

Lactating Holstein cows (52 multiparous and 90 primiparous) were monitored over a period of 10 mo to observe effects of grouping primiparous cows (PPC) separately from multiparous cows (MPC) on performance, feeding behavior, feed intake, feed efficiency, and milk production of PPC. Cows were kept in 2 symmetrical pens each equipped with a robotic milking unit, 2 waterers, and 28 feeding spaces. Typically, 100 lactating cows were present at a time, thereby ensuring 1.78 cows per feeding place in each pen. One pen (PP) was composed exclusively of PPC whereas the other pen (PM) included 30% PPC and 70% MPC. Primiparous cows were evenly distributed to each pen by days in milk and daily milk production. As they calved, additional primiparous cows were assigned sequentially to each of the 2 treatment groups; multiparous cows calving during the study were allocated to the PM group. Both PP and PM groups were managed equally and were fed the same basal ration twice daily plus 3 kg/d of concentrate during milking. Individual eating behavior and feed consumption at each visit were monitored electronically. Milk production was recorded daily, and milk composition monthly. Observed arithmetic means and standard errors are presented but application to other management situations is limited because animals within pen were not independent. Total dry matter intake (18.7 vs. 18.1 +/- 0.9 kg/d) and milk production (25.9 vs. 25.6 +/- 0.8 kg/d) of PPC were similar in both the PM and PP groups, respectively. Primiparous cows in the PP group had numerically more visits to the robotic milking unit (3.26 vs. 2.68 +/- 0.15) and to the feed troughs (4.91 vs. 4.02 +/- 0.43), but apparently spent less time eating (2.72 vs. 3.22 +/- 0.1 h/d) than did PPC in the PM group. Differences in feed efficiency were low but PPC in the PP group had numerically higher feed efficiency at times through 200 d in milk. Alternative grouping strategies illustrate potentially important differential responses among primiparous cows that warrant further study.

Animal Nutritional Physiological Phenomena↗

PubMed2005

Nitrogen metabolism in the rumen.

Protein metabolism in the rumen is the result of metabolic activity of ruminal microorganisms. The structure of the protein is a key factor in determining its susceptibility to microbial proteases and, thus, its degradability. Ruminal protein degradation is affected by pH and the predominant species of microbial population. Ruminal proteolytic activity decreases as pH decreases with high-forage dairy cattle-type rations, but not in high-concentrate beef-type rations. Accumulation of amino acid (AA) N after feeding suggests that AA uptake by rumen microorganisms could be the limiting factor of protein degradation in the rumen. In addition, there are several AA, such as Phe, Leu, and Ile, that are synthesized by rumen microorganisms with greater difficulty than other AA. The most common assessment of efficiency of microbial protein synthesis (EMPS) is determination of grams of microbial N per unit of rumen available energy, typically expressed as true organic matter or carbohydrates fermented. However, EMPS is unable to estimate the efficiency at which bacteria capture available N in the rumen. An alternative and complementary measure of microbial protein synthesis is the efficiency of N use (ENU). In contrast to EMPS, ENU is a good measurement for describing efficiency of N capture by ruminal microbes. Using EMPS and ENU, it was concluded that optimum bacterial growth in the rumen occurs when EMPS is 29 g of bacterial N/kg of fermented organic matter, and ENU is 69%, implying that bacteria would require about 1.31 x rumen-available N per unit of bacterial N. Because the distribution of N within bacterial cells changes with rate of fermentation, AA N, rather than total bacterial N should be used to express microbial protein synthesis.

Amino Acids↗

PubMed2004

Cost-effectiveness and high patient satisfaction in the elderly: sevoflurane versus propofol anaesthesia.

BACKGROUND AND OBJECTIVE: The use of propofol compared with isoflurane is associated with improved patient comfort and decreased costs. However, as the cost saving, the quicker recovery time and patient comfort may not be evident if sevoflurane is substituted for isoflurane; these two anaesthetic agents were analysed in elderly patients. METHODS: In a prospective randomized study, 96 patients undergoing elective ophthalmic surgery received either total intravenous anaesthesia with propofol (Group P), propofol for induction and sevoflurane for maintenance (Group P/S) or sevoflurane for inhalation induction and maintenance (Group S). Analyses focussed on haemodynamics, the quality of recovery, and the costs for the anaesthetic and the entire procedure. RESULTS: Bradycardia or hypotension, mainly registered in Groups P and P/S, did not influence patients' recovery. In Group S, postoperative nausea and vomiting occurred frequently, and 50% of patients complained of discomfort during induction. In Group P/S, the costs for anaesthetics and total costs were lower than those in Groups P and S. CONCLUSIONS: Propofol- and sevoflurane-based maintenance of anaesthesia were similar with regard to patient comfort and recovery in the elderly. Cost analysis revealed that it was less expensive to use propofol for induction and sevoflurane for maintenance than to use either propofol or sevoflurane as sole agents for anaesthesia.

Aged↗

PubMed2004

[Use of vacuum therapy during defect coverage of the upper extremity with microsurgically grafted arterialized venous flaps].

Arterialized venous soft tissue flaps are defined as tissue portions usually harvested from the anterior and distal third of the forearm over a venous pathway to be transplanted to another recipient area. Basically, they are composed of skin, subcutaneous tissue, and subdermal venous plexus. At the recipient site flaps are perfused by a nourishing artery while the other veins are connected to one or more regional veins. The retrograde blood perfusion often results in edema, temporary epidermolysis, or even some degree of skin necrosis that disappear during subsequent treatment. To circumvent these drawbacks grafting of arterialized flaps was combined with local application of vacuum to overcome the venous initial stasis, resulting in improved healing and survival of these flaps.

Adult↗

PubMed2004

[Salvage of exposed alloplastic materials in irradiated wounds - a case report].

BACKGROUND: Modern multimodal concepts of complex reconstructions and advanced wound management enlarge strategies for surgical oncological therapies. One of the mainstays of classical surgical therapy in case of exposed alloplastic materials in irradiated wounds was to remove the foreign body due to the risk of infection. This loss of integrity and function of the contaminated host bed was to allow wound healing and closure. METHOD: We report the management of a 56-year-old female patient who developed a lyomyosarcoma at her left shoulder girdle 8 years after radiation of the left thorax because of breast cancer. After radical tumor resection and exarticulation of her left arm in the shoulder joint a necrosis of the soft tissue envelope developed, leading to an exposed alloplastic mesh. Staged debridement and continuous application of negative pressure was performed three times. Ultimate plastic coverage was performed by means of a pectoralis myocutaneous island flap from the other breast. RESULTS: After staged debridement and repeated vacuum application excellent wound cleaning, neovascularisation, wound contraction and formation of granulation tissue within the previously irradiated tissue zone was observed. Until fourteen months postoperative wound coverage remained stable and no signs of infection were observed. DISCUSSION: By means of negative pressure therapy even in radiated wounds excellent wound cleaning and sufficient formation of granulation tissue can be achieved. In some cases negative pressure therapy together with staged debridement allows reintegration of exposed and therefore potentially contaminated alloplastic meshes into new formed granulation tissue in radiated wounds respectively radiation ulcers. Thus leading to the possibility of ultimate plastic coverage.

Breast Neoplasms↗

PubMed2004

Msx1-deficient mice fail to form prosomere 1 derivatives, subcommissural organ, and posterior commissure and develop hydrocephalus.

Msx1 is a regulatory gene involved in epithelio-mesenchymal interactions in limb formation and organogenesis. In the embryonic CNS, the Msx1 gene is expressed along the dorsal midline. Msx1 mutant mice have been obtained by insertion of the nlacZ gene in the Msx1 homeodomain. The most important features of homozygous mutants that we observed were the absence or malformation of the posterior commissure (PC) and of the subcommissural organ (SCO), the collapse of the cerebral aqueduct, and the development of hydrocephalus. Heterozygous mutants developed abnormal PC and reduced SCO, as revealed by specific antibodies against SCO secretory glycoproteins. About one third of the heterozygous mutants also showed hydrocephalus. Other defects displayed by homozygous mutants were ependymal denudation, subventricular cavitations and edema, and underdevelopment of the pineal gland and subfornical organ. Some homozygous mutants developed both SCO and PC, probably as a consequence of genetic redundancy with Msx2. However, these mutants did not show SCO-immunoreactive glycoproteins and displayed obstructive hydrocephalus. This suggests that Msx1 is necessary for the synthesis of SCO glycoproteins, which would then be required for the maintenance of an open aqueduct.

Animals↗

PubMed2004

Infusion of glucose directs circulating amino acids to the mammary gland in well-fed dairy cows.

The effect of intestinal glucose supply on mammary utilization of amino acids (AA) was studied in four lactating dairy cows. Glucose (0, 443, 963, and 2398 g/d) was continuously infused in the duodenum over 14-d periods using a Latin square design. A grass silage-based diet was formulated so that treatments (diet + infusions) were isoenergetic and isonitrogenous and met 100 and 110% of energy and protein requirements, respectively. Mammary AA uptake was determined by arteriovenous difference and continuous blood flow measurement. The milk protein yield tended to be quadratically increased (to +88 g/d for 963 g of glucose) by glucose infusion, but milk protein content was not significantly affected. Treatments did not change significantly arterial concentrations of urea and glucogenic AA. Mammary arterial fluxes of essential AA increased linearly with glucose infusion, whereas fluxes of nonessential and glucogenic AA were not significantly affected. Mammary arteriovenous differences and extraction rates were roughly unchanged by treatments. Mammary uptake of all essential AA, excluding Arg and Val, increased linearly with increasing supply of glucose. Ratio of blood AA uptake to milk protein output increased significantly for His, Met, and Leu. For the highest infused dose of glucose, all AA except for His were taken up in excess relative to their secretion in milk. Based on evolution of extraction rate and ratio of uptake to output, His and Leu could have limited the milk protein yield response to glucose infusions.

Amino Acids↗

PubMed2004

Glucose metabolism in lactating cows in response to isoenergetic infusions of propionic acid or duodenal glucose.

A bibliographical study showed that increasing supplies of glucogenic nutrients lead to a curvilinear increase in milk and protein yield. Increased post-hepatic glucose availability may be involved in the increase in milk yield. In the present experiment, 5 dairy cows were arranged in a 5 x 5 Latin square design to compare the respective effects of 2 amounts of either duodenal glucose or ruminal propionic acid (C3) on glucose metabolism. Treatment consisted of a grass silage-based diet supplemented with glucogenic nutrients infused into the rumen as a mixture of volatile fatty acids (control) or C3 (6.5 and 13 mol/d) or as glucose (3.4 and 6.9 mol/d) infused into the duodenum. Treatments were isoenergetic and isonitrogenous and contained 100 and 115% of energy and protein requirements, respectively, according to the Institut National de la Recherche Agronomique. Glucose appearance rate (Ra) tended to increase with the level of infusions of both glucogenic materials and with the high dose of duodenal glucose. Plasma insulin-like growth factor-I (IGF-I) concentration increased with the infusion of glucogenic materials compared with the control and was significantly higher with glucose than with C3 treatments. This experiment did not indicate whether the increased Ra was the key mechanism to increased milk yield because milk yield only tended to increase and the standard error for Ra was high. With the high dose of glucose infused into the duodenum, the Ra increase was greater than the increased lactose production in milk. Because of that connection, IGF-I may also be involved by favoring the glucose utilization by the mammary gland.

Animal Feed↗

PubMed2004

Technical note: a computerized system for monitoring feeding behavior and individual feed intake of dairy cattle.

The objective of this study was to develop and validate a computerized system to monitor feeding behavior and feed intake of loose-housed dairy cattle. The system consisted of 28 scales located in front of each self-locking place of a regular feedbunk. All cows had access to all scales indifferently. Each visit to the feedbunk was monitored by a transponder in the ear of each cow that was detected by a proximity reader located at the top right corner of each headlock. The data from the scales and the proximity readers were continuously recorded by a computer with an average scanning time of 3.5 s. The monitoring system was validated using all 28 feeding places and 51 lactating cows in a series of 4-h observations during 5 different d. During the observation periods, for each feeder, 2 observers recorded the cow number and the exact time of the visit. The observed data were then compared with the computer records. To validate the ability of the system to monitor feed consumption, on separate days, the amount of feed consumed by a cow during a visit was also measured manually with an external scale, and the feed that disappeared from each scale in 2 different 24-h periods was compared with the sum of feed consumed in each scale during these 2 periods. The average time spent in a given scale by each cow determined by direct observations was similar to that determined by the computer. The system was accurate and showed a high specificity (98.8%) and sensitivity (99.6%) for cow detections. Feed weights determined by the computer system were similar to those measured manually with an external scale, implying that the system was also accurate in measuring individual intake weights. In conclusion, the system provided a reasonable estimate of the number of visits per animal, length of each visit, amount of feed consumed per visit and animal, the total amount of feed consumed daily by each animal, and the rate at which animals consume feed.

Animals↗

PubMed2003

Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haematological malignancies.

BACKGROUND: In contrast to the high risk of haemorrhage associated with the implantation of a central venous catheter (CVC) via the internal jugular or subclavian access, the use of a peripherally inserted catheter (PICC) offers the advantage of a lower risk of bleeding complications. However, the rate of phlebitis is higher with the PICC and its use has been declining. We have studied the benefits and adverse events of a new type of PICC and a common type. METHODS: From October 1999 to October 2001, 70 PICCs (Olimpicc, Vygon, Germany, n=40; and LIFECATH-PICC(PUR)5FR Vygon, Germany, n=30) were inserted into 66 patients with haematological malignancies and used for high-dose chemotherapy, total parenteral nutrition and autologous blood stem cell transplantation. While removing the catheter, central and peripheral blood cultures were taken. The catheter tip was investigated by the semi-quantitative roll-out method of Maki. RESULTS: Sixty-five PICCs were removed after a median of 8.9 days. In five cases a catheter-associated significant colonisation with coagulase-negative staphylococci occurred. In two instances catheter-related bacteraemia was found. CONCLUSION: In our study this catheter system was inserted in 94% of patients without problems and showed a low incidence of phlebitis (5/65). Because of the high rate of catheter malfunction reported during and after our study, the Olimpicc catheter is no longer available. The PICC system, and the LIFECATH-PICC(PUR)5FR in particular, offers a safe and effective alternative for central venous access to the internal jugular vein.

Adult↗

PubMed2003

Lactational effect of propionic acid and duodenal glucose in cows.

Five dairy cows were arranged in a 5 x 5 Latin square design to compare the effects of two amounts of either duodenal glucose or ruminal propionic acid (C3) on milk yield and composition. Treatments consisted of a grass silage-based diet supplemented with glucogenic nutrients either infused in the rumen as a mixture of volatile fatty acids (control) or pure C3 (1.72 and 3.45 Mcal/d) or in the duodenum as glucose (1.72 and 3.45 Mcal/d). Treatments were isoenergetic and isonitrogenous and contained 100 and 115% of energy and protein requirements according to INRA (1989), respectively. Only C3 treatments significantly modified ruminal volatile fatty acid composition and linearly increased C3 percentage (up to 25.5%). Both treatments substantially decreased milk fat yield and content, and linearly increased milk and protein yields. Although no significant differences between glucose and C3 were highlighted for milk yield and composition, it seems that mechanisms involved in milk fat decrease are different. Indeed, whereas C3 treatments decreased fatty acid production in an homogeneous way, short- and long-chain fatty acids decreased and medium-chain fatty acid production increased with glucose treatments. A bibliographical study confirmed that increasing glucogenic precursors (GP) supply curvilinearly increase milk yield, linearly increase milk protein content (+ 0.04% per Mcal of GP) and curvilinearly decrease milk fat content (- 0.14% per Mcal of GP). Thus, it appears important to account for the nature of energy supplied by the ration in formulation.

Animal Feed↗

PubMed2002

[Efficient OP management. Suggestions for optimisation of organisation and administration as a basis for establishing statutes for operating theatres].

Economic aspects have gained increasing importance in recent years. The operating room (OR) is the most cost-intensive sector and determines the turnover process of a surgical patient within the hospital. Thus, optimisation of workflow processes is of particular interest for health care providers. If the results of surgery are viewed as a product, everything associated with surgery can be evaluated analogously to a manufacturing process. All steps involved in producing the end-result can and should be analysed with the goal of producing an efficient, economical and quality product. The leadership that physicians can provide to manage this process is important and leads to the introduction of a specialised "OR manager". This position must have the authority to issue directives to all other members of the OR team. An OR management subordinates directly to the administration of the hospital. By integrating and improving management of various elements of the surgical process, health care institutions are able to rationally trim costs while maintaining high-quality services. This paper gives a short introduction into the difficulties of organising an OR. Some suggestions are made to overcome common shortcomings in the daily practise. A proposal for an "OR statute" is presented that should be a basis for discussion within the OR team. It must be modified according to individual needs and prerequisites in every hospital. The single best opportunity for dramatic improvement in effective resource use in surgical services lies in the perioperative process. The management strategy must focus on process measurement using information technology and feed-back implementing modern quality management tools.However, no short-term effects can be expected from these changes. Improvements take about a year and continuous feed-back of all measures must accompany the reorganisation process.

Appointments and Schedules↗

PubMed2002

Duodenal infusion of glucose decreases milk fat production in grass silage-fed dairy cows.

Four lactating dairy cows were arranged in a 4 x 4 Latin square design to study the effect of intestinal glucose supply on milk fat synthesis. Glucose (0, 443, 963, and 2398 g/d) was continuously infused in the duodenum over 14-d periods. Grass silage-based diets were formulated to be isoenergetic and isonitrogenous and met 100 and 110% of energy and protein requirements according to INRA (1989). Mammary uptake of nutrients was estimated through assay of arteriovenous differences and blood flow measurements. Glucose infusions decreased arterial concentrations of acetate, beta-hydroxybutyrate, and nonesterified fatty acids linearly and total glycerides curvilinearly. Milk fat yield was slightly decreased (- 52 g/d) between 0 and 963 g/d of glucose and milk fatty acid composition was modified by a marked decrease in long-chain fatty acids and an increase in de novo synthesis. The decrease in long-chain fatty acids, related to the decreased mammary uptake of plasma total glycerides, was likely due to a decrease in lipoprotein lipase and esterification activities. In regards to the evolution of metabolite concentrations in milk, the enhanced de novo synthesis and chain elongation was probably allowed by a greater availability of NADPH synthesized through pentose phosphate pathway. The greatest dose of glucose clearly decreased milk fat yield (-234 g/d). A mammary cell mediated intracellular reaction likely caused a homothetic decrease in milk fatty acids. However, reduced synthesis was not due to a shortage of glycerol-3-phosphate because its milk concentration remained unchanged. In conclusion, changes in exogenous glucose supply, in cows fed a grass silage-based diet, decreased milk fat production and modified milk fatty acid composition.

3-Hydroxybutyric Acid↗

PubMed2001

Grotthus-type and diffusive proton transfer in 7-hydroxyquinoline.(NH(3))(n) clusters.

Proton translocation along ammonia wires is investigated in 7-hydroxyquinoline.(NH(3))(n) clusters, both experimentally by laser spectroscopy and theoretically by Hartree-Fock and density functional (DFT) calculations. These clusters serve as realistic finite-size models for proton transfer along a chain of hydrogen-bonded solvent molecules. In the enol tautomer of 7-hydroxyquinoline (7-HQ), the OH group acts as a proton injection site into the (NH(3))(n)cluster. Proton translocation along a chain of three NH(3) molecules within the cluster can take place, followed by reprotonation of 7-HQ at the quinolinic N atom, forming the 7-ketoquinoline tautomer. Exoergic proton transfer from the OH group of 7-HQ to the closest NH(3) molecule within the cluster giving a zwitterion 7-HQ-.(NH(3))(6)H+ (denoted PT-A) occurs at a threshold cluster size of n = 6 in the DFT calculations and at n = 5 or 6 experimentally. Three further locally stable zwitterion clusters denoted PT-B, PT-B', and PT-C, the keto tautomer, and several transition structures along the proton translocation path were characterized theoretically. Grotthus-type proton-hopping mechanisms occur for three of the proton transfer steps, which have low barriers and are exoergic or weakly endoergic. The step with the highest barrier involves a complex proton transfer mechanism, involving structural reorganization and large-scale diffusive motions of the cluster.

Journal Article↗

PubMed2001

Weekly trastuzumab and paclitaxel therapy for metastatic breast cancer with analysis of efficacy by HER2 immunophenotype and gene amplification.

PURPOSE: This phase II study evaluated weekly trastuzumab and paclitaxel therapy in women with HER2-normal and HER2-overexpressing metastatic breast cancer. Efficacy was correlated with immunohistochemical and fluorescent in situ hybridization (FISH) assay results. PATIENTS AND METHODS: Eligible patients had bidimensionally measurable metastatic breast cancer. Up to three prior chemotherapy regimens, including prior anthracycline and taxane therapy, were allowed. Trastuzumab 4 mg/kg and paclitaxel 90 mg/m2 were administered on week 1, with trastuzumab 2 mg/kg and paclitaxel 90 mg/m2 administered on subsequent weeks. HER2 status was evaluated using four different immunohistochemical assays and FISH. RESULTS: Patients received a median of 25 weekly infusions (range, one to 85 infusions). Median delivered paclitaxel dose-intensity was 82 mg/m2/wk (range, 52 to 90 mg/m2/wk). The intent-to-treat response rate for all 95 patients enrolled was 56.8% (95% confidence interval, 47% to 67%). A response rate of 61.4% (4.5% complete response, 56.8% partial response) was observed in 88 fully assessable patients. In patients with HER2-overexpressing tumors, overall response rates ranged from 67% to 81% compared with 41% to 46% in patients with HER2-normal expression (ranges reflect the different assay methods used to assess HER2 status). Differences in response rates between patients with HER2-overexpressing tumors and those with normal HER2 expression were statistically significant for all assay methods, with CB11 and TAB250 antibodies and FISH having the strongest significance. Therapy was generally well tolerated, although three patients had serious cardiac complications. CONCLUSION: Weekly trastuzumab and paclitaxel therapy is active in women with metastatic breast cancer. Therapy was relatively well tolerated; however, attention to cardiac function is necessary.

Adult↗

PubMed2001

[Computer simulation and pharmacoeconomics. Computer simulation as an aid for the analysis of operating room efficiency: an example].

In this study we compared operating room (OR) efficiency of total intravenous anaesthesia (TIVA) with remifentanil and propofol and balanced anaesthesia (BAL) with fentanyl and isoflurane in cataract surgery using computersimulation. We simulated patient flow for one OR and for three ORs. Time intervals of patient flow were randomly generated from the results of a prospective, randomized trial. Both for one and for three ORs, the postanaesthesia care unit (PACU) finished earlier and one additional case per OR and per day could be performed when TIVA was used for the procedures. Overtime in the PACU was less after TIVA. With a workload of 13 or 15 operations per day in three ORs, monitoring equipment for an additional patient in the PACU was required when BAL was used. TIVA with remifentanil and propofol was associated with more OR efficiency than balanced anaesthesia with fentanyl and isoflurane when given for cataract surgery.

Anesthesia, Intravenous↗

PubMed2001

[Microbiological and clinical effects of selective bowel decontamination in transthoracic resection of carcinoma of the esophagus and cardia].

INTRODUCTION: Surgical therapy of carcinoma of the esophagus or cardia by transthoracic esophageal resection is associated with a high morbidity in which nosocomial infections have a great importance. This study investigates the influence of prophylactic selective bowel decontamination on the course and results of transthoracic resection of the esophagus. METHODS: Seventy patients with carcinoma of the esophagus and cardia were included in this prospective and partially randomized study at the University of Heidelberg. Twenty-five patients received prophylactically selective bowel decontamination with tobramycin, polymyxin B and amphotericin B. The treatment course was documented uniformly. In addition, microbiological screening was performed by swab examinations of nose, throat and anus, by urine and blood cultures, and the documentation of results of additional microbiological diagnostic studies. RESULTS: Bacteriological screening confirmed a reduction in infectious agents and a change of their spectrum in the respiratory and digestive tract without an increase in multiresistant bacteria. Patients who received selective bowel decontamination had a lower infection rate, a shorter artificial respiration period and a shorter intensive care stay without statistically significant differences. The mortality rate was 4% vs 9% in the control group (95% confidence interval -0.172-0.116). CONCLUSION: This study confirms the feasibility and microbiological effectiveness of selective bowel decontamination in the context of surgical therapy which is associated with a high nosocomial infection rate. The result of the clinical treatment seems slightly more favorable in the treatment group. Decisive are complications caused by surgery which fundamentally determine the clinical course and frequently cause infectious complications. The prophylactic use of selective bowel decontamination may be useful in patients with an increased risk of prolonged ventilation support or colon interposition but it is not to be generally recommended.

Aged↗