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Biomedical subjects

A Humar

Publications and source records attributed to A Humar.

At least 91 records · Page 5Linked to original sources
PubMed1996

Elimination of an outbreak of gram-negative bacteremia in a hemodialysis unit.

BACKGROUND: The purpose of this study was to identify the cause of an unusual outbreak of gram-negative bacteremia in patients undergoing long-term hemodialysis. METHODS: We performed direct observation and investigation of current dialysis techniques and facilities including microbiologic sampling in a long-term hemodialysis unit in a tertiary care center. We also performed a retrospective review of medical charts and laboratory data of 10 patients undergoing long-term hemodialysis who experienced 11 episodes of gram-negative bacteremia between March 4 and June 28, 1993. RESULTS: All of these patients underwent dialysis by jugular venous access. Containers used to collect flush solution after priming of dialysis tubing remained unemptied for extended periods of time, and quantitative culture revealed more than 200 colony-forming units/ml gram-negative bacilli, including species isolated in blood cultures. Dialysis tubing and connector were left submerged in flush solution collection containers during priming, and the process of disinfecting tubing before patient connection had recently been discontinued. Control measures included emptying of flush containers after each use and daily decontamination. All dialysis tubing was to be disinfected before patient connection. CONCLUSION: Outbreak was due to contamination during dialysis setup. After institution of appropriate control measures, no new cases have occurred.

Aged↗
PubMed1996

Salvage of a renal allograft with renal vein occlusion secondary to extrinsic compression.

We report a case of renal vein occlusion in a transplant kidney that occurred secondary to extrinsic compression from a large kidney being placed extraperitoneally in a small iliac fossa. Prompt reexploration in the immediate postoperative period resulted in salvage of the graft. The abdominal wall was reconstructed using prosthetic mesh, which decreased the compartmental pressure within the iliac fossa sufficiently to allow the kidney to perfuse and the renal vein to remain patent. The patient was eventually discharged home with a functioning graft and normal flow in the vessels, as demonstrated by duplex Doppler studies.

Abdominal Muscles↗
PubMed1994

Insulin sensitivity and glucose tolerance following transposition of pancreatic venous drainage to the systemic circulation.

In these studies it has been demonstrated that the diversion of pancreatic venous drainage to the systemic circulation (1) increases the peripheral insulinemia and metabolic clearance of glucose under basal conditions; (2) decreases insulin sensitivity, as measured by the hyperinsulinemic euglycemic clamp, more than 2-fold; and (3) decreases peripheral insulin sensitivity and the suppression of endogenous glucose production during exogenous glucose infusion. In spite of these changes, tolerance to the intravenously infused glucose improves. This is accounted for by higher insulin concentrations following diversion, more than compensating for decreases in insulin sensitivity and the suppression of endogenous glucose production. Data on insulin sensitivity and glucose tolerance after pancreas transplantation are not completely consistent, as discussed above. When the site of venous drainage of the pancreas was the only factor altered in the experimental model, unequivocal insulin resistance resulted. This occurred in a relatively short period (ie, 2 weeks). The results here are consistent with a number of studies that have demonstrated normal glucose tolerance coupled with hyperinsulinemia in a partially pancreatectomized dog model as well as in human pancreas transplants. Data presented here imply that the hyperinsulinemia which results after surgical diversion of the pancreatic venous drainage from the portal to the systemic circulation causes an important degree of insulin resistance. Physiological insulin delivery and therefore portal drainage during transplantation may therefore be relevant for the complete normalization of glucoregulation in diabetes. The reduction of hyperinsulinemia may also be important in light of the recent emphasis on the role that this and insulin resistance may play in the development of complications such as cardiovascular disease or hypertension.

Animals↗
PubMed1993

Fibromatosis in infancy and childhood: the spectrum.

Fibromatoses form an interesting group of tumors occupying a midposition in the spectrum of fibrous tissue neoplasms. Within the fibromatoses subgroups there exists a variety of tumors whose clinical behavior spans the range from completely benign to locally aggressive. Four case histories are presented to illustrate this point. All four patients were initially seen with asymptomatic head or neck masses. The first had complete excision with no recurrence to date. The second underwent spontaneous regression after confirmation of diagnosis with biopsy. The third case had a very locally aggressive disease requiring three surgical resections to date, while the last case had one recurrence after the initial resection. With certain exceptions, initial wide local excision offers the best possible chance for cure.

Biopsy↗
PubMed1993

Computed tomographic and cytologic assessment of cystic pancreatic neoplasms: a difficult preoperative diagnosis.

The computed tomography (CT) findings or cytologic results, or both, for 21 patients with cystic pancreatic neoplasm (4 with microcystic cystadenoma, 6 with macrocystic mucinous cystadenoma, 10 with macrocystic mucinous cystadenocarcinoma and 1 with a papillary cystic neoplasm) were reviewed. CT scans for 14 of the patients were reviewed by two gastrointestinal radiologists who were blinded with respect to the patients' identities and the diagnoses. The radiologists used previously published criteria for distinguishing between microcystic and macrocystic neoplasms. Of the four cases of microcystic cystadenoma, two were correctly diagnosed by one radiologist, and one was correctly diagnosed by the other. Three and four cases respectively of five cases of macrocystic cystadenoma were correctly identified, as were three and five of five cases of macrocystic cystadenocarcinoma. Cytologic evaluation of samples from fine-needle aspiration biopsy had been performed for 15 of the patients, and these records were reviewed. One of three cases of microcystic cystadenoma, two of four cases of macrocystic cystadenoma, five of seven cases of macrocystic cystadenocarcinoma and the papillary cystic neoplasm were correctly diagnosed on the basis of the cytologic findings. The combination of CT and cytologic assessment is helpful in distinguishing different types of cystic pancreatic neoplasms, but there is significant overlap among the clinical and radiographic features of these lesions, and therefore operative assessment is often necessary.

Adult↗
PubMed1991

Emergency department management of blunt cervical tracheal trauma in children.

A case history of a young girl who sustained a small posterior laceration of her cervical trachea after blunt trauma is presented. She was brought to the emergency department (ED) by her parents roughly two hours after the incident with only minor symptoms. While in the ED, she developed significant airway compromise over a span of minutes. Orotracheal intubation was performed to secure her airway, and she responded to conservative management of her laceration. Her signs and symptoms, resolved, and she was discharged after five days. This case illustrates the importance of urgent evaluation and careful observation of patients with possible tracheal damage, as even very small tears have the potential to cause life-threatening airway compromise.

Child↗
PubMedDate not supplied

Evaluation of a non-isotopic polymerase chain reaction-based assay to detect and predict treatment failure of Plasmodium vivax malaria in travellers.

With the emergence of chloroquine-resistant Plasmodium vivax (CRPV), new tests to detect P. vivax and predict response to therapy would be useful for clinical and research applications. We performed a 'blinded' evaluation of a non-isotopic (colourimetric) polymerase chain reaction (PCR) based assay (Digene SHARP Signal System) compared with microscopy and PCR/radiometric probe hybridization of ribosomal ribonucleic acid genes (RPH) for the detection of P. vivax malaria in 182 febrile travellers. Compared with PCR/RPH as the reference standard, the colourimetric assay had a sensitivity of 100% and specificity of 98%. Using microscopy as the reference standard, 84 of 87 patients with P. vivax infection had a positive colourimetric assay. The 3 patients with a negative assay were subsequently shown to be infected with P. ovale as determined by PCR/RPH. In a subset of patients followed longitudinally, the colourimetric assay was positive in 5 of 13 patients 6 or more days after initiation of therapy. Of these 5 patients, 4 were subsequently demonstrated to be infected with CRPV as determined by treatment failure in vivo and/or chloroquine blood levels. A positive assay result 6 or more days after initiation of therapy was associated with subsequent treatment failure (P < 0.01). This non-isotopic assay is a sensitive, specific, and rapid method for the detection of P. vivax PCR products and may prove useful in predicting treatment failure.

Antimalarials↗