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Biomedical subjects

C Rosman

Publications and source records attributed to C Rosman.

13 recordsLinked to original sources
PubMed2006

Diagnosis and treatment of acute appendicitis in children: a survey among Dutch surgeons and comparison with evidence-based practice.

BACKGROUND: Considerable variability exists in the surgical approach to acute appendicitis in children, affecting both quality and costs of care. A national survey provides insight into daily surgical practice and enables comparison of practice with the available evidence. METHODS: A national survey was conducted in all 121 Dutch hospitals asking detailed information concerning diagnosis and treatment of children suspected of acute appendicitis. An evidence-based practice (EBP) score was developed on the basis of a critical appraisal of the literature, allowing for classification of reported practices with regard to the level of evidence and identification of hospitals working in accordance with the best available evidence. RESULTS: The overall response rate was 93%. For the diagnosis of acute appendicitis, respondents relied predominantly on patient history (29%) and clinical examination (31%), followed by laboratory results (22%). Only 20% of the departments routinely measured total white blood cell count (WBC), C-reactive protein (CRP) and leukocyte differential count (proportion of polymorphonuclear cells), being part of the triad that provides diagnostic evidence. Although strong evidence exists in favour of routine prophylaxis for suspected appendicitis, only two thirds of surgical departments reported this as part of their routine practice. For a number of issues, reasonably consistent evidence is available (e.g. primarily versus delayed closure, drainage versus lavage, routine peritoneal culturing). Thirty-eight percent of the departments routinely cultured abdominal fluid despite various reports that it provides no therapeutic advantage. Not more than 22% of the departments closed the skin in perforated appendicitis in spite of clear supportive evidence. Considerable variation exists in cleaning the abdomen in perforated appendicitis, despite evidence favouring lavage. Comparing departments in terms of compliance with available evidence revealed that most paediatric surgery departments worked according to evidence-based medicine. CONCLUSIONS: Available evidence on diagnosis and treatment of acute appendicitis in children is only partly applied in a small proportion of hospitals in the Netherlands. It is recommended that national guidelines be published, which could decrease health care costs and increase more uniform policy, improve quality of care for this group of patients and improve training of residents in general surgery in the Netherlands.

Acute Disease↗
PubMed2005

Hernia repair in elderly patients under unmonitored local anaesthesia is feasible.

BACKGROUND: There is a growing interest in the use of local anaesthesia for inguinal hernia repair. It certainly seems to be an acceptable alternative for the elderly. Supporting intravenous sedation, however, still requires monitoring, anaesthetic personnel and some preparations for the patient. Therefore we set up a feasibility study of hernia repair under local anaesthesia without intravenous sedation or monitoring in elderly patients. METHOD: A total of 62 patients (aged 65 years or more) with unilateral inguinal hernia received a Mesh Plug Repair. Prospectively collected data included procedure-related complications and information on pain and quality of life as measured by Short Form 36. RESULTS: No procedure-related complications were noted. Comparing the preoperative scores, the SF-36 on day 14 (n=61) did not differ significantly. After a median follow-up of ten months (n=54), significantly higher scores were found for scales of physical and emotional role and pain (all p<0.05). Twenty-two patients reported some form of pain (40.7%). 94.4% of the patients would recommend the procedure when asked. CONCLUSION: The results of this study indicated that Mesh Plug Repair performed under unmonitored local anaesthesia with no intravenous sedation is a feasible alternative for elderly patients. It has advantages for the medical organization without disadvantages for the patient.

Aged↗
PubMed2005

Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair.

BACKGROUND: Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene Hernia System. The choice of technique may be influenced by the effects on postoperative pain and quality of life. METHODS: A total of 334 patients were allocated blindly and at random to receive one of these three meshes for open hernia repair. Quality of life was assessed with the Short Form 36 and pain by a visual analogue scale 14 days, and 3 and 15 months after surgery. RESULTS: Operative complications were rare and comparable between the groups. Long-term follow-up was completed by questionnaire in 95.8 per cent of patients. There were no significant differences in pain parameters between the three meshes; overall, 43.3 per cent of patients reported some form of groin pain. The severity of the chronic pain correlated with a higher pain score in the first 2 weeks after surgery (P < 0.001). A significant reduction in scores for role emotional (short term) and vitality (long term) quality of life domains was found in patients who had a Lichtenstein repair. CONCLUSION: These short- and long-term results did not show any clinically significant difference in postoperative pain and quality of life between the three types of mesh hernia repair. Severe early postoperative pain reliably predicted the likelihood of persisting chronic groin pain.

Adult↗
PubMed1999

Local treatment of generalised peritonitis in rats; effects on bacteria, endotoxin and mortality.

OBJECTIVE: To assess the effect of debridement, intraoperative lavage with saline, and additional instillation of taurolidine or imipenem/cilastatin in rats with faecal peritonitis. DESIGN: Laboratory study. SETTING: University hospital, The Netherlands. MATERIAL: 60 male Wistar rats. INTERVENTIONS: Rats were given an intraperitoneal injection of a faecal suspension containing Escherichia coli and Bacteroides fragilis. Six groups of 10: sham operation, debridement, debridement with saline lavage, debridement with saline lavage with intraperitoneal instillation of saline or taurolidine, or imipenem/cilastatin, were studied. MAIN OUTCOME MEASURES: Bacterial growth and endotoxin concentration in abdominal exudate and plasma, abscess formation, and mortality. RESULTS: Debridement temporarily reduced bacterial growth and the concentration of endotoxin in abdominal exudate, and delayed mortality. Lavage with saline further reduced bacterial growth and the endotoxin concentration. It also reduced the plasma endotoxin concentration, and mortality. Additional instillation of taurolidine did not reduce bacterial growth, but did initially reduce the endotoxin concentration in abdominal exudate and plasma. Instillation of imipenem/cilastatin, after debridement and lavage, significantly reduced all variables measured. CONCLUSION: In rats with faecal peritonitis, debridement, lavage with saline, and additional instillation of imipenem/cilastatin, all have cumulatively reducing effect on bacterial growth, endotoxin concentrations, abscess formation, and mortality. Instillation of taurolidine reduces only the amount of endotoxin.

Abdominal Abscess↗
PubMed1996

Effect of intraperitoneal antimicrobials on the concentration of bacteria, endotoxin, and tumor necrosis factor in abdominal fluid and plasma in rats.

The efficacy of intraperitoneal instillation of antimicrobial agents in eliminating the bacterial contaminant in patients with generalized peritonitis remains controversial. We determined the effect of intraperitoneal instillation of taurolidine or imipenem on mortality, and on the concentration of bacteria, endotoxin, and tumor necrosis factor (TNF) in rats with intraperitoneally injected bacteria. Thirty rats were inoculated intraperitoneally with two enteric bacterial strains, followed by either taurolidine, saline, or imipenem. Abdominal fluid and blood were analyzed at different time intervals. The survival rate was highest in the imipenem group (p < 0.05). The bacterial concentration in abdominal fluid in the taurolidine and imipenem group was lower than in the saline group (p < 0.005), but the concentration in the imipenem group was lowest (p < 0.005). The endotoxin concentration in abdominal fluid and plasma in the taurolidine group was lower than in the other two groups (p < 0.05). The TNF concentration in abdominal fluid and plasma in the taurolidine group was lower than in the saline group (p < 0.05), whereas the concentration in the imipenem group was higher (p < 0.005). We conclude that topically applied taurolidine in rats with intraperitoneally injected bacteria may have a weak antibacterial effect, and lowered concentrations of endotoxin and TNF. Topically applied imipenem had a profound bactericidal activity but induced endotoxin and TNF release.

Abdomen↗
PubMed1994

Translocation of bacteria and endotoxin in organ donors.

OBJECTIVE: To determine if bacterial translocation and endotoxin absorption occur in organ donors with an anatomically intact gastrointestinal tract. DESIGN: Case series. SETTING: Intensive care units in general and university hospitals. PATIENTS: Twenty-one (multiple) organ donors. INTERVENTION: None. MAIN OUTCOME MEASURES: Occurrence of factors that may promote bacterial translocation and/or endotoxin absorption. Bacterial concentration in mesenteric lymph nodes, abdominal fluid, blood, liver, lung, and spleen. Endotoxin level in abdominal fluid, peripheral blood, and portal blood. Anatomical integrity of the bowel wall. RESULTS: Factors that may promote bacterial translocation and/or endotoxin absorption were present in all organ donors. Culture specimens revealed bacteria in 14 organ donors (67%). In 210 (81%) of 260 culture specimens, the bacteria isolated were identical to those isolated from the bowel content, demonstrating bacterial translocation. Endotoxin was found in nine (53%) of 17 abdominal fluid samples, in four (19%) of 21 peripheral blood samples, and in two (10%) of 21 portal blood samples. Light- and electron-microscopic examination of the bowel wall showed no anatomical abnormalities. CONCLUSION: Bacterial translocation and endotoxin absorption are frequent among organ donors and may adversely influence organ function in transplant recipients and other critically ill patients.

Ascitic Fluid↗
PubMed1993

Fish oil increases the release of tumour necrosis factor and interleukin-6, and has no effect on the incidence of multiple organ failure in rats with peritonitis.

OBJECTIVE: To find out if fish oil given intraperitoneally would cause a reduction in the release of tumour necrosis factor and interleukin-6 in abdominal exudate and blood (experiment A), and if it reduces the incidence of organ failure in rats with peritonitis (experiment B). DESIGN: Laboratory experiment. SETTING: University animal laboratory. MATERIAL: Thirty-six selectively decontaminated rats in each experiment. INTERVENTIONS: All rats were pretreated with 2 ml fish oil, lecithin, or saline, intraperitoneally for one or six weeks before intraperitoneal injection of zymosan. Experiment A: Samples of abdominal exudate and plasma were taken regularly for 24 hours after the zymosan had been given. Experiment B: Clinical, biochemical, and histological variables were measured over a 12-day period after the zymosan had been given. MAIN OUTCOME MEASURES: Experiment A: Concentrations of tumour necrosis factor and interleukin-6 in abdominal exudate and plasma. Experiment B: Incidence of multiple organ failure. RESULTS: Experiment A: Concentrations of tumour necrosis factor and interleukin-6 in abdominal exudate and plasma were significantly higher in rats pretreated with fish oil, compared with control rats. This effect was more pronounced after six weeks of pretreatment. Experiment B: There were no significant differences between the groups for any variable. CONCLUSION: Fish oil given intraperitoneally increased rather than reduced local and systemic release of tumour necrosis factor and interleukin-6, and did not reduce the incidence of organ failure in rats with sterile peritonitis.

Animals↗
PubMed1992

Selective decontamination of the digestive tract prevents secondary infection of the abdominal cavity, and endotoxemia and mortality in sterile peritonitis in laboratory rats.

BACKGROUND AND METHODS: This study was undertaken to find out whether translocation of bacteria to the abdominal cavity and endotoxemia in rats with sterile peritonitis could be prevented by selective decontamination of the digestive tract. Sterile peritonitis was caused by the intraperitoneal injection of either 100, 150, 200, or 300 mg of zymosan suspended in paraffin. RESULTS: The frequency of infection of the abdominal cavity depended on the dose of zymosan given, ranging from 20% in rats receiving 100 mg to 89% in rats receiving 300 mg of zymosan. In rats not receiving antibiotics for selective decontamination of the digestive tract (the control group). Gram-negative bacilli were isolated from the digestive tract in all rats, and Gram-negative bacilli were isolated from the abdominal cavity in ten of 19 rats. In rats receiving antibiotics for selective decontamination of the digestive tract, Gram-negative bacilli were isolated from the digestive tract in none of the 14 rats, and likewise, Gram-negative bacilli were isolated from the abdominal cavity in none of the 14 rats (p < .005). Moreover, in rats receiving antibiotics for selective decontamination of the digestive tract, endotoxin levels in feces and plasma were significantly lower, as compared with rats not receiving antibiotics for selective decontamination of the digestive tract. CONCLUSION: Selective decontamination of the digestive tract prevents translocation of Gram-negative bacilli to the abdominal cavity, and endotoxemia and mortality in rats with sterile peritonitis.

Animals↗