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Charles F Bellows

Publications and source records attributed to Charles F Bellows.

14 recordsLinked to original sources
PubMed2006

Epidemiology of exposure to blood borne pathogens on a surgical service.

BACKGROUND: The goal of this study was to analyze the type and mechanism of blood exposure injuries on the surgical service in order to develop appropriate preventative strategies. METHODS: A retrospective review of all exposure injuries affecting members of the operative care line at a single teaching institution between December 2002 and December 2005 was performed. RESULTS: Of 98 exposure injuries on the surgical service, only 17 (17%) were inflicted by hollow-bore needles. Seventy-four (76%) of these reported injuries occurred in the operating room (OR) and 24 (24%) occurred in other clinical areas. Sharps injuries accounted for 69 (93%) of OR injuries and were inflicted by suture needles (n = 37, 50%), hollow-bore needles (n = 7, 9%), and sharp instruments (n = 25, 34%). Mucocutaneous contamination accounted for 5 (7%) of the OR exposures. Professionals most frequently injured were residents (n = 43, 44%), followed by nurses (n = 28, 29%), students (n = 17, 17%) and other healthcare workers (n = 10, 10%). CONCLUSIONS: Blood exposure prevention strategies should be directed at safety within the surgical field and focused beyond hollow-bore needle stick injuries to include education, mentoring, and competency training.

Blood-Borne Pathogens↗
PubMed2006

Decellularized human cadaveric dermis provides a safe alternative for primary inguinal hernia repair in contaminated surgical fields.

BACKGROUND: Repair options for inguinal hernias in contaminated surgical fields include local tissue repair or mesh repair. The former is associated with higher hernia recurrence rates. The latter generally is avoided because of an unacceptably high infection rate. AlloDerm (Lifecell Corp., Branchburg, NJ) can potentially provide a strong repair resistant to infection. The aim of our study was to evaluate if AlloDerm provides a safe alternative for inguinal hernia repair in contaminated surgical fields. METHODS: We retrospectively reviewed the medical records of all patients who underwent inguinal hernia repair with AlloDerm from December 2004 to April 2006. Demographics, risk factors, perioperative data, and recurrence rates were evaluated. RESULTS: Twelve patients with contaminated surgical fields underwent inguinal hernia repair with AlloDerm. Serious perioperative complications occurred in only 1 patient. Two patients developed superficial wound infections (treated conservatively). There were no mortalities. No hernia recurrence has been documented with a follow-up period of 3 to 17 months (median, 9 mo). CONCLUSIONS: AlloDerm provides a safe alternative for inguinal hernia repair in contaminated surgical fields.

Aged↗
PubMed2006

Laparoscopic splenectomy: present status and future perspective.

Laparoscopic splenectomy has become widely accepted as the approach of choice for the surgical treatment of benign and malignant hematologic diseases. Advances in technology have led to better outcomes for the procedure, and have allowed surgeons to apply the technique to disease processes that were at one time felt to be contraindications to laparoscopic splenectomy. However, challenges still remain. There is a steep learning curve associated with the procedure. The development of cost-effective laparoscopic simulators to target the skills required for laparoscopic splenectomy and other laparoscopic procedures is essential. The advent of devices which isolate and seal the large blood vessels that surround the spleen have reduced intra-operative bleeding and minimized conversions to open splenectomy. Improvements in optics and instrumentation, as well as robotic technology, will continue to define the frontier of minimally invasive surgery, and further facilitate the acceptance of laparoscopic splenectomy for the treatment of benign and malignant hematologic diseases.

Animals↗
PubMed2006

Abdominal wall reconstruction using biological tissue grafts: present status and future opportunities.

Surgeons often encounter the challenge of treating acquired abdominal wall defects following abdominal surgery. The current standard of practice is to repair most defects using permanent synthetic mesh material. Mesh augments the strength of the weakened abdominal wall fascia and enables the hernia repair to be performed in a tension-free manner. However, there is a risk of acute and/or chronic infection, fistula formation and chronic abdominal wall pain with the use of permanent mesh materials, which can lead to more complex operations. As a means to avoid such problems, surgeons are turning increasingly to the use of xenogenic and allogenic materials for the repair of abdominal wall defects. Their rapid evolution and introduction into the clinical operating room is leading to a new era in abdominal wall reconstruction. There are promising, albeit limited, clinical data with short-term follow-up for only a few of the many biological tissue grafts that are being promoted currently for the repair of abdominal hernias. Additional clinical studies are required to better understand the long-term efficacy and limitations of these materials.

Abdominal Muscles↗
PubMed2005

Modulation of macrophage nitric oxide production by prostaglandin D2.

BACKGROUND: Nitric oxide and prostaglandins readily become activated in response to inflammatory events. The overproduction of nitric oxide is detrimental to the host. The present study was conducted to examine whether prostaglandin D(2) (PGD(2)) modulates nitric oxide production in macrophages in response to an inflammatory stimulus. METHODS: Cultures of RAW 264.7 murine macrophages were exposed to Escherichia coli lipopolysaccharide (LPS, 0.01 and 1.0 microg/ml) before and after exposure to PGD(2) (0.01 to 10 nmol). After 24-h incubation, supernatants were collected and nitrite was quantitated by Greiss reaction as a measure of nitric oxide synthesis. Inducible nitric oxide synthase (iNOS) protein was measured by Western blot analysis. RESULTS: Macrophages exposed to 0.01 and 1.0 microg/ml LPS produced 8.3 +/- 0.2 and 15.0 +/- 1.4 nmol/1.1 x 10(6) cells/24 h of nitrite, respectively. The simultaneous addition of PGD(2) with LPS inhibited nitrite production in a dose-dependent fashion and suppressed iNOS protein expression. A strong time effect was also exhibited when macrophages were incubated with PGD(2) 1 hour before as compared to 7 hours after the addition of LPS (0.01 or 1.0 microg/ml), indicating that the earlier the time PGD(2) was added to the culture media, the greater the inhibition. Prostaglandin D(2) had the capacity to block nitrite synthesis even when added as much as 7 hours after an LPS challenge. Blocking endogenous prostaglandins, using indomethacin (10 microM), suppressed nitrite production. CONCLUSION: Exogenous PGD(2) caused dose- and time-dependent decreases in LPS-stimulated nitrite production by RAW 264.7 macrophages by hindering iNOS protein expression. Conversely, the endogenous prostaglandins released by these same cells in response to an LPS challenge stimulated nitrite production, which may consequently dampen the inhibitory actions of exogenous PGD(2).

Animals↗
PubMed2005

Management of gallstones.

Many patients with gallstones can be managed expectantly. Generally, only persons with symptoms related to the presence of gallstones (e.g., steady, nonparoxysmal pain lasting four to six hours located in the upper abdomen) or complications (such as acute cholecystitis or gallstone pancreatitis) warrant surgical intervention. Biliary pain is alleviated by cholecystectomy in the majority of cases. Laparoscopic cholecystectomy is considered the most cost-effective management strategy in the treatment of symptomatic gallstones. Medical management strategies are mostly palliative and are not widely supported. Patients with longer-lasting biliary pain, in combination with abdominal tenderness, fever, and/or leukocytosis, require an ultrasound evaluation to help establish a diagnosis of acute cholecystitis. Once a patient is diagnosed, having cholecystectomy early in the course of the disease can significantly reduce the hospital stay.

Cholecystectomy↗
PubMed2005

Length of human immunodeficiency virus disease and not immune status is a risk factor for development of anal carcinoma.

BACKGROUND: The anal epithelium is subject to dysplastic change in patients with human immunodeficiency virus (HIV). We sought to determine if the duration of HIV disease or the patient's immune status were associated with the development of anal carcinoma. METHODS: HIV-positive patients diagnosed with anal neoplasms were reviewed. Statistical analysis was performed via an unpaired Student t test and the Fisher exact test. RESULTS: Fourteen patients were identified, 7 with anal intraepithelial neoplasms (group 1) and 7 with anal carcinoma (group 2). Human papillomavirus was detected in 100% of patients in group 1 and in 67% of patients in group 2. There was no significant difference in the level of immunosuppression as assessed by the CD4 counts (266.9 +/- 48.5 vs. 274.7 +/- 92.0 cell/c microl; P = .94) and viral loads (19,243 +/- 18,034 vs. 67,140 +/- 39,570 RNA/mL; P = .29) between groups 1 and 2, respectively. Group 2 had been HIV positive for a significantly longer period of time (12.6 +/- 2.3 y) compared with group 1 (5.9 +/- 2.0 y, P = .05). CONCLUSIONS: The most significant factor for the development of invasive anal carcinoma in patients with HIV is duration of disease. As a result of improved long-term survival secondary to new HIV therapy, anal invasive carcinoma will become an increasing problem.

Adult↗
PubMed2003

Vaccinia virus-induced inhibition of nitric oxide production.

BACKGROUND: The role of nitric oxide (NO) in the host defense against viruses has not been well defined. Several studies have implicated NO as responsible for the destruction of a variety of viruses. However, others have reported that certain viruses can impair the ability of macrophages to produce NO. This study was initiated to determine the ability of macrophages to produce NO in response to vaccinia virus infection. METHODS: RAW 264.7 murine macrophages in minimum essential medium were exposed to virus-containing supernatants for 1 h before stimulation with Escherichia coli lipopolysaccharide (LPS, 0.001 and 1.0 microg/ml). After further 24-h incubations, nitrite concentration, cell viability, and inducible nitric oxide synthase (iNOS) were quantitated. RESULTS: The viral preparation alone did not stimulate nitric oxide synthesis (measured as nitrite) by macrophages. However, macrophages exposed to 0.001 and 1.0 microg/ml LPS produced 7.7 +/- 0.6 and 16.6 +/- 0.8 nmole/1.1 x 10(6) cells/24-h nitrite, respectively. Production of nitrite caused cell death. Macrophages incubated with vaccinia virus prior to exposure to LPS resulted in a dose-dependent decrease in nitrite production. An 80% inhibition of nitrite was noted when macrophages were exposed to vaccinia virus (m.o.i. 10(-4)) plus LPS (1.0 microg/ml) (P < 0.05). Further study showed that this inhibition was not associated with changes in cell viability or substrate availability, but was associated with a marked reduction in iNOS protein. When the virus was inactivated with UV-irradiation, the same incubation caused a 46% inhibition of nitrite production (P < 0.05 vs active virus). However, this effect occurred without altering the quantity of iNOS protein. CONCLUSION: These results indicate that active vaccinia virus inhibits the ability of stimulated macrophages to produce NO by hindering iNOS protein expression. Because live viral particles were not entirely required for this inhibition, it is possible that by products of viral infection, such as soluble viral proteins, may also be responsible for this effect.

Animals↗
PubMed2003

Role of fibronectin in pancreatitis-associated lung injury.

Acute pancreatitis (AP) in humans can lead to increased vascular permeability in the lungs and respiratory failure. Fibronectin plays an important role in maintaining the structural integrity of the pulmonary epithelium and endothelium. However, its importance in pancreatitis-associated lung injury has not been defined. AP was produced by infusing caerulein (5 ug/kg/hr) in rats for 8 or 24 hr. Lung injury was assessed histologically and by determining lung microvascular permeability by bronchoalveolar lavage (BAL) analysis. Organ distribution of a target particle given intravenously was determined by the vascular clearance of magnetic iron oxide particles. Plasma fibronectin was measured by the enzyme-linked immunosorbent assay technique. After 8 hr of cerulein infusion, serum amylase increased 8-fold. Pancreatitis correlated with lung injury. BAL at 8 hr showed a 90% increase (P < 0.05) in albumin levels. Histological analysis at 8 hr revealed an increased number of leukocytes within the lungs. By 8 hr, plasma fibronectin significantly decreased 25% (P < 0.05) and the pulmonary uptake of iron oxide increased 111% (P < 0.05). By 24 hr, these effects had nearly resolved. These results indicate that decreases in serum fibronectin and increases in pulmonary leukocyte margination during acute pancreatitis may compromise the integrity of the air-blood barrier and also increase the pulmonary uptake of circulating pathogenic materials, thus making lung injury more likely.

Acute Disease↗
PubMed2002

Cosmetic approach to anterior mediastinal masses.

A new approach for the removal of thymic tissue or any anterior mediastinal pathology is described. It uses a novel low U-shaped skin incision combined with a J-shaped upper mini-sternotomy. This technique was designed to provide wide exposure of the mediastinum and to be cosmetically appealing. Our study included 12 patients, 4 with a preoperative diagnosis of myasthenia gravis. There were no operative mortality and three complications. This procedure allows for complete removal of all thymic tissue under direct vision, and is less invasive that full sternotomy.

Adult↗
PubMed2002

The surgical abdomen associated with cocaine abuse.

Cocaine use is common and is associated with gastrointestinal complications that can present as a surgical abdomen. We report a case of a previously healthy 25-year-old man who presented to the Emergency Department with severe abdominal pain and vomiting after using IV cocaine. Exploratory celiotomy revealed massive free intraperitoneal (IP) clotted blood with no evidence of underlying pathology. This unusual case underscores the possibility of life-threatening hemorrhage in cocaine consumers.

Abdomen, Acute↗
PubMed2002

Two unusual cases of adult intussusception.

Adult intussusception is very rare. We report 2 unusual cases, a 58-year-old man with a transverse colo-colonic intussusception caused by a malignant sessile polyp that also had an asymptomatic synchronous neoplasm of the kidney, and an 18-year-old female with an ileocecolic intussusception caused by acute appendicitis. This report stresses the point that intussusception in adults may represent an underlying malignancy. The age of the patient and the anatomic location of the intussusception provide significant input as to the etiology and hence the most appropriate surgical procedure.

Acute Disease↗
PubMedDate not supplied

Infiltration of suture sites with local anesthesia for management of pain following laparoscopic ventral hernia repairs: a prospective randomized trial.

BACKGROUND: Postoperative pain control after laparoscopic ventral hernia repairs remains a significant clinical problem. We sought to determine the pain-sparing efficacy of local anesthetic infiltrated into the abdominal wall wounds created by the placement of transabdominal sutures used to ensure adequate fixation of the mesh during laparoscopic ventral hernia repair. METHODS: Patients undergoing laparoscopic ventral/incisional hernia repair were randomized to receive local anesthesia (0.25% bupivacaine with epinephrine) into all layers of the abdominal wall to the level of the parietal peritoneum at suture fixation sites immediately before suture placement (Group I; n=9) or no local anesthesia (Group II, control; n=9). The anesthetic technique was otherwise standard for both groups. Postoperatively, pain was assessed with a 10-point visual analogue scale (VAS) at 1, 2, 4, and 24 hours. Analgesic use and hospital stay were also recorded. RESULTS: The groups were similar in age, sex, ASA, and size of hernia defect. The operative times were not statistically different between the 2 groups (Group I, 118+/-12 minutes; Group II, 144+/-21 minutes; P>0.05). Group I had a statistically significant decrease in the pain scores compared with Group II (2.2+/-0.8 vs. 6.4+/-0.9; P<0.05) at 1 hour postoperatively. At 2 and 4 hours, the mean pain scores were decreased but not statistically different. Similarly, the cumulative consumption of pain medication at 1, 2, and 4 hours postoperatively as well as the average hospital stay (Group I, 2.0+/-0.4; Group II, 2.4+/-0.4 days) were lower but not statistically significant in patients in Group I compared with those in Group II. CONCLUSION: This small, randomized study demonstrates that infiltration of suture fixation sites is effective in reducing early postoperative pain but not analgesic consumption following laparoscopic incisional and ventral hernia repairs. A larger study is required to investigate this strategy on later postoperative pain and hospital stay.

Adult↗