PubMed Health⌕ Search

Biomedical subjects

P Benotti

Publications and source records attributed to P Benotti.

11 recordsLinked to original sources
PubMed2000

Wound closure technique and acute wound complications in gastric surgery for morbid obesity: a prospective randomized trial.

BACKGROUND: During the past 10 years, numerous clinical studies have supported the use of continuous monofilament fascial closure after laparotomy. Because of the increased incidence of surgical-site infections and other acute wound complications in the morbidly obese, these patients are well suited for a study of technical factors that may affect the frequency of these wound complications. STUDY DESIGN: A prospective, randomized study of the midline fascial closure technique in gastric bariatric operations was conducted between 1991 and 1998 in 331 consecutive morbidly obese patients. At the time of closure of the upper midline laparotomy wound, the patients were randomized into two groups: Group I patients (n = 172) underwent continuous fascial closure and group II patients (n = 159) underwent interrupted fascial closure. All patients received prophylactic antibiotics in a similar fashion. Wounds were monitored for 30 days postoperatively, and acute wound complications were classified as superficial or deep. Superficial complications included superficial surgical-site infections, seromas, and hematomas. In all superficial complications, the fascia remained uninvolved and intact. Deep wound complications included deep surgical-site infections and fascial dehiscence. RESULTS: A total of 49 acute wound complications occurred (15%). There were 22 superficial (7%) and 27 deep (8%) wound complications in the 331 in the patients studied. Group I patients experienced fewer total wound complications than group II patients (18 versus 31; p=0.021). Group I patients also experienced fewer deep wound complications than group II (5 versus 22; p = 0.003). CONCLUSIONS: Continuous fascial closure reduces major acute wound complications in morbidly obese patients undergoing gastric operations for obesity.

Cholecystectomy↗
PubMed1994

A phase II multicenter, double-blind, randomized, placebo-controlled study of three dosages of an immunomodulator (PGG-glucan) in high-risk surgical patients.

OBJECTIVE: To examine the safety and efficacy of multiple doses of PGG-glucan (poly-[1-6]-B-D-glucopyranosyl-[1-3]-B-D-glucopyranose) in high-risk patients undergoing major thoracic or abdominal surgery. DESIGN: An interventional, multicenter, double-blind, randomized, placebo-controlled study. SETTING: Four university-affiliated medical centers. PATIENTS: Sixty-seven high-risk patients undergoing major thoracic or abdominal surgery. INTERVENTION: Patients were randomized in a 1:1:1:1 ratio to receive saline placebo or PGG-glucan at a dose of 0.1 mg/kg, 0.5 mg/kg, and 1.0 mg/kg or 2.0 mg/kg. One dose was administered before surgery and three doses were administered after surgery. MAIN OUTCOME MEASURES: To examine the safety and efficacy of PGG-glucan infusion and to identify potentially important factors for a planned phase III study. RESULTS: A dose-response trend with regard to infection incidence among patients who received PGG-glucan was observed. Serious infections occurred in four patients who received placebo and in three patients who received PGG-glucan at a dose of 0.1 mg/kg. However, only one patient who received PGG-glucan at a high dose had a serious infection. The incidence and severity of adverse events was comparable in all groups. CONCLUSIONS: PGG-glucan was generally safe and well tolerated, may decrease postoperative infection rates, and warrants further investigation in a planned phase III trial.

Adjuvants, Immunologic↗
PubMed1992

Patterns of recurrent colorectal cancer and recovery surgery.

In only two areas of colorectal cancer recurrence does surgery provide benefit. For a minority of patients with liver metastases that can be resected completely, cure is possible. Recent data from a prospective liver surgery protocol provide a perspective on the outcome, morbidity, and mortality of the procedure and confirm many of the suggestions in previous retrospective reviews. For patients with isolated pelvic or perineal recurrence, surgical removal of recurrent tumor provides palliation, but only if in-hospital convalescence is minimal and if recently introduced reconstructive techniques allow early rehabilitation.

Colorectal Neoplasms↗
PubMed1985

Complications and management of implanted venous access catheters.

A totally implanted subclavian venous access system composed of a reservoir and silastic catheter was employed in 92 patients receiving infusion chemotherapy and/or hyperalimentation. The major catheter complication was subclavian or jugular vein thrombosis observed in 15 patients (16%). Thrombosis was observed in the ipsilateral subclavian or jugular vein surrounding the catheter without restricting function, except in two patients with thrombosis in the vein at the end of the catheter. Prophylaxis with low-dose Coumadin was effective in preventing thrombosis in high-risk patients as defined by a history of prior thrombosis. Streptokinase and/or heparin relieved the signs and symptoms of thrombosis, but clot dissolution or reversal of collateral flow was not observed. Explantation of the catheter was not necessary in all patients in that embolic complications of the thrombosis were not observed, and the system was retained and functioned in five patients in spite of the presence of thrombosis around the catheter. Other complications of the implanted system include "pocket" infection, catheter migration, and occlusion. Most complications may be managed without obligate catheter removal.

Anti-Bacterial Agents↗
PubMed1979

Protein and caloric or macronutrient metabolic management of the critically ill patient.

Aggressive and early use of nutritional support therapies in critically ill patients represents a major advance in critical care medicine. The net protein catabolism and erosion of protein stores which is characteristic of the metabolic response to injury results in significant added morbidity and mortality in critical care units. The early administration of appropriate protein and energy in support of enhanced demands will maintain host defense and preserve organ function, thus, allowing time for stabilization of clinical status while life support strategies are implemented. In all circumstances, protein, vitamins, minerals, and nonprotein calories must be provided within fluid and electrolyte restrictions and in conjunction with optimal hemodynamic and pulmonary support.

Aged↗
PubMedDate not supplied

Hyperalimentation during pregnancy: a case report.

Severe, prolonged hyperemesis gravidarum was managed with total parenteral nutrition throughout three trimesters. Reversal of maternal weight loss and adequate fetal growth were achieved. A viable, large for gestational age infant was delivered prematurely at 34 wk. Serum values for selected nutrients, taken at delivery from maternal and cord blood, suggest that present estimates of parenteral nutritional needs for vitamins and minerals during pregnancy are probably low. An important corollary to maternal weight gain and caloric intake is to provide adequate nutrition as early as possible for optimal fetal weight gain.

Adult↗
PubMedDate not supplied

Resting energy expenditure in patients with end-stage liver disease and in normal population.

Resting energy expenditure (REE) was measured in 10 patients with end-stage liver disease (ELD) and in 31 normal controls. Basal energy expenditure (BEE) was also predicted by the Harris-Benedict equation. In order to correlate REE to lean body mass, the 24-hr urinary creatinine was measured in patients with ELD and in normal controls and expressed as kcal/g urinary creatinine. Linear regression analysis showed a statistically significant (p less than 0.0001) correlation (r = 0.72) between the REE and the 24-hr urinary creatinine in normal controls, irrespective of age and sex. Mean BEE (1580 +/- 160 vs 1575 +/- 210) and REE (1755 +/- 215 vs 1800 +/- 330) were not significantly different between patients with ELD and controls. However, the mean REE was 1900 +/- 610 kcal/g creatinine in patients with ELD and 1180 +/- 260 (p less than 0.0001) in controls. When related to lean tissue, patients with ELD had increased energy expenditure, confirming the hypermetabolic state suggested on clinical grounds. The use of urine creatinine to estimate energy expenditure may be a simple clinical technique to predict dietary energy needs in malnourished, unstressed patients. When this estimated energy expenditure/g creatinine (EEE) is compared to measured energy expenditure/g creatinine in malnourished, stressed patients, the EEE provides an index of the extent of hypermetabolism.

Adolescent↗