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Biomedical subjects

T Berne

Publications and source records attributed to T Berne.

14 recordsLinked to original sources
PubMed2006

Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis.

INTRODUCTION: Though ruptured appendicitis is not a contraindication to laparoscopic appendectomy (LA), most surgeons have not embraced LA as the first-line approach to ruptured appendicitis. In fact, in 2002, the Cochrane Database Review concluded: 1) the clinical effects of LA are "small and of limited clinical relevance," and 2) the effects of LA in perforated appendicitis require further study. OBJECTIVE: To study the effects of LA vs open appendectomy (OA) among adults with appendicitis. METHODS: In 2003, 272 adults underwent appendectomy at a large County hospital, and were enrolled in a prospective clinical pathway that detailed their hospital course from time of diagnosis to discharge. Data included patient demographics, time elapse from diagnosis to surgery, surgical technique (LA vs. OA), operative diagnosis (acute vs perforated appendicitis) and post-operative length of stay (LOS). RESULTS: Complete data was obtained for 264 (97%) patients. Patient demographics were similar in the LA and OA groups (p > 0.05). Patients with LA had a significantly shorter LOS than OA by 1.6 days (p < 0.05). This LOS was significantly shorter among those with ruptured appendicitis vs. non-ruptured appendicitis (2.0 days vs. 0.3 day reduction, p = 0.0357). Rank-order multiple regression analysis, controlling for all other factors, showed laparoscopy to have a significant effect on postoperative LOS in all appendicitis cases, especially ruptured appendicitis. CONCLUSIONS: The two-day reduction in LOS among those with ruptured appendicitis who underwent LA was significant enough to overcome the smaller benefit of LA in acute appendicitis. From a hospital utilization point of view, LA should be considered as the first-line approach for all patients with appendicitis.

Adult↗
PubMed2002

Effect on outcome of early intensive management of geriatric trauma patients.

BACKGROUND: Despite significant injuries elderly patients (aged 70 years or more) often do not exhibit any of the standard physiological criteria for trauma team activation (TTA), i.e. hypotension, tachycardia or unresponsiveness to pain. As a result of these findings the authors' TTA criteria were modified to include age 70 years or more, and a protocol of early aggressive monitoring and resuscitation was introduced. The aim of the present study was to assess the effect of the new policy on outcome. METHODS: This trauma registry study included patients aged 70 years or more with an Injury Severity Score (ISS) greater than 15 who were admitted over a period of 8 years and 8 months. The patients were divided into two groups: group 1 included patients admitted before age 70 years and above became a TTA criterion and group 2 included patients admitted during the period when age 70 years or more was a TTA criterion and the new management protocol was in place. The two groups were compared with regard to survival, functional status on discharge and hospital charges. RESULTS: There were 336 trauma patients who met the criteria, 260 in group 1 and 76 in group 2. The two groups were similar with respect to mechanism of injury, age, gender, ISS and body area Abbreviated Injury Score. The mortality rate in group 1 was 53.8 per cent and that in group 2 was 34.2 per cent (P = 0.003) (relative risk (RR) 1.57 (95 per cent confidence interval 1.13 to 2.19)). The incidence of permanent disability in the two groups was 16.7 and 12.0 per cent respectively (P = 0.49) (RR 1.39 (0.59 to 3.25)). In subgroups of patients with an ISS of more than 20 the mortality rate was 68.4 and 46.9 per cent in groups 1 and 2 respectively (P = 0.01) (RR 1.46 (1.06 to 2.00)); 12 of 49 survivors in group 1 and two of 26 in group 2 suffered permanent disability (P = 0.12) (RR 3.18 (0.77 to 13.20)). CONCLUSION: Activation of the trauma team and early intensive monitoring, evaluation and resuscitation of geriatric trauma patients improves survival.

Aged↗
PubMed1994

Early morbidity and mortality of non-therapeutic operations for penetrating trauma.

A retrospective study was performed in order to evaluate early morbidity and mortality associated with non-therapeutic operations for penetrating trauma. Over a 3-year period, 1,062 operations were performed on 1,015 patients for penetrating injury: abdomen 860, chest 103, neck 40, and extremities 58. A total of 230 (21.7%) of these operations were non-therapeutic. The incidence of significant complications directly related to the anesthesia or operation in this group of patients was 8.2 per cent. One patient with an additional major thoracic injury died secondary to complications related to a non-therapeutic abdominal operation (0.4%). The average hospital stay for uncomplicated non-therapeutic operations was 5.1 days, and for patients with complications 11.9 days. We conclude that non-therapeutic operations for penetrating trauma are associated with significant morbidity and mortality that must be considered when designing management schemes for penetrating injury.

Adolescent↗
PubMed1989

Evaluation of the UNOS point system for kidney recipient selection.

1. The ultimate distribution of 479 consecutive cadaver donor kidneys in the Los Angeles area was examined to determine whether the distribution had been equitable. Half of the kidneys had been allocated by the UNOS point system (or slight modifications thereof) and half by the transplant centers according to their own criteria. 2. With respect to waiting time, the pool of 1,000 was composed of 14% patients who had waited more than 2 years. The UNOS point system forced the transplantation of more patients (27%) who had waited longer than 2 years than the nonpoint system (11%). 3. Although the waiting pool was composed of 28% waiting for retransplantation, the UNOS point system resulted in transplantation of 16% and the nonpoint system, 8%. 4. In the waiting pool, 16% of the patients had cytotoxic antibodies reactive to more than 80% of the panel, whereas 11% of the transplants by the UNOS point system were transplanted into highly sensitized patients and only 2% of the patients transplanted by the nonpoint system were highly sensitized. 5. In Los Angeles, where 11% of the population is Black, 10% of the kidneys transplanted were into Black patients. Since 18% of the waiting pool of patients were Black, some shortfall was noted. However, this can be attributed to the fact that only 7% of the donors were Black. The importance of increasing donation from the Black community is emphasized. 6. Because of the limited pool size of 1,000 patients only a small number of 0 B,DR transplants were achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1986

Early graft function.

1. The average serum creatinine level during the first 20 days after transplantation was lower in HLA-identical siblings than in parental donor transplants, suggesting an early effect of histocompatibility. 2. In rather small numbers of patients, the daily average serum creatinine values were not different with HLA-DR mismatching and HLA-B,DR mismatching, but were lower in the better matched transplants for the HLA-A,B loci and the HLA-A,B,DR loci. 3. The average serum creatinine values in the first 20 days after transplantation were correlated with the one-year graft survival rates. Those patients with serum creatinine levels less than 2.4 mg/dl had one-year graft survival rates of over 80% compared with those with serum creatinine levels above 7.5 mg/dl after the first week who had one-year graft survival rates about 30% less. Intermediate serum creatinine values yielded intermediate one-year graft survival rates. 4. The cyclosporine dosage in the first month after transplantation varied considerably among the four centers studied here. These values were not directly correlated with the one-year graft survival rate, average serum creatinine levels or cumulative rejection rates in this preliminary examination. 5. Patients who rejected transplants 11 to 60 days posttransplant had been given lower cyclosporine dosages than those who rejected early or who had no rejections. 6. Although firm conclusions cannot be drawn from the small numbers of patients encompassed in this study, we hope the potential value of this type of analysis will be realized.

Creatinine↗
PubMed1986

The Los Angeles Transplant Society.

For some 20 years a coordinated arrangement for sharing cadaver organs has been in place in Southern California. It's 11 transplant centers have performed 4,947 kidney transplants from 7,480 referred donors. There were 430 transplants done in 1985. The policy has been to keep one kidney and share the other within the pool. This has resulted in a better than average level of matching for HLA, and an overall better than average graft survival. The graft survival rates at the centers have been increasing yearly. Much of the improvement in graft survival resulted from the introduction of cyclosporine, but a summation of many factors contributed to a steady yearly increase. There are some 600 patients waiting for transplantation. With greater efforts in procurement of cadaver kidneys, especially from minorities, and continued collaboration between the transplant centers, it should become possible to transplant all those who are in need of a kidney.

Adolescent↗
PubMed1981

Posttransplant serum analysis in human kidney allografts.

Monitoring of 25 first cadaver transplant recipients was carried out weekly after transplantation. A total of 441 sera were tested from these patients against B and T lymphocytes at 4 degrees C and 37 degrees C for development of cytotoxic antibodies. Thirteen of the 25 patients (52%) developed B-cold antibodies as their first antibodies and all had functioning kidneys. Five of the patients developed B-warm antibodies initially, and all 5 rejected their transplants within 24 days. Of the seven patients who did not develop antibodies, 3 rejected their kidneys within 72 days. We conclude that it is important to distinguish between two types of antibodies to B lymphocytes--those reactive in the cold and those reactive in the warm--since they have opposite effects. Of the 17 successful grafts, 13 first developed B-cold cytotoxins.

B-Lymphocytes↗
PubMed1979

Antibody-dependent cell-mediated cytotoxicity tests for immunosuppression monitoring of transplant patients.

The antibody-dependent cell-mediated cytotoxicity (ADCC) effector activity and phytohemagglutinin (PHA) response of kidney transplant patients were monitored by a new whole blood microassay that permitted performance of 20 tests using only 1 ml of blood. Eleven patients were followed on as many as 55 different occasions with these tests. The ADCC activity of dialysis patients was essentially the same (78% chromium release as compared with 83% in normal controls). However, patients with kidney transplants undergoing immunosuppression had approximately one-half the chromium release (40%). Daily fluctuation in the chromium release could not be used as a predictor of subsequent rejection. The PHA response was as much as 50-fold less in the immunosuppressed patients. Both values also tended to be slightly higher among patients who were doing well than those who were doing poorly. This may reflect the need for greater immunosuppression in the rejecting patients.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1979

Dilutions and specificity analysis of pretransplant sera.

Six serial dilutions of 51 sera from pretransplant patients were reacted against T and B lymphocytes at 5 degrees C and 37 degrees C. By the use of defined panels of T and B lymphocytes it could be shown that 10% of the 51 positive sera contained T-warm antibodies against HLA-A, -B, and -C specificities. There were 28% of the sera that had antibodies against non-HLA antigens reactive to B lymphocytes in the cold. Other sera contained mixtures of HLA and non-HLA antibodies. By dilution analysis of the sera, the mixtures could be detected and the HLA specificities identified. This ability to distinguish between HLA and non-HLA antibodies should be important in classifying pretransplant patients into high- and low-risk patients. Prior evidence that we have presented suggests that the non-HLA antibodies may be enhancing antibodies.

Antibody Specificity↗
PubMed1968

Renal dialysis center operational plans.

The Southern California region has available a Renal-Dialysis Center at the University of Southern California School of Medicine and the Los Angeles County General Hospital. The center is prepared to carry out dialysis, transplantation, research and education in nephrology.Patient selection for dialysis will be randomized among optimum candidates.The high cost of dialysis per patient might be reduced through home dialysis and by successful homotransplantation. The center plans to arrange transplantation of cadaver kidneys matched by tissue typing to a recipient undergoing hemodialysis. Such an approach will keep a constant turnover of patients and will help in research efforts toward better understanding of problems in nephrology.

Community Health Services↗