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PubMed2003

Perceptual efficacy of electrical stimulation of human retina with a microelectrode array during short-term surgical trials.

PURPOSE: This work is part of a feasibility assessment of a retinal prosthesis as a means to restore vision to patients with blindness caused by retinitis pigmentosa. The primary goal was to assess the concordance of the form of induced perception and the pattern of electrical stimulation of the retina, and the reproducibility of the responses. METHODS: Five volunteers with severe retinitis pigmentosa and one with normal vision were studied. A companion paper in this issue provides details on demographics, visual function, surgical methods, general stimulation strategy, and data analysis. Volunteers were awake during surgery while a 10-microm-thick, microfabricated electrode array was placed on the retina. The array was connected to extraocular current sources that delivered charges to 50-, 100-, and 400-microm-diameter electrodes. Negative control trials were randomly included. Perceptual quality was judged by the similarity between the form of stimulation and perception (i.e., accuracy) and the reproducibility of responses. RESULTS: Only 1 of 40 control tests yielded a false-positive result. On average, volunteers 3, 5, and 6 reported percepts that matched the stimulation pattern 48% and 32% of the time for single- and multiple-electrode trials, respectively. Two-point discrimination in the best cases may have been achieved in two blind subjects using (center-to-center) electrode separation of 600 and 1960 microm. Reproducibility was achieved 66% of the time in the blind subjects. By comparison, in the normal-sighted subject, perceptual form was reported accurately 57% of the time, with 82% reproducibility, and two-point discrimination may have been achieved in one trial with 620-microm electrode spacing and in two trials each with 1860- and 2480-microm electrode spacing. In subjects 5 and 6, perceptual size was inconsistently related to the charge, although relatively large differences in charge (median: 0.55 microcoulombs [microC]) between two trials produced differently sized percepts. Longer stimuli did not produce rounder percepts. CONCLUSIONS: Single percepts induced by single-electrode stimulation were relatively small, but the form of percepts, especially after multielectrode stimulation, often did not match the stimulation pattern, even in a normal-sighted volunteer. Reproducible percepts were more easily generated than those that matched the stimulation pattern.

Adult↗

PubMed2005

Life-threatening abdominal wall hematoma in a chronic renal failure patient after a single dose of enoxaparin.

We present a patient with chronic renal insufficiency who developed a massive posttraumatic abdominal wall hematoma after a single therapeutic dose of enoxaparin administered during workup of chest pain. Surgical evacuation of the hematoma was required to control life-threatening hemorrhage. Low-molecular-weight heparin use is not without risk and mandates appropriate indication and accurate dosing. Bleeding can occur at any site during heparin therapy, and abdominal wall hematoma should be considered as a source after traumatic injury.

Abdominal Injuries↗

PubMed1986

Comparison of epidemiologic data from multiple sources.

We compared epidemiologic data collected from medical records and by interview for 462 subjects who were part of a case-control study of a chronic disease (cancer of the breast). The collected data included such clinical and pharmaceutical features as history of lactation, hysterectomy, diabetes mellitus, type of menopause, and whether a woman had used exogenous estrogens. We found that agreements between medical record and interview data are variable, and depend on the type of data examined and the strategy for handling incomplete or ambiguous (indeterminate) responses. For variables that represent inherent features of the patients' clinical condition, such as gynecologic surgical procedures and a family history of breast cancer, we found excellent agreement between the medical record and interview. For pharmaceutical features, however, we discovered considerable variability between the two data sources. We also detected substantial problems with a common tactic in which information from individual data sources are pooled to form a new "combined data source". In this analysis, combining data sources creates estimates for the proportion exposed that are different from estimates in either of the original information sources.

Breast Neoplasms↗

PubMedDate not supplied

[Pseudomonas aeruginosa outbreak, in the area of surgical wound ambulatory care, in postmastectomy patients].

OBJECTIVE: To describe an outbreak due to Pseudomonas aeruginosa in postmastectomy wounds. MATERIAL AND METHODS: Cases were patients with a surgical infection caused by P. aeruginosa resistant to ciprofloxacin and gentamycin seen between March 13, 2000 and May 18, 2000, at Instituto Nacional de Cancerologia in Mexico City. Specimens for culturing were taken from faucets, antiseptics, and tap water, as well as from healthcare workers. A case-control analysis was conducted. RESULTS: Thirteen late surgical infections were caused by a ciprofloxacin and gentamycin-resistant P. aeruginosa. The causative Pseudomonas was isolated from a nurse's nostrils and non-sterile gauzes left by her on the Mayo table at the Breast Tumor ambulatory clinic. None of the closed packages was positive to Pseudomonas. On April 14, 2000, the nurse was transferred to another ward and strict infection control practices were established. After this date, 4 additional cases were diagnosed. Radiation therapy was the only risk factor for infection (Or = 5.1, 95% cI 1.1-28.4). CONCLUSIONS: This outbreak was probably caused by a common source initially, and later disseminated by cross-infection among patients. The poor compliance with infection control practices during wound cleaning and drainage led to implementing a series of specific preventive interventions.

Ambulatory Care↗

PubMed2004

Liver grafts preserved in Celsior solution as source of hepatocytes for drug metabolism studies: comparison with surgical liver biopsies.

Suitability of human liver grafts preserved in Celsior solution (CS) for preparing metabolically competent hepatocyte cultures has been examined. To this end, basal and induced activity and mRNA levels of major hepatic cytochrome P450 (P450) enzymes have been measured. By 24 h in culture, measurable levels of the 10 P450 mRNAs studied were found in all hepatocyte preparations examined, with CYP2E1, CYP2C9, and CYP3A4 mRNAs being the most abundant. Compared with hepatocytes obtained from surgical liver resections (SLRs), lower content of each P450 mRNA was found in hepatocytes from the CS group; however, the relative distribution of individual P450 mRNAs was similar. Similar results were observed after measuring P450 activities. CYP1A2, CYP2A6, CYP2C9, CYP2C19, CYP2E1, and CYP3A4 activities in hepatocytes from CS-flushed grafts were lower than but comparable with those of cultures prepared from SLRs. No differences in the metabolite profile of testosterone were found. Treatment of hepatocytes from CS-preserved grafts with model P450 inducers shows that 2 microM methylcholanthrene only increased CYP1A1 and CYP1A2 mRNAs (>100-fold over control), 1 mM phenobarbital markedly increased CYP2A6, CYP2B6, and CYP3A4 mRNA content (>7-fold), and 50 microM rifampicin highly increased CYP3A4 mRNA levels (>10-fold), whereas minor effects (<3-fold) were observed in CYP2A6, CYP2B6, and CYP2C9 mRNAs. This induction pattern of P450s was similar, in terms of magnitude, reproducibility, and specificity, to that shown in primary hepatocytes from surgical biopsies. Overall, our results indicate that, cold-preserved in CS, liver grafts constitute a valuable source of human hepatocytes for drug metabolism studies.

Biopsy↗

PubMed1995

Why do patients default from follow-up at a genitourinary clinic?: a multivariate analysis.

OBJECTIVE: Firstly to compare the proportion of patients defaulting from follow up at a genitourinary medicine clinic with those attending other hospital based clinics. Secondly to determine which factors are associated with non attendance at a city centre genitourinary medicine clinic. METHODOLOGY: The proportion of patients who defaulted at a genitourinary medicine clinic, a general medical clinic, a general surgical clinic and a dermatology clinic during March 1995 were compared. A multivariate logistic regression analysis was performed comparing attenders and non attenders at the genitourinary medicine clinic with respect to time of appointment, diagnosis, previous contacts with clinic staff, potential domestic commitments and patient demographics in a prospective case control study. RESULTS: The default rate at the genitourinary medicine clinic was 15% compared with 13%, 15% and 14% for medical, surgical and dermatology clinics respectively. Patients who defaulted from the genitourinary medicine clinic (167) were compared with 172 attenders and significant differences found for timing of appointments, area of residence, frequency of counselling by the health advisor and age of the patient. Other factors such as the diagnosis, whether a woman had children, sexual orientation, whether negative results had been given over the phone, source of referral, sex of patient, employment status and the weather were not found to be significantly associated with defaulting from an appointment. CONCLUSIONS: The time of the appointment and being seen by a health advisor were the only variables identified over which the clinic has control and therefore could potentially reduce non attendance rates.

Adult↗

PubMed1979

Airflow effects in surgery.

Accumulated evidence of the last decade has emphasized the multifaceted nature of wound infection control. Clean air is definitely one of the facets in the complex, but its place in the hierachy of precautions against wound infection has not been established, nor has the method of achieving acceptably clean air been universally agreed on. The surgical team and the patient are the prime sources of contamination during an operation, as evidenced by the good matches between bacteria of infected wounds and those of the team or the patient and by the poor matches between bacteria of infected wounds and airborne bacteria. Therefore, special air-handling systems, despite their ability to lower ambient bioparticulate counts, cannot be credited with being a highly relevant factor in the reduction of wound infection rates.

Air↗

PubMedDate not supplied

The contribution of hospital volume, payer status, and other factors on the surgical outcomes of scoliosis patients: a review of 3,606 cases in the State of California.

While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P < 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P < 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.

Adolescent↗

PubMed1984

[Computerized tomography in the evaluation of the state of the retroperitoneal lymph nodes].

The authors consider the potentialities of computerized tomography (CT) in the diagnosis of lesions of the retroperitoneal lymph nodes in their metastatic involvement and hemoblastoses. CT data on 142 patients with hemoblastoses and tumors of different sites are discussed. This type of examination made it possible to reveal the involvement of the retroperitoneal lymph nodes in 59 patients resulting in the diagnosis of the generalization of the underlying disease in 41.5% of the cases. CT makes it possible to correctly interpret the state of practically all groups of the retroperitoneal lymph nodes. Besides, CT gives an opportunity to detect lymph node enlargement in the negative results of lymphography or to reveal lesions of some groups of the lymph nodes which are inaccessible to contrast examination, all of these being of great importance for the planning of radiation or surgical treatment. CT provides an opportunity for a dynamic control over therapeutic results both in hospitals and in polyclinics. The results of the examination were of importance in each case for the choice of the tactics and method of specific therapy as well as for prognosis of a subsequent source of the underlying disease.

Humans↗

PubMed2005

Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site.

AIM: The purpose of this prospective, randomized, controlled study was the comparison of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, large drape) vs control precautions (mask, cap, sterile gloves, small drape) and of transparent polyurethan film vs gauze dressing for use on central venous (CVC) nontunneled catheters, inserted via the jugular vein. Skin colonization at the insertion site (defined by quantitative skin cultures performed at the time of insertion and in days 2 and 5) was used as a primary endpoint. Catheter tip colonization was also assessed through qualitative culture and CVC related sepsis was defined by the isolation of the same organism from the catheter tip and the blood, with clinical sepsis of no other apparent source. METHODS: Eighty-two consecutive patients were enrolled, admitted to a mixed medical-surgical ICU, aged 72+/-12 years, 58% male, SAPS II 42+/-13. One-hundred and seven CVCs were studied (presenting 750 catheter in situ days); CVCs were in place for a mean period of 6.9+/-4.7 days and 5 episodes of central catheter-related bloodstream infection were detected (6.6 per 1000 catheter days). RESULTS: A multiple logistic regression detected an increased risk of skin colonization in male gender (OR=2.5) and control precautions (OR=3.4) and no difference with regard to age, dressing and diagnostic group. CONCLUSIONS: Maximal sterile barrier proved to be an effective and recommended practice. However surveillance skin cultures revealed the common and changing nature of colonization of skin at the insertion site.

Aged↗

PubMed2005

Molecular epidemiology of microbial contamination in the operating room environment: Is there a risk for infection?

BACKGROUND: Modern operating rooms are considered to be aseptic environments. The use of surgical mask, frequent air exchanges, and architectural barriers are used to reduce airborne microbial populations. Breaks in surgical technique, host contamination, or hematogenous seeding are suggested as causal factors in these infections. This study implicates contamination of the operating room air as an additional etiology of infection. METHODS: To investigate the potential sources of perioperative contamination, an innovative in situ air-sampling analysis was conducted during an 18-month period involving 70 separate vascular surgical procedures. Air-sample cultures were obtained from multiple points within the operating room, ranging from 0.5 to 4 m from the surgical wound. Selected microbial clonality was determined by pulse-field gel electrophoresis. In a separate series of studies microbial nasopharyngeal shedding was evaluated under controlled environmental conditions in the presence and absence of a surgical mask. RESULTS: Coagulase-negative staphylococci were recovered from 86% of air samples, 51% from within 0.5 m of the surgical wound, whereas Staphylococcus aureus was recovered from 64% of air samples, 39% within 0.5 m from the wound. Anterior nares swabs were obtained from 11 members of the vascular team, clonality was observed between 8 strains of S epidermidis, and 2 strains of S aureus were recovered from selected team members and air-samples collected throughout the operating room environment. Miscellaneous Gram-negative isolates were recovered less frequently (<33%); however, 7 isolates expressed multiple patterns of antimicrobial resistance. The traditional surgical mask demonstrated limited effectiveness at curtailing microbial shedding, especially during symptomatic periods of rhinorrhea. CONCLUSIONS: Gram-positive staphylococcal isolates were frequently isolated from air samples obtained throughout the operating room, including areas adjacent to the operative field. Nasopharyngeal shedding from person participating in the operation was identified as the source of many of these airborne contaminants. Failure of the traditional surgical mask to prevent microbial shedding is likely associated with an increased risk of perioperative contamination of biomedical implants, especially in procedures lasting longer than 90 minutes.

Air Microbiology↗

PubMed1989

The role of antiseptics and disinfectants in the control of nosocomial infections.

More than 600,000 cases per year of nosocomial infection in Italy reflect, in part, the scant attention given to the vehicles of infection, conditions which favour cross-contamination and not least to the inappropriate use of antiseptics and disinfectants in our hospitals. Disinfection procedures are intended to remove or neutralise sources of potentially pathogenic organisms or to prevent their transmission by blocking the routes of transmission. Data to support many disinfection policies, particularly those of routine disinfection of inanimate surfaces, i.e. floors and walls, appear unable to show significant benefit to the patient. With the exception of particular areas, a correlation between reduction in counts of airborne bacteria and microbial colonisation or clinical infection has failed to be demonstrated. However, certain antiseptic practices e.g. correct hand washing procedures, surgical skin preparation and instrument sterilisation are of invaluable use in the control of nosocomial infection. It is therefore of critical importance in this period of cost cutting and financial restraint within the hospital services that we adopt those infection control measures which are of greatest cost effectiveness. A recent critical evaluation of the use of antiseptics in several Italian hospitals, illustrates the principal characteristics of antiseptics and their fundamental role in the control of hospital infection. This study also highlights common misuses of antiseptics and their cost/benefit ratio.

Anti-Infective Agents, Local↗

PubMedDate not supplied

[Intestinal tuberculosis in children. Differential diagnosis and treatment].

Lately, tuberculosis has became a top priority problem in health all over the world. The actual level of epidemiological indicates of tuberculosis Shaw that Romania is the country that has the most unfavorable situation in Europe except for Bosnia-Herzegovina. Tuberculosis incidence from 1996 to 1997 ranks Dolj county second in Romania from the point of view of the increasing rate (154.3% + 25.4% versus 107% + 4.3%). The National Programme of Controlling Tuberculosis for 1997-2000 has as main object the neutralization of a least 85% of the discovered contamination sources. At the same time with the pulmonary tuberculosis were discovered 17.2% extrapulmonary localizations. The purpose of these works is that of presenting in the frame of extrapulmonary TBC the localization of intestinal TBC with children (peritonitic form with infants and pseudotumoral with child). In class cooperation with the veterinary Medicine Service we have also studied the possibility of same sources of TBC infection of animal origin, knowing the fact that besides the human Koch bacillus were discovered bovine, ovine, poultry sources. Presenting a number of 16 cases of intestinal tuberculosis with children, rare cases of extra pulmonary tuberculosis, the authors also present 2 cases with children whose differential diagnosis had to be made ou a histopathological base between tuberculosis with an abdominal lymphoma or peritonitic carcinomatosis. The results of the surgical treatment that made the diagnosis with the help of the histopathological examination and the tuberculostatic treatment were very good, the evolution and the control in true of all the patients, proving that intestinal tuberculosis extrapulmonary form with children can be cured.

Adolescent↗

PubMedDate not supplied

Should immunonutrition become routine in critically ill patients? A systematic review of the evidence.

CONTEXT: Several nutrients have been shown to influence immunologic and inflammatory responses in humans. Whether these effects translate into an improvement in clinical outcomes in critically ill patients remains unclear. OBJECTIVE: To examine the relationship between enteral nutrition supplemented with immune-enhancing nutrients and infectious complications and mortality rates in critically ill patients. DATA SOURCES: The databases of MEDLINE, EMBASE, Biosis, and CINAHL were searched for articles published from 1990 to 2000. Additional data sources included the Cochrane Controlled Trials Register from 1990 to 2000, personal files, abstract proceedings, and relevant reference lists of articles identified by database review. STUDY SELECTION: A total of 326 titles, abstracts, and articles were reviewed. Primary studies were included if they were randomized trials of critically ill or surgical patients that evaluated the effect of enteral nutrition supplemented with some combination of arginine, glutamine, nucleotides, and omega-3 fatty acids on infectious complication and mortality rates compared with standard enteral nutrition, and included clinically important outcomes, such as mortality. DATA EXTRACTION: Methodological quality of individual studies was scored and necessary data were abstracted in duplicate and independently. DATA SYNTHESIS: Twenty-two randomized trials with a total of 2419 patients compared the use of immunonutrition with standard enteral nutrition in surgical and critically ill patients. With respect to mortality, immunonutrition was associated with a pooled risk ratio (RR) of 1.10 (95% confidence interval [CI], 0.93-1.31). Immunonutrition was associated with lower infectious complications (RR, 0.66; 95% CI, 0.54-0.80). Since there was significant heterogeneity across studies, we examined several a priori subgroup analyses. We found that studies using commercial formulas with high arginine content were associated with a significant reduction in infectious complications and a trend toward a lower mortality rate compared with other immune-enhancing diets. Studies of surgical patients were associated with a significant reduction in infectious complication rates compared with studies of critically ill patients. In studies of critically ill patients, studies with a high-quality score were associated with increased mortality and a significant reduction in infectious complication rates compared with studies with a low-quality score. CONCLUSION: Immunonutrition may decrease infectious complication rates but it is not associated with an overall mortality advantage. However, the treatment effect varies depending on the intervention, the patient population, and the methodological quality of the study.

Arginine↗

PubMed2006

Somatic pain sensitivity during formation and healing of acetic acid-induced gastric ulcers in conscious rats.

A classical feature of visceral pain is its referring to somatic locations. Gastric ulcer is a source of visceral pain. In the present study we investigated whether gastric ulcers may trigger the changes in somatic nociception. For this aim somatic pain sensitivity was estimated under conditions of gastric ulcer development and healing. Gastric ulcers were induced by luminal application of 60% acetic acid under surgical conditions. Control rats were subjected to the same surgical procedure, but with the application of saline instead of the acid. Somatic pain sensitivity (tail flick latency), plasma corticosterone level, adrenal and thymus weight were investigated under conditions of the formation and the healing of gastric ulcers. The application of the acid resulted in the formation of kissing gastric ulcers, the increase of somatic pain sensitivity (the decrease of tail flick latency) as well as the appearance of typical signs of chronic stress: long-lasting increase of plasma corticosterone level, adrenal gland hypertrophy and thymus gland involution. Natural healing of gastric ulcers was accompanied by restoration of pain sensitivity as well as attenuation of the signs of chronic stress. Delay of ulcer healing by the daily indomethacin administration (2 mg/kg, s.c.) prevented the restoration of somatic pain sensitivity. The results suggest that chronic gastric ulcers may trigger somatic hypersensitivity.

Acetic Acid↗

PubMed2000

Mucormycosis of the nose and paranasal sinuses.

Rhinocerebral mucormycosis is an invasive fungal infection initiated in the paranasal sinuses that frequently progresses to orbital and brain involvement. If recognized early, involvement is limited to the nasal cavity and paranasal sinuses. Diabetics in poor control are at greatest risk, however, any immunocompromised individual may be infected. The mainstays of therapy are reversal of immunosuppression, systemic amphortericin B, and surgical débridement. Survival has improved dramatically, yet deaths still occur if the infection is not recognized and not treated early in its course or if the source of immunocompromise is not reversible. Several case examples illustrate the clinical course of this unusual, but potentially fatal, fungal infection. Taxonomy, clinical presentation, diagnosis, and management of mucormycosis of the paranasal sinuses are reviewed in detail.

Aged↗

PubMed1988

Modified toluidine blue O stain for Pneumocystis carinii: further evaluation of some technical factors.

A modified toluidine blue O (TBO) stain for Pneumocystis carinii cysts was evaluated with regard to the influence of (i) the age and extent of use of the sulfation reagent, (ii) the source of TBO, (iii) the TBO content of the staining solution, and (iv) the amount of TBO present in the alcohol wash solutions. All TBOs evaluated, except for a new TBO obtained from Roboz Surgical Instrument Co., Inc., Washington, D.C., produced satisfactory results. Each lot of TBO should be quality controlled before use to ensure that the P. carinii cysts stain lavender against a blue background. We have ourselves decided to use only certified TBO with a high dye content. As extensively used sulfation reagent provided less satisfactory results than did either freshly prepared or 1-week-old unused sulfation reagent, we have decided to prepare fresh sulfation reagent at least weekly and to discard used sulfation reagent after 10 slides have been processed.

Animals↗

PubMed2004

Histopathological analysis in experimental macular surgery with trypan blue.

AIM: To analyse the effect of trypan blue on the retina in an experimental setting of macular surgery. METHODS: Porcine eyes were used within 3 hours after death. The eyes were hemisected and the vitreous removed. Trypan blue (0.15%) was applied over the trephined posterior pole, whereas the rest of the eye cup was filled with a balanced salt solution (BSS). The dye and the BSS were removed after 1 minute and the complete eye cup irrigated and filled with fresh BSS. Both the treated and untreated retinas were illuminated with a standard surgical light pipe and source at maximum power for 10 minutes. Both the trypan blue exposed retina and the non-treated surrounding retina were processed for histology. RESULTS: Exposure of the retina to trypan blue for 1 minute, followed by illumination caused no histologically detectable damage compared to the controls. No microarchitectural disorganisation, cellular disruption, or affection of the vitreoretinal interface was detected. CONCLUSIONS: These findings indicate that a 1 minute exposure of trypan blue followed by illumination does not cause an acute morphologically detectable toxic effect on the porcine retina.

Animals↗