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PubMed1975

[Explorative laparotomy].

In the 10 year surgical material of the authors the incidence of explorative laparotomy was 9.3%. In the 850 exposures the findings of 263 patients were negative. Of the 263 cases, 207 are analyzed in detail, including the history, laboratory results and findings during operation. At follow-up, in 41% of the patient the pain had ceased, while in 30% it improved. A mortality of 0.51% could be ascribed directly to the exploration. It is concluded that explorative laparotomy is an indispensable and useful procedure.

Abdominal Neoplasms↗

PubMedDate not supplied

The rational approach to the electrical exploration of the heart.

A rational approach is inevitable in any scientific activity. Such an approach is opposed not only to irrationality, at all inadmissible in scientific thinking, but also to empiric reasoning. Many years ago, Sodi Pallares introduced the rational method in the electrical exploration of the heart based on experimental findings obtained in his laboratory. This method has progressively been accepted and used with good results for diagnoses and has led to logical therapeutic inferences. To confirm the results from the logical interpretation of electrical tracings, we present some examples of its application in three fields: arrhythmias, myocardial infarction, and left ventricular hypertrophy. In the studied cases--two with tachycardia, one with a posterior infarct, and two with left ventricular hypertrophy--a very satisfactory correlation has been observed between the electrical exploration findings and those obtained through direct examination of the heart. It is desirable, and even profitable, to analyze in this way the electrical tracings to get as close as possible to reality, rejecting the stereotyped aspects of a simple routine exploration, which often induce errors and lead to some fallacious asseverations.

Electrocardiography↗

PubMedDate not supplied

[Primary hemostasis exploration].

Primary hemostasis exploration involves many tests, but most of them are highly specialized. Meanwhile, a few simple and reliable assays can make possible a first orientation of the diagnosis in a routine laboratory. This review is organized in four parts. It highlights the importance of pre-analytical steps when exploring hemostasis, especially a carefully conducted clinical history and blood collecting conditions. It first presents the tests involved in the global exploration: the platelet count, the bleeding time, the occlusion time and the prothrombin consumption test. Then, this review presents the tests essential for the diagnosis of thrombocytopenia, von Willebrand disease and platelet disorders. Finally, we discussed about the limits and the future of diagnosis in primary hemostasis, and more particularly about endothelial cells and the adhesion proteins that are implicated.

Blood Coagulation Disorders↗

PubMed2002

Exploring medication use to seek concordance with 'non-adherent' patients: a qualitative study.

BACKGROUND: 'Concordance' has been proposed as a new approach towards sub-optimal medication use; however, it is not clear how this may be achieved in practice. AIM: To develop a strategy for understanding sub-optimal medication use and seek concordance during primary care consultations. DESIGN: A developmental qualitative study using a modified action research design. SETTING: Three Scottish general practices. METHOD: Patients using treatment sub-optimally and having poor clinical control were offered extended consultations to explore their situation. Their authority to make treatment decisions was made explicit throughout. Clinicians refined a consultation model during ten 'Balint-style' meetings that ran in parallel with the analysis. The analysis included all material from the consultations, meetings, and discussion with patients after the intervention. RESULTS: Three practitioners recorded 59 consultations with 24 adult patients. A six-stage process was developed, first to understand and then to discuss existing medication use. Understanding of medication use was best established using a structured exploration of patients' beliefs about their illness and medication. Four problematic issues were identified: understanding, acceptance, level of personal control, and motivation. Pragmatic interventions were developed that were tailored to the issues identified. Of the 22 subjects usefully engaged in the process, 14 had improved clinical control or medication use three months after intervention ceased. CONCLUSIONS: A sensitive, structured exploration of patients' beliefs can elucidate useful insights that explain medication use and expose barriers to change. Identifying and discussing these barriers improved management for some. A model to assist such concordant prescribing is presented.

Chronic Disease↗

PubMed2002

Laparoscopic diagnostic exploration of the vaginal processus in the pediatric age. Preliminary experiences.

BACKGROUND: Laparoscopic surgical procedures, employed even in the paediatric age, bearing both diagnostic and therapeutic value, are currently used in the evaluation of peritoneal-vaginal duct patency during surgery for controlateral inguinal hernia or other diseases requiring opening of abdominal wall. METHODS: From January 1996 to December 2000, at the Department of Pediatric Surgery of the University of Siena a prospective study protocol has been performed to evaluate the effectiveness of laparoscopy versus traditional surgery in showing patency of peritoneal-vaginal duct. RESULTS: From our study we have been able to see how this laparoscopic procedure is well tolerated by children and parents, and is lacking in clinical complications. Patency of peritoneal-vaginal duct has been pointed out in 21.73% of cases. This result is in line with the international literature; in fact, the majority of authors have found a negative controlateral exploration in 50-80% of patients examined, thus confirming the uselessness of routine surgical controlateral inguinal exploration in hernia cases. CONCLUSIONS: The use of diagnostic laparoscopy in the study of peritoneal duct patency is a rapid and relatively easy technique, practically without intra- and peri operative risks. It allows an easy solution of the diagnostic doubt, without the need to necessarily perform a traditional explorative surgical procedure.

Adolescent↗

PubMed2002

Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study.

BACKGROUND: Our objective is to compare the results of laparoscopic cholecystectomy (LC) and common bile duct (CBD) exploration to those of endoscopic stone extraction and LC in patients with CBD lithiasis based on a prospective randomized study. METHODS: From April 1997 until August 2000, 78 patients were assigned in two groups. Group A (n'36) patients underwent laparoscopic either direct or trancystic duct, CBD exploration and LC. Group B (n'42) patients were referred for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) for duct clearance and at a later stage LC was performed. Selection of patients of both groups was done, considering prognostic factors of a preliminary study. RESULTS: Laparoscopic duct clearance was achieved in 85.7% of patients while the respective percentage for the combined approach was 84.3%. CONCLUSIONS: Laparoscopic CBD exploration is not yet established as the gold standard procedure for choledocholithiasis and there is the need for further randomized trials and possibly future meta-analyses.

Adult↗

PubMed2002

Preoperative use of enoxaparin compared with unfractionated heparin increases the incidence of re-exploration for postoperative bleeding after open-heart surgery in patients who present with an acute coronary syndrome: clinical investigation and reports.

BACKGROUND: Enoxaparin has become an attractive therapy for use during acute coronary syndrome (ACS) because of its potential superior efficacy over unfractionated heparin (UFH), its longer activity, and its subcutaneous route of administration. However, because a significant number of patients presenting with ACS may be sent directly to open heart surgery while still on anticoagulation, it is important to understand any potential bleeding risks that may be associated with the use of enoxaparin under these circumstances. METHODS: From 1998 to 2001, 1159 consecutive patients presenting with an acute coronary syndrome who received either UFH (n=1008) or enoxaparin (n=151) before proceeding to open heart surgery for urgent therapy during the same hospitalization were included in this study. Incidence of perioperative bleeding as evidenced by the units of blood products (packed red blood cells or platelets) transfused or the need for surgical re-exploration for postoperative bleeding was recorded. RESULTS: Average age was 65+/-11 and 67+/-11 years for patients receiving UFH and enoxaparin, respectively (P=0.005). Seventy-five percent of those receiving UFH and 64% of those receiving enoxaparin (P<0.005) were males. After discharge, the incidence of rehospitalization for hemorrhage requiring return to surgery for re-exploration was 7.9% in the enoxaparin group and 3.7% in the UFH group (adjusted hazard ratio=2.6, P=0.03). The use of blood products did not differ between groups (UFH=2.7+/-6.5 U and enoxaparin=2.3+/-4.5 U; P=NS). CONCLUSION: The preoperative use of enoxaparin compared with UFH in patients presenting with an ACS who undergo open-heart surgery during the same hospitalization is associated with a significantly increased incidence of re-exploration for postoperative bleeding. Further study is needed to understand the mechanism of this phenomenon and to develop appropriate guidelines to address this potentially important issue.

Acute Disease↗

PubMed2002

Exploring the costs of a limited public sector antiretroviral treatment programme in South Africa.

BACKGROUND: The role of antiretroviral treatment for adults in the pubic sector in South Africa is debated with little consideration of programme choices that could impact on the cost-effectiveness of the intervention. This study seeks to explore the impact of these programme choices at an individual level, as well as explore the total cost of a rationed national public sector antiretroviral treatment programme. METHODS: Eight scenarios were modelled of limited national treatment programmes over the next 5 years, reflecting different programme design choices. The individual cost-effectiveness of these scenarios were compared. The total costs of the most cost-effective scenario were calculated, and the potential for savings in other areas of health care utilisation was explored. RESULTS: The direct programme costs per life-year saved varied between scenarios from R5,923 to R11,829. All the costs of the most cost-effective scenario could potentially be offset depending on assumptions of health care access and utilisation. The total programme costs for the most cost-effective scenario in 2007 with 107,000 people on treatment are around R409 million. CONCLUSION: Specific policy choices could almost double the number of people who could benefit from an investment in a limited national antiretroviral treatment programme. Such a programme is affordable within current resource constraints. The consideration of antiretroviral treatment calls for a unique public health approach to the rationing of health services in the public sector.

Adult↗

PubMedDate not supplied

Biliary drainage tube evaluation after common bile duct exploration for choledocholithiasis.

BACKGROUND/AIMS: We studied the postoperative evaluation of transcystic duct tube drainage (C-tube), T-tube drainage (T-tube), and retrograde transhepatic biliary drainage after common bile duct exploration for patients with choledocholithiasis. METHODOLOGY: We analyzed the preoperative clinical features of patients, intraoperative findings, postoperative status and management, daily output of bile, liver function, postoperative infections, and postoperative complications for patients who underwent common bile duct exploration including 16 C-tube, 17 T-tube, and 8 retrograde transhepatic biliary drainage cases. RESULTS: There were no significant differences in the preoperative clinical features, intraoperative findings, or the daily output of bile from the tube. The removal day of the biliary drainage tube and postoperative hospital stay were shorter in the C-tube group than in the T-tube and retrograde transhepatic biliary drainage groups. Aspartate amino-transferase level and body temperature in the C-tube group on day 7 were lower than those in the T-tube group, and the total bilirubin level in the C-tube group on day 14 was lower than in the T-tube and retrograde transhepatic biliary drainage groups. Moreover, postoperative complications occurred significantly less frequently in the C-tube group (25.0%) than in the T-tube group (76.5%). CONCLUSIONS: C-tube drainage is thought to be most useful after common bile duct exploration for patients with choledocholithiasis.

Common Bile Duct↗

PubMed1992

Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited: where are we in the early 1990s? A plea against unilateral parathyroid exploration.

BACKGROUND: Most of the available data on multiglandular disease (MGD) originate from long-term series. The spectrum of the disease has changed now because of earlier diagnosis. We decided to assess the current frequency of MGD in seemingly sporadic primary hyperparathyroidism. METHODS: MGD was defined as the finding that more than one grossly enlarged gland weighed more than 50 mg and the rim of normal parathyroid tissue was diagnostic of adenoma. Nine hundred eight consecutive neck explorations for hyperparathyroidism were performed, 624 before 1989 and 284 between 1989 and 1991, and studied retrospectively. Since 1989, oil Red O staining has been done to assess hyperfunction. RESULTS: When multiple endocrine neoplasia and non-multiple endocrine neoplasia familial cases of hyperparathyroidism are excluded, the frequency of MGD in seemingly sporadic primary hyperparathyroidism, 17.7% before 1989, is still 14% since then, including a 3% frequency of true multiple adenomas. With more restrictive criteria, which exclude the second enlarged gland if it weighed less than 100 mg, if it had no rim, and if oil Red O staining was negative, the frequency of MGD in sporadic hyperparathyroidism has remained 11% since 1989. Unilateral exploration had missed 78% of second enlarged glands, and preoperative imaging studies, when performed, showed more than one gland in only two of 22 cases. CONCLUSIONS: Routine bilateral neck exploration is recommended in primary hyperparathyroidism because of a current frequency of MGD of at least 11%.

Adenoma↗

PubMed1992

[Bilateral exploration in unilateral inguinal hernia (cost-benefit)].

The authors performed simultaneous inguinal exploration of the right side on 100 girls operated on for the left sided inguinal hernia and hernial sac was found in 73 cases on the right asymptomatic side too. Though the simultaneous bilateral exploration has been proposed by several authors in the case of unilateral inguinal hernia of infants and children, the controversy continues among the pediatric surgeons in this respect at present too. The great number of the hernial sac found on the asymptomatic side according to the authors opinion must be enough to be agreeable with the routine bilateral exploration on girls. There has not been found any publication in the Hungarian literature about this topic.

Age Factors↗

PubMed2005

[Parathyroidectomy: bilateral exploration of the neck vs minimally invasive radioguided treatment].

AIM: In the therapy of primary hyperparathyroidism, the first surgical intervention, if efficacious, can remarkably reduce the incidence of persistence and relapses which are approximately about 5%. At present, the surgical approach of choice should involve the bilateral exploration of the neck. METHODS: In the light of the high sensibility (91%) and specificity (98.8%) in the localization of parathyroid adenomas obtained by the parathyroid 99mTc-MIBI scintigraphy, we submitted, prospective and at random, between January 2001 and July 2004, 69 patients with primary hyperparathyroidism, to a conventional surgical treatment (bilateral exploration of the neck: 35 patients) or minimally-invasive approach (minimally invasive radioguided parathyroidectomy: 34 patients). This method consists of the injection of 50 mCi of 99mTc Sestamibi 2 h before the operation and the execution of parathyroid scintigraphy. When the adenoma is evident, we perform an incision of about 4 cm in the neck, 2 cm over the jugulum and the surgical dissection is guided by a probe showing the emission of gamma rays. RESULTS: The parameters considered in order to compare the 2 groups, i.e. operating time, hospital stay and time of recovery were reduced in a significant way in the group submitted to the minimally invasive radioguided parathyroidectomy (MIRP). There were no complications in the 2 groups. In the follow-up we did not observe cases of persistence or relapses. CONCLUSIONS: Therefore, we can confirm that the minimally invasive radioguided parathyroidectomy is a safe and efficacious method as well as the bilateral exploration of the neck. Moreover, cost reduction may convince many surgeons to consider MIRP the < > in the management of primary hyperparathyroidism.

Adult↗

PubMed2005

mVisualizer: Easily Accessible Data Exploration for Clinicians.

In medical research and clinical work, having direct access to a large knowledge base of information about patients is very useful. Software for information visualisation can help the user browse, analyse and learn from such knowledge, thus providing new insights and accelerating research. However, when introducing new software to clinicians, who may have limited computer knowledge, adoption can be hindered by the complexity of the applications and the time investments necessary to learn them. By involving clinicians directly in the design process, we have developed mVisualizer, an application that provides a hands-on workspace to visualise and explore patient data. mVisualizer was designed for accessibility and simplicity, and to encourage users to explore the data in order to make discoveries and pose new questions relevant for knowledge gathering and research. The user-centered approach helped ensure that mVisualizer is understandable and easy to learn for clinicians. The application is in use by clinicians today, and its use has led to new discoveries and theories that will be the subject of future medical research. This leads to the conclusion that information visualisation software for exploring patient data can help clinicians and researchers by making the data more accessible, which stimulates research and learning.

Biomedical Research↗

PubMed2006

Exploring stress and coping among urban African American adolescents: the Shifting the Lens study.

INTRODUCTION: Stress can have a significant effect on an adolescent's long-term physical and mental well-being. An understanding of the role of unmanaged stress during early adolescence is critical for the prevention of chronic diseases such as depression. The purpose of the Shifting the Lens study was to explore perceptions of stress, sources of social support, and use of coping strategies among urban African American ninth graders. METHODS: A youth-driven, mixed-method approach was used to assess teens' perceptions of stress. During the 2001-2002 school year, teen participants (N = 26) from East Baltimore, Md, completed questionnaires, audio journals, pile-sort activities, and personal social support network maps. RESULTS: In contrast with existing literature that emphasizes the influence of violence and neighborhood factors on stress among teens, teens prioritized other sources of stress, particularly from school, friends, and family. For support, they relied on different individuals, depending on the source of the stress--friends for romantic relationship stress and family for job, school, and family stress. Sex differences in the coping styles of the participating teens were found. Girls reported more frequent use of support-seeking and active coping strategies than boys. CONCLUSION: The use of multiple data collection strategies to explore stress uniquely contributes to our understanding of how one group of teens perceives and copes with stress. Future research should explore stress from the youth perspective in communities that are similar to East Baltimore, Md. In addition, programmatic recommendations include the need for sex-specific stress management activities and education about youth stress for adults. Community participatory translation interventions based on study findings, such as a youth-produced video and a resource guide for youth service providers, were implemented.

Adaptation, Psychological↗

PubMedDate not supplied

Laparoscopic common bile duct exploration in pregnancy with acute gallstone pancreatitis.

BACKGROUND: We present a case in which a laparoscopic common bile duct exploration was performed safely in a pregnant patient with acute gallstone pancreatitis. CASE REPORT: A 25-year-old female, gravida 4 para 3, at 14-weeks gestation presented to her obstetrician with complaints of epigastric pain radiating to the back. She was otherwise healthy with no past medical or surgical history. A physical examination revealed a healthy young female with no evidence of jaundice and in no acute distress. An abdominal examination was remarkable for a gravid abdomen with mild tenderness to palpation in her epigastrium and negative Murphy's sign. The patient safely underwent a laparoscopic common bile duct exploration after a laparoscopic cholecystectomy was performed. CONCLUSION: This case illustrates the role of laparoscopic common bile duct exploration in the diagnosis and treatment of possible choledocholithiasis in a pregnant patient.

Acute Disease↗

PubMedDate not supplied

In the wake of structural adjustment programs: Exploring the relationship between domestic policies and health outcomes in Argentina and Uruguay.

BACKGROUND: The implementation of structural adjustment programs (SAPs) in developing countries has been followed by a marked reduction in their progress on economic growth, health outcomes, and social indicators. Comprehensive and contextualized explorations of the effects of SAPs are needed to assist health and social policy-makers in better determining responses to such programs that continue to dominate global trade, aid and debt cancellation negotiations. METHODS: A comparative case study of Argentina and Uruguay was developed exploring the effects of SAPs on health. Using a framework developed to analyze the relationship between globalization and health, changes in domestic policies resulting from SAPs and the corresponding economic, social and health outcomes of the countries were explored. RESULTS: In general, SAPs were implemented with greater severity and speed in Argentina than in Uruguay, with the greatest differences occurring over the 1980s. The more gradual and modest reforms implemented in Uruguay were associated with better economic, social and health outcomes. CONCLUSIONS: Findings support those of previous studies demonstrating that countries that have maintained more dynamic public social and health programming while applying SAPs have been better able to protect the health of the most vulnerable sectors of society.

Argentina↗

PubMed2004

[Exploration of biliary tracts for laparoscopy for treatment of choledocholithiasis].

BACKGROUND: Common bile duct stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy. If the diagnosis of choledocholithiasis is made in the preoperative work-up it is a common practice to refer patients to endoscopic retrograde cholangiography and endoscopic sphincterotomy. However, if the diagnosis is established during the intraoperative cholangiogram the surgeon confronts a therapeutic dilemma between laparoscopic common bile exploration, conversion to open surgery or post-operative endoscopic sphincterotomy. OBJECTIVE: We have opted to resolve the choledocholithiasis in only one session during the laparoscopic cholecystectomy, with the transcystic common bile duct exploration technique using the choledochoscope, or with laparoscopic choledochotomy. We report our early experience in terms of success of stone removal, operative time, morbidity, mortality and hospital stay. METHODS: from 1992 to 2003 we performed 460 laparoscopic cholecystectomies and using selective cholangiography in 138 patients (30%) we found 52 patients with common bile duct stones, for an incidence of 11.3%. RESULTS: Of this group we performed laparoscopic common bile duct exploration in 46 patients, and our success rate for stone removal was 95.6% (44 of 46) with only two failures related to multiple stones and impactation at the ampulla for a conversion rate of 4%. The mean operative time was 120 +/- 40 min. A morbidity of 8.6% was found, with no mortality. Hospital stay was 48 hrs. Mean recovery time was 7 days, and time to return to work 15 +/- 3 days. CONCLUSIONS: We concluded that must of the patients with common bile duct stones found during laparoscopic cholecystectomy can be treated with success using the laparoscopic technique with choledochoscopy, without increased morbidity or mortality, and with a short hospital stay and recovery time similar to patients in whom only laparoscopic cholecystectomy is perform. According to our results we encourage that this method should become the primary strategy in the great majority of patients with common bile duct stones found during intraoperative cholangiography.

Adolescent↗

PubMed1991

Effects of prenatal exposure to diazepam on exploration behavior and learning retention in mice.

Diazepam (2 mg/kg, DZP) or placebo were administered by oral gavage throughout gestation in 40 mice. The automatic hole board test for mice (Boissier and Simon) was used to measure the locomotor activity and the number of holes explored by the offspring (mean age 30.6 days). During the first test, this number represents curiosity. Its progressive decrease when the test is repeated (4 times at 1-day intervals) is a consequence of learning retention. In the first test, neither curiosity nor activity were linked with the mother's treatment or sex. During the next tests, there was no difference in locomotor activity between DZP and placebo groups. However, the DZP exposed pups explored fewer holes than controls. Although there was a tendency towards greater activity in the female group, the number of holes explored in the placebo group was significantly higher in females than in males. Paradoxically, this difference in learning memory function which exists between control males and females was not observed in the DZP group, corresponding to an impaired learning retention.

Administration, Oral↗