SEARCH · PubMed Health

Results for “Surgical source control”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources

PubMed1986

Total parenteral nutrition and cancer clinical trials.

Twenty-eight prospective randomized controlled clinical trials evaluating the use of total parenteral nutrition (TPN) in cancer patients were identified through a search of major indexing sources. The data were pooled across studies to increase the ability to detect therapeutic effects. The impact of publication bias and the quality of reporting each trial were used to critically assess the conclusions drawn from the pooled analysis. The authors conclude that TPN may be useful when used preoperatively in patients with gastrointestinal tract cancer. It appears to be beneficial in reducing major surgical complications (pooled P = 0.01) and operative mortality (pooled P = 0.02). No statistically significant benefit from TPN could be demonstrated in survival, treatment tolerance, treatment toxicity, or tumor response in patients receiving chemotherapy or radiotherapy. An increase in the risk of developing an infection in chemotherapy patients given TPN (pooled P less than 0.0001) underscores the importance of demonstrating significant benefits in randomized trials before TPN is used routinely in these patients.

Clinical Trials as Topic↗

PubMed1992

A reliable and safe way of shortening cadaver kidney ischemia time: prenephrectomy tissue typing using donor lymph node cells.

The purpose of this study was to investigate the impact of prenephrectomy donor tissue typing on tissue typing quality and transplantation outcome in human kidney transplantation. We report on 680 consecutive kidney transplantations performed at the Vienna Transplantation Center from 1986 to June 1991. In 343 of them, HLA typing was performed using donor lymph node cells obtained in a small surgical procedure several hours before organ retrieval. The mean cold ischemia time (CIT) could be reduced to 17.7 h in these patients compared with 21.9 h in the control group (n = 337, conventional tissue typing using spleen lymphocytes obtained during the organ removal, P = 0.0001). There was a trend towards better initial and long-term function in the lymph node group; however, this did not reach statistical significance. The clarity of tissue typing results was significantly better when lymph nodes were used as the lymphocyte source. We conclude that prenephrectomy tissue typing is a feasable and inexpensive method of shortening CIT in renal transplantation and favors HLA typing, both likely to benefit transplantation outcome particularly within organ exchange programs.

Cadaver↗

PubMed1989

Nosocomial bloodstream infection at a veterans hospital; 1979 to 1987.

Studies of nosocomial bloodstream infection (NBI) have come primarily from university, municipal or community hospitals with little specific information from veterans hospitals. The objective of this study was to define trends in NBI at a tertiary care veterans hospital. Patients with NBI were identified by retrospective review of microbiology records and of infection control surveillance records from 1979 to 1987 at the Buffalo Veterans Administration Medical Center (VAMC). Between 1979 and 1985 there was no significant upward or downward trend. Beginning in early 1986 a significant increase in NBI was noted. This increase was because of changes in incidence of gram-positive NBI (primarily Staphylococcus aureus [corrected] and enterococcus) while there was no change in incidence of gram-negative NBI. The most common source of NBI were similar to previous studies and included urinary tract infection, pneumonia, surgical wound infections and intravenous catheter related infections. The frequency of various organisms causing NBI was likewise similar to other studies except for pneumonia in which Streptococcus pneumoniae most commonly was isolated. The yearly incidence of gentamicin resistance among gram-negative NBI isolates demonstrated no significant trend. In conclusion, there was a significant increase in incidence of NBI at the Buffalo VAMC between 1979 and 1987 that occurred primarily in the last two years studied. The importance of gram-positive organisms as a cause of NBI at the Buffalo VAMC has been clearly documented as a recent phenomenon.

Catheters, Indwelling↗

PubMed2005

Leptin in corneas from keratoconus and infectious keratitis patients.

PURPOSE: Leptin is produced primarily by adipose tissue. More recent studies have shown extra sites of leptin production in physiologic and ill human tissues. However, whether leptin originates from human corneas in infectious keratitis and keratoconus is not known. The aim of this study was to demonstrate and quantitate leptin expression in corneas with infectious keratitis and keratoconus and make comparisons to control corneas. METHODS: We examined the immunohistochemical staining of leptin in nine corneas surgically excised from patients with infectious keratitis (3 patients), keratoconus (3 patients), and donor corneas (3 patients). RESULTS: The results were analyzed using a semiquantitative scoring system of mild, moderate, and strong. Cells of the infectious keratitis group had the strongest leptin staining intensity, the control group had moderate, and the keratoconus group had mild staining intensity. The more vascular corneas in the infectious keratitis group were also associated with the greatest leptin staining. CONCLUSIONS: Our findings indicate that leptin expression was present in all three sources of corneas (infectious keratitis, keratoconus, and normal control). Quantitative scoring would imply it may play a role in infectious keratitis, although further experiments are necessary to establish any causal relationship.

Adult↗

PubMedDate not supplied

[Results of a cytological study of needle aspiration in 85 cases of nodular pathology of the thyroid gland, surgically controlled].

UNLABELLED: The present retrospective study is related to 85 patients with nodular thyroid pathology submitted to surgical therapy. In these patients preoperative cytology, through fine needle biopsy aspiration (FNBA), has been compared with histological examination performed on the surgical specimen. Malignant lesions were detected in 30 cases (35.3%). True positives cases were 14, true negative 48, false positive and false negative (FN) were 2 and 3 respectively. Due to the high number of FN, sensibility of FNBA was only 51.8%, specificity was 96% and accuracy 80.5%. Positive and negative predictive value were 87.5% and 78.6% respectively. CONCLUSIONS: Evaluation of the several sources of error comes to a conclusion that FNBA is certainly the main diagnostic tool in nodular thyroid pathology. Its employment should undergo to a centralized diagnostic evaluation in such a way that cytology is analysed together with clinical and other instrumental data.

Adolescent↗

PubMed1979

Primary postoperative wound infection due to Staphylococcus pyogenes.

Using S. pyogenes as a tracer organism, an examination of the importance of air-borne infection of clean wounds in the modern, plenum-ventilated operating room has been made. It appears that, for most surgical procedures, additional ultra-clean air installations are not necessary. It has been shown that even if the air is sterile, the skin remains a possible source of infection. This is especially so as far as the patient's skin is concerned. It will remain so, since the skin cannot be sterilized. Indeed, until the ecology of the skin is better understood, rigorous efforts directed toward its disinfection may compromise its inherent defense mechanisms and its protective bacterial flora. It will be argued by some that operating rooms with ultraclean air should be afforded for certain specialized procedures in sugery; for example, those in which prosthetic materials are being implanted or in which the patient's immune mechanisms are depressed. Although not disagreeing with this, I wish to note that the only controlled trial on this aspect of surgery that exists to date shows no advantage for patients randomly apportioned to have hip arthroplasty, either in an isolator or in the same modern operating room but without the isolator. From this experience, I believe that any further trial of this nature, if it is to be controlled to a similar high level, will require very large numbers of patients to show even a marginal advantage for ultraclean air or isolator installations over the modern, plenum-ventilated and meticulously managed operating suite. The verdict on the need to install ultraclean air plant for operating rooms must, therefore, be couched in the third alternative that exists under Scots Law-- "not proved." I suggest the money could be better spent on devising methods to keep skin pathogens out of surgical wounds. Perhaps more urgently, there is a need to discover how to increase the defense mechanisms of the wound milieu to implanted harmful bacteria. There is also a pressing need to improve the ward environment with the aim of diminishing secondary infections of surgical wounds.

Air Microbiology↗

PubMed2005

Treatment of persistent infection after anterior cruciate ligament surgery.

Infection after anterior cruciate ligament reconstruction that persists despite debridement is a challenging problem with limited information available in the literature. Our purpose was to determine whether an aggressive protocol would be effective in treating these persistent infections. This is a retrospective review of five consecutive patients with persistent septic arthritis of the knee after anterior cruciate ligament reconstruction. All patients previously had one to three irrigation and debridement procedures that failed to control the infection. Our treatment protocol consists of arthrotomy, complete synovectomy, removal of any implants, graft removal, and curettage of the femoral and tibial tunnels. Cultures are obtained from many sources (joint fluid, synovial lining, graft, and bone) and antibiotic therapy is given for 6 weeks. At a median followup time of 20 months (range, 6-27 months) infection was controlled in all patients. Three of five infections (60%) were polymicrobial. In these cases, different organisms were cultured from multiple tissue samples. Tunnel osteomyelitis was present in three of five patients (60%). Persistent septic arthritis of the knee after anterior cruciate ligament reconstruction can be controlled with a protocol based on radical debridement. Polymicrobial infections may be present and multiple cultures from different sources are required to identify all pathogens.

Adult↗

PubMed1990

The deep temporal nerve-orbicularis oculi muscle pedicle as a possible means for reanimation of the upper face.

Selective reinnervation of paralyzed facial musculature using the ansa hypoglossi nerve-muscle pedicle has been shown to be feasible in laboratory animals and in people. Because this structure cannot be brought beyond the level of the orbicularis oris muscle, the deep temporal nerve-orbicularis oculi nerve-muscle pedicle was investigated in six human cadavers as a possible source for reanimation of the paralyzed upper face. These studies show that it is possible to create a nerve-muscle pedicle that can easily reach the orbicularis oculi muscle in all specimens. Interest in electrical control of paralyzed structures to reestablish facial expression may allow further application of our findings.

Facial Muscles↗

PubMed2006

Effect of obese living donors on the outcome and metabolic features in recipients of kidney transplantation.

Living kidney donors must be evaluated carefully focusing on risk factors for long-term complications. Our transplant center performs 70% of its kidney transplantations from living sources including 19.9% obese donors. We evaluated the long-term follow-up of recipients of organs from 37 living donor patients with obesity defined by a body mass index (BMI) > 30 kg/m2. We compared this group with a control group of normal BMI before donation. The follow-up was 50.8 +/- 28.5 months. We observed a lower glomerular filtration rate among organs from obese versus non-obese donors. At the same time we reviewed percentage of acute rejection episodes (ARE), primary allograft function, and surgical complications we observed incidence of ARE higher among the group who received kidneys from obese donors.

Adult↗

PubMed2005

Recombinant factor VIIa in the treatment of non-hemophiliac bleeding.

OBJECTIVE: To review the clinical evidence for the use of recombinant factor VIIa (rFVIIa) in the prevention and/or treatment of bleeding in non-hemophiliac patients. DATA SOURCES: A MEDLINE search (1966-December 2004) was conducted to identify pertinent literature. Results were limited to English-language reports and clinical trials. References of relevant articles and selected abstracts presented at scientific meetings were also reviewed. STUDY SELECTION AND DATA EXTRACTION: Human data from prospective and retrospective studies that examined the hemostatic effect of rFVIIa in non-hemophiliac patients were reviewed, with a focus on surgical prophylaxis, liver disease, intractable bleeding associated with trauma and surgery, and anticoagulation reversal. DATA SYNTHESIS: Results from limited controlled trials on the use of rFVIIa as an adjunct for prevention of bleeding in surgery and liver diseases have not been consistent. For treatment of intractable bleeding, earlier use of rFVIIa in one trauma trial was shown to decrease the number of blood transfusions, but no differences in terms of clinical outcomes were observed in all trials. Controlled trials do not suggest an increased risk of thrombotic events. Optimal dosing and timing of administration have yet to be defined. CONCLUSIONS: Until further prospective controlled data are available, it is recommended that conventional intervention for prevention and control of hemorrhage in non-hemophiliac patients should remain the standard of care. Close monitoring of coagulation parameters is recommended before, during, and after therapy, especially in high-risk patients. Pharmacoeconomic analysis may be useful to help control costs and maximize clinical benefits.

Blood Loss, Surgical↗

PubMed1991

Estimates of radiation absorbed dose for intraperitoneally administered iodine-131 radiolabeled B72.3 monoclonal antibody in patients with peritoneal carcinomatoses.

Using a newly available model for determining estimates of radiation absorbed dose of radioisotopes administered intraperitoneally, we have calculated absorbed dose to tumor and normal tissues based on a surgically controlled study of radiolabeled antibody distribution. Ten patients with peritoneal carcinomatosis received intraperitoneal injections of the murine monoclonal antibody B72.3 radiolabeled with 131I. Biodistribution studies were performed using nuclear medicine methods until laparotomy at 4-14 days after injection. Surgical biopsies of normal tissues and tumor were obtained. The marrow was predicted to be the critical organ, with maximum tolerated dose [200 rad (2 Gy) to marrow] expected at about 200 mCi (7.4 GBq). In patients with large intraperitoneal tumor deposits, the tumor itself is an important source tissue for radiation exposure to normal tissues. Local "hot-spots" for tumor-absorbed dose were observed, with maximum tumor-absorbed dose calculated at 11,000 rad (11 Gy) per 100 mCi (3.7 GBq) administered intraperitoneal; however, tumor rad dose varied considerably. This may pose serious problems for curative therapy, especially in patients with large tumor burdens.

Absorption↗

PubMed1983

Current thinking on tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy, though less frequently performed now than in the 1930s, remain among the most common surgical procedures in the United States. The need for and benefits of tonsillectomy and adenoidectomy have been a source of controversy for several decades. Nonetheless, there are situations in which these procedures definitely are beneficial. Tonsillectomy and adenoidectomy are two distinct procedures with separate indications, and they are performed concurrently only when the specific indications for each coexist. Tonsillectomy is indicated by recurrent tonsillitis, peritonsillar abscess, chronic tonsillitis, tonsillar neoplasm, or tonsillar hypertrophy that is obstructive to the upper aerodigestive tract (respiratory distress, dysphagia, or interference with performance of an adenoidectomy). Adenoidectomy is indicated for nasal airway obstruction due to adenoidal enlargement from hypertrophic or inflammatory processes. Although correlation exists among obstructive adenoids, mouth breathing, and dentofacial anomalies, present evidence is not sufficient to justify adenoidectomy solely on the basis of craniofacial or dentofacial abnormalities. Today, elimination of an occult source of infection (once called focal infection) in patients with disorders such as rheumatic fever or serous otitis media is not a valid indication for either operation. Contraindications to tonsillectomy and adenoidectomy include bleeding disorders, familial anesthetic intolerance, velopharyngeal insufficiency, and concurrent disease that may enhance operative risks. Like all surgical procedures, tonsillectomy and adenoidectomy entail morbidity and risk of mortality. The most frequent complication of these operations is hemorrhage. Risk of mortality is approximately 0.006%. Mortality and morbidity can be minimized by appropriate preoperative evaluation, complete control of the airway with endotracheal anesthesia, and meticulous surgical technique.

Adenoidectomy↗

PubMed2002

DNA fingerprinting of methicillin-resistant Staphylococcus aureus (MRSA) by pulsed-field gel electrophoresis (PFGE) in a teaching hospital in Malaysia.

Methicillin-resistant Staphylococcus aureus (MRSA) has been prevalent in our hospital over the last three years. Differentiation among MRSA strains by DNA typing in addition to antibiotic resistance pattern surveillance is crucial in order to implement infection control measures. The aim of this study was to characterize MRSA isolates from patients admitted to Hospital Universiti Kebangsaan Malaysia (HUKM) by phenotypic (analyses of antibiotic susceptibility pattern) and genotypic (PFGE) techniques to determine the genetic relatedness of the MRSA involved and to identify endemic clonal profiles of MRSA circulating in HUKM. Seventy one MRSA strains collected between January to March 2000 from patients from various wards in HUKM were tested for antimicrobial resistance and typed by pulsed-field gel electrophoresis (PFGE). Four major types of PFGE patterns were identified (A, B, C and D) among MRSA strains. Two predominant PFGE types were recognised, Type A (59.2%) and Type B (33.8%). Most of these strains were isolated from ICU, Surgical wards and Medical wards. MRSA strains with different PFGE patterns appeared to be widespread among wards. Strains with the same antibiotype could be of different PFGE types. Most of isolates were resistant to ciprofloxacin, erythromycin, gentamicin and penicillin. One isolate with a unique PFGE pattern Type D and susceptible to gentamicin was identified as a different clone. Some isolates obtained from the same patient showed different PFGE subtypes suggesting that these patients were infected/colonized with multiple MRSA strains. PFGE analysis suggests that MRSA strains with different PFGE types was propagated within our hospital. The relationship between antibiotic susceptibility and PFGE patterns was independent. The ability of PFGE technique in differentiating our MRSA strains make it a method of choice for investigating the source, transmission and spread of nosocomial MRSA infection, and thus an appropriate control programme can be implemented to prevent the spread of MRSA infection.

DNA Fingerprinting↗

PubMed1991

Cardiovascular causes of syncope. Identifying and controlling trigger mechanisms.

Syncope usually has a cardiovascular source, so neurologic evaluation has a low diagnostic yield in these patients. Cardiac arrhythmias in persons with or without structural heart disease can produce syncope. Neurocardiogenic dysfunction that results in diminished venous return and hypercontractility is another frequent cause. Postural hypotension or left ventricular outflow obstruction may also be to blame. Careful history taking and physical examination, head-up tilt testing, echocardiography or radionuclide isotope imaging, and electrophysiologic study are often diagnostic. However, syncope remains undiagnosed in some patients, and they may require periodic reassessment. Treatment options are available for most cardiovascular disorders, among them use of pharmacologic agents; catheter, surgical, or radio-frequency modification of certain tachycardias; and permanent pacing.

Cardiac Pacing, Artificial↗

PubMed2003

Body-exhaust suit versus occlusive clothing. A randomised, prospective trial using air and wound bacterial counts.

We randomly allocated 50 total knee replacements to scrub teams wearing body-exhaust suits (BES) or Rotecno occlusive clothing. The effectiveness of the clothing was assessed using air andwound bacterial counts. Bacteria were recovered from 62% of wounds (64% BES, 60% Rotecno). The mean air count was 0.5 CFU/ m3 with BES and 1.0 CFU/m3 with Rotecno (p = 0.014). The mean wound counts were 14 bacteria/wound with BES and eight bacteria/wound with Rotecno (p = 0.171). There was no correlation between the air and wound counts (r = -0.011, Spearman's). The higher air counts suggest that Rotecno occlusive clothing is less effective than BES, but wounds were equally contaminated with both types of clothing suggesting that at very low levels of air contamination the contribution of bacteria to the wound from the air is irrelevant. Even doubling the air counts from 0.5 to 1.0 CFU/m3 had no detectable effect on the wound. This allows a reassessment to be made of other sources of contamination the effect of which would previously have been overwhelmed by contamination from air.

Air Microbiology↗

PubMed2006

Cytokine-containing gelfoam implants at a postsurgical tumor excision site to stimulate local immune reactivity.

We previously demonstrated increased numbers of CD34(+) progenitor cells in the peripheral blood of tumor bearers. Also demonstrated was the feasibility of chemoattracting these cells by sponge implants containing VEGF. The present study used a murine Lewis lung carcinoma (LLC) model to test if CD34(+) cells that are chemoattracted to a tumor excision site can be differentiated in situ into dendritic cells and whether this leads to increased local immune reactivity. After surgically excising established LLC tumors, mice received at the excision site gelatin sponge implants containing VEGF to chemoattract CD34(+) cells, and/or GM-CSF plus SCF to induce CD34(+) cell differentiation into dendritic cells. In some studies, lysates of GFP-transfected LLC cells (LLC(GFP)) were also included in the implants as a source of tumor antigen. After 2 weeks, implants and local lymph nodes were removed and analyzed. Implants containing VEGF, GM-CSF/SCF or VEGF/GM-CSF/SCF had a higher proportion of CD34(+) cells compared to control implants. However, the number of dendritic cells was higher in implants containing GM-CSF/SCF or VEGF/GM-CSF/SCF than those containing either VEGF or diluent. Regional lymph node from mice containing GM-CSF/SCF or VEGF/GM-CSF/SCF implants showed increased dendritic cell levels. However, when lysates from LLC(GFP) were added to the implants, the highest proportion of dendritic cells associated with GFP was in lymph nodes of mice containing GM-CSF/SCF implants. Lymph node cells from mice with GM-CSF/SCF or VEGF/GM-CSF/SCF had a higher level of proliferation and IFN-gamma secretion in response to in vitro LLC lysate challenge, with the greatest response being from lymph node cells of mice with GM-CSF/SCF implants. These results suggest the feasibility of using GM-CSF/SCF-containing implants to increase dendritic cell levels, uptake of tumor antigens, trafficking to lymph nodes and stimulation of immune reactivity at tumor excision sites with residual tumor.

Animals↗

PubMed1990

The Dieulafoy gastric erosion. An infrequently recognized cause of upper gastrointestinal hemorrhage in the elderly.

Definitive treatment of the Dieulafoy erosion--once recognized--has generally been surgery. Numerous surgical approaches have been suggested, including: simple oversewing of the lesion, wedge restriction, and gastrectomy with and without vagotomy and pyloroplasty. Attempts at endoscopic electrocoagulation and angiographic embolization have generally been disappointing; however, Pointer et al have recently reported satisfactory control of hemorrhage from Dieulafoy lesions with bipolar electrocoagulation and endoscopic injection sclerotherapy, either independently or in combination. These case reports describe two elderly patients with massive upper gastrointestinal tract bleeding from Dieulafoy's gastric erosion; it is hoped the geriatrician will be alerted to an often unrecognized source of hemorrhage.

Aged↗

PubMed1998

Focusing and steering through absorbing and aberrating layers: application to ultrasonic propagation through the skull.

The time-reversal process is applied to focus pulsed ultrasonic waves through the human skull bone. The aim here is to treat brain tumors, which are difficult to reach with classical surgery means. Such a surgical application requires precise control of the size and location of the therapeutic focal beam. The severe ultrasonic attenuation in the skull reduces the efficiency of the time reversal process. Nevertheless, an improvement of the time reversal process in absorbing media has been investigated and applied to the focusing through the skull [J.-L. Thomas and M. Fink, IEEE Trans. Ultrason. Ferroelectr. Freq. Control 43, 1122-1129 (1996)]. Here an extension of this technique is presented in order to focus on a set of points surrounding an initial artificial source implanted in the tissue volume to treat. From the knowledge of the Green's function matched to this initial source location a new Green's function matched to various points of interest is deduced in order to treat the whole volume. In a homogeneous medium, conventional steering consists of tilting the wave front focused on the acoustical source. In a heterogeneous medium, this process is only valid for small angles or when aberrations are located in a layer close to the array. It is shown here how to extend this method to aberrating and absorbing layers, like the skull bone, located at any distance from the array of transducers.

Brain Neoplasms↗