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PubMed2001

Current status of bacterial contamination of autologous blood for transfusion.

Autologous transfusion, although not without risk, does decrease the risk of transmitted diseases via homologous transfusion. However, strict quality control is required for autologous transfusion. In Japan, a recent enactment requires that written informed consent be obtained prior to blood transfusion, which therefore requires that clinicians provide sufficient explanation of the risks involved with this procedure. To the best of our knowledge, this is the first study to comprehensively evaluate the manner in which the safety of autologous blood transfusion can be compromised by bacterial contamination. For a 24-month period, between April 1996 and March 1998, bacterial contamination of all kinds of autologous blood samples was tested by sampling the culture immediately prior to transfusion. Subculturing, identification and susceptibility testing of the isolates were performed. From the 287 units of all kinds of autologous blood transfused, 18 were culture positive (6.3%). Positive blood cultures were obtained in two of the 59 units (3.4%) of autologous transfusion donated preoperatively (ATDP) that was infused intraoperatively, in three of the 117 units (2.6%) of hemodilution/autologous transfusion (HAT) and in three of the 81 (3.7%) of ATDP infused postoperatively. There was a high percentage (33.3%) of positive blood cultures in the cases of intraoperative blood salvage (IOBS). The total rate of positive blood cultures was 6.3% including IOBS and 3.1% excluding IOBS. The most common microorganism isolated from autologous blood was coagulase-negative Staphylococci in 12 of 18 culture-positive units (66.7%). Alpha Streptococcus uiridans was isolated in 2 units (11%) and Staphylococcus aureus was isolated in 1 unit (5.5%). However, none of the patients who received the culture-positive autotransfusion blood showed clinical signs or laboratory findings of bacteremia. Safe ATDP is threatened by bacterial contamination that can be introduced by numerous sources, such as the donors' blood, the skin at the site of venipuncture, the environment and the phlebotomist's finger. In the cases of IOBS, protection against bacterial contamination at the surgical site is crucial. Here we discuss the relevance of our findings to the efforts to minimize the risks of contamination associated with autologous blood transfusion; risks that must be communicated to the patient in the process of informed consent. Continued research is required to identify the safest method of autologous blood transfusion.

Aerobiosis↗

PubMed2005

Although leukoplakia responds to some treatments relapses and adverse effects are common.

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, Cochrane Central Trials Register, Medline and Embase were searched, as well as the following journals: Cancer, Community Dentistry and Oral Epidemiology, European Journal of Oral Sciences, Journal of Dental Research, Oral Oncology, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics. The reference lists of included studies and reviews were checked, and oral medicine experts were contacted through a European mailing list (EURORALMED). STUDY SELECTION: Randomised controlled trials (RCT) were included if they had enrolled patients who had a diagnosis of oral leukoplakia and who were undergoing any surgical or medical (topical and systemic) treatment. The primary outcome considered was malignant transformation of leukoplakia demonstrated by histopathological examination. Other outcomes considered were clinical resolution, histological modification and frequency of adverse effects. DATA EXTRACTION AND SYNTHESIS: Data were collected using a specific extraction form. The validity of studies included was assessed by two reviewers, on the basis of the method of allocation concealment, blindness of the study and loss of participants. Data were analysed by calculating relative risk (RR). When valid and relevant data were collected, a meta-analysis of the data was undertaken. RESULTS: The possible effectiveness of surgical interventions, including laser therapy and cryotherapy, has never been studied by means of an RCT. Nineteen RCT of nonsurgical interventions were identified: seven were included. Vitamin A and retinoids were tested in five RCT (245 patients); the other drugs tested were bleomycin (one study), mixed tea (one study) and beta-carotene (one study). Malignant transformation was recorded in just two studies. None of the treatments tested showed a benefit compared with placebo. Treatment with beta-carotene and vitamin A or retinoids was associated with significant rates of clinical resolution, compared with placebo or absence of treatment. Whenever reported, a high rate of relapse was a common finding. Side effects of variable severity were often described but interventions were well accepted by patients, since dropout rates were similar between treatment and control. CONCLUSIONS: To date there is no evidence of effective treatment in preventing malignant transformation of leukoplakia. Treatments may be effective in the resolution of lesions, but relapses and adverse effects are common.

Comment↗

PubMed1998

Transvenous cold mapping and cryoablation of the AV node in dogs: observations of chronic lesions and comparison to those obtained using radiofrequency ablation.

INTRODUCTION: Radiofrequency (RF) is the most commonly used energy source for the treatment of cardiac arrhythmias. Surgical experience has shown that cryoablation also is effective for ablating arrhythmias. The aims of this study were to (1) investigate the feasibility of inducing permanent complete AV block (CAVB), (2) investigate the value of cold mapping to select the cryoablation site to produce permanent CAVB, (3) study the macro- and microscopic lesion characteristics 6 weeks later, and (4) compare them to those produced with RF energy. METHODS AND RESULTS: A new steerable 8.5-French bipolar electrode catheter having a thermocouple with a 3-mm tip using N2O as the refrigerant controlled by a cryoconsole was used. Six mongrel dogs were anesthetized, and the catheter was positioned via the femoral vein across the tricuspid valve to record a large low right atrial and a small His-bundle potential. After cold mapping (-15 degrees to -20 degrees C tip temperature) resulted in ECG modifications, cryothermia (-70 degrees C) was given twice, lasting 5 minutes each, to create permanent CAVB (Cryo group). Additionally, RF catheter ablation of the AV node was performed in two anesthetized mongrel dogs (RF group). In the Cryo group, a permanent proximal CAVB was created in four dogs (block occurred within 10 to 20 sec of cryothermia). Permanent right bundle branch block was obtained in one dog and transient CAVB in the remaining dog. In both dogs of the RF group, permanent CAVB was obtained. The cryolesions consisted of well-circumscribed, homogeneous areas of fibrotic tissue without viable cardiomyocytes. Lesions produced with RF were less circumscribed and inhomogeneous, with clear evidence of viable cardiomyocytes and cartilage formation (patchy lesions). CONCLUSIONS: (1) Permanent CAVB can be created by using a steerable cryoablation catheter. (2) Histologically, cryoablated sites were homogeneous and showed fibrotic tissue without signs of chronic inflammation and no evidence of viable myocytes. (3) Lesions created with RF were less homogenous and still contained viable myocytes within the lesion and cartilage formation. (4) The arrhythmogenic significance of these differences requires further study. (5) The technology of using reversible cold mapping has the potential to identify the successful ablation site and warrants further clinical study.

Animals↗

PubMed2005

A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease.

Radiotherapy has been the primary therapy for managing metastatic spinal disease; however, surgery that decompresses the spinal cord circumferentially, followed by reconstruction and immediate stabilization, has also proven effective. We provide a quantitative comparison between the "new" surgery and radiotherapy, based on articles that report on ambulatory status before and after treatment, age, sex, primary neoplasm pathology, and spinal disease distribution. Ambulation was categorized as "success" or "rescue" (proportion of patients ambulatory after treatment and proportion regaining ambulatory function, respectively). Secondary outcomes were also analyzed. We calculated cumulative success and rescue rates for our ambulatory measurements and quantified heterogeneity using a mixed-effects model. We investigated the source of the heterogeneity in both a univariate and multivariate manner with a meta-regression model. Our analysis included data from 24 surgical articles (999 patients) and 4 radiation articles (543 patients), mostly uncontrolled cohort studies (Class III). Surgical patients were 1.3 times more likely to be ambulatory after treatment and twice as likely to regain ambulatory function. Overall ambulatory success rates for surgery and radiation were 85% and 64%, respectively. Primary pathology was the principal factor determining survival. We present the first known formal meta-analysis using data from nonrandomized clinical studies. Although we attempted to control for imbalances between the surgical and radiation groups, significant heterogeneity undoubtedly still exists. Nonetheless, we believe the differences in the outcomes indicate a true difference resulting from treatment. We conclude that surgery should usually be the primary treatment with radiation given as adjuvant therapy. Neurologic status, overall health, extent of disease (spinal and extraspinal), and primary pathology all impact proper treatment selection.

Aged↗

PubMed1997

Pharmacologic therapy of portal hypertension and variceal hemorrhage.

Patients with large esophageal varices who are deemed compliant and have no contraindications to beta-blocker therapy should be started on nonselective beta-adrenergic blockers (Fig. 5). The dose should be titrated to a 25% decrease in resting heart rate, a resting heart rate of 55 to 60 beats per minute, or development of symptoms, in which case the dose should be decreased until the patient's symptoms abate. If available, measurements of the HVPG at baseline and 3 months can be very helpful in ascertaining the response to treatment and in making the appropriate adjustments (e.g., adding a second drug). Sclerotherapy or endoscopic variceal ligation are the preferred therapies for treatment of acute esophageal variceal bleeding. Concomitant use of vasoactive drugs can supplement endoscopic treatment. They offer the advantage of early administration as soon as the diagnosis is suspected while awaiting endoscopy. Unlike endoscopic treatment, they decrease portal pressure and are the only established treatment for nonvariceal sources of bleeding related to portal hypertension. Once the index bleed is controlled, the patient should be started on treatment to reduce the high risk of recurrent variceal hemorrhage (Fig. 6). For patients with well-compensated cirrhosis, pharmacologic therapy may be desirable. For less compliant patients or patients with decompensated cirrhosis, an endoscopic technique, such as variceal ligation, may be preferable. Combinations of pharmacologic agents or pharmacologic agents and endoscopic procedures may offer hope for better control, but their efficacy needs to be demonstrated in RCTs. For patients who rebleed despite maximal pharmacologic or endoscopic therapy, a TIPS procedure, surgically created shunt, or liver transplantation should be considered, with the decision based on the patient's condition and the local availability of these options.

Esophageal and Gastric Varices↗

PubMed1985

Problems and proposals for interview data in epidemiological research.

We assessed the reliability of epidemiological data obtained by interview of 120 patients in a case-control study. The collected data, which were obtained by interview on two separate occasions, included such clinical and pharmaceutical features as history of lactation, hysterectomy, diabetes, type of menopause, and whether a woman had ever used exogenous oestrogens. Although we found generally high rates of agreement between interviews, errors in collecting and classifying data did occur, and were especially common for complicated clinical events, such as whether an oophorectomy accompanied the surgical removal of the uterus. Patients were also likely to disagree with previous responses when asked to recall a drug exposure occurring many years before. We identified seven sources of this variability, five in collecting the data, and two in coding. As a result of these findings, strategies are proposed for improving the quality of interview data obtained in epidemiological research.

Aged↗

PubMed2006

The evolution of uterine surgery.

Although described in antiquity, the real dawn of uterine surgery was in the mid-19th century when hysterectomy was occasionally performed vaginally, usually for cancer or prolapse. Then, as now, women experienced symptoms of bleeding and pain emanating from the uterus, and when severe and debilitating, brave surgeons and patients sometimes explored hysterectomy as an alternative. Abdominal hysterectomy mortality rates in the mid-1850s were extremely high, but reduced drastically in the early to mid-20th century. By the 1950s, total hysterectomy supplanted supracervical techniques, largely as a method for preventing carcinoma of the cervix. Surgical alternatives to hysterectomy started in the 1930s with abdominal myomectomy and the first publication of nonhysteroscopic endometrial ablation from Germany, but by the end of the 20th century, included a plethora of techniques including laparoscopic, hysteroscopic, and interventional radiologic approaches. The advent of early detection of, and even prevention of, preinvasive cervical neoplasia, has led to a reevaluation of the need for total hysterectomy in many patients. In the early years of the millennium, targeted leiomyoma therapy was under development with a range of energy sources including cryogenic and radiofrequency probes, as well as focused ultrasound, targeted and controlled by magnetic resonance imaging.

Female↗

PubMed2001

[Atherosclerotic aortic plaques and risk of embolic stroke].

There is mounting evidence to implicate complex atherosclerotic aortic plaques as a significant independent risk factor for embolic stroke. Ulcerated plaques at autopsy, plaques thicker than 4 to 5mm at transesophageal echocardiography and those with mobile components are more likely to be associated with stroke. Mobile thrombus in the lumen may be a source of cerebral emboli. Among patients with ischemic stroke, those with plaques thicker than 4mm in the aortic arch have the highest risk of recurrent stroke, myocardial infarction, other vascular event including vascular death. However, since no randomized trials have been conducted to evaluate the role of any antithrombotic therapies in patients with aortic atheroma, no recommendation can be made regarding the best treatment strategies. Antiplatelet agents, oral anticoagulant, thrombolytic therapy, and elective surgical endarterectomy or graft replacement are all reasonable options that have been proposed and that must be evaluated in term of benefit/risks ratio in specific randomized controlled trials. Meanwhile, antiplatelet agents and aggressive risk factor management appear to be the first line treatment. No recommendation can be made to use oral anticoagulation in these patients nor for a target INR. Concerns also exist on the possibility of anticoagulation driven cholesterol embolism in these patients.

Aorta, Thoracic↗

PubMed1996

A Review of Post--Cardiopulmonary Bypass Bleeding, Aminocaproic Acid, Tranexamic Acid, and Aprotinin.

OBJECTIVE: To review the mechanism and cause of hemostatic defects following cardiopulmonary bypass (CPB) and determine the safety and efficacy of antifibrinolytic agents for use in cardiac surgery and patients likely to benefit. DATA SOURCES: A MEDLINE search (1966 to present) of the English-language literature pertaining to aminocaproic acid (ACA), tranexamic acid (TA), and aprotinin was performed. Additional literature was obtained from reference citations of pertinent articles identified through the search. STUDY SELECTION AND DATA EXTRACTION: While all articles of relevance were considered for inclusion, this review evaluates only clinical trials with emphasis on prospective, randomized, controlled studies. DATA SYNTHESIS: In reported trials, ACA and TA each reduce mediastinal blood losses by about one-third, while transfusion needs remain unchanged. ACA and TA dosing inconsistencies, omission of transfusion criteria, and unidentified surgical risk factors prevent optimal findings. Thromboembolic complications could not be ascribed to either ACA or TA in more than 950 patients studied. Aprotinin decreased mean mediastinal blood losses by 42%, 67% and 48% in primary coronary artery bypass grafting (CABG), reoperative CABG, and in CABG patients receiving aspirin, respectively. Transfusion needs were reduced 42% in primary CABG patients and 55% to 88% in high-risk patients. Patients at high risk of bleeding (i.e., reoperative CABG and patients on aspirin) demonstrated greater transfusion needs and blood loss than primary CABG patients. As blood conservation measures may eliminate the need for transfusions among primary CABG patients, patients at higher risk may benefit most from the addition of antifibrinolytic prophylaxis. CONCLUSION: The efficacy of all antifibrinolytic agents in cardiac surgery has been established, but comparative data is inconclusive to suggest an agent of choice. Thromboembolic complications have been rare and difficult to ascribe to antifibrinolytic agents. Future trials comparing efficacy of agents in high risk patients and rigorously evaluating thromboembolic events will allow unconditional recommendations.

Journal Article↗

PubMedDate not supplied

[Cushing's disease. A challenge of size].

Cushing's syndrome constitutes a real challenge for the clinician who has to elucidate its etiology. ACTH determinations should allow to classify the etiology as belonging to either the ACTH-dependent or the ACTH-independent group, but variable biological characteristics of pituitary or ectopic ACTH secreting tumors may complicate the investigation. For small pituitary adenomas, magnetic resonance imaging (MRI) has increased the sensitivity of detection over CT scans; however, the small average size of 4-5 mm of corticotroph adenomas, including a significant proportion of tumors of less than 3 mm, limits MRI to a sensitivity which varies between 42-80%. In situations where a pituitary tumor is small (< 6 mm or not detectable by MRI), it is recommended to perform bilateral petrosal sinus sampling including a stimulation of ACTH secretion by CRH administration, to confirm the pituitary source of ACTH prior to undertaking pituitary exploration. Transsphenoidal selective removal of the pituitary corticotroph adenoma is the treatment of choice; immediate surgical success rate is high (75-90%) when the tumor is a microadenoma visible at MRI. However success rate decreases (50-60%) when surgical exploration is performed without radiological detection. The other end of the spectrum of size of the corticotroph adenomas includes either tumors larger than 10 mm (macroadenomas) or tumors invading the cavernous sinus; in either case, immediate success rate of surgical removal is only 50-70%. Radiotherapy coupled to medical (ketoconazole, op "DDD) or surgical (bilateral laparoscopic adrenalectomy) control of hypercorticism may be necessary. Longer follow-up series indicate a relapse rate of up to 25% after 10 years, suggesting frequent incomplete resection. It is hoped that further progress in our understanding of the molecular basis of the pathophysiology of this disease will allow the development of new therapeutic strategies which will circumvent the current limitations resulting in part, from the size of these tumors.

Cushing Syndrome↗

PubMed2000

Complications of bone metastases: surgical management.

BACKGROUND: Patients with metastatic disease to the bone present a management challenge. Of the complications encountered in these patients, the predominant types that require surgical intervention are pathologic or impending fractures and neurologic compromise secondary to cord compression from spinal metastases. A multimodality approach is helpful in caring for these patients, and addressing complications related to bony metastatic disease with timely and appropriate intervention is an important step in optimizing care and quality of life. METHODS: This article incorporates information from multiple sources and presents recent reviews of the experience at the Memorial Sloan-Kettering Cancer Center with acetabular reconstruction for metastatic lesions, and with the use of the posterolateral transpedicular approach to address metastatic disease in the spine. RESULTS: Of 55 patients who underwent reconstruction of the acetabulum for metastatic disease, although there was a 25% incidence of local disease progression, there was only a 9% incidence of late fixation failure. Of the 41 who were evaluable at 3 months, 83% continued to experience significant pain relief, and 50% of nonambulatory patients regained walking ability secondary to the procedure. Of the patients with more than 2 years of follow-up, 86% maintained pain relief and 71% maintained their ability to ambulate and function in their community. The preliminary series of 25 patients managed with a posterolateral transpedicular approach to address metastatic disease in the spine showed excellent tumor control, pain relief, and neurologic preservation with the technique. Particular benefit was obtained for patients with extensive epidural disease in which an anterior approach was contraindicated. CONCLUSIONS: Although a multimodality approach to the treatment of patients with metastatic disease to bone combining appropriate surgical intervention with systemic therapy and radiation can entail a major operative procedure, the overall benefits to a patient's quality of life outweigh the risks in most cases. Clinician awareness of the various therapeutic options and their indications, and aggressive advocacy of quality of life for these patients, can improve the care delivered to people with metastatic disease.

Bone Neoplasms↗

PubMed1996

Methodology for using the UMLS as a background knowledge for the description of surgical procedures.

The Unified Medical Language System (UMLS) contains and organizes a large number of terms from a variety of biomedical terminology systems. This study examines the relevance of the UMLS content and structures to the specific purpose of the conceptual representation of medical procedures. The MAOUSSC modelling is a compositional formalism with a description of elementary procedures in terms of elementary concept entities and combinations of such descriptions into more complex ones. The UMLS knowledge base is expected to provide semantically categorized medical concepts and interconcept relations. A method to reuse the UMLS has been developed. Quantitative and qualitative results are presented. Some difficulties in reusing the UMLS as a background knowledge are related to the preeminence of some terminology sources and to the instanciation of interconcept links. Other ones suggest that purpose-independence in categorization cannot be achieved.

Artificial Intelligence↗

PubMed1995

Respiratory protection and the risk of Mycobacterium tuberculosis infection.

Tuberculosis (TB) can be transmitted to susceptible healthcare workers via inhalation of droplet nuclei carrying viable Mycobacterium tuberculosis bacilli. Several types of respiratory protective devices are compared with respect to efficacy against droplet nuclei penetration: surgical masks, disposable dust/mist particulate respirators (PRs), elastomeric halfmask respirators with high-efficiency (HEPA) filters, and powered air-purifying respirators (PAPRs) with elastomeric halfmask facepieces and HEPA filters. It is estimated that these devices permit, respectively, 42%, 5.7%, 2%, and 0.39% penetration of droplet nuclei into the facepiece. More limited data for the disposable HEPA filtering-facepiece respirator suggest that it would allow droplet nuclei penetration of 3% or less, similar to the value estimated for the elastomeric halfmask HEPA filter respirator. Because a respirator wearer's cumulative infection risk depends on the extent of droplet nuclei penetration, the cumulative risk will differ, given use of these different respirators. Hypothetical but realistic "low-exposure" and "high-exposure" scenarios are posed that involve, respectively, a 1.6% and a 6.4% annual risk of infection for healthcare workers. For the low-exposure scenario, the 10-year cumulative risks given no respirators versus surgical masks versus disposable dust/mist PRs versus elastomeric halfmask HEPA filter respirators versus HEPA filter PAPRs are, respectively, 15%, 6.7%, 0.94%, 0.33%, and .064%. For the high-exposure scenario, the 10-year cumulative risks for no respirator use versus use of the same four types of respirators are, respectively, 48%, 24%, 3.7%, 1.3%, and 0.26%. The use of disposable HEPA filtering-facepiece respirator should permit cumulative risks close to those estimated for the elastomeric halfmask HEPA filter respirator. It is concluded that when an infectious TB patient undergoes a procedure that generates respiratory aerosols, and when droplet nuclei source control is inadequate, healthcare workers attending the patient may need to wear highly protective respirators, such as HEPA filter PAPRs.

Aerosols↗

PubMed2004

Intracerebral transplantation of carotid body in rats with transient middle cerebral artery occlusion.

Recent laboratory and clinical studies demonstrate therapeutic efficacy of intracerebral transplantation of carotid body (CB) in Parkinson's disease, possibly through secretion of neurotrophic factors. Here, we examined the role of CB in experimental stroke. In the first experiment, we hypothesized that removal of CB would exacerbate cerebral infarction and stroke-related behavioral deficits. Eight-week-old, male Sprague-Dawley rats were randomly divided into two groups: stroke with intact CB and stroke with surgically removed CB. We used the stroke model of temporary middle cerebral artery occlusion. The ipsilateral CB was removed in animals assigned to treatment group exposed to stroke with surgically removed CB. Behavioral tests, using the elevated body swing test, were conducted at days 1-3 after surgery. Cerebral infarction was visualized by TTC staining on day 3 post-surgery. The data revealed no significant differences in behavioral deficits and infarct volumes between the two groups. In the second experiment, CB cell suspension grafts or control adult tissue grafts were intracerebally transplanted into the ischemic penumbra immediately (within 1 h) after stroke surgery. The results revealed significant reduction of behavioral deficits and infarct volumes, accompanied by increased levels of neurotrophic factors, as detected by ELISA, in transplanted ischemic striatum collected from CB-grafted stroke animals. These observations suggest that surgical resection of CB in the periphery did not alter stroke pathology; however, CB when made available in the CNS, via intracerebral transplantation, could protect against stroke possibly through the synergistic release of neurotrophic factors. The present study extends the use of CB as efficacious graft source for transplantation.

Analysis of Variance↗

PubMed2000

Adhesion molecules in nonrheumatic aortic valve disease: endothelial expression, serum levels and effects of valve replacement.

OBJECTIVES: We studied the expression of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and endothelial selectin (E-selectin) on aortic valve endothelium in patients undergoing valve replacement. We also assessed the relation between serum levels and endothelial expression and also the changes in serum levels following surgery. BACKGROUND: Nonrheumatic aortic valve disease is believed to be a degenerative condition. Increased tissue and soluble adhesion molecule levels are described in inflammatory conditions. METHODS: Aortic valves from 22 surgical (16 bicuspid, 6 tricuspid) and 6 autopsy (4 normal, 2 thickened) cases were studied by immunohistochemistry. Soluble adhesion molecules were measured in peripheral blood preoperatively, and at 6 and 18 months postoperatively, and compared with controls. RESULTS: The majority of the surgically removed tricuspid and bicuspid valves expressed adhesion molecules (E-selectin, 75% and 100%; ICAM-1, 75% and 80%; VCAM-1, 69% and 60%, respectively). The normal postmortem valves did not express these, while the diseased ones did. Endothelial expression of E-selectin correlated strongly with serum levels (r = 0.695, p = 0.004). Soluble E-selectin levels were significantly higher at baseline compared with controls (p = 0.017) and fell significantly at 18 months postoperatively (p = 0.005). CONCLUSIONS: Adhesion molecule expression on diseased valves supports an inflammatory component in "degenerative" aortic valve disease. The diseased valves may be the main source of elevated soluble E-selectin in this condition as blood levels correlate with endothelial expression and blood levels fall at 18 months postoperatively.

Aged↗

PubMed1975

Comparison of two amino acid solutions for total parenteral nutrition of normal and traumatized hats.

Two amino acid solutions were compared at different levels of nitrogen (N) intake for their effectiveness in promoting N retention in normal and in traumatized rats when given as part of a complete diet under total intravenous feeding conditions. An essential amino acid pattern based on that found in whole egg and one with an essential amino acid pattern based on an egg-potatoe mixture, were equally efficacious in promoting N retention in normal, 300-g rats infused with 75 mg of N and 80 kcal/day. Traumatized rats were in positive N balance on infusions of 400 mg of N/day from either the egg or the egg-protein amino acid solution for the first 5 days postinjury. On day 5 the injured animals showed no significant changes in plasma total protein, albumin, glucose, urea N, total bilirubin, and L-aspartate aminotransferase when compared with each other or with orally fed control rats. The two amino acid solutions were satisfactory sources of amino acids when infused as part of a complete intravenous diet for the purpose of studies in the parenterally fed rat. The results of these studies supported the adequacy of the amino acid requirement data for the adult rat of Nasset (J. Nutr. 61, 555-569, 1957) and of Smith and Johnson (Brit. J. Nutr. 21, 17-27, 1967) but suggested that the NRC values calculated from the data of Benditt et all. (J. Nutr. 40, 335-350, 1950) were too high for several amino acids. An improvement in the surgical cannulation technique is also discussed.

Amino Acids↗

PubMedDate not supplied

Microbiologic survey of prosthetic blood pumps presterilization and poststerilization and at explant retrieval.

Device-associated infection remains a major complication of implanted total artificial hearts (TAH). The possibility of microbes being introduced on the device was investigated by conducting a gross microbial assay, pre- and poststerilization, and following explant retrieval. Culture samples were obtained from the housing, base, and blood-contacting diaphragm of Utah-100 artificial ventricles. Additional samples were obtained from atrial sewing cuffs, outflow grafts, drive lines, and percutaneous leads, along with reference control samples prior to ethylene oxide sterilization (ETO). Culturing was repeated poststerilization and at device explant retrieval. Positive bacterial and fungal cultures were found in 24% of the presterilization samples; in the poststerilization samples, positive cultures were found in 6%. Following device explant retrieval, 84% of the cultures were positive. The reference control samples were positive in a limited number of the poststerilization samples. There was no correspondence of the species of micro-organisms found at the same location for each sampling condition. These data demonstrate that the surfaces of the TAH can become contaminated during fabrication. The presence of microbial activity poststerilization raises the possibility of inadequacy of the ETO protocol used with these devices, or contamination of the surgical field. Hearts at explant retrieval had cultures positive for microbes differing from those identified prior to implantation. This finding suggests that device-associated micro-organism colonization occurs through a source other than manufacturing or surgical contamination.

Animals↗

PubMed2006

Surveillance of hospital-acquired infections: a model for settings with resource constraints.

BACKGROUND: Surveillance activities have been considered of paramount importance for effective infection control programs in health care organizations. OBJECTIVES: Our objective was to design a capture system able to assure surveillance of hospital-acquired infections (HAI) in acute hospitals with few resources devoted to infection control. METHODS: We performed 4 biweekly repeated prevalence studies to identify major HAI (urinary tract infections, surgical site infections, lower respiratory tract infection, bloodstream infections) as defined by the Centers for Disease Control and Prevention (CDC) criteria in 3 large hospitals in northeastern Italy (6 internal medicine departments, 5 general surgery departments, 3 intensive care units, and 1 bone marrow transplant unit). RESULTS: One thousand five hundred fifty-four patients were screened (63.9% in medical wards, 27.5% in surgical wards, and 8.5% in intensive care units and bone transplant unit). The overall prevalence of infection was 4.9% (77/1,554); 4.5% (70/1,554) of patients were infected. A capture system based on the presence of fever >or=38 degrees C, antibiotic use, and presence of devices guarantees 100% sensitivity in detecting HAI but requires an assessment of 62% of the population. Using the presence of fever and devices as criteria guarantees a sensitivity of 98%, requiring an assessment of 41.4% of patients, whereas presence of fever and antibiotic use has the same sensitivity but requires an assessment of 50% of patients. Using nursing records, physician records, and direct patient examination as sources of documentation guarantees that all necessary data are collected while requiring a mean of 4 minutes and 42 seconds per patient (standard deviation, 1 minute and 30 seconds). CONCLUSION: A capture system based on biweekly repeated prevalence studies that select patients for the presence of fever, antibiotics, and medical devices ensures the detection of all HAI in a resource-limited environment.

Aged↗