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 739 records · Page 41Linked to original sources

PubMed1997

Effects of tectal grafts on sound localization deficits induced by inferior colliculus lesions in hooded rats.

The goals of this research were to examine the role of the inferior colliculus (IC) in mediating sound localization behavior and the ability of tectal grafts to restore function after IC ablation in the Long-Evans rat. Previous work has suggested that the IC is a major center for processing of information used in localizing sound sources in space. Adult rats were trained on a lick suppression paradigm to discriminate the location of the second pulse in a noise burst pair presented in the horizontal interaural plane. Following baseline testing, rats received bilateral IC lesions, bilateral lesions followed in 1 week by bilateral tectal grafts, or were sham operated. Sound localization ability was then tested 15 to 30 days and 40 to 50 days following surgical procedures. Performance across experimental groups was statistically the same during baseline testing. During the first operative test period lesion-only and grafted animals showed deficits in sound localization ability relative to controls. By the second postoperative test period control and grafted animals did not differ statistically in sound localization ability and performance of both groups was superior to that of lesion-only animals. Histology revealed a similar extent of IC damage in lesion-only and lesion-graft animals and revealed the presence of implanted tectal tissue in all grafted animals. There was significant neuron loss in the dorsal nucleus of lateral lemniscus (DNLL) in lesion-only animals relative to grafted rats and sham controls. Behavioral results suggest that the IC of pigmented rat is important for sound localization ability. The sparing of DNLL neurons in grafted animals suggests that the tectal grafts may directly integrate into or aid intrinsic recovery of the host auditory pathway.

Animals↗

PubMed1999

Gastric cancer.

OBJECTIVES: To review the current status, recent advances, and ongoing research related to screening, diagnosis, staging, and treatment of gastric cancer. DATA SOURCES: Professional journals, research studies, and review articles relating to gastric cancer. CONCLUSIONS: Surgical resection is the gold standard curative treatment for gastric cancer; however, diagnosis is often at later stages of disease, leaving poor long-term survival rates. An emphasis has been placed on developing more effective chemotherapy regimens; currently, fluorouracil is the standard single agent used for gastric cancer. Radiation therapy has been used for palliative symptom management. IMPLICATIONS FOR NURSING PRACTICE: An understanding of current treatment modalities for gastric cancer will help oncology nurses assist their patients throughout their course of treatment with education, nutritional support, and symptom control.

Aged↗

PubMed1996

Management of secondary peritonitis.

OBJECTIVE: The authors review current definition, classification, scoring, microbiology, inflammatory response, and goals of management of secondary peritonitis. SUMMARY BACKGROUND DATA: Despite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, up to one third of patients still die of severe secondary peritonitis. Against the background of current understanding of the local and systemic inflammatory response associated with peritonitis, there is growing controversy concerning the optimal antibiotic and operative therapy, intensified by lack of properly conducted randomized studies. In this overview the authors attempt to outline controversies, suggest a practical clinical approach, and highlight issues necessitating further research. METHODS: The authors review the literature and report their experience. RESULTS: The emerging concepts concerning antibiotic treatment suggest that less-in terms of the number of drugs and the duration of treatment-is better. The classical single operation for peritonitis, which obliterates the source of infection and purges the peritoneal cavity, may be inadequate for severe forms of peritonitis; for the latter, more aggressive surgical techniques are necessary to decompress increased intra-abdominal pressure and prevent or treat persistent and recurrent infection. The widespread acceptance of the more aggressive and demanding surgical methods has been hampered by the lack of randomized trials and reportedly high associated morbidity rates. CONCLUSIONS: Sepsis represents the host's systemic inflammatory response to bacterial peritonitis. To improve results, both the initiator and the biologic consequences of the peritoneal infective-inflammatory process should be addressed. The initiator may be better controlled in severe forms of peritonitis by aggressive surgical methods, whereas the search for methods to abort its systemic consequences is continuing.

Abdomen↗

PubMed2006

Ectopic ACTH syndrome.

Ectopic adrenocorticotropin secretion (EAS) accounts for 10-15% of cases of Cushing's syndrome and comprises a spectrum of tumours from undetectable isolated lesions to widespread metastatic and aggressive malignancies. EAS is often associated with severe hypercortisolaemia causing hypokalaemia, diabetes, generalized infections, hypertension and psychotic reactions. Surgical resection of the primary lesion, achievable with a curative intent in about 40% of patients with EAS, is associated with complete remission in up to 80% of such cases. It is therefore mandatory to localize the source of ectopic ACTH hypersecretion in order to stage the disease and adopt optimal treatment modalities. Modern cross-sectional imaging techniques can identify the majority of the ACTH secreting lesions, either initially or at follow-up reassessment. However, in approximately 10-20% of patients with EAS, the source of ACTH hypersecretion remains occult in spite of extensive investigation and prolonged followup. In such cases, control of the hypercortisolemia can be achieved with long-term adrenolytic medication. When conditions require a prompt and definitive resolution of the hypercortisolaemia (i.e. as in pregnancy), bilateral adrenalectomy remains an alternative option. This review focuses on the clinical features, diagnostic pitfalls, management and long-term followup of the EAS based on the extensive experience of major referral centres.

ACTH Syndrome, Ectopic↗

PubMed2001

The poor quality of information about laparoscopy on the World Wide Web as indexed by popular search engines.

BACKGROUND: This study was undertaken to determine the quality of information on the Internet regarding laparoscopy. METHODS: Four popular World Wide Web search engines were used with the key word "laparoscopy." Advertisements, patient- or physician-directed information, and controversial material were noted. RESULTS: A total of 14,030 Web pages were found, but only 104 were unique Web sites. The majority of the sites were duplicate pages, subpages within a main Web page, or dead links. Twenty-eight of the 104 pages had a medical product for sale, 26 were patient-directed, 23 were written by a physician or group of physicians, and six represented corporations. The remaining 21 were "miscellaneous." The 46 pages containing educational material were critically reviewed. At least one of the senior authors found that 32 of the pages contained controversial or misleading statements. All of the three senior authors (LKN, NAO, GAF) independently agreed that 17 of the 46 pages contained controversial information. CONCLUSION: The World Wide Web is not a reliable source for patient or physician information about laparoscopy. Authenticating medical information on the World Wide Web is a difficult task, and no government or surgical society has taken the lead in regulating what is presented as fact on the World Wide Web.

Abstracting and Indexing↗

PubMed2005

Lymphoscintigraphic monitoring of the lower limb lymphatic system response to bone fracture and healing.

Closed bone fractures, and torn muscles and tendons are "internal wounds". What kind of reaction do they evoke in the local and systemic immune system? Cellular debris of damaged tissue and extravasated blood cells are removed by scavenger cells. They are transported via lymphatics to the lymph nodes. There elimination of self antigens takes place. Clinically, no enlargement of lymph nodes is observed after closed fractures and soft tissue damage. The question arises whether there is really no enlargement of regional lymph nodes, in other words, no reaction to damaged cell antigens. This question was studied by using lymphoscintigraphy to visualize lymphatics and lymph nodes draining the site of closed bone fracture. The lymphoscintigraphic pictures of two groups of patients, those with a rapid noncomplicated healing of leg fractures, and those with protracted healing and undergoing surgical reconstructions, were evaluated. The surface area of lymphatic pathways and inguinal lymph nodes on the injured and contralateral normal limb were measured. Enlarged superficial lymphatics and inguinal lymph nodes were found in limbs with healed bone fractures, and decreased inguinal lymph nodes and visualization of deep lymphatics and popliteal nodes in the majority of patients with nonhealing fractures. There was a lack of correlation between age of patients, duration of healing, and surgical interventions and the lymphoscintigraphic changes. These findings suggest that the fracture gap tissue is a dominant source of signals to the lymph nodes, releasing cellular and humoral regulatory factors. Taken together, there is a strong immune reaction of lymph node to the fracture, although it cannot be recognized clinically.

Adult↗

PubMed1967

Bacterial endocarditis occurring after open-heart surgery.

A review was made of 520 patients who survived cardiopulmonary bypass for repair of congenital or acquired heart disease between 1956 and 1965. The incidence of early and late bacterial endocarditis was 2.7%, a figure which was higher than the reported incidence in the pre-bypass era but comparable to the experience reported by others. When those patients who had ball-valve prostheses inserted were considered separately, endocarditis was found to have occurred in 3.9%. The most common infecting organism was Staphylococcus albus (nine of 14 cases). Twelve of the 14 patients died, most often from complications of the infection, such as disruption of patches and prosthetic valves. The infections were difficult to control and in three patients recurred from one to three times. There was no apparent source of infection. Six patients developed infections six to 45 months after operation; the remaining eight had proved endocarditis within two months of operation. With one possible exception, treatment with antibiotics appeared to be ineffective in eradicating the infection unless foreign material was removed from the heart.

Adult↗

PubMed1983

Bacteria isolated from deep joint sepsis after operation for total hip or knee replacement and the sources of the infections with Staphylococcus aureus.

A wide variety of bacterial species, many usually regarded as of low pathogenicity, were isolated from septic joints after operation for total hip or knee joint replacement in a multi-centre trial of ultraclean air in operating rooms. The prophylactic antibiotics generally used appeared to reduce considerably the rates of infection with most species but to be ineffective against 'gut' organisms. For about half the septic infections involving Staphylococcus aureus nasal swabs had been obtained from the patient and operating staff at the time of operation for insertion of the prosthesis. Strains of Staph, aureus isolated from these and from the infected joints were phage typed and tested for antibiotic sensitivity. A probable source among the carriers was found for seven out of the 14 infections and a possible source for another five. Very small numbers of Staph. aureus were needed to initiate infection.

Air Microbiology↗

PubMed2004

Experience with various surgical options for the treatment of atrial fibrillation.

BACKGROUND: New alternatives exist using various energy sources and lesion lines for the surgical treatment of atrial fibrillation (AF). The efficacy of these options compared to the cut-and-sew maze III procedure is unknown. METHODS: From August 1996 to August 2003, 79 patients have undergone a procedure for AF, with 70 patients currently more than 3 months postsurgery. The patients (58 continuous, 12 paroxysmal) underwent a surgical procedure for AF, lone AF (12) and with concomitant procedures (58). Techniques included cut and sew (23), bipolar radiofrequency (RF) (28) and unipolar-RF (10), and cryothermy (9). Lesions included maze III (46), pulmonary vein isolation (16), and pulmonary vein isolation plus mitral annular connecting line only (8). RESULTS: Follow-up was complete in 58 (83%) of 70 patients at a mean time of 595 +/- 750 days (range, 24-2530 days). The operative mortality was 0% in lone AF patients and 7.1% (5/70) in patients undergoing concomitant procedures. Need for perioperative pacemaker was 22.9%. Overall, normal sinus rhythm (NSR) was restored in 82.7% of patients, with success in 83.3% (10/12) lone procedures and 82.6% (38/46) concomitant procedures ( P = NS); the rate of continuous AF was 85.1% (40/47) and SR with paroxysmal fibrillation was 72.7% (8/11) ( P = NS). Traditional maze was successful in 80.6% (29/36) patients, pulmonary vein isolation was successful 93.3% (14/15), and left-sided maze in 71.4% (5/7) ( P = NS). Cut and sew procedures were successful in 88.2% (15/17), RF-bipolar in 84.0% (21/25), RFunipolar in 77.8% (7/9), and cryothermy in 71.4% (5/7) ( P = NS). Energy source, lesion set, AF duration, and lone/concomitant procedure were the factors subjected to logistic regression analysis. No factors were predictive of achieving postoperative NSR. CONCLUSIONS: Our early experience with newer surgical techniques employing different energy sources and fewer incision lines suggests that the success rate may approach the results obtained with traditional cut-and-sew Cox-maze III procedures.

Atrial Fibrillation↗

PubMed1994

Massive hemoptysis. Assessment and management.

The first priorities in treating the patient with massive hemoptysis are to maintain the airway, optimize oxygenation, and stabilize the hemodynamic status. The major question to be answered is whether or not the patient should be intubated for better gas exchange, suctioning, and protection from sudden cardiorespiratory arrest. If the bleeding site is known, the patient should be placed with the bleeding lung in the dependent position. Once stabilization is accomplished, diagnostic and therapeutic interventions should be promptly performed because recurrent bleeding occurs unpredictably. Early bronchoscopy, preferably during active bleeding, should be performed with three goals in mind: to lateralize the bleeding side, localize the specific site, and identify the cause of the bleeding. In those patients with lateralized or localized persistent bleeding, immediate control of the airway may be obtained during the procedure with topical therapy, endobronchial tamponade, or unilateral intubation of the nonbleeding lung. If bleeding continues but the side of origin is uncertain, lung isolation or use of a double-lumen tube is reasonable, provided that the staff is skilled in this procedure. If the bleeding cannot be localized because the rate of hemorrhage makes it impossible to visualize the airway, emergent rigid bronchoscopy or emergent arteriography is indicated. Arteriography and embolization should be used emergently for both diagnosis and therapy in those patients who continue to bleed despite endobronchial therapy. Emergent surgical intervention should be considered in operative candidates with unilateral bleeding when embolization is not available or not feasible, when bleeding continues despite embolization, or when bleeding is associated with persistent hemodynamic and respiratory compromise. For patients in whom bleeding has ceased or is decreased, emergent intervention may not be necessary. If the bleeding site has been localized or lateralized with early bronchoscopy, recurrent bleeding can be managed more confidently and rapidly. The cause of bleeding can be determined at bronchoscopy in patients with endobronchial adenomas, carcinomas, foreign bodies, or broncholiths. If no diagnosis is obtained at bronchoscopy, elective angiography of the bronchial and, if necessary, the pulmonary vasculature is reasonable. The precise timing and nature of the further evaluation are dictated by the suspected underlying pathologic process and the clinical condition of the patient. Surgery is the most definitive form of therapy for patients with hemoptysis because it removes the source of bleeding. Whether to proceed with elective surgery in patients with a major bleed that stops or one that is controlled angiographically is a difficult decision. Little data are available to assist in this decision, even for specific diseases, such as bronchiectasis. Similarly, the long-term course of patients treated with endobronchial tamponade or topical therapy is unknown. For patients with inoperable disease, limited reserve, or bilateral progressive disease, embolization frequently controls bleeding for prolonged periods.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis, Differential↗

PubMed2005

Aortoesophageal fistula--an unusual complication of esophagitis caused by Dieffenbachia ingestion.

Aortoesophageal fistula (AEF) is a rare and mostly lethal cause of upper gastrointestinal bleeding in children. We report a successful outcome of surgical treatment after resuscitation of a girl aged 12 1/2 years with AEF as a complication of esophagitis caused by Dieffenbachia ingestion. The girl ate a leaf of Dieffenbachia picta in a suicidal attempt. After 5 weeks of medical treatment of esophagitis, small blood-stained vomitus and melena appeared. Within a few hours, it was followed by a massive gastrointestinal bleeding leading to exsanguination. The girl survived despite the pitfalls in clinical presentation and errors in diagnostic approach and treatment. Emergency exploration of cervical esophagus, followed by laparotomy and thoracotomy, was performed in attempt to find the source of bleeding and to control it. Aortoesophageal fistula was located between the ascending aorta near the origin of the brachiocephalic trunk and thoracic esophagus. Resection of the fistula led to prompt circulatory stabilization. The common houseplant, Dieffenbachia picta, causes edematous swelling of mucus membranes when chewed. Dieffenbachia-caused esophagitis is very rare and this etiology of AEF has not been reported in children.

Aortic Diseases↗

PubMed1999

The role of lasers and light sources in the treatment of leg veins.

Telangiectasia of the legs occurs in 29% to 41% of women in the United States. The variation in size, flow, depth, and type preclude the possibility of a single effective treatment modality. When a systematic approach is used where feeder vessels are first surgically removed and sclerotherapy proceeds from largest to smallest vessels, 80-90% of vessels respond to a single sclerotherapy treatment. Because of the relatively modest results demonstrated with lasers and light sources and the high rate of success and the relatively low cost of ambulatory phlebectomy, compression sclerotherapy and superficial sclerotherapy, we generally recommend using lasers and light sources only for vessels that remain after this treatment approach. Lasers and light sources should be considered prior to sclerotherapy in patients who are fearful of needles, who do not tolerate sclerotherapy, who fail to respond to sclerotherapy, or who are prone to telangiectatic matting. Carefully monitored, controlled studies are essential to better define the role of the available laser and light sources in the treatment of leg veins.

Algorithms↗

PubMed2001

Measuring and reporting errors in surgical pathology. Lessons from gynecologic cytology.

Substantial improvements in measuring and reporting errors in gynecologic cytology have been made during the last decade. Measuring and reporting errors in surgical pathology recently has gained renewed interest. However, review of current literature demonstrates mistakes in how these data are measured and reported. Error rates have been reported from review of consecutive material, biopsy material, and consultation material and range from 0.25% to 43%. Errors have been divided into anatomic regions and specimen types and separated according to their clinical significance. However, to be comparable, errors must be reported in reference to the incidence of disease and not to overall caseload. Blinding and reviewer error have been addressed only rarely, and the true incidence of errors is almost certainly higher than reported. "Gold standards" are not well defined. In addition, available data strongly suggest that the greatest source of error is with false-negative diagnoses, which are detected only rarely by review of consultation material. Most of these issues have been addressed in the gynecologic cytology literature. Errors in surgical pathology are more common than generally believed, and efforts should be made to define methods that allow appropriate interlaboratory comparisons.

Cytodiagnosis↗

PubMed2003

Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force.

BACKGROUND: Obesity poses a considerable and growing health burden. This review examines evidence for screening and treating obesity in adults. DATA SOURCES: MEDLINE and Cochrane Library (January 1994 through February 2003). STUDY SELECTION: Systematic reviews; randomized, controlled trials; and observational studies of obesity's health outcomes or efficacy of obesity treatment. DATA EXTRACTION: Two reviewers independently abstracted data on study design, sample, sample size, treatment, outcomes, and quality. DATA SYNTHESIS: No trials evaluated mass screening for obesity, so the authors evaluated indirect evidence for efficacy. Pharmacotherapy or counseling interventions produced modest (generally 3 to 5 kg) weight loss over at least 6 or 12 months, respectively. Counseling was most effective when intensive and combined with behavioral therapy. Maintenance strategies helped retain weight loss. Selected surgical patients lost substantial weight (10 to 159 kg over 1 to 5 years). Weight reduction improved blood pressure, lipid levels, and glucose metabolism and decreased diabetes incidence. The internal validity of the treatment trials was fair to good, and external validity was limited by the minimal ethnic or gender diversity of volunteer participants. No data evaluated counseling harms. Primary adverse drug effects included hypertension with sibutramine (mean increase, 0 mm Hg to 3.5 mm Hg) and gastrointestinal distress with orlistat (1% to 37% of patients). Fewer than 1% (pooled samples) of surgical patients died; up to 25% needed surgery again over 5 years. CONCLUSIONS: Counseling and pharmacotherapy can promote modest sustained weight loss, improving clinical outcomes. Pharmacotherapy appears safe in the short term; long-term safety has not been as strongly established. In selected patients, surgery promotes large amounts of weight loss with rare but sometimes severe complications.

Adult↗

PubMed2003

Arterioportal fistula causing jejunal variceal hemorrhage.

Hepatoportal arteriovenous fistulas are an uncommon cause of portal hypertension and may lead to severe gastrointestinal bleeding. Esophageal varices are the main source of hemorrhage in patients with portal hypertension. We report a 40-year-old man with a hepatic arterioportal fistula, who had gastrointestinal bleeding from jejunal varices. He had had hematemesis four years previously and was diagnosed as esophageal variceal bleeding secondary to hepatic arterioportal fistula-complicated portal hypertension. The fistula had been successfully closed with a detachable balloon but it was found to have reformed during his recent hospitalization for jejunal variceal bleeding. Alcoholism and development of portal vein thrombosis afterwards were the other contributing factors for jejunal variceal formation. Hemorrhage was controlled with medical treatment. Since he refused any surgical intervention he was discharged and advised to continue follow-up.

Adult↗

PubMed1982

[Radioimmunologic and radioreceptor analysis of human chorionic gonadotropin for the diagnosis and control of ectopic pregnancy].

The authors report here their studies on the use of a radioreceptor assay study of HCG for the diagnosis and management of ectopic pregnancy. Seven blood samples were collected before, during and three days after the surgical intervention; their HCG content was assayed with a radioreceptor method and the results were compared with those of radioimmunological method. The radioreceptor assay, with a sensitivity of 200 mUI/ml, has provided 85% reliability in detecting pregnancy, the radioimmunoassay the 100%. A case of ectopic resorbing pregnancy showed a HCG content of 25 mUI/ml (RIA) and a RRA negative; the low concentration of hcg caused the negativity of RRA, the sensibility of which is too low in this case. A deeper analysis of the technical results shows some possible sources of error.

Chorionic Gonadotropin↗

PubMed1983

Fatal epistaxis in craniofacial trauma.

Facial trauma often results in minor and infrequently results in major bleeding in the structures of the face. We have recently observed two patients who suffered fatal hemorrhages which could have been controlled using relatively simple measures. Treating physicians often overlook this serious and potentially life-threatening source of hemorrhage until the patient has been in shock for long periods of time and irreversible ischemic brain damage and renal failure have occurred. With careful attention to examination of the face and oropharynx, hemorrhage from these sites can be identified early and the appropriate measures taken to control epistaxis.

Adolescent↗

PubMed2000

[Hybrid 3D visualization and virtual endoscopy in cochlear implants].

PURPOSE: The aim of this study was to demonstrate on a complex anatomical structure the possibilities and the advantages of a superimposition of a color-coded surface and volume rendering (hybrid rendering) method with the possibility of the performance of a virtual endoscopy. MATERIAL AND METHOD: In 6 patients with cochlear implants a high-resolution spiral computed tomography of the petrous bone was performed. The cochlear implants, the middle and inner ear structures were visualized using a color-coded surface rendering method, either shaded or as a grid. The petrous bone was visualized using a transparent volume rendering method. RESULTS: The hybrid 3D visualization uses the advantages of both the color-coded 3D surface and volume rendering method. In comparison to the axial source images, the hybrid 3D visualization thus facilitates a clearer representation and better assessment of the complex topographical relationship without loss of diagnostic information. The virtual endoscopy facilitates an intraluminal visualization and inspection of all color-coded 3D surface- and volume rendered structures. CONCLUSIONS: The hybrid rendering and virtual endoscopy make the morphological assessment of cochlear implants easier by the simultaneous visualization of the surrounding structures and thereby support the diagnostic imaging methods. This image processing method can be used pre-operatively for the individual planning, simulation, training and further development of surgical procedures and interventions and post-operatively for the control of the position and further developments of implants.

Adolescent↗