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PubMed1980

Studies in intestinal healing VI. Effect of pharmacologically induced peristalsis on fresh intestinal anastomoses in dogs.

This study was devised to disclose any harmful effect of stimulation of the bowel by neostigmine (Prostigmin), alone, or in combination with castor oil in 220 canine anastomoses (60 stapled, 60 two-layer silk and catgut inverted, and 100 one-layer silk everted) performed in enteroenterostomies, ileocolostomies, and colocolostomies. Two techniques were used for the one-layer everted anastomoses--a through-and-through simple interrupted ("Navy") and a horizontal mattress interrupted. One hundred and ten experimental dogs received neostigmine intramuscularly on each of the first three postoperative days. Forty-five of these dogs also received castor oil orally on the first two postoperative days. Peristalsis induced by neostigmine, alone or in combination with castor oil, has no deleterious effect on stapled or conventional two-layer inverted or one-layer Navy everted anastomoses of small bowel or colon, but adversely affects the one-layer "mattress" closure in the colon. Dogs with induced peristalsis had their first evacuation sooner and ate sooner.

Animals↗

PubMed1996

Are bedding and rebreathing suffocation a cause of SIDS?

Suffocation by bedclothes became a popular diagnosis in the 1940s but gradually became replaced with the diagnostic label of Sudden Infant Death Syndrome (SIDS). In 1991 a paper purported that, instead of SIDS, pillows filled with polystyrene beads had caused death by rebreathing suffocation; this conclusion was reached on the basis of experiments with anesthetized rabbits breathing through a doll's head that was placed face down on the pillow. Because of the anesthesia, rabbits could not change their face down position. The doll's nares could not collapse, which would have resulted in rapid death due to conventional suffocation. The rabbits required up to 3 hours or more to die of hypercarbia and hypoxia. Studies in normal infants revealed that they turned from the face-down position after only 2 minutes. (The only infant who retained CO2 soon died of a fatal neurologic disorder, with central hypoventilation). Using the rabbit/doll's head and mechanical models, a wide range of bedding was indicted, including cushions, sheepskins, pillows, comforters, foam mattresses, and even simple blankets and sheets as potentially causing fatal rebreathing. Except for the use of pillows in general, as well as mattresses filled with kapok and bark, there has been no epidemiologic support for these indictments. Although normal infants are unlikely to succumb to rebreathing suffocation, infants with blunted ventilatory responsiveness and delayed arousal due to prior hypoxia were hypothesized to be at increased risk. Support for this concept was found in the pathology of the brain stem in victims of SIDS that was attributed to prior hypoxic injury. In infants who survived prolonged apnea, less than 20% have demonstrated a diminished ventilatory responsiveness to hypercarbia, but, more significantly, none had an absent response. Arousal to hypercarbia, an abnormality which is crucial to the hypothesis of rebreathing suffocation, is regularly present in normal subjects, but the threshold is higher in near-SIDS infants; however, no instances of failure to arouse have been reported in near-SIDS. If the infant is placed on his or her back or side, the issue of bedding could become moot; unfortunately, a sizable percentage of infants are still being placed prone for sleep. Instead of confusing parents with an ever-expanding list of "dangerous bedding," the message "Back to Sleep" should be emphasized.

Animals↗

PubMed2000

Some practical issues in the design, monitoring and analysis of a sequential randomized trial in pressure sore prevention.

A sequential double blind (assessor and patient) triangular design was used to compare the incidence of pressure sores following elective major surgery among patients lying on a standard foam mattress with those on a dry visco-elastic polymer pad during their operation. A total of 446 patients were recruited into the trial between 1994 and 1996. Interim analyses were carried out after 181 patients were entered into the trial and then subsequently after approximately every 100 patients recruited. The trial unexpectedly reached a stopping boundary at the first interim analysis, however the Independent Data Monitoring Committee recommended continuation of the trial. They were concerned that there was a need for a larger definitive trial and about an apparent treatment by centre interaction. They required a substudy to be undertaken to further validate the subjective endpoint, and that further sensitivity analyses of the main trail endpoint should be carried out in the second interim analysis. The trial was stopped at the third interim analysis when again a stopping boundary was crossed indicating that the gel pad was associated with significantly fewer pressure sores than the standard mattress (log odds ratio -0.7, (95 per cent confidence interval (CI), -1.28, -0.11), p=0.02) (estimate CI, p-value adjusted for group sequential conduct). The design, monitoring and analysis of this trial will be presented as an example of the practical problems or non-problems encountered for the local hospitals, for the trials unit, for the data monitoring committee and for the funding committee.

Beds↗

PubMedDate not supplied

Costs and acceptability of two special overlays for the prevention of pressure sores.

In a randomized clinical trial, 187 adult patients with chronic neurologic conditions who were at a high risk of developing pressure sores were assigned for 3 months to either an alternating air (AA) mattress overlay or a silicore (S) mattress overlay. Costs associated with each overlay were calculated and compared by adding depreciation and yearly expenses related to maintenance, operation, and repair for 148 patients who completed the trial. Acceptability was measured by questionnaires and interviews involving 45 of the patients' primary nurses and a sample of 40 patients (20 from each overlay group). The annual cost of the AA overlay was 54% more than that of the S overlay. Although most nurses (more than 74%) believed that both overlays helped prevent pressure sores and deter their progression, many (more than 56%) would not recommend either type to other facilities or to patients at home due to specific negative features. Implications for manufacturers, investigators, clinicians, and administrators are identified.

Adolescent↗

PubMed1994

Intraoperative pressure sore prevention: an analysis of bedding materials.

The relationship between operating room (OR) table surfaces and skin integrity was examined. Preoperatively, patients (N = 505) were rated for pressure sore potential (Hemphill); postoperatively, skin condition was assessed. Skin changes were more likely with a standard mattress only or with surgery longer than 2.5 hr. The overlay was more effective than the foam and gel or standard foam mattresses for preventing pressure sore formation. Factors predictive of pressure sore development included surgery of 2.5+ hr, 40+ years, vascular disease, and a preoperative Hemphill value of 4+. Patient characteristics, surgical experience variables, and OR table surfaces are determinants in pressure sore development.

Adolescent↗

PubMed1993

Relationship between exposure to dust mite allergen and bronchial response to exercise in schoolchildren sensitized to dust mites.

We assessed the relationship between the exposure to dust mite allergens and a bronchial response to exercise in 8-year-old schoolchildren. Dust was collected from the mattresses of 1,291 children and the concentration of mite allergens was estimated by a commercially available ELISA test using monoclonal antibodies (ALK, Copenhagen) against the major allergens of Dermatophagoides pteronyssinus (Der pt) and Dermatophagoides farinae (Der f). A positive bronchial response to exercise (decrease of peak expiratory flow > or = 15% after exercise) occurred in 21 (22.6%) of 101 children sensitized to mite allergens (wheal size > or = 4 mm) and in 51 (4.8%) of 1,070 nonsensitized children. In the highest exposure groups (> 10 micrograms allergen/g dust), 15% of children sensitized to Der f and 20% of children sensitized to Der pt were responsive to exercise. Corresponding figures for the lowest exposure groups (< 0.4 micrograms allergen/g dust) were 11 and 28%, respectively. This negative finding may indicate that measurement of allergen concentration in mattresses does not reflect true exposure or alternatively that at the age of 8 years high exposure to dust mite allergens does not affect bronchial response to exercise in sensitized children.

Allergens↗

PubMed1988

Optimal efficacy of a fungicide preparation, natamycin, in the control of the house-dust mite, Dermatophagoides pteronyssinus.

The efficacy of a fungicidal preparation, natamycin, for the effective control of Dermatophagoides pteronyssinus (Trouessart), was determined at different concentrations on mattress-dust microsites, including ticking. One treatment with the commercially available natamycin concentration (Tymasil) resulted in a 65% reduction of house-dust mite populations within 4 weeks of treatment. The acaricidal control could be proven despite the protective role of mattress fibres such as ticking. However, mite fecundity was much more affected after treatment with twice the commercial concentration, which then assured a long-term control. Concentrations below the commercially available one were not effective. In a maritime climate, six sequential treatments three times a year would be effective for an adequate long-term control because of the high growth of house-dust fungi and the close interaction between the mite and the mould Aspergillus penicilloides.

Animals↗

PubMed1998

Methods for warming intravenous fluid in small volumes.

PURPOSE: Laboratory experiments were performed to determine warming rates of albumin 5% at room temperature and human packed red blood cells (PRBCs) at 4 degrees C in small volumes. Four methods used in clinical practice to warm volumes appropriate for neonates were studied. METHODS: The fluids were warmed either by infusion through a fluid warmer with temperature-controlled coaxial tubing (Group I), immersion in a water bath at 37 degrees C (Group II), placing pre-filled syringes (10 and 20 ml) between a circulating water mattress and a forced-air warming blanket (Group III), or placing the same syringes between the water mattress and cotton towels (Group IV). The temperature of each fluid was recorded for the next 60 sec after the bolus injection in group I and every five minutes for a total of 30 min for the other groups. The time constant of warming for each group was calculated. The time constant and the temperature reached after the warming period were compared among groups. RESULTS: In group I 20 ml room temperature albumin 5% or 4 degrees C blood reached temperatures of 36.9 +/- 1.5 degrees C and 34.5 +/- 2.3 degrees C within 60 sec, respectively. This was faster than all other techniques used (P < 0.001). The time constants measured for the albumin and the PRBCs were 0.23 +/- 0.1 and 0.20 +/- 0.05 minutes respectively. After 15 min albumin and PRBCs in group II reached 35.5 +/- 0.4 degrees C and 33.4 +/- 0.3 degrees C, in group III reached 33.7 +/- 1.0 C and 32.8 +/- 1.7 C, and in group IV reached 29.5 +/- 0.1 degrees C and 23.3 +/- 0.8 degrees C after 15 min respectively. CONCLUSION: Warming of intravenous fluids in small volumes is accomplished most rapidly using a fluid warmer with temperature-controlled coaxial tubing and occurs more slowly in syringes, bottles, or bags exposed to various environmental conditions.

Albumins↗

PubMed2006

Arthroscopic transosseous reinsertion of the rotator cuff.

OBJECTIVE: Arthroscopic reinsertion of the supraspinatus and infraspinatus tendons by means of imitation of an open transosseous reinsertion technique. INDICATIONS: Tears in the tendon cuffs of the supraspinatus and infraspinatus muscles. Patients < 75 years of age. CONTRAINDICATIONS: Retracted tendons that cannot be sufficiently mobilized to provide a tension-free reinsertion. Tears of the tendon cuff of the subscapsularis muscle. SURGICAL TECHNIQUE: The free edges of the tendons are sparingly resected. The tendon attachment site on the greater tuberosity is freed of soft tissue and decorticated using an arthroscopic bone burr. A full-radius burr is used to drill insertion sites for the sutures in the tuberosity. A hollow needle is inserted percutaneously to puncture the free edges of the tendon for a single reinsertion suture. The hollow needle is then fed through the greater tuberosity to the lateral portal. The suture is guided through the needle and advanced via a working cannula. If the tear is > 2 cm in width, a mattress suture should be placed via another channel in the bone. This is to provide plane contact of the tendon to the reinsertion site. POSTOPERATIVE MANAGEMENT: Restriction of movement using a shoulder bandage for 6 weeks after the operation. RESULTS: In the 75 patients treated using a single suture, there was an improvement compared to the related Constant Score from 55.8% before the operation to 80.4% at the follow-up examination, after an average of 26.8 months. The average age in this group was 58.2 years (range 35-75 years). In the 21 patients treated with a mattress suture, there was an improvement compared to the related Constant score from 59% before the operation to 83% at 14.3 months after the operation. The average age in this group was 58 years (range 35-75 years).

Adult↗

PubMed2004

Reproducibility of patient positioning for fractionated extracranial stereotactic radiotherapy using a double-vacuum technique.

BACKGROUND AND PURPOSE: Precise reproducible patient positioning is a prerequisite for conformal fractionated radiotherapy. A fixation system based on double-vacuum technology is presented which can be used for conventional as well as hypofractionated stereotactic extracranial radiotherapy. MATERIAL AND METHODS: To form the actual vacuum mattress, the patient is pressed into the mattress with a vacuum foil which can also be used for daily repositioning and fixation. A stereotactic frame can be positioned over the region of interest on an indexed base plate. Repositioning accuracy was determined by comparing daily, pretreatment, orthogonal portal images to the respective digitally reconstructed radiographs (DRRs) in ten patients with abdominal and pelvic lesions receiving extracranial fractionated (stereotactic) radiotherapy. The three-dimensional (3-D) vectors and 95% confidence intervals (CI) were calculated from the respective deviations in the three axes. Time required for initial mold production and daily repositioning was also determined. RESULTS: The mean 3-D repositioning error (187 fractions) was 2.5 +/- 1.1 mm. The largest single deviation (10 mm) was observed in a patient treated in prone position. Mold production took an average of 15 min (10-30 min). Repositioning times are not necessarily longer than using no positioning aid at all. CONCLUSION: The presented fixation system allows reliable, flexible and efficient patient positioning for extracranial stereotactic radiotherapy.

Adult↗

PubMed2002

Improving the biomechanical properties of the T-fix using oblique direction: in vitro study on bovine menisci.

UNLABELLED: This study compared pullout strengths of the T-fix device versus horizontal suture toward improving T-fix biomechanical properties. Twenty bovine medial menisci were used for this study. Four groups were tested and mean tearing stress were obtained. In group 1 a standard T-fix suture was performed (50.2+/-4.2 N); in group 2 horizontal mattress sutures were placed in the meniscus using 2-0 vicryl (54.6+/-4.2 N); in group 3 three T-fix suture anchors were placed: the central suture a double suture anchor and those on either side single suture anchors, resulting in two horizontal sutures (61.8+/-3.8 N); in group 4 we modified the technique used in group 3. The double suture anchor was placed the incision, at a 30 degrees angle oblique to the horizontal (71.0+/-5.9 N). There was a statistically significant difference between groups 3 and 4 but not between groups 1 and 2. IN CONCLUSION: Using a T-fix suture anchor in the standard technique has similar biomechanical properties to the horizontal mattress suture. To improve the tensile properties of the T-fix suture a double T-fix suture anchor should be used obliquely to the other two single T-fix sutures on either side.

Animals↗

PubMed2005

Evaluation of hip fracture risk in relation to fall direction.

The purpose of this study is to evaluate hip fracture risk in relation to fall direction, and to elucidate factors that influence the impact force in falls on the hip. Eight healthy volunteers performed deliberate falls in three directions (lateral, posterolateral and posterior) on a force platform covered by a mattress of 13 cm thickness. Fall descent motions and impact postures were examined by a three-dimensional analyzer. The maximum ground force reaction, velocity of the greater trochanter at impact, and activity of quadriceps and gluteus medius were measured. In all trials of lateral and posterolateral falls, but not of posterior falls, the subjects hit their greater trochanter directly on the mattress. The impact forces were between 2,000 N and 4,000 N. Posterolateral falls showed significantly higher velocity at impact than did posterior falls. The height and the lower limb length exhibited positive correlations with the impact force in all directions of fall. In the lateral fall, there was a positive correlation between the activity of quadriceps and the impact force. In view of the impact point, force, and velocity, the posterolateral fall seemed to carry the highest risk of hip fracture.

Accidental Falls↗

PubMed2006

Prevention of latex allergy among health care workers and in the general population: latex protein content in devices commonly used in hospitals and general practice.

BACKGROUND: In this study the latex protein content in devices commonly used in hospitals and general practice were investigated. The main aim was to acquire information for preventing latex allergy in health care workers and in the general population. METHODS: About 22 different types of medical devices and 23 devices commonly used in general practice were examined evaluating the total allergenic potency by a modified RAST-inhibition assay and quantitative determination of single allergens (Hev b1, Hev b5 and Hev b6.02) by using commercial ELISA kit. RESULTS: A high level of inhibition was found in medical devices, such as elastic bandage (81.57%), tourniquet (74.09%), Foley urinary catheter (68.35%), Penrose drainage (67.25%) and taping (39.6%), and in common devices, such as rubber inner-sole (84.20%), toy balloon (78.62%), latex mattress (74.27%), household rubber gloves (49.10%), working gloves (38.25%), inflatable floating mattress (32.10%). Concentrations of latex extractable proteins and Hev b1, Hev b5 and Hev b6.02 antigens were high in some medical and general devices. CONCLUSIONS: Latex exposure sources were found in hospitals and the home. These findings, though only preliminary and far from conclusive, could enable sensitized persons to avoid risky exposures and prevent allergic reactions. From the point of view of prevention, the time may come when every natural rubber object could be systematically labelled as "containing latex" together with the warning that "this item may cause allergic reactions in sensitized subjects."

Consumer Product Safety↗

PubMed1991

Comparison of supraannular and subannular pledgeted sutures in mitral valve replacement.

Ten fresh canine hearts were used to compare the peak left ventricular pressure required to disrupt prosthetic mitral valves sutured in place with horizontal mattress sutures with either subannular or supraannular pledgets. Each group consisted of 5 animals. A 29-mm Medtronic mitral valve was secured in the mitral position with ten pledgeted sutures. The aorta was cannulated and normal saline solution was infused into the left ventricle until valvar disruption occurred. The peak pressure and the location and mechanism of disruption were then noted. At the peak left ventricular pressure required for valvar disruption, no individual sutures were broken. Instead, in all specimens a subannular myocardial rupture occurred in the posterior portion of the mitral annulus along the extent of the atrioventricular groove. In addition, the posterior wall of the left atrium dissected upward subsequently. Significantly greater pressures were required in the group with subannular suture placement as compared with the supraannular group (354 +/- 37 versus 236 +/- 33 mm Hg; p less than 0.0007). These data suggest that placement of horizontal mattress sutures with pledgets in the subannular position is superior to the currently recommended method of supraannular suture placement in mechanical valves.

Animals↗

PubMed1989

Hepatic trauma revisited.

As stated in the introduction to this monograph, much has changed in the management of major hepatic injuries during the past 5 to 10 years. The major changes are summarized as follows: 1. Computed tomographic scanning is now the mainstay of diagnosis for hepatic injuries after blunt trauma and allows for nonoperative therapy in many patients with lacerations, intrahepatic hematomas, or subcapsular hematomas; 2. Realization that the time limit for application of the Pringle maneuver can be extended. 3. Recognition that fibrin glue appears to be a useful topical agent in preliminary clinical studies; 4. Use of hepatotomy with selective vascular ligation instead of mattress sutures for deep lacerations or to control hemorrhage from tracts of penetrating wounds; 5. Use of resectional débridement of devitalized tissue and selective vascular ligation instead of formal anatomical resection; 6. Use of an "omental pack" as a filler of deep cracks or hepatotomy sites instead of closure with mattress sutures; 7. Use of perihepatic packing in selected patients instead of resection when a coagulopathy or major subcapsular hematoma is present; 8. Discontinued use of perihepatic drains for minor or moderate hepatic injuries as long as discrete methods of selective vascular and biliary ligation have been used.

Humans↗

PubMed1993

Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children.

An old and simple operative technique for the treatment of rectal prolapse in children, first described by Ekehorn in 1909, has been reviewed. The technique consists of the insertion of a mattress suture (nonabsorbable and multifilament material) in the rectal ampulla through the lowermost part of the sacrum: the strands of the mattress suture are tied firmly over a piece of dry gauze at the level of the sacrococcygeal junction. By leaving the suture in place for 10 days, the local inflammation and infection causes firm adhesions between the rectal wall and the perirectal tissue so that the anorectal wall is bound to the surroundings (sacrorectopexy). The results of this retrospective study on 22 patients proves that this form of transsacral rectopexy in the management of rectal prolapse in children is effective (100%), simple and without complications compared to other techniques. There were no recurrences and no major morbidity. The overall surgical treatment of rectal prolapse in children is briefly reviewed.

Causality↗

PubMed1975

Experimental evaluation of bladder closure techniques.

Two methods of bladder closure have been evaluated in dogs. A conventional two-layer closure including the mucosa and a single layer running horizontal mattress extramucosal closure have been compared. Observations including adequacy of healing, strength of scar, degree of inflammatory reaction, dna degree of bladder adhesions have been made. The extramucosal running horizontal mattress closure appears to approach the ideal bladder closure.

Animals↗

PubMed1988

Control of house dust mites by electrical heating blankets.

The contents of house dust mites, Dermatophagoides (D), in 10 beds supplied with electrical heating blankets (EHBs) and in 10 control beds were followed for 1 year. All beds were in regular use during the study period. Dust from mattresses and EHBs was collected monthly and analyzed for D by microscopy. Blankets were turned on during daytime and were washed every 3 months. For each bed the median concentration of D during the entire period was related to initial value. In the beds supplied with blankets, the overall median was 52% compared to 122% in the control beds (p less than 0.05). The difference between the two groups of beds was observed within the first month. Major antigens from D were reduced to 32% in the beds supplied with blankets and increased to 120% in the control beds (p less than 0.05). Climatic conditions were measured beneath the blanket in a spare bed. When beds were covered by eiderdown, temperature was increased by 26 degrees C, and the relative humidity was decreased by 24% within 3 hours. In conclusion, EHBs appear capable of reducing relative humidity and concentration of house dust mites on mattress surfaces.

Allergens↗