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At least 865 records · Page 48Linked to original sources

PubMed1998

Feasibility study of a mechanical suturing device for less invasive mitral operations.

BACKGROUND: Because of smaller incisions and limited exposure, less invasive operations on the mitral valve can be arduous and time-consuming. This study examined the feasibility of a mechanical suturing device to facilitate less invasive mitral replacement. METHODS: Five mongrel dogs underwent limited left thoracotomy. After conventional cardiopulmonary bypass and cardioplegia, the mitral valve was exposed through a left atriotomy. After excision of the anterior leaflet, subannular sutures were placed using a mechanical suturing device. This device simultaneously passes two ends of a pledgeted 2-0 braided suture through the valvular annulus, then mechanically grasps both needles on the atrial aspect. Hence, a mattress suture is accomplished one-handed in a single continuous motion. This procedure was repeated around the entire annulus. A mechanical valve was seated and the sutures were tied and cut. RESULTS: All mechanical valves were implanted successfully. In the 4 animals in which it was attempted, cardiopulmonary bypass was successfully weaned. No evidence of perivalvular leak was observed by echocardiography. CONCLUSIONS: These data establish the feasibility of a mechanical suturing device for operations on the mitral valve. The device is easily mastered, maintains precise spacing between sutures, and permits rapid placement of mattress sutures. We predict widespread application for both less invasive and conventional valve operations.

Animals↗

PubMed1998

Common protective movements govern unexpected falls from standing height.

Simple energy considerations suggest that any fall from standing height has the potential to cause hip fracture. However, only 1-2% of falls among the elderly actually result in hip fracture, and less than 10% cause serious injury. This suggests that highly effective movement strategies exist for preventing injury during a fall. To determine the nature of these, we measured body segment movements as subjects (aged 22-35 yr) stood upon a gymnasium mattress and attempted to prevent themselves from falling after the mattress was made to translate abruptly. Subjects were more than twice as likely to fall after anterior translations of the feet, when compared to posterior or lateral translations. In falls which resulted in impact to the pelvis, a complex sequence of upper extremity movements allowed subjects to impact their wrist at nearly the same instant as the pelvis (average time interval between contacts = 38 ms), suggesting a sharing of contact energy between the two body parts. Finally, marked trunk rotation was exhibited in falls due to lateral (but not anterior or posterior) perturbations, resulting in the avoidance of impact to the lateral aspect of the hip. These results suggest that body segment movements during falls, rather than being random and unpredictable, involve a repeatable series of responses which facilitate safe landing.

Accidental Falls↗

PubMed1984

Temperature measurement in term and preterm neonates.

Body temperatures of 99 term and 44 preterm infants were measured at four sites: core (5 cm beyond the anus, with an electronic telethermometer), rectum (2 cm, with a mercury-in-glass thermometer), axilla, and between the skin and mattress. Temperatures measured at the four sites agreed closely in this group of largely normothermic infants. However, five of seven term infants with abnormal core temperature (greater than 1.5 SD below or above the mean) would have been judged to be normothermic by each of the three other measurements. The temperatures in preterm infants were lower and varied less with the site of measurement, indicating a smaller core-surface temperature gradient because of their relative lack of thermal insulation by body fat. Axillary temperature was as reliable as rectal temperature measured in the usual way with a mercury-in-glass thermometer. Measurement of the temperature between the skin and mattress was nearly as accurate as the other more frequently used methods. Ninety percent of temperatures were within 0.1 degree C of their final stabilization readings by 5 minutes for each type of thermometer and measurement site.

Axilla↗

PubMed1993

Penile prosthesis corporotomy closure: a new technique.

A new technique for corporotomy closure during penile prosthesis implantation is described. Horizontal mattress sutures placed after the corpus cavernosum is opened serve first as stay sutures and then are used to close the corporotomy after device implantation. This technique eliminates placing stay sutures as a separate step, avoids damage to the prosthesis and provides an aesthetic horizontal mattress closure.

Humans↗

PubMed1997

House dust mite avoidance measures improve peak flow and symptoms in patients with allergy but without asthma: a possible delay in the manifestation of clinical asthma?

BACKGROUND: Asthma caused by allergy to house dust mite is a growing problem. Patients with allergy who do not have asthma (yet) might develop asthma depending on exposure to precipitating factors. OBJECTIVE: We sought to determine whether house dust mite avoidance measures have an effect on the development of asthma. METHODS: Patients with allergy (n = 29) who had no diagnosis of asthma (FEV1 of 99.1% +/- 10.6% of predicted, peak flow variability of 5.21% +/- 3.41%, reversibility of FEV1 after 400 microg salbutamol of 3.92% +/- 3.75% according to the reference values) were randomly allocated (subjects blinded) to a treatment (n = 16) and a placebo group (n = 13). House dust mite avoidance treatment consisted of applying Acarosan (Allergopharma, J. Ganzer KG, Hamburg, Germany) (the placebo group used water) to the floors (living room, bedroom), and the use of covers for mattresses and bedding that were impermeable to house dust mite (the placebo group used cotton covers for mattresses only). We tested whether the intervention had an effect on peak flow parameters and asthma symptom scores during 6 weeks of treatment. RESULTS: Significant improvements were seen in the treatment group in symptom scores (Borg score) for disturbed sleep, breathlessness, wheeze, and overall symptom score. Slight but statistically significant improvements in peak flow (morning, evening, and variability) were seen in the treatment group also. No significant changes were seen in the placebo group. CONCLUSIONS: Although this study is not long enough to study the development of asthma, the results indicates that house dust mite avoidance measures had an effect on peak flow parameters and asthma symptoms in patients with allergy but without asthma. These findings might implicate that a shift in developing clinically manifest asthma could be achieved with house dust mite avoidance measures. To give a better answer to whether preventing the development of asthma is possible, larger studies with a longer follow-up period are necessary.

Adolescent↗

PubMed1998

Preventive effect of bedding encasement with microfine fibers on mite sensitization.

BACKGROUND: The indoor levels of mite allergens are known to determine the thresholds of sensitization and asthma exacerbation. However, the method for preventing mite sensitization by reducing the levels of house dust mites (HDMs) is not well established. OBJECTIVE: We investigated whether mite-blocking bedding encasing made from microfine fibers can prevent infants from being sensitized to HDMs. METHODS: Fifty-seven Japanese infants with atopic dermatitis who had high levels of IgE antibodies against either egg white, cow's milk, or soybean (but not against HDMs) were randomly chosen and divided into two groups. Thirty families of atopic infants (group A) were instructed to decrease HDMs by controlling the indoor environment, including bedding cleaning, whereas 27 families receiving the same instructions (group B) were further guided to use the Allerguard encasing for quilts and mattresses of all family members. We repeatedly examined Der p 1 + Der f 1 in the infants' mattresses and anti-Dermatophagoides farinae (Df) IgE in the infants' sera, and we performed skin prick tests with Df extract for 1 year. RESULTS: The mite-blocking encasing markedly reduced the levels of Der p 1 + Der f 1 (3.0 microg/g dust for group A vs 0.77 microg/g dust for B, p < 0.001). It also prevented the increase in serum levels of anti-Df IgE (2.5 U/ml for group A vs 0.7 U/ml for group B, p < 0.05) and positive reactions to skin prick testing with Df extract (63% for group A vs 31% for group B, p < 0.02) over 1 year. CONCLUSION: The bedding encasement with the mite-blocking fibers was effective for preventing atopic infants from being sensitized to HDMs, and it seems to be beneficial to modern busy housekeepers.

Allergens↗

PubMed1999

School as a risk environment for children allergic to cats and a site for transfer of cat allergen to homes.

BACKGROUND: Many children are allergic to furred pets and avoid direct pet contact. The school may be a site of indirect exposure to pet allergens, which may induce or maintain symptoms of allergic diseases. OBJECTIVE: We sought to investigate airborne levels of cat allergen (Fel d 1) at schools and in homes with or without cats and to study clothes as a route for dissemination of allergens between homes and school. METHODS: Airborne cat allergen was collected with personal samplers from (1) children attending classes with many (>25%) or few (<10%) cat owners and (2) homes with or without cats. A recently developed amplified ELISA assay, which detects low levels of airborne cat allergen in pet-free environments, was used. Dust samples were collected from clothes and mattresses. RESULTS: There was a 5-fold difference in the median levels of airborne cat allergen between classes with many and few cat owners (2.94 vs 0.59 ng/m3; P <.001). The median airborne cat allergen concentration in classes with many cat owners was significantly higher than that found in the homes of non-cat owners (P <.001) but lower than that found in homes with cats (P <.001). Allergen levels in non-cat owners' clothes increased after a school day (P <.001). Non-cat owners in classes with many cat owners had higher levels of mattress-bound cat allergen (P =.01). CONCLUSION: The results indicate significant exposure to cat allergen at school. Allergen is spread through clothing from homes with cats to classrooms. There the allergen is dispersed in air and contaminates the clothes of children without cats. The allergen levels in non-cat owners' homes correlate with exposure to cat allergen at school.

Air Pollutants↗

PubMed1998

Correction of the protruding ear with a modified anterior scoring technique.

PURPOSE: This article describes a modified anterior scoring technique to provide natural-looking results after correction of the protruding ear. The modified technique is described, and its advantages are compared with the conventional anterior scoring technique and with the other two basic techniques (Converse and Mustardé). PATIENTS AND METHODS: The modified technique was used to treat eight patients. In these cases, the use of transfixion mattress sutures placed through the perichondrium was very helpful in achieving a smooth curvature. RESULTS: Results up to 1 year showed no alteration in form when compared with the short-time results. CONCLUSION: The conventional anterior scoring technique for otoplasty is one of the most useful and reliable techniques, applicable in all cases of prominent ears. However, in some cases, it is difficult to control the cartilage bending completely. By using three adjusting mattress sutures (4-0 vicryl) through the perichondrium on the posterior side, combined with shallower scoring incisions, it is possible to create symmetry with the opposite ear and prevent "telephone ear" complication.

Adolescent↗

PubMed2001

The effect of differing support surfaces on the efficacy of chest compressions using a resuscitation manikin model.

AIM: External chest compression (ECC) efficacy is influenced by factors including the surface supporting the patient. Air-filled support surfaces are deflated for cardiopulmonary resuscitation, with little evidence to substantiate this. We investigated the effect that differing support surfaces had on ECC efficacy using a CPR manikin model. METHODOLOGY: Four participants carried out four cycles of ECC with an assistant ventilating. The subjects were blinded to the seven support surfaces and the order was randomised. For each participant/surface combination, ECC variables and the participants' perceptions were measured. RESULTS: Participants produced effective ECC with the manikin on the floor (mean proportion correct, 94.5%; mean depth, 42.5 mm). Compared with the floor: the proportion of correct ECC was less for the overlay inflated (P<0.05); the depth of ECC was less effective (30-37 mm) for the overlay inflated/deflated and low-air-loss inflated and foam mattresses (P<0.05). The foam mattress, overlay inflated/deflated, and low-air-loss inflated were perceived as being less stable and as having reduced ECC efficacy compared with the floor. There was no difference or agreement, regarding subjects' perceptions or ECC variables, between the support surfaces or between inflated/deflated air-filled support surfaces. CONCLUSION: The efficacy of ECC is affected by the support surfaces. There seems little evidence to substantiate deflating all air-filled support surfaces for CPR.

Beds↗

PubMedDate not supplied

Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up.

We present 53 patients who underwent arthroscopic rotator cuff repair and had a minimum of 2-year follow-up. Most tears were avulsions of the supraspinatus from the greater tuberosity, some with associated longitudinal tears. Longitudinal tears were repaired with a side-to-side suturing technique. Avulsion tears from the tuberosity were repaired using nonretrievable suture anchors. Traditional open-mobilization techniques, such as elevating the cuff off the glenoid neck and scapular fossa, and cutting the coraco-humeral ligament, were performed arthroscopically as needed. All repairs were performed using O-PDS or 1-PDS suture and a 7-mm suture punch for suture delivery. Both simple and mattress suture configurations were used. An anterolateral operative portal was used in most cases. A modified UCLA rating system that included additional points for abduction range of motion and strength was adapted for clinical evaluation in this study (maximum score, 45 points). The average preoperative rating was 17 (range, 9 to 26). The average postoperative rating was 41 (range, 16 to 45). There were 36 excellent (41 to 45 points), 13 good (36 to 40 points), 1 fair (30 to 35 points), and 3 poor (< 30 points) results. We have seen intraoperative but no cases of postoperative anchor pullout. The simple sutures performed as well as, and in some ways better than, mattress configurations. All fair and good results were with O-PDS. To perform an arthroscopic repair, the tear must be well visualized and mobilizable back to the tuberosity with only moderate tension. The anterolateral operative portal has been very useful because it allows better angle of entry for instruments and anchors and improved visualization in the subacromial space. The use of PDS and simple suture configurations has made the repair technically easier to perform with the instruments that are currently available. We do recommend 1-PDS suture because it breaks less easily even though it is slightly more difficult to deliver and tie. Arthroscopic cuff mobilization is relatively simple and has allowed us to repair larger tears. Based on our experience, arthroscopic rotator cuff repair is technically achievable and a superior alternative in selected cases for an experienced shoulder arthroscopist. Patients who underwent arthroscopic repairs had less scarring and shorter hospital stays and, we believe, less postoperative pain and easier rehabilitation compared with open repairs.

Adult↗

PubMed1991

[Verification of bacteriological safety of PCM 40 air conditioner].

This study assessed the bacteriological safety of the bedside air conditioner PCM 40 (Howorth Airtech), used for prevention of intraoperative hypothermia, by blowing filtered warm air through a special mattress. The 3 microns bacterial filter of the device released 2,968 +/- 5,618 particles of diameter less than 3 microns per m3 of room air, containing 78,798 +/- 37,243 of such particles per m3. The amount of bacteries in the air pulsed from the mattress was 30 +/- 41 cfu/m3 vs 120 cfu/m3 in the ambient air and in the hot air supply tubing it reached 6 +/- 5 cfu/m3 vs 175 +/- 77 cfu/m3. It is concluded that bacteriological data do not contra-indicate the use of this air conditioner in the operating theater. The only limitations for use are the position (prone or lateral position) and type of surgery (neurosurgery).

Air Conditioning↗

PubMed1994

Corneal lip tunnel incision.

To evaluate whether the corneal lip tunnel incision or the sutureless closure causes any refractive problems, we performed a retrospective study on 387 cataract surgery patients who were divided into four groups based on type of wound closure and whether the corneal lip was made. The four groups consisted of patients who received an X-stitch closure without the corneal lip, a horizontal mattress stitch without the lip, a horizontal mattress stitch with the lip, and a sutureless closure with the lip. All patients had phacoemulsification in situ; implantation of a foldable silicone lens was performed through a scleral tunnel incision. Clinical evaluations included preoperative characteristics and postoperative Snellen visual acuity, intraocular pressure, and vector analysis of cylinder. In all four groups, a 4.0 mm wide incision was used. Entrance into the clear cornea during the corneal lip tunnel incision did not induce additional cylinder, and the sutureless closure did not decrease induced cylinder or increase the against-the-rule shift. The results of this study indicate that the combination of a 4.0 mm incision with 1.5 mm corneal lip, phacoemulsification in situ, foldable lens implantation, and sutureless closure is a safe and effective procedure for cataract surgery.

Aged↗

PubMed1999

The contribution made by an armchair with integral pressure-reducing cushion in the prevention of pressure sore incidence in the elderly, acutely ill patient.

The paper describes a clinical controlled trial of an armchair with integral pressure-reducing cushion, which took place on two elderly acute medical wards in a district general hospital. The aim of the study was to evaluate whether the armchair would have an impact on reducing the occurrence of pressure sores. All patients were provided with a mattress or overlay in accordance with the hospital policy on mattress provision following a Waterlow risk assessment. Patients on ward A were provided with an armchair with integral pressure-reducing cushion, whilst patients on ward B continued to use their existing bedside armchair. Nominal data were collected on all pressure sores in patients who were not bedridden. Ward A had a significantly lower incidence of hospital-acquired pressure sores compared to ward B, and non-hospital-acquired pressure sores on this ward showed more improvement than those on ward B.

Acute Disease↗

PubMed1996

A study of the contribution of effective pressure care on elderly female patients attending accident and emergency who have a suspected fractured neck of femur.

This study describes the benefit of pressure relief and the use of pressure reducing mattresses on elderly female patients with a suspected fractured neck of femur, attending an Accident and Emergency department. The main aim of the study was to determine if pressure care, appropriate to each individual patient, reduced red pressure areas and if so, in what way? The results demonstrated that pressure relief given at regular intervals was most effective at reducing red pressure areas. The pressure reducing mattresses also showed to be beneficial in reducing these areas. The study highlighted the importance of giving regular pressure relief in all patients at risk of development of pressure sores.

Aged↗

PubMedDate not supplied

The Rousso stitch: a new everting skin closure technique.

The purpose of this article is to describe a new suturing technique that everts the skin and is a modification the horizontal mattress suture called the Rousso stitch. The technique is described step by step, along with reference pictures. The Rousso stitch technique was developed based on the well-documented theory behind everting the edges of thicker skin on closure of surgical incisions to allow for ideal coaptation and minimal scar formation. It is an easy technique to learn and appears to be a good time-saving option for the surgeon to use for the same applications of the typical horizontal mattress suture.

Dermatologic Surgical Procedures↗

PubMedDate not supplied

A new method for reattachment of the tendo Achillis following retrocalcaneal exostectomy.

Currently there are a number of surgical techniques being utilized to address the entity of symptomatic, recalcitrant retrocalcaneal exostosis. This article presents a mechanical study of a modified surgical approach which has been developed at the Northern Virginia Podiatric Residency Program for the purposes of complete resection of all offending exostosis and calcifications, and maintenance of the anatomic configuration of the Achilles tendon with resultant asymptomatic function and cosmetic healing. The centerpiece of the surgical modification is the way in which the portion of reflected Achilles tendon is reattached to the calcaneus, utilizing soft-tissue anchors in combination with a modified Krackow suture technique. In order to delineate the relative strength of this suture technique, a cadaveric study was performed using six specimens. Each specimen underwent tendon repair with both a modified Krackow technique and a modified vertical mattress coaptation technique for a total of 12 studies. The force required to displace the tendon for distances of 0.5 cm and 1.0 cm was then recorded, and the data were statistically analyzed, with the modified Krackow technique proving to have a significantly better ability to resist distractive forces at both 0.5 cm (p = .01) and at 1.0 cm (p = .02) compared to the vertical mattress coaptation technique.

Achilles Tendon↗

PubMed2006

Sensitization and exposure to house dust and storage mites in high-altitude areas of ecuador.

BACKGROUND: Few studies have addressed exposure and sensitization to mite allergens in Andean countries. OBJECTIVES: To identify the main mite species in 3 locations at different altitudes in Ecuador and to verify skin test reactivity to various mite species in allergic individuals in Quito, Ecuador. METHODS: Mattress dust samples were collected in Quito (2,800 m above sea level), Cuenca (2,500 m above sea level), and Guayaquil (sea level). Mite species present in the samples were isolated, identified, and counted. Der p 1 and Der f 1 levels were measured using monoclonal antibody-based enzyme immunoassays. Four hundred thirty-five patients in Quito diagnosed as having allergic rhinitis or asthma underwent skin testing with commercial extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, Tyrophagus putrescentiae, and Lepidoglyphus destructor. In addition, Glycyphagus domesticus, Acarus siro, and Aleuroglyphus ovatus were tested in 362, 262, and 279 patients, respectively. RESULTS: Twenty-one mite species were identified. Large populations of mites were detected above 2,500 m of altitude. All the dust samples contained detectable levels of Der p 1 or Der f 1. Positive skin prick test reactions to D. pteronyssinus, D. farinae, B. tropicalis, L. destructor, T. putrescentiae, A. ovatus, A. siro, and G. domesticus were obtained in 60.9%, 56.8%, 17.0%, 19.3%, 10.6%, 15.8%, 8.8%, and 11.0% of the patients, respectively. CONCLUSIONS: Most analyzed mattresses contained several species of mites. Mite allergen levels were high. This study confirms the importance of house dust and storage mite allergens in Ecuador in areas above 2,500 m of altitude, where humidity remains high year round.

Acaridae↗

PubMed2006

Room-specific characteristics of suburban homes as predictors of indoor allergen concentrations.

BACKGROUND: Room characteristics predicting indoor allergen exposure in suburban homes have not been clearly identified. OBJECTIVE: To examine relationships between room characteristics and concentrations of indoor allergens in homes of suburban asthmatic patients. METHODS: The homes of 339 asthmatic children ages 6 to 17 years were studied. Home inspections were conducted by a trained technician, and dust samples were analyzed for indoor allergen content. A high allergen concentration was defined as 8 microg (U)/g or more of fine dust. RESULTS: Infrequent sheet washing and wall-to-wall carpet were risk factors for high bedroom dust mite concentrations. Infrequent sheet washing was also a risk factor for high Fel d 1 concentrations. Food remains in the bedroom was a risk factor for high bedroom Bla g 1 levels, and exposed food, leaks, and dirty pots were all risk factors for high kitchen Bla g 1 levels. The combination of lack of mattress or pillow encasements, infrequent sheet washing, and carpeting was associated with a 24-fold increase in odds of a high dust mite concentration (odds ratio [OR], 24.1; 95% confidence interval [CI], 3.2-181.4). Among non-cat owners, the combination of stuffed toys on the bed, lack of mattress or pillow encasements, and infrequent sheet washing was associated with a 49-fold increase in odds of a high Fel d 1 level (OR, 49.4; 95% CI, 2.8-887.3). The combination of leaks, exposed food, and dirty pots was associated with a high kitchen Bla g 1 concentration (OR, 10.6; 95% CI, 2.8-40.5). CONCLUSIONS: Specific room characteristics predict high indoor allergen exposure among children with asthma, and a combination of these characteristics may further increase the risk of high allergen exposure.

Adolescent↗