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PubMed1990

Section of the descending columns of the fornix produces delay- and interference-dependent working memory deficits.

Rats were allocated to one of three surgical treatment groups, and given either sham operations (SHAM), transection of the descending columns of the fornix (DCF), or transection of fibres at the base of the lateral septal nuclei (SC). They were trained on a rewarded alternation task, run as a spatial working memory task on an elevated T-maze, with a minimal intratrial interval. There were no differences between the SHAM and the SC rats. The DCF rats showed an initial impairment in acquisition, but their performance gradually improved to control levels. The imposition of a 20-s intratrial interval impaired choice accuracy in all groups, but the extent of the impairment was significantly greater in the DCF group. Addition of an extra, and conflicting, 'information run', to provide a source of proactive interference, also impaired performance in all groups, but the impairment was again greatest in the DCF group, suggesting that this lesion increases intrusion errors. Subsequent testing in the acquisition of 2-way active avoidance revealed that the DCF lesion facilitated learning with respect to the other two groups. The results indicate that there are clear functional differences between the different outputs from the subiculum, and that the descending subicular output plays a significant role in normal memory.

Animals↗

PubMed1997

Pulsed low dose rate brachytherapy for pelvic malignancies.

PURPOSE: The pulsed low dose rate remote afterloading unit was designed to combine the radiation safety and isodose optimization advantages of high dose rate technology with the radiobiologic advantages of continuous low dose rate brachytherapy. This is the first report of a prospective clinical trial evaluating the relative incidence of acute toxicity and local control in patients with pelvic malignancies who underwent interstitial or intracavitary brachytherapy with the pulsed low dose rate remote afterloader. METHODS AND MATERIALS: From 5/11/92-6/21/95, 65 patients underwent 77 brachytherapy procedures as part of their treatment regimen for pelvic malignancies. Using the pulsed low dose rate Selectron, equipped with a single cable-driven 0.3-1.0 Ci Ir192 source, target volume doses of 0.40-0.85 Gy per pulse were prescribed to deliver the clinically determined dose. Forty-five intracavitary and 32 interstitial procedures were performed. Fifty-four patients had primary and 11 recurrent disease. Patients were followed closely to assess incidence of Grade 3-5 acute and delayed toxicity, local control, and survival. RESULTS: With a median follow-up of 16.1 months (range 1-29), 33 patients are NED, 10 alive with disease, 13 dead with disease, 4 dead of intercurrent disease, and 5 lost to follow-up. Local control was maintained until last follow-up or death in 48 cases, local failure occurred in 11, unknown in 5. Grade 3-5 acute toxicities (requiring medical or surgical intervention) occurred in 5 out of 77 procedures (6.5%), delayed complications in 10 patients (15% actuarial incidence at 2 years). In the 52 procedures performed for 42 patients with cervix cancer, the acute toxicity incidence was 5.8%, with a 14% 2-year actuarial incidence of delayed complications. Of 32 interstitial templates performed on 30 patients for pelvic malignancies, there were three incidences of acute toxicity and five delayed toxicities. CONCLUSION: Using the parameters described for this initial clinical study in patients treated for pelvic malignancies, pulsed low dose rate brachytherapy shows no significant increase in acute toxicity above that seen with the standard continuous low dose rate approach. Using the isodose optimization possible with pulsed brachytherapy, local control is excellent in patients treated at initial presentation, although longer follow-up is required for full assessment of local control and late toxicity. Further trials will need to be carried out to determine if larger doses per pulse and shorter total treatment times have comparable therapeutic ratios.

Brachytherapy↗

PubMed1987

Microvascular anastomosis in spontaneously hypertensive and stroke-prone rats.

Carotid end-to-end microvascular anastomoses (MVA) were performed in 100 rats [50 spontaneously hypertensive (SHR); 30 spontaneously hypertensive stroke-prone (SHR-SP); and 20 normotensive controls (WKY)]. Animals were sacrificed at various intervals from immediately after anastomosis to 60 days after surgery, and vascular healing was studied with the scanning electron microscope. In this manner vascular healing in normotensive rats (WKY) could be compared with that in hypertensive rats (SHR and SHR-SP) with vascular disease. Results of this study suggest that vascular healing in hypertensive rats is delayed when compared with normotensive controls. Furthermore, suture material was occasionally incompletely endothelialized in hypertensive animals as long as 60 days after surgery and served as a potential source of emboli. Additionally, an increased susceptibility of hypertensive endothelium (SHR and SHR-SP) to clamp and needle injury was apparent. In spite of this, there was a 100% patency rate of all anastomoses performed, indicating that patency, per se, is unaffected by hypertensive vasculopathy.

Animals↗

PubMed2004

Acute normovolemic hemodilution.

Patients and physicians continue to be motivated to find methods to reduce the use of allogeneic blood. Even though donor screening has increased the safety of donated blood products, autologous blood is the most desirable source of red cells during the perioperative period. The methods commonly used to obtain autologous blood during the perioperative period can be initiated prior to the operative procedure (autologous preoperative donation, acute normovolemic hemodilution) or during surgery (cell scavenging). Acute normovolemic hemodilution (ANH) involves a controlled removal of whole blood immediately prior to the operation. The patient's intravascular volume is maintained with solutions that contain non-red cells. The operative procedure is conducted with a normal blood volume, but with a reduced red cell mass. At the conclusion of the operation, the stored autologous blood is restored to the patient. If operative blood loss is not excessive, the replacement of autologous blood may provide an acceptable red cell mass. In addition to surgical blood loss, some of the key factors in determining how effective acute normovolemic hemodilution will be in limiting allogeneic transfusion are: the patient's initial hematocrit and blood volume; the volume of autologous blood removed prior to the operation; the effectiveness of the hemodilution; and the timing of autologous blood replacement. In contrast to autologous pre-donation, autologous blood removed during acute normovolemic hemodilution is usually stored and re-infused in the operating room.

Blood Loss, Surgical↗

PubMed2002

An outbreak of Serratia marcescens bacteremia after general anesthesia.

OBJECTIVE: To investigate an outbreak of Serratia marcescens bacteremia among patients after general anesthesia. DESIGN: A case-control study. SETTING: A 304-bed, pediatric teaching hospital. PATIENTS: Twenty-three pediatric patients who developed S. marcescens bacteremia within 2 weeks after general anesthesia between June 15 and September 22, 1999, were compared with 46 age-matched control-patients who had undergone procedures on the same clinical services of the hospital during the same period. RESULTS: Cases were distributed over a wide range of surgical services and were not correlated with exposure to any of the surgical, anesthesia, or nursing staff. Case-patients were significantly more likely than control-patients to have received cefazolin (odds ratio [OR], 11.1; 90% confidence interval [CI90], 1.9 to 24.3) or to have had perioperative placement of a central vascular catheter (OR, 4.2; CI90, 1.2 to 18.8). The timing of the procedures of patients who subsequently developed S. marcescens bacteremia was significantly associated with the shifts of one or more of five operating room technicians (OR, 2.9 to 6.8) who were responsible for preparing intravenous fluids used both to reconstitute perioperatively administered antibiotics and to prime central vascular catheter assemblies. CONCLUSIONS: Our findings are consistent with a pattern of intermittent contamination due to periodic breaches in sterile technique, rather than a point-source of contamination. The unique challenges that such a procedural breakdown presents to an epidemiologic investigation are discussed. This outbreak stresses the importance of providing comprehensive training in antisepsis when multifunctional personnel are incorporated into an operating room work environment.

Adolescent↗

PubMed1998

Spinal cervical infection: a case report and current update.

Cervical spine infection is a term used to encompass osteomyelitis, discitis and epidural abscess. Most cases are caused by Staphylococcus aureus but other organisms have been isolated. The most frequent source is hematogenous spread from a nearby or distant source. Diagnosis is often confusing. The most common symptom is worsening back or neck pain that increases with movement. Patients may have motor or sensory changes if there is compression of the nerve roots or spinal cord. If the condition is not treated promptly, it may progress to irreversible neurologic deficit. Positive blood cultures and an elevated erythrocyte sedimentation rate (ESR) may be seen. Radiologic findings may include a paravertebral swelling, a destruction of the vertebral end plates and adjacent portions of the bodies and disc space and the presence of an epidural mass. Treatment includes radical surgical intervention for debridement and decompression to stabilize the spine in conjunction with 8-12 weeks of intravenous antibiotics. Closed continuous local antibiotic irrigation with a gravity control outflow system has been used.

Abscess↗

PubMed1977

Serratia: opportunistic pathogen of increasing clinical importance.

Serratia marcescens can become a formidable nosocomial (hospital acquired) pathogen, and is reported increasingly in the world literature. However, it is only a recently recognized problem in Australia. Serratia can carry an antibiotic-resistance plasmid, and, after entry of the organism into very sick patients, it may be hard or impossible to eliminate. Initial experience of Serratia in 34 consecutive cases isolated in a three-months period is presented. Rapid increase in the number of Serratia infections occurred after the appearance of a resistant strain. Urinary infection was the commonest presentation (91% of cases). The presence of an indwelling urinary catheter in a debilitated patient was the major predisposing factor. Significant bacteraemia followed in four cases with one death. Contamination of burns (surfaces) and surgical wounds was found in four cases. Serratia strains were found to be highly resistant to most antimicrobial agents in routine sensitivity testing, 20% being fully resistant to all tested agents, and nalidixic acid being the most effective inhibitor in the remainder. With bacteriocin typing of Serratia, two types were found to be dominant. These two bacteriocin types were not identified among strains isolated from other sources such as soil, water and local hospitals. Pharyngeal carriage was found in only one case, but faecal excretion of Serratia was found in 11 cases and may be a significant portal of dissemination. Cross-infection from a hospital reservoir of resistant organisms is postulated. A model of cross-infection is also proposed, and methods of control are discussed. In view of the established danger of Serratia in the hospital setting, its isolation can no longer be ignored.

Anti-Bacterial Agents↗

PubMed2002

Blinded review as a method for quality improvement in surgical pathology.

CONTEXT: Several studies have shown that blinded review, because it is less biased and may improve vigilance, is an excellent method for detecting errors and improving performance in gynecologic cytology. The value of blinded review in surgical pathology is not known. OBJECTIVE: To determine the value of blinded review in surgical pathology. METHODS: Five hundred ninety-two biopsy cases were reviewed without knowledge of the original diagnosis or history, and the results were compared with those of the original diagnosis. RESULTS: Complete agreement was obtained in 567 (96%) of 592 cases. The technique of blinded review of biopsy material had a sensitivity of 98%, failing to identify a lesion in 7 cases; no cases of malignancy were missed. The specificity was 100%. Differences in diagnostic threshold were the most common source of disagreement. False-negative cases were identified by the technique and were clinically significant. Power studies show that the number of cases requiring review to identify significant errors are large, but potentially achievable by blinded review. CONCLUSION: Blinded review is a sensitive and effective method for identifying areas of disagreement, including false-negative cases, and for decreasing errors in surgical pathology biopsy material.

Diagnostic Errors↗

PubMed1980

Gram-negative sepsis in neonates: a nursery outbreak due to hand carriage of Citrobacter diversus.

An outbreak of Citrobacter diversus infections occurred in a newborn nursery at a 350-bed community hospital during September and October 1978. Two infants developed sepsis and meningitis and nine additional infants had asymptomatic umbilical colonization. These infants did not differ from control, noncolonized infants with respect to numerous clinical and environmental variables. Surveillance cultures failed to implicate an environmental source for the Citrobacter. However, cultures of nursery personnel identified a hand-carrier whose removal eliminated neonatal colonization with C diversus and decreased the number of isolates of certain other enteric bacteria found on umbilical stumps. Factors implicated in the perpetuation of the carrier state in this nurse included marked dermatitis from repeated hand washing and hand care practices involving the overnight use of plastic gloves and nutritive hand cream. The mode of transmission within the nursery appeared to be from nurse's hands to infant's umbilicus. Use of triple dye on umbilical stumps and chlorhexidine hand washing preparations did not eliminate this cycle. Surgical manipulation of colonized umbilical stumps may have been responsible for illness in two infants.

Carrier State↗

PubMed2000

Hospital morbidity due to post-operative infections in obstetrics & gynecology.

OBJECTIVE: To study the incidence and risk factors for postoperative infection following cesarean sections and major gynecological surgery. METHODS: Postoperative infection was documented in the specified registers in all patients following cesarean sections and major gynecological surgery from January 1997 to December 1998. This study was a part of the prospective analysis of hospital-based morbidity and mortality in the Department of Obstetrics and Gynecology. RESULTS: There were a total of 89 cases of postoperative infections amongst 4,032 patients undergoing major operations giving an overall infection rate of 2.2%. The morbidity due to infections was 3.3% in cesarean sections and 0.9% in major gynecological surgery. Abdominal hysterectomies had a higher infection rate than vaginal surgery. The most common causative organisms isolated were Enterococcus, Staphylococcus and Klebsiella species. CONCLUSION: It was found that vaginal flora was a significant source of contamination during surgery, which could be minimised by local sterilisation methods. The high infective morbidity in abdominal hysterectomies needs further analysis of the risk factors. Infection surveillance with a regular review of antibiotic protocols is recommended.

Anti-Bacterial Agents↗

PubMedDate not supplied

Massive lower gastrointestinal hemorrhage from the surgical anastomosis in patients with multiorgan trauma: treatment by subselective embolization with polyvinyl alcohol particles.

PURPOSE: To evaluate the efficacy and safety of subselective arterial embolization with polyvinyl alcohol (PVA) particles with or without microcoil augmentation to control postoperative lower gastrointestinal (GI) bleeding. METHODS: Ten patients with clinical, scintigraphic, and angiographic evidence of postoperative lower GI bleeding were considered for subselective embolization. Subselective embolizations were performed through coaxial microcatheters with 355-500 micron PVA particles with or without additional coil embolization. RESULTS: Embolization was technically successful in 9 of 10 (90%) patients. In one patient, subselective embolization was not possible; consequently no embolization was performed. Clinical success was achieved after a single embolization in 6 of 10 (60%) patients and after a second embolization in an additional 3 of the 10 (30%) patients. While there was no rebleeding in patients with normal coagulation parameters, all three patients (100%) with coagulopathy rebled, two of them from another source. Although no acute ischemic effects developed, no long-term sequela such as ischemic stricture were specifically looked for. Seven patients developed abdominal discomfort and/or fever within 24-48 hr. Four of 10 patients died of complications other than hemorrhage or ischemia. CONCLUSION: Subselective PVA embolization with or without a microcoil embolization is an effective and safe means of managing postoperative lower GI hemorrhage in patients with multiorgan trauma.

Adult↗

PubMed1988

Video transurethral resection using controlled continuous flow resectoscope.

A video camera, attached by direct-beam coupler to the controlled continuous flow (CCF) resectoscope, is used to aid in the performance of transurethral resection (TUR). A television monitor becomes the source for judgment in guiding the resectoscope loop. The surgeon stands during the TUR to watch the image from the resectoscope lens, as projected on the video monitor screen, to decide where to cut tissue and fulgurate blood vessels. Fifty cases of transurethral resection of prostate (TURP) performed by the video method with the CCF resectoscope are compared with 400 TURP cases performed by the conventional method of looking through the scope using the same instrument. Resulting data from the video method were statistically similar to that obtained from the conventional method. The video method was a safe and effective means of visualizing the surgical field during TURP.

Aged↗

PubMed1995

Cell fate in the Arabidopsis root meristem determined by directional signalling.

Postembryonic development in plants is achieved by apical meristems. Surgical studies and clonal analysis have revealed indirectly that cells in shoot meristems have no predictable destiny and that position is likely to play a role in the acquisition of cell identity. In contrast to animal systems, there has been no direct evidence for inductive signalling in plants until now. Here we present evidence for such signalling using laser ablation of cells in the root meristem of Arabidopsis thaliana. Although these cells show rigid clonal relationships, we now demonstrate that it is positional control that is most important in the determination of cell fate. Positional signals can be perpetuated from more mature to initial cells to guide the pattern of meristem cell differentiation. This offers an alternative to the general opinion that meristems are the source of patterning information.

Arabidopsis↗

PubMed2005

[Advances in necrotizing enterocolitis].

OBJECTIVE: To evaluate recently reported findings on necrotizing enterocolitis, Paying particular attention to pathogenesis, management and preventative strategies. DATA SOURCES: The articles covered in this report consist of randomized and quasi-randomized trials, case control studies, meta-analyses and reviews published recently. Certain other articles were also included because of their utmost importance to the subject. RESULTS: Necrotizing enterocolitis remains a major cause of morbidity and mortality in preterm infants. Those who are born with intra-uterine-growth retardation are at a several-fold increased risk. Possible pathophysiologic processes beginning in utero and continuing after birth are discussed in this review. Other factors involved in the process are related to the role of arginine and the production of intestinal nitric oxide and the action of epidermal growth factor in the regulation of cell regeneration. Perforated necrotizing enterocolitis is a complex surgical problem; definitive evidence-based guidelines for the best approach are yet to be determined. After surgery, although residual small bowel length and the presence of the ileo-cecal valve remain important predictors of duration of parenteral nutrition in infants, other factors, such as the early use of breast milk or amino acid-based formula, may also play a role in intestinal re-adaptation. Prevention strategies have centered on feeding practices and emerging experiments such as amino acid supplementation, are also discussed. CONCLUSION: Significant results in terms of mortality and morbidity will be achieved through better understanding of necrotizing enterocolitis pathogenesis and clinical and surgical management in addition to the employment of preventative strategies.

Enterocolitis, Necrotizing↗

PubMedDate not supplied

[The concentration of calcium and its fractions during heart surgery using extracorporeal circulation].

Changes in the concentration of calcium and its fractions have been studied in 115 patients subject to standard bypass techniques. It has been found that calcium homeostasis disturbances do really develop and are caused by the use of solutions that are not balanced with blood in their calcium content. The main source of calcium in hemodiluents was gelatinol. A decrease in gelatinol volume to 450-600 ml prevented the onset of marked hypercalcemia. As ionized calcium (Ca2+) concentration is determined not only by the total Ca level, but also by the shifts in the degree of pH- and pCO2-dependent ionization and binding and in ligand and protein content, Ca2+ determination is considered an optimal method of calcium homeostasis control during cardiopulmonary bypass.

Adolescent↗

PubMed1995

Knowledge acquisition from the UMLS sources: application to the description of surgical procedures.

The re-usability of lexicons and knowledge in medicine is a crucial challenge. The Unified Medical Language System (UMLS) project has attempted to provide a repository of concepts, semantically categorized for biomedical domain. This paper describes some results about the relevance of UMLS structures for specific purposes. We have focused on the description of surgical procedures. Discussion concerns synonymy of terms, granularity of concepts, and ontology. A preliminary work on the exploitation of interconcept links by a computerized application reveals a heterogeneous implementation of those relationships. However, the UMLS provides a powerful knowledge base for developers.

General Surgery↗

PubMed1997

Evidence that inner hair cells are the major source of cochlear summating potentials.

The role of the inner hair cells (IHCs) in generating the cochlear summating potentials (SP) was assessed by measuring SP, cochlear nerve action potentials (CAP), cochlear microphonics (CM) and 2f1-f2 distortion product otoacoustic emissions (DPOAEs) in 15 chinchillas with either acute chemical de-afferentation, accomplished by applying kainic acid to the round window, or surgical de-afferentation and basal IHC loss, which developed within two months after sectioning the auditory nerve. In the auditory nerve sectioned ears, type I ganglion cells disappeared whereas most, if not all, type II ganglion cells were still present. Histological analysis of surface preparations and sections through the modiolus verified the de-afferentation in both models and showed a large IHC loss at the base of the cochlea in the ears with the auditory nerve sectioned while other structures of the cochlea remained intact. Unoperated (left) ears of 9 animals served as controls. CM and DPOAEs were normal in all ears whereas the CAP was substantially depressed in de-afferented ears. Comparisons among the SP input-output functions suggest that (1) the IHCs are the major generator of SP recorded from the round window in chinchilla, in particular at low to moderate stimulus levels, (2) the SP recorded from the round window largely reflects the responses from hair cells at the base of the cochlea, and (3) kainic acid results in an increase of SP amplitude to high-level stimuli whereas the SP to low- to moderate-level stimuli remains in the normal range.

Acoustic Stimulation↗

PubMed2003

Rabbit articular cartilage defects treated with cultured costal chondrocytes (preliminary report).

An attempt to repair articular cartilage defects by costal chondrocytes transplantation was made. A full-thickness defect in the rabbit's femoral patellar groove was artificially made. Cultured costal cartilage chondrocytes were then transplanted into the defects and covered with periosteal flaps. Empty defects were used as the control group. Animals were divided into two groups (five rabbits each). They were examined after four and twelve weeks from the day of transplantation, respectively. The reparative tissue was evaluated by macroscopic and histological examinations. The reparative tissues in defects with transplanted chondrocytes had an hyaline-like cartilage appearance and were firmly attached to the surrounding normal cartilage. No trace of newly formed bone was detected. The reparative tissues found in defects that were left empty had a fibrous character. They were loosely connected to the surrounding cartilage and were more compliant than tissues from transplanted defects. Considering these initial findings, the ease of surgical procedures during the harvesting of the costal cartilage and few interventions into the joint make the costal cartilage a promising source of chondrocytes for transplantation. However, this needs to be confirmed on a larger scale over a longer period of time.

Animals↗