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Aspirin-sensitive asthma is not well documented in children. It may present as a triad of (1) allergic rhinitis, (2) nasal polyps and/or sinusitis and (3) bronchial asthma precipitated by aspirin. Four cases in children are presented. The pathophysiology probably involves the biosynthesis of prostaglandins.
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Sensitivity to hymenoptera in adult males.
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10,003,402
The authors studied the sera of 86 selected adult male office workers for IgE antibodies to yellow jacket and honey bee venoms and to environmental inhalants and foods. Structured histories provide information about the experiences of these men with the Hymenoptera and other immunological information. Three men (3%) gave a history of a local or general reaction to the Hymenoptera but no antibodies were detected. Ten men (12%) had IgE antibodies to yellow jacket or honey bee venoms but none gave a history of a reaction. Nine of these men were atopic. The authors speculate that IgE antibodies to the Hymenoptera in atopic adult males may be more common than is currently recognized.
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10,003,403
Acute bronchial and cardiovascular effects of increasing doses of pirbuterol acetate aerosol in asthma.
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10,003,404
Pretreatment of exercise-induced asthma by fenoterol delivered as inhalation powder and pressurized aerosol.
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10,003,405
Fifteen adult asthmatics with reproducible exercise-induced asthma were included in a randomized double-blind, crossover study to compare the prophylactic effect of fenoterol (Berotec as inhalation powder to fenoterol from an aerosol inhaler. The compound was found equally given as an inhalation powder or as an aerosol.
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10,003,406
The bronchodilating effect of acupuncture in patients with acute asthma.
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10,003,407
The effectiveness of acupuncture therapy for asthmatic patients was studied by continuous monitoring of the respiratory function. Using the forced 5 Hz oscillating technique, the investigators could estimate the change of total respiratory resistance (Rrs) of asthmatic patients throughout their reception of acupuncture therapy. They performed a single-blind study consisting of a placebo acupuncture, a placebo stimulation and real acupuncture therapy For further control of this study, they selected an easily locatable point for needle placement among the many traditional meridian points. In 10 out of 26 acupuncture therapies. Rrs significantly decreased while in only one of 17 placebo treatments did Rrs decrease.
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10,003,408
Feather pillows and allergic patients.
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10,003,409
An evaluation of childhood rhinorrhea.
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10,003,410
The differences in children with allergic and nonallergic rhinitis were reviewed. Thirty-two patients were studied prospectively. Ten patients were diagnosed as having allergic rhinitis (AR) on the basis of history correlating with RAST's and elevated IgE for age. Twenty-two patients had no evidence of atopy as a cause for their rhinorrhea and were classified as having vasomotor rhinitis (VMR). In this group 10 patients demonstrated eosinophilic nonallergic rhinitis (ENR). Responsiveness of the various group to medical therapy was noted. It was found that patients with AR and ENR are significantly more responsive to medical therapy than patients with VMR. The authors feel that there is a definite advantage in performing nasal cytology for determining eosinophilia in chronic childhood rhinorrhea.
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10,003,411
Pneumococcal bacteremia in pediatric patients.
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10,003,412
Patients treated for pneumococcal bacteremia were prospectively evaluated over a 21-month period. Of 2,610 blood cultures obtained, 79 (3%) were positive for Streptococcus pneumoniae. Of these, 37 patients (47%) initially had a focus of infection, and 73 (92%) were reevaluated after the results of the blood culture were known. Two-thirds of these were evaluated within 24 hours of the blood culture being drawn; the remainder were seen between 24 and 72 hours after the initial visit. Twenty-three patients were febrile (greater than 37.4 C) on reevaluation. Six demonstrated persistence of the original disease, nine showed no focus of infection, seven developed a focus of infection, and one developed a second focus of infection. No patients with temperatures less than 37.4 C developed significant disease. A regimen for management of patients with pneumococcemia is given.
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10,003,413
An 18-month evaluation of the Akron General Medical Center assault/rape protocol.
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10,003,414
A prospective study of the Akron General Medical Center rape protocol reviewed the examination and follow-up of 60 alleged sexual assault victims. Six of eight examining physicians thought the protocol was too thorough; five of eight believed it took too long. The average time required for an examination was 53 minutes. Three of six nurses experienced technical difficulties with the protocol. Saliva specimens were inadequate in seven cases, and two vaginal swabs contained insufficient material. Thirteen cases reached Summit County Grand Jury, where no medical/legal difficulties with the protocol were encountered during testimony.
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10,003,415
Sexual abuse of children.
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10,003,416
We review the characteristics of 843 cases of sexual abuse seen at the emergency department of the Hospital for Sick Children (HSC) in Toronto in 1962, 1967, and from 1970 to 1978. The children ranged in age from 23 days to 18 years, with a mean age of 9.8 years. Most (89.4%) were girls. The 174 cases seen from 1977 to 1978 were analyzed in detail. Among these, intercourse was the form of abuse in 70 (40%); molestation, in 41 (24%); and exhibitionism, in 36 (20%). Almost half (49%) of the offenses occurred in the child's or assailant's home.
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10,003,417
Persistent hiccups.
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10,003,418
We present the case of a patient who presented with persistent hiccups induced by a hair irritating the tympanic membrane and activating the vagally mediated hiccup neural reflex arc. Commonly identified etiologies and treatments of this condition are then reviewed.
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10,003,419
In defense of plain abdominal radiography.
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10,003,420
Critical care medicine and the emergency physician.
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10,003,421
Progress in acute cardiac care.
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10,003,422
Questions arise over bretylium study.
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10,003,423
[Recent advances in atopic dermatitis (author's transl)].
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10,003,424
[Darier disease in children. Eight case-reports (author's transl)].
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10,003,425
[Epidermal nevus syndrome (Solomon syndrome) in general pediatrics (author's transl)].
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10,003,426
[Granuloma gluteale infantum (author's transl)].
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10,003,427
[Generalized non-bacterial exanthematous pustulosis or generalized pustular psoriasis in children. Two case-reports (author's transl)].
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10,003,428
[Hypodermic scleroderma-like induration of the buttocks and vitamin K1 injections at birth (author's transl)].
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10,003,429
[Pyoderma gangrenosum in a child. Treatment with thalidomide (author's transl)].
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10,003,430
[Introduction (to an issue on pediatric dermatology) (author's transl)].
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10,003,431
[Classification of topical corticosteroids marketed in France (author's transl)].
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10,003,432
[Systemic side-effects of topical preparations in children (author's transl)].
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10,003,433
Post-traumatic disorders of the jaw joint.
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0.004997015465050936, 0.022728247568011284, 0.06067417562007904, -1.713750741316744e-8, -0.011767597869038582, -0.016177816316485405, -0.08514927327632904, -0.08846290409564972, -0.06117982789874077, -0.013121601194143295, -0.0626257136464119, 0.0320865660905838, 0.007051818072795868, -0.01621023193001747, -0.010299780406057835, -0.03198897838592529, -0.06651688367128372, -0.03622117638587952, -0.05612311139702797, -0.08306113630533218, 0.004435177892446518, -0.006666519213467836, -0.009296292439103127, -0.0831192135810852, -0.06110328435897827, -0.020999835804104805, 0.09825177490711212, 0.02146485634148121, -0.02781861275434494, 0.05330663546919823, 0.03453497216105461, 0.06308671087026596, -0.05548717826604843, 0.033686038106679916, -0.013525708578526974, 0.048288825899362564, -0.07086127251386642, -0.05765671655535698, -0.061576493084430695, -0.02080858312547207, 0.059766821563243866, -0.027369733899831772, -0.009196881204843521, -0.00528211984783411, -0.01077868789434433, 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10,003,434
A group of 165 patients with surgical diseases of the temporomandibular joint treated in 3 Australian university hospitals is reviewed. A facial trauma is relatively common patients have been included in the post-traumatic group only if there was an undisputed history of injury requiring medical or dental treatment or admission to hospital. In 38.3% of patients with histologically proven osteoarthritis there was an undisputed history of trauma. In a further group with recurrent mandibular dislocation 62.6% were post-traumatic. Trauma was the cause of 62.5% of cases of mandibular ankylosis. There is a general tendency to underdiagnose degenerative joint disease and to perpetuate conservative treatment when it is crystal clear that these measures are not being successful. It is probable that intracapsular fractures of the jaw joint are frequently undiagnosed and a higher index of suspicion is required. Mandibular ankylosis continues to pose some difficulty of management and a critical review confirms that wide surgical exposure of the joint is essential; the importance of long-term review is stressed. The outcome of the surgical treatment of recurrent luxation is excellent and an operation of commendable simplicity is advocated.
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10,003,435
A decade of missile-induced vascular trauma.
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10,003,436
During 10 years of serious strife the Royal Victoria Hospital, Belfast, has dealt with trauma inflicted by a wide variety of missiles. Injuries involving 316 vessels were sustained by 192 patients. A group of "knee-cappings' accounted for a large proportion of popliteal vessel injuries. A majority of patients also suffered damage to other regions of the body. Hypotension was a notable feature and several patients arrived in extremis, particularly those with injuries to a major vessel trunks and vital organs. The benefits of rapid evacuation in relation to ischaemia time are discussed. The operative management of a wide range of arterial and venous injuries is described. The use of simple and compound vein grafts allowed adequate excision of damaged vessels. The advantages of meticulous repair, timely fasciotomy, and early reintervention are reflected in the results, contributing to the small lower-lib amputation rate of 5.1%.
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10,003,437
Performance of low-pressure cuffs. An experimental evaluation.
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10,003,438
A study was carried out in vitro to determine the minimum intracuff pressure needed to produce no-leak ventilation and prevent aspiration in Portex Profile and Searle Medical Sensiv endotracheal tubes. The mean pressures required to produced no-leak ventilation were 4.16 and 1.06 kPa respectively and the mean pressures at which aspiration occurred were 2.93 and 0.54 kPa respectively. The implications of these findings are discussed and recommendations are made regarding cuff specifications.
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10,003,439
Early closure of transverse loop colostomies.
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10,003,440
A transverse loop colostomy was constructed in 60 patients at the time of primary elective surgery and the stoma was then resected within one month under antibiotic cover. There was a single death unrelated to operation. Four patients developed faecal leakage, 1 became obstructed, and 6 had infected wounds. With the exception of colostomy closure following sutured coloanal anastomosis a transverse loop colostomy can be closed within one month of construction with acceptable morbidity.
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10,003,441
Operative cholangiography.
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10,003,442
Possible waterborne transmission and maintenance of influenza viruses in domestic ducks.
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10,003,443
Two duck farms in Hong Kong were examined monthly for 1 year for the occurrence and persistence of influenza viruses within the duck communities. The predominant virus in one community was H3N2, a virus antigenically related to the pandemic Hong Kong strain. This virus was isolated monthly throughout the year from feces or pond water or both, indicating a cycle of waterborne transmission. Viruses of the same antigenic combination were isolated 1 and 2 years after the last sampling occasion, implying persistence in the community. Infection was asymptomatic. Maintenance of virus appeared to be dependent upon the continual introduction of ducklings susceptible to infection onto virus-contaminated water; the feces of ducks 70 to 80 days old were generally free of detectable virus despite the exposure of the ducks to virus in pond water. In the second community, in which ducklings were not introduced after the initial sampling, the prevailing viruses, H7N1 and H7N2, also present asymptomatically, ceased to be detected once the ducks were 70 to 80 days old. The normal practice of raising ducks of different ages on the same farm, wherein the water supplies are shared, as typified by the first community, appears to be instrumental in maintaining a large reservoir of influenza viruses in the duck population of southern China.
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10,003,444
Development of a two-step enrichment procedure for recovery of Yersinia enterocolitica from food.
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10,003,445
Two new enrichment media were formulated for the recovery of Yersinia enterocolitica from foods: (i) yeast extract-rose bengal broth for preenrichment at 4 or 10 degrees C; and (ii) bile-oxalate-sorbose broth, a selective enrichment incubated at 22 degrees C. Comparison of these media in a two-step enrichment procedure against cold enrichment and modified Rappaport broth showed improved and more rapid recovery of human strains of Y. enterocolitica from inoculated foods. The use of bile-oxalate-sorbose broth as a selective enrichment also improved the performance of cold enrichment with phosphate-buffered saline. Determination of the best enrichment system for recovery of Y. enterocolitica from samples of retail pork and fresh pork tongues depended on whether the criterion was the number of positive samples, the variety of different serotypes recovered, or the ability to recover the important human serotype O:3. A single enrichment system with the widest selectivity would include preenrichment at 4 degrees C with either phosphate-buffered saline for 14 days or yeast extract-rose bengal broth for 9 days followed by selective enrichment with bile-oxalate-sorbose broth at 22 degrees C for 5 days.
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10,003,446
Isolation of a bile salt sulfatase-producing Clostridium strain from rat intestinal microflora.
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10,003,447
Bile acid sulfates, formed in human and rat livers, are desulfated by the intestinal microflora. In our study we first isolated from conventional rat feces an unnamed bacterium, termed strain S1, which desulfated the 5 beta-bile salt 3 alpha-sulfates in vitro and in vivo after association with gnotobiotic rats. Strain S1 also possessed 12 alpha-hydroxysteroid dehydrogenase and bile salt-deconjugating activities. The strain was a strict anaerobic, CO2-requiring, gram-negative, sporeforming rod and was designated as belonging to the genus Clostridium. Growth was scarce in culture media, unless in the presence of 0.1% taurine, a sulfur-containing amino acid. Addition of this substance raised the number of bacteria in thioglycolate and peptone yeast media from 10(4) per ml to 10(6) to 10(7) per ml and increased the colony diameter on agar medium from 0.2 mm to 0.5 to 0.9 mm. Sulfatase activity was specific for the 5 beta-bile salt sulfates, leaving the 5 alpha-bile salt sulfates unchanged. In addition, the sulfatase activity was cell bound, and its production was dependent on the composition of the culture medium, although no minimal sulfur medium was required for sulfatase activity.
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10,003,448
Detection and quantitation of Newcastle disease virus proteins in infected chicken embryo cells.
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10,003,449
A technique was analyzed by which Newcastle disease virus (NDV) proteins could be quantitatively detected in the presence of chicken embryo cellular proteins in NDV-infected cells. The technique involved removal of electropho-proteins from a sodium dodecyl sulfate-polyacrylamide-agarose gel matrix by chemical cleavage of the acrylamide gel cross-linker. The proteins were subsequently transferred and covalently bound to diazobenzyloxymethyl paper. By incubating the paper with unlabeled antisera and 125I-labeled Staphylococcus aureus protein A, the specificity of the antisera and the sensitivity of this method of quantitative antigen detection were tested. The results demonstrated that as little as 1 ng of an individual NDV protein could be detected. Furthermore, this technique can simultaneously quantitate the synthesis of multiple NDV proteins under experimental conditions in which immunofluorescence, hemadsorption, and plaque assays failed to show virus protein synthesis or the formation of virus progeny.
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10,003,450
Failure of Legionella pneumophila sensitivities to predict culture results from disinfectant-treated air-conditioning cooling towers.
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10,003,451
The disinfection of cooling towers based on manufacturers' treatment protocols, as employed in units installed at various public gathering places in Dallas, Tex. (hotels, municipal auditorium), and at the city health department, was evaluated for effectiveness in controlling Legionella pneumophila and compared with previous laboratory studies. In specimens collected in September and December, 1978, L. pneumophila was isolated from 2 of 4 specimens from untreated cooling towers, 2 of 4 specimens from towers treated with agents deemed ineffective in earlier laboratory tests, 6 of 11 specimens from towers treated with putatively effective agents, and 0 of 4 specimens from towers treated with an agent unknown efficacy. These results suggest the need for further studies to identify biocidal agents effective in eliminating L. pneumophila from air-conditioning cooling towers.
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10,003,452
Inactivation of Giardia cysts by chlorine.
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10,003,453
Cysts of Giardia lamblia from symptomatic and asymptomatic carriers had similar resistances to chlorination.
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10,003,454
Comparison of coliphage and bacterial aerosols at a wastewater spray irrigation site.
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10,003,455
Microbiological aerosols were measured on a spray irrigation site at Fort Huachuca, Ariz. Indigenous bacteria and tracer bacteriophage were sampled from sprays of chlorinated and unchlorinated secondary-treatment wastewaters during day and night periods. Aerosol dispersal and downwind migration were determined. Bacterial and coliphage f2 aerosols were sampled by using Andersen viable type stacked-sieve and high-volume electrostatic precipitator samplers. Bacterial standard plate counts averaged 2.4 x 10(5) colony-forming units per ml in unchlorinated effluents. Bacterial aerosols reached 500 bacteria per m3 at 152 m downwind and 10,500 bacteria per m3 at 46m. Seeded coliphage f2 averaged 4.0 x 10(5) plaque-forming units per ml in the effluent and were detected 563 m downwind. Downwind microbial aerosol levels were somewhat enhanced by nighttime conditions. The median aerodynamic particle size of the microbial aerosols was approximately 5.0 micrometer. Chlorination reduced wastewater bacterial levels 99.97% and reduced aerosol concentrations to near background levels; coliphage f2 was reduced only 95.4% in the chlorinated effluent and was readily measured 137 m downwind. Microbiological source strength an meteorological data were used in conjunction with a dispersion model to generate mathematical predictions of aerosol strength at various sampler locations. The mean calculated survival of aerosolized bacteria (standard plate count) in the range 46 to 76 m downwind was 5.2%, and that of coliphage f2 was 4.3 %.
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10,003,456
The role of electron microscopy in the management of surgical patients.
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10,003,457
This report records a 12-month experience with 49 neoplasms submitted to the hospital pathologists for electron microscopic (EM) diagnosis as a part of routine clinical surgical practice. Twenty-five specimens were from a private community hospital and 24 from a university hospital. In 40 of 49 cases (82%), EM confirmed a tentative light microscopic (LM) diagnosis. In 11 of these 40 cases, EM provided a more specific histogenetic diagnosis than was possible by LM. In three cases (6%), EM corrected the original LM diagnosis. In two cases EM did resolve a diagnostic dilemma. EM is a beneficial adjunct to the correct diagnosis of selected tumors. Although in general EM does not help differentiate benign from malignant tumors, it is helpful in identifying the cell of origin of poorly differentiated neoplasma. A more precise histogenetic diagnosis was judged to be clinically helpful in 56% of th cases studied in this experience. EM is a relatively inexpensive ($115-250) and prompt (three to five days) adjunct to surgical care. It should be routinely available to the practicing surgeon for help in determining the cell type of confusing tumors. EM is no longer simply a research tool.
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10,003,458
Effect of postoperative nutrition on muscle high energy phosphates.
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10,003,459
This study examines the effect of hypocaloric nutritional regimens on muscle high energy phosphates in normal subjects and patients following total hip replacement. Eighteen patients undergoing total hip replacement and 11 normal subjects on a four-day period of bedrest were studied. The patients were randomly assigned to receive either: (1) 90 gms/day glucose; (2) 70 gms/day amino acids; or (3) 90 gms/day glucose + 70 gms/day amino acids. A percutaneous muscle biopsy was performed before operation and on the morning of the fourth day after operation. Samples were analyzed for adenine triphosphate (ATP), adenine diphosphate (ADP), adenine monophosphate (AMP), phosphocreatine (PC), free creatine (CR), lactate, and pyruvate. Normal subjects were assigned to receive either: (1) 90 gms/day glucose; (2) 70 gms/day amino acids; or (3) no caloric intake. The patients receiving amino acid alone demonstrated a decrease in ATP, ADP, and PC, while AMP and free creatine rose. No significant changes were seen in patients who received 90 gms/day glucose either with, or without, amino acids. There were also no significant changes in any of the normal subjects. These results suggest that a series of metabolic changes occur in skeletal muscle following injury such that small amounts of glucose are important for maintenance of cellular energy levels.
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10,003,460
Implications of leukocytosis and fever at conclusion of antibiotic therapy for intra-abdominal sepsis.
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10,003,461
Outcomes of 65 patients after operation who had exhibited a clinical response to treatment for intra-abdominal sepsis were compared based on the presence or absence of leukocytosis and fever at the conclusion of antibiotic therapy. Fifty-one patients were afebrile when antibiotics were stopped. Intra-abdominal infection developed in 7 of 21 (33%) who had a persistent leukocytosis, but no intra-abdominal infections developed after operation in 30 patients who had normal WBC counts at the end of antibiotic treatment (p less than 0.005). Nosocomial infections developed in 6 (12%) of the 51 patients, and there was no difference in the incidence between patients with or without leukocytosis. Eleven of 14 (79%) patients who were still febrile when antibiotics were discontinued developed infections after operation. Nosocomial infections occurred in three (21%) and intra-abdominal infections in eight (57%). Of the 15 patients who developed intra-abdominal infection after operation, only four responded to appropriate antibiotic treatment without requiring further surgery. The other patients required surgical management for definitive control within two months of the initial operation. In conclusion, patients at risk of developing infection after operation after exhibiting a clinical response to treatment of intra-abdominal sepsis are those who are afebrile with a persistent leukocytosis or who are still febrile when antibiotics are stopped.
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10,003,462
A rational approach to surgery of the chronic venous statis syndrome.
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10,003,463
Ambulatory venous pressure (AVP) and ascending and retro-grade phlebography have been used to elucidate the precise pathogenetic factors in cases of venous stasis. On the bases of this information, procedures aimed at the correction of the particular pathophysiological alterations were carried out. Fifty-two lower extremities in 49 patients suffering from chronic venous statis were studied. The AVP was performed by having the patient walk in place for 15 seconds without tourniquet and with one or two tourniquets at different levels of the extremity. The per cent drop of pressure in a foot vein during exercise and the time to return to standing pressure were used to determine a venous sufficiency index. Four distinct factors or groupings could be distinguished: incompetent perforators (31), deep vein incompetence (14), incompetence of the saphenous vein (3), and obstruction of deep veins (4). Six types of surgical procedures were done: ligation of perforators (25), superficial femoral valvuloplasty (3), segmental venous transposition (1), ligation of the superficial femoral vein (1), cross femoral venous bypass (1) and high ligation and stripping of the long saphenous vein (3). Three patients had skin sloughing after perforator ligation, and one patient developed a hematoma requiring evacuation following segmental venous transfer. Post-operative AVP evaluation in 11 patients after perforator ligation, two patients following superficial femoral valvuloplasty, one patient after segmental venous transfer, and one patient after cross femoral venous bypass showed significant improvement. Early follow-up results are very satisfactory.
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10,003,464
Prognostic factors for melanoma patients with lesions 0.76 - 1.69 mm in thickness. An appraisal of "thin" level IV lesions.
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10,003,465
Fourteen variables were tested for their prognostic usefulness in 203 patients with clinical Stage I melanoma and primary tumor 0.76-169 mm thick. Only two variables, primary tumor location and level of invasion, were useful in predicting death from melanoma for these patients. Of the 12 deaths from melanoma, 11 occurred in patients with primary tumors located on the upper back, posterior arm, posterior neck, and posterior scalp (=BANS). There has been only one death from melanoma in 136 patients with melanoma located at other sites (11/67 vs 1/136, p less than 0.0001 Fisher's Exact Test). Of the 67 BANS patients, 51 had level II or level III lesions and five (10%0 died of melanoma. This compared with six deaths from melanoma in 16 patients (37.5%) with level IV BANS lesions (5/51 vs 6/16, p = 0.01 Fisher's Exact Test). The relatively high incidence of both melanoma deaths and regional node metastases for the BANS group merits consideration for testing the efficacy of elective regional node dissection for these patients.
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10,003,466
Prognostic factors for patients with clinical stage I melanoma of intermediate thickness (1.51 - 3.39 mm). A conceptual model for tumor growth and metastasis.
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10,003,467
Fourteen variables were tested for their ability to predict visceral or bony metastases in 177 patients with clinical Stage I melanoma of intermediate thickness (1.51 - 3.39 mm). A Cox multivariate analysis yielded a combination of four variables that best predicted bony or visceral metastases for these patients: 1) mitoses greater than 6/min 2 (p = 0.0007), 2) location other than the forearm of leg) p = 0.009, 3) ulceration width greater than 3 mm (p = 0.04), 4) microscopic satellites (p = 0.05). The overall prognostic model chi square was 32.40 with 4 degrees of freedom (p less than 10 (-5). Combinations of the above variables were used to separate these patients into at least two risk groups. The high risk patients had at least a 35% or greater chance of developing visceral metastases within five years, while the low risk group had greater than an 85% chance of being disease free at five years. Criteria for the high risk group were as follows: 1) mitoses greater than 6/mm 2 in at least one area of the tumor, irrespective of primary tumor location, or 2) a melanoma located at some site other than the forearm or leg and histologic evidence in the primary tumor of either ulceration greater than 3 mm wide or microscopic satellites. The low risk group was defined as follows: 1) mitoses less than or equal to 6/mm 2 and a location on the leg or forearm, or 2) mitoses less than or equal to 6/mm 2 and the absence in histologic sections of the primary tumor of both microscopic satellites and ulceration greater then 3 mm wide. The number of patients in this series who did not undergo elective regional node dissection (N = 47) was probably too small to detect any benefit from this procedure. Based on survival rates from this and other studies, it is estimated that approximately 1500 patients with clinical Stage I melanoma of intermediate thickness in each arm of a randomized clinical trial would be needed to detect an increase in survival rates from elective regional node dissection.
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10,003,468
Effect of the surgical clerkship on student perception of essential skills and self-assessed abilities.
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A multivariate analysis of prognostic factors for melanoma patients with lesions greater than or equal to 3.65 mm in thickness. The importance of revealing alternative Cox models.
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10,003,470
Fourteen prognostic factors were examined in 79 patients with clinical Stage I melanoma greater than or equal to 3.65 mm in thickness. All nine patients with melanoma of the hands or feet died of melanoma. A Cox proportional hazards (multivariate) analysis of the remaining 70 patients showed that a combination of the following four variables best predicted bony or visceral metastases: 1) a nearly absent or minimal lymphocyte response at the base of the tumor, 2) histologic type other than superficial spreading melanoma, 3) location on the trunk, and 4) positive nodes or no initial node dissection. Ulceration and/or ulceration width were not useful in predicting outcome either singly or in combination with other variables. Patients with negative lymph nodes and primary tumors of the trunk, hands, and feet did not do better than patients with positive nodes at those sites. Conversely, non of 16 patients with negative lymph nodes and extremity melanomas (excluding the hands and feet) or head and neck melanomas developed visceral or bony metastases (i.e., five-year disease-free survival rate 100%).
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10,003,471
The effect of burn wound size on ureagenesis and nitrogen balance.
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-0.011545157991349697, 0.060761213302612305, -0.03915535658597946, 0.003979431465268135, -0.07973360270261765, -0.010138506069779396, 0.03452421352267265, -0.054536689072847366, 0.02541072480380535, 0.06224607303738594, -0.03984847664833069, -0.051312848925590515, -0.02261776477098465, 0.013742459006607533, -0.02966858074069023, 0.11359836161136627, 0.02255954034626484, 0.12147574126720428, 0.04023806005716324, 0.08885108679533005, -0.06898374855518341, -0.014428120106458664, 0.03071756474673748 ]
10,003,472
Hypermetabolic burn patients are frequently in negative nitrogen balance despite provision of estimated caloric needs. We studied 18 thermally injured adult patients in order to evaluate the relationship of burn wound size to urea production and nitrogen balance. We selected data from 147 patient-days when the patients received 100 +/- 25% of their estimated caloric needs. Three significantly different burn size groups (by body surface area [BSA]) were identified by calculation of the catabolic index (CI): group 1, 0-10% BSA (CI = -0.1); group 2, 11-30% BSA (CI = 6.4); and group 3,31-60% BSA (CI = 10.5). The urine urea nitrogen (UUN) for groups 1,2, and 3 was 11.1, 18.9, and 25.3 gm/day, and nitrogen balance was 1.0, -3.9, and -5.8 gm/day, respectively. When nitrogen was given in a calorie:nitrogen ratio of 150:1, only those patients in group I were able to achieve positive balance. We conclude that large burn wounds are associated with increased ureagenesis and impaired nitrogen retention. The protein intake, at the customary calorie:nitrogen ratio of 150:1, may not provide adequate nitrogen to achieve equilibrium, even when energy demands have been met, in patients with burn wounds greater than 10% BSA.
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10,003,473
Plasma and skeletal muscle amino acids following severe burn injury in patients and experimental animals.
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10,003,474
This study describes and analyzes sequential changes in plasma and skeletal muscle free amino acids following severe burn injury. Plasma free amino acids were determined in children (n = 9) with burns averaging 60% total body surface area and were compared with laboratory beagles (n = 44) which received a flame burn totaling 30% of their body surface area. In addition, needle biopsy specimens were obtained from the semitendonosus muscle in the animals to determine free intracellular amino acids. In both patients and animals the amount of total free amino acids in plasma fell following burn, suggesting relative protein deficiency. This drop was primarily due to a 47% drop in nonessential amino acids. However, plasma phenylalanine was consistently higher than normal following burn, and was strongly associated with death and weight loss in both animals and patients, especially when analyzed as a ratio with tyrosine. This finding suggested excessive catabolism, hepatic dysfunction, or both. Plasma levels of several amino acids correlated significantly with weight loss. Alterations in muscle free amino acids generally were similar to plasma amino acids. Exceptions were muscle alanine and glycine which strongly correlated with weight loss. However, the determination of muscle free amino acid profiles did not yield clinically useful information not available from plasma profiles. Plasma levels of liver enzymes suggested progressive hepatic dysfunction. These studies show that the laboratory beagle is a good model for studying the metabolic alterations of amino acids that accompany burn injury, since they mimic humans in many parameters which appear to be most useful with respect to clinical evaluation.
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10,003,475
Evaluation of results of surgical procedures in the elderly.
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10,003,476
Authorities are not in full agreement in regard to risk of surgery in the elderly. One hundred eight studies of surgery in the elderly over the past 40 years were reviewed. The purpose was not merely to tabulate results, but to identify differences existing between reports with regard to data reported that could affect results independent of the surgical management itself. Sources of variance that need to be taken into account in comparing mortality rates between studies, such as whether mortality was computed by number of patients or operations, differing lengths of follow-up for recording mortality, proportions of emergency versus elective operations, and types of surgical procedures, were documented. A nine-item confidence in results scale was used to classify studies into high and low confidence groups. Surgical specialties scored substantially higher than general surgical studies. More recent studies received higher scores than earlier studies. Although mortality rates varied widely depending on methods of their calculation, there appeared to be a trend toward increases in elective, but not emergency, mortality rates in general surgery since 1941 that should be examined more closely. One thing that cannot be answered clearly from these studies is the relative risk of surgery with age. Some control of variations between studies and standardization of reporting surgical deaths are required before risk of surgery in the elderly can be assessed more accurately.
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10,003,477
Acute acalculous cholecystitis. An increasing entity.
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10,003,478
Acute acalculous cholecystitis was observed to increase in frequency between 1950 and 1979, an increase that was statistically significant. The greatest part of this increase occurred between 1965 and 1979. Acute acalculous cholecystitis was also found to be associated with a higher mortality rate, more than twice that of acute calculous cholecystitis. Acute acalculous cholecystitis occurred in a variety of clinical settings including bacterial sepsis, severe trauma including surgical trauma and burns, multiple transfusions, and severe debilitation. The lesion in the gallbladder consists of intense injury of blood vessels in the muscularis and serosa similar to those induced experimentally by in vivo activation of factor XII dependent pathways. Possibly because of the intensity of vascular injury, acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Undelayed surgical treatment, which has become more widely accepted over the past 50 years, is essential. It may have also contributed to the increased recognition of this clinical entity.
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0.05045301094651222, 0.011625704355537891, 0.07642456889152527, 0.03202424943447113, 0.02478177659213543, -0.07311519980430603, -0.046345487236976624, -0.01439916156232357, -0.03158332034945488, -0.02369716577231884, -0.048937201499938965, -0.01949070394039154, 0.046319253742694855, 0.048022471368312836, -0.009834413416683674, 0.042632538825273514, 0.06803148984909058, 0.023030729964375496, 0.03307347372174263, 0.04515356197953224, 0.10962377488613129, 0.03319579362869263, 0.03915303200483322, -0.07910104840993881 ]
10,003,479
Factors in management of acute cholangitis.
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10,003,480
Ninety episodes of acute cholangitis in 66 patients have been analyzed. In 71% of the episodes, an operation was performed. Eight deaths occurred, for a patient mortality rate of 12%. Sixty-seven per cent of the operations were performed after at least 72 hours of antibiotic therapy, whereas only 17% had to be done as life-threatening emergencies within 24 hours of admission to the hospital. Although 86% of the operative deaths occurred in the group operated on more than 72 hours after admission, this was not statistically significant. However, death did correlate with failure to respond to antibiotic therapy (p less than 0.001) irrespective of time of operation. Biliary cancer and congenital lesions were etiologic for 31% of the operative cases in this series, but were responsible for 71% of the postoperative deaths (p less than 0.05). We conclude that acute cholangitis has a wide spectrum of severity and that most cases will respond to antibiotic therapy, affording the surgeon the luxury of operating in an elective fashion. Moreover, acute cholangitis complicated by failure to respond to antibiotic therapy is more likely to occur in biliary cancer and congenital lesions, and subsequently will have a poorer prognosis.
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10,003,481
Esophagogastrectomy for adenocarcinoma of the cardia. Ten years' experience and current approach.
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10,003,482
During a 10-year period, 94 surgical resections for adenocarcinoma of the cardia (75 "curative" and 19 palliative) were performed using three primary approaches: Group I (46 curative, 14 palliative), esophagogastrectomy performed through a left thoracotomy or left thoraco-abdominal incision; Group II (17 curative, 4 palliative), resection done through two separate incisions (abdominal and thoracic) with delayed reconstruction between two and three months later; and Group III (12 curative, 1 palliative), resection, also through abdominal and thoracic incisions, with simultaneous reconstruction. Operative mortality in the 75 procedures done for cure was 19.5%, 18%, and 8.3% in Groups I, II, and III, respectively. Microscopic residual tumor at the line of resection was 56%, 12%, and 8%. Free margins less than 3 cm had the same local recurrence rate (21%, 6%, and 8%) within 18 months as did margins with residual microscopic tumor. The length of time from operation to first regular meal was 12, 110, and 7 days, respectively. Wide resection with subtotal esophagectomy and simultaneous reconstruction is advocated.
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10,003,483
Adenocarcinoma of the ampulla of Vater. Diagnosis and treatment.
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10,003,484
Fifty-one patients underwent operation for adenocarcinoma of the ampulla of Vater. Seven patients underwent palliative bypass, with an operative mortality of 28.6%; 44 additional patients underwent potentially curative pancreaticoduodenal resection (PDR), with an operative mortality of 15.9%. Postoperative complications occurred in 63% of patients. Postoperative gastrointestinal bleeding was observed in 11 of 44 patients who underwent PDR (25%). Although anastomotic ulcers (AU) were directly implicated in five cases (45%), the 12% incidence of AU-related bleeding among 33 patients who underwent PDR without truncal vagotomy (TV) was not significantly different from the 9% incidence observed in 11 patients who underwent PDR plus TV. However, performance of TV appeared to result in a higher incidence of postoperative pulmonary complications. Five patients who underwent curative resection survived for five years (11%). Only one of seven patients who underwent palliative bypass survived three years (14%), and none survived to five years. Acceptable survival rates following resectional therapy warrant an aggressive approach to this tumor. Further, our experience suggests that TV may increase postoperative patient morbidity without actually providing any protection from anastomotic ulceration.
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10,003,485
A prospective analysis of laboratory tests and imaging studies to detect hepatic lesions.
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10,003,486
A prospective study of the ability of laboratory tests and liver imaging tests to detect hepatic metastases was performed. Eighty patients at risk for hepatic metastases but without clinical evidence of disease were tested with 13 laboratory tests and three liver imaging tests. No single laboratory test had greater than 65% accuracy in the detection of hepatic lesions. No combination of the laboratory tests increased this accuracy. If the laboratory tests were used with one of the liver imaging tests, the accuracy was improved in some combinations to 76%. The CEA assay when analyzed in patients with colorectal primaries had an accuracy of 79%. The results show that the laboratory tests alone are not sufficiently accurate to detect liver metastases. Additional accuracy can be obtained by the combined use of a single liver imaging test and selected laboratory tests. Use of all the liver imaging tests and laboratory tests lowers the accuracy and increases the expense and thus is unnecessary.
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10,003,487
The role of antibiotic bonding in the prevention of vascular prosthetic infections.
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10,003,488
Oxacillin, a negatively charged antibiotic, was bonded to polytetrafluoroethylene (PTFE) grafts using the cationic surfactant, benzalkonium chloride. Control PTFE grafts and bonded grafts prepared at room temperature and at 90 C were placed in the infrarenal aorta of dogs and challenged by local contamination with Staphylococcus aureus. Bonded grafts were superior to controls in negative cultures, patency, and survival. The possible role of antibiotic bonding in the prevention of vascular prosthetic infection is discussed.
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10,003,489
The importance of splenic blood flow in clearing pneumococcal organisms.
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10,003,490
Overwhelming infection from encapsulated bacteria occurs after splenectomy. Decreases in IgM, tufsin, and serum opsonin are known to occur in animals and humans after splenectomy. A substantial immunologic advantage exists if some splenic tissue remains, but this may not offer sufficient protection from encapsulated bacteria if splenic arterial blood flow is reduced. This experiment was designed to examine the rate of pneumococcal clearance by the spleen and to determine the relationship between splenic blood flow and splenic tissue mass in bacterial clearance from the blood. Pneumococcal clearance, splenic blood flow, and residual splenic weight were measured in 171 rabbits with normal spleens, ligated splenic arteries, splenic autotransplants, hemisplenectomies, and splenectomies. Interruption of the splenic artery results in delayed pneumococcal clearance that is due to reduced blood flow and not to a decrease in splenic tissue mass. Splenic artery ligation to preserve an injured spleen cannot be assumed to give protection from sepsis.
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10,003,491
Candida infections in surgical patients. Dose requirements and toxicity of amphotericin B.
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10,003,492
The natural history of candidiasis in general surgical patients has been poorly documented, and the toxicity of amphotericin B is widely heralded. For these reasons therapy for candidiasis is frequently withheld in situations where antimicrobial treatment seems indicated on clinical grounds. The clinical courses of 47 general surgical patients who received amphotericin therapy for presumed Candida infection were reviewed. Nineteen patients had had solid tumors, but 12 were either localized or resected tumors. Only nine patients had received prior cancer themotherapy. Twenty-one patients were treated for fungemic disease, 10 for Candida in peritonitis fluid, and 16 for apparent colonization associated with fever and organ failure syndromes. Pre-existing renal or other organ failure was the primary determinant of survival with 4/22 survivors (18%) in patients with renal failure compared with 17/25 (78%) survivors in patients without such organ failure. In patients with serum creatinine values less than 2.5 mg/dl, amphotericin therapy was associated with a transient 30% fall in creatinine clearance and a proportionate rise in serum creatinine. Dose response curves were determined and revealed substantial sterilization of cultures in both fungemic and nonfungemic patients receiving greater than or equal to 6 mg/kg. This was confirmed by autopsy material. We suggest that in this acutely ill patient popoulation uncontrolled infection is the primary determinant of organ failure. Short-term limited dosing with amphotericin B (6-8 mg/kg total dose) in conjunction with appraisal of clinical response is adequate therapy for most presumed Candida infections. Long-term high dose therapy, such as that recommended in immuodepressed patients, is not a routine necessity.
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10,003,493
Esophageal perforations after forceful dilatation in achalasia.
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10,003,494
The reported incidence of esophageal perforation after forceful dilatation in achalasia is between 1-5%. Over the past nine years we have treated five patients with this complication. After demonstrating the perforation with a Gastrografin swallow, a left posterolateral thoracotomy is made. The full-thickness laceration is sutured in two layers. A Heller esophagocardiomyotomy is then performed on the contralateral side of the esophagus. The muscular layer on either side of the esophagocardiomyotomy is mobilized well so as to allow easy closure of the outer muscular layer of the esophagus in the area of the laceration. There were no deaths and minimal morbidity in these five patients, and functional results were excellent. It is concluded that perforations of the esophagus after dilatation in achalasia should be operated on promptly and undergo closure of the laceration with a complimentary esophagocardiomyotomy.
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10,003,495
Surgical aspect ot cystic dilatation of the bile duct. An anomalous junction of the pancreaticobiliary tract in adults.
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10,003,496
Twenty-two cholangiograms of adults with congenital dilatation of the common bile duct were studied and analyzed. Diagnosis of this disease was established by endoscopic retrograde cholangiopancreaticography in nine patients, by percutaneous transhepatic cholangiography in two patients, and by operative cholangiography in 11 patients. All patients, except one with Caroli's disease, were classified as type I according to Alonso-Lej. An anomalous junction of the pancreaticobiliary ductal system (AJPBDS) was observed in 15 cases. In nine patients the common bile duct joined the main pancreatic duct, and in the remaining six patients, the pancreatic duct was noted to join the common bile duct. These anomalies are considered to be an important etiologic factor in the development of choledochal dilatation. Total cyst excision and hepaticojejunostomy in a Roux-en-Y fashion is recommended as the procedure of choice in those cases with AJPBDS. This is based on the high incidence of cholangitis and the high propensity to induce malignancy of cystic wall following simple drainage.
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10,003,497
The occurrence of severe epithelial dysplasia and its bearing on treatment of longstanding ulcerative colitis.
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10,003,498
One hundred twenty-four patients with extensive ulcerative proctocolitis were operated upon with proctocolectomy. The mean observation time was 10.3 years. Before surgery rectal biopsies were taken in all patients. The relationship between precancerous lesion in rectal biopsies and the presence of precancer and/or cancer in the rectum or colon in the removed specimen was evaluated. Thirteen out of 14 patients showed evidence of severe rectal dysplasia as well as severe dysplasia in the large bowel specimen, and five of these patients had a carcinoma as well. The 14th patient showed severe dysplasia only in the rectum as well as a rectal carcinoma. Of 110 patients without severe rectal dysplasia, 36 showed evidence of severe colon dysplasia, and three of these patients had a large bowel carcinoma as well. Only one patient had a large bowel carcinoma without evidence of severe dysplasia in the rectum or colon. Thus, nine patients out of ten with large bowel carcinoma showed severe dysplasia in rectum and/or colon. Four of these carcinomas were unknown before surgery. Although severe dysplasia in the rectal biopsy is a strong indication of a large bowel carcinoma (6/14), a negative rectal biopsy does not exclude a large bowel carcinoma (4/110). Proctocolectomy cannot be looked upon only as a prophylactic procedure in patients with severe dysplasia in the rectal biopsy, but also as an attempt to curative surgery, as large bowel carcinoma may have already developed in a considerable number of patients where precancer is diagnosed in biopsies.
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10,003,499
Caloric requirements in patients with inflammatory bowel disease.
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