Perioperative mortality risk score using pre- and postoperative risk factors in older patients.

We developed a risk score for 30-day postoperative mortality: the Perioperative Mortality risk score. We used a derivation cohort from a previous study of surgical patients aged 70 years or more at three large metropolitan teaching hospitals, using the significant risk factors for 30-day mortality from multivariate analysis. We summed the risk score for each of six factors creating an overall Perioperative Mortality score.

The Effect of Preoperative Aspirin and/or Heparin Therapy on Coagulation and Postoperative Blood Loss after Coronary Artery Bypass Surgery.

Objective: To assess the effects of preoperative aspirin and/or intravenous heparin therapy on perioperative coagulation tests and postoperative blood loss for 24-hour after coronary artery bypass surgery.

Methods: Multiple conventional coagulation tests, activated clotting time, thrombelastograph, skin bleeding time and platelet aggregation were performed before induction of anaesthesia, following protamine administration and after skin closure in 45 patients.

Results: There was no significant difference in either coagulation tests or postoperative blood loss (median of 860 mL with a range of 275 to 2800 mL, versus 833 ml with a range of 500-1380 mL) between the aspirin and no-aspirin patients.

The epidemiology of major early adverse physiological events after surgery.

Objective: To study the incidence of major post-operative adverse physiological events in a tertiary hospital.

Methods: Non-cardiac, surgical in-patients were studied for the first three post-operative days. Daily assessment was by patient visit, chart review and laboratory result analysis.

Effect of an anaesthesia department led critical care outreach and acute pain service on postoperative serious adverse events.

Unlabelled: We examined whether a combined critical care outreach and acute pain service comprising both medical and nursing staff from the Department of Anaesthesia would decrease the incidence of postoperative serious adverse events in a hospital with an established Medical Emergency Team. We called this combined service

Impact: Inpatient Management of acute Pain and Advice on Clinical Treatment. We conducted a prospective, before-and-after trial with a baseline phase (319 patients) of standard acute pain management followed by the IMPACT phase (271 patients), during which the IMPACT team systematically reviewed high-risk postoperative patients for the first three days after their return to the general wards.

The effect of critical care outreach on postoperative serious adverse events.

We proposed that critical care outreach would decrease the incidence of postoperative serious adverse events and so conducted a sequential cohort study with a surveillance-only phase (baseline) followed by an intervention phase. We studied high-risk patients in a large Australian hospital. A critical care qualified nurse reviewed patients for the first three days after return to the general wards.

Changes in plasma creatinine concentration after cardiac anesthesia with isoflurane, propofol, or sevoflurane: a randomized clinical trial.

Background: Renal impairment often follows cardiac surgery. The authors investigated whether sevoflurane produces greater increases in plasma creatinine concentration than isoflurane or propofol after elective coronary artery surgery.

Methods: As part of maintenance anesthesia, including during cardiopulmonary bypass, patients were randomly allocated to receive one of three agents: isoflurane (n = 118), sevoflurane (n = 118), or propofol (n = 118).

Prediction of the mediastinal drainage after coronary artery bypass surgery.

Using multiple correlation and linear regression approaches, we investigated the association between the amount of mediastinal drainage for the first 24 postoperative hours and clinical variables as well as multiple haematological tests performed at three time points: before anaesthesia induction, 10 minutes after protamine administration and just after skin closure, on 46 patients undergoing primary coronary artery bypass grafting. Three models from the three times were then developed to predict mediastinal drainage. The number of internal mammary grafts, the total number of grafts and plasma fibrinogen concentration were useful predictors of mediastinal drainage at all three times.

Postoperative fibrinolysis diagnosed by thrombelastography.

Thrombelastography is a useful method for the monitoring of bedside coagulation, especially for fibrinolysis. We report a case where thrombelastography facilitated early detection of fibrinolysis with significant clinical bleeding in a patient immediately following hip replacement surgery. The early diagnosis enabled institution of antifibrinolytic therapy and monitoring of the patient's response.

The effect of vaginal microbes on in vivo and in vitro expression of human papillomavirus 16 E6-E7 genes.

Since other viruses can influence expression of human papillomavirus (HPV) 16 E6-E7 genes in vitro, this study addressed whether specific vaginal bacteria do so as well. The vaginal microflora of 18 women with cervical intraepithelial neoplasia (CIN) or normal histology and HPV 16 infection, was evaluated by quantitative culture. Expression of HPV 16 E6-E7 oncogenes was assessed in exfoliated cervical cells by quantitative polymerase chain reaction.

Factors associated with human papillomavirus infection detected by polymerase chain reaction among urban Canadian aboriginal and non-aboriginal women.

Objectives: To determine the prevalence and correlates of human papillomavirus (HPV) infection among women attending an ethnically mixed, predominantly low-income, inner-city primary care clinic.

Study Design: Cross-sectional survey (N = 1,477). Demographic, behavioral, and reproductive history data were collected by questionnaire.

Orthotopic liver transplantation in two patients with hypertrophic obstructive cardiomyopathy.

Orthotopic liver transplantation (OLT) in patients with end-stage liver disease is a procedure associated with high cardiac output, low systemic vascular resistance (SVR), coagulopathy and the potential for significant blood loss. A feature of hypertrophic obstructive cardiomyopathy (HOCM) is left ventricular outflow tract obstruction which may be exacerbated by reduced SVR, reduced filling pressures, tachycardia and positive inotropy. We report two cases of OLT in patients with HOCM.

Evaluation and validation of a monoclonal immunofluorescent reagent for direct detection of Bordetella pertussis.

An outbreak of pertussis in Manitoba, Canada, provided an opportunity to evaluate the recently developed monoclonal antibody (MAb) BL-5 for the direct detection of Bordetella pertussis. The MAb recognizes a lipooligosaccharide epitope. A total of 1,507 consecutive nasopharyngeal swabs for culture and companion smears for direct fluorescent-antibody (DFA) detection were evaluated at Cadham Provincial Laboratory between September and November 1994.

Expression of human papillomavirus type 16 E6-E7 open reading frame varies quantitatively in biopsy tissue from different grades of cervical intraepithelial neoplasia.

The proteins encoded by the human papillomavirus type 16 E6-E7 open reading frame are essential for transformation of the host cell. Two mRNA species, E6*I and E6*II, generated by alternative splicing of a polycistronic pre-mRNA, encode truncated E6 proteins and the E7 protein. Our investigation assessed whether or not the level of expression of E6*I and E6*II varies quantitatively in relation to the grade of cervical intraepithelial neoplasia (CIN).

Bupivacaine enantiomer pharmacokinetics after intercostal neural blockade in liver transplantation patients.

Bupivacaine, being a racemic local anesthetic, exists as an equal mixture of its component enantiomers R(+)- and S(-)-bupivacaine, which behave pharmacokinetically as independent drugs after injection into the body. Intercostal neural blockade using bupivacaine was performed for postoperative analgesia in 12 patients after orthotopic liver transplantation. Arterial blood, sampled serially, was assayed by enantioselective high-performance liquid chromatography for R(+)- and S(-)-bupivacaine.

Blood loss and transfusion requirements in liver transplantation: experience with the first 75 cases.

The blood loss data and transfusion requirements including blood bank, salvaged washed red cells, fresh frozen plasma and cryoprecipitate were analysed for the first 75 cases of liver transplantation performed at the Austin Hospital between June 1988 and October 1992. The mean blood loss was 8.8 litres (standard deviation 14.

Patterns of coagulopathy during liver transplantation: experience with the first 75 cases using thrombelastography.

Using both conventional laboratory clotting profile and thrombelastography, coagulation status was monitored intraoperatively during liver transplantation in the first 75 cases performed at the Austin Hospital between June 1988 and October 1992. Superimposed on a baseline coagulopathy due to liver disease is a specific pattern of coagulation disturbance which occurs during a liver transplant. Fibrinolysis occurs in the anhepatic stage, worsens with early reperfusion and then spontaneously resolves.

Seed storage protein variation in Arachis species.

Seventy-two accessions, representing 22 species from sections Arachis, Erectoides, Extranervosae, and Triseminalae of the genus Arachis, were screened for seed storage protein polymorphism. Variation was detected between sections, between genome types, between species, and in some cases between different accessions of the same species or different seeds of the same accession. Arachis duranensis and one accession of A.

Variability of polymerase chain reaction-based detection of human papillomavirus DNA is associated with the composition of vaginal microbial flora.

The results of repeated human papillomavirus (HPV) DNA testing were compared to changes in cervical pathology and the composition of vaginal microorganisms. A cohort of 19 women with HPV cervical infections in the absence of cervical intraepithelial neoplasia at enrollment was reexamined on average at 7.3-month intervals over a 2-year period.

Quantification of HPV-16 E6-E7 transcription in cervical intraepithelial neoplasia by reverse transcriptase polymerase chain reaction.

Human papillomavirus type 16 (HPV-16) is associated with neoplastic lesions of the uterine cervix. Viral transforming functions have been localized to the E6-E7 open reading frame (ORF) and this ORF is conserved consistently in cervical intraepithelial neoplasia (CIN). Two mRNAs, generated by alternative splicing, are expressed from the E6-E7 ORF.

Human papillomavirus infection and the size and grade of cervical intraepithelial neoplastic lesions associated with failure of therapy.

Objective: This investigation was designed to identify specific risk factors associated with treatment failure for cervical intraepithelial neoplasia.

Method: A cohort of 436 women was assessed for the presence of cofactors associated with therapy failure. The risk factors included the HPV infection status of the patient, a previous history of genital condyloma and the size of cervical lesions.

Detection of human papillomavirus 16 transcription in human prostate tissue.

Previously we demonstrated human papillomavirus type 16 DNA in a high proportion of benign hyperplastic (BPH) and cancerous (CaP) prostate specimens using the polymerase chain reaction (PCR). While these data designate the prostate as a possible reservoir for sexual transmission of HPV, an etiological role for the virus in prostatic neoplasia is uncertain. Since transcription of the E6/E7 genes of HPV 16 is essential for both viral replication and cellular transformation, we sought to assess the transcriptional activity of HPV 16 found in prostate tissues.

Characterization of HPV-16 E6/E7 transcription in CaSki cells by quantitative PCR.

Human papillomavirus (HPV) is associated with specific benign and malignant lesions of the epithelial and mucosal surfaces. Of the sexually transmitted types, HPV type 16 (HPV-16) is the most commonly associated with carcinoma of the uterine cervix. Expression of the E6/E7 open reading frame of the viral genome is considered critical in the development of neoplasia.