Laser-assisted demucosalized gastrocystoplasty with autoaugmentation in a canine model.

Objectives: Laser-assisted autoaugmentation gastrocystoplasty has been performed successfully. Experiments were performed to determine the optimal laser for tissue welding during demucosalized autoaugmentation gastrocystoplasty using both a 1.9-microm diode and a 1.

Inflammatory cytokines and cell response in surgery.

The systemic inflammatory response as mediated by the cytokine network is undoubtedly complex. While inflammatory cytokines are indispensable in wound healing and the restoration of homeostasis, it is often the excessive activity of either proinflammatory or anti-inflammatory cytokines that causes injury to the host or renders the host immunocompromised, respectively. Central to the functional biology of cytokines in surgical injury and infections are the responses of immune cells to such insults.

Clinical characteristics and molecular epidemiology associated with imipenem-resistant Klebsiella pneumoniae.

Eight patients were infected or colonized with imipenem-resistant Klebsiella pneumoniae (IRKP) from December 1994 to November 1995. Initial Klebsiella isolates were susceptible to imipenem but resistant to all cephalosporins, aminoglycosides, and beta-lactam inhibitor combinations. All patients had been in the surgical intensive care unit and had undergone abdominal surgery or tracheostomy during hospitalization.

Osteoconductive materials and their role as substitutes for autogenous bone grafts.

The term osteoconduction applies to a three-dimensional process that is observed when porous structures are implanted into or adjacent to bone. Capillaries, perivascular tissues, and osteoprogenitor cells migrate into porous spaces and incorporate the porous structure with newly formed bone. The observed process is characterized by an initial ingrowth of fibrovascular tissue that invades the porous structure followed by the later development of new bone applied directly within it.

Successful treatment of ceftazidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B: case report and review.

Increasing prevalence of multidrug-resistant gram-negative organisms has led to a rise in clinically significant infections with these organisms and an increasing therapeutic dilemma. We present a case of a neurosurgical patient who developed ventriculoperitoneal shunt-associated ventriculitis due to ceftazidime-resistant Klebsiella pneumoniae susceptible to cefepime, imipenem, meropenem, and polymyxin B only. Successful management was accomplished by removal of the shunt and therapy with systemic meropenem and intraventricular polymyxin B.

Autonomic dysreflexia presenting as a severe headache.

Hypertension, bradycardia, and severe headache have been associated with autonomic dysreflexia. Autonomic dysreflexia affects those with spinal transection above the level of T6 after plastic changes of the afferent pathways. This restructuring in the presence of noxious stimuli below the level of the lesion leads to autonomic dysreflexia.

Radiation therapy to prevent stenosis of peripheral vascular accesses.

Postangioplasty vascular restenosis is a major clinical problem. There has been an upsurge in interest in the use of postangioplasty endovascular brachytherapy in preventing vascular restenosis. Much of the work in this field is being driven by the interventional cardiology community, and there has been a tendency to use a one-size-fits-all approach.

What works? The Diabetes Care and Information Center.

This report focuses on the contribution of a referral practice that offers specialist diabetes care to a multi-ethnic population in New York, and describes the process and outcome of an intensive management policy that is particularly strong on communication. The Diabetes Care and Information Center (DCIC), which practices shared care with local primary care physicians, has developed a programme of intensive management for Type 1 and Type 2 diabetes based on a detailed initial patient assessment by a physician, nurse-educator and dietician team. The assessment is followed by an individualized programme of patient education that includes a combination of individual and group education, and counselling.

Effect of angiotensin-converting enzyme inhibitors on response to erythropoietin therapy in chronic dialysis patients.

Background: Erythropoietin (EPO) therapy is a common and effective treatment for the correction of anemia in patients with end-stage renal disease. Simultaneous treatment with angiotensin-converting enzyme (ACE) inhibitors for the control of hypertension and/or heart failure is often necessary. Recent reports in the literature have raised concern about a potential interaction between these drugs, with a resultant decreased EPO efficacy.

Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella.

Context: Resistance to most or all cephalosporin antibiotics in Klebsiella species has developed in many European and North American hospitals during the past 2 decades.

Objective: To determine if restriction of use of the cephalosporin class of antibiotics would reduce the incidence of patient infection or colonization by cephalosporin-resistant Klebsiella.

Design: A before-after comparative 2-year trial.

Advances and new concepts in oral and maxillofacial pathology.

New techniques in surgical pathology at the cellular and molecular levels offer the clinician help in determining modalities of treatment of specific diseases. In addition to routine staining, adjunctive tests such as immunohistochemical analysis, and the various methods of evaluating nucleic acid have helped make this possible. The efficacy of fine-needle aspiration biopsy has been enhanced by these diagnostic aids that enable the assessment of information from small amounts of tissue.

Potential angiotensin-converting enzyme inhibitor-epoetin alfa interaction in patients receiving chronic hemodialysis.

We compared epoetin alfa (EPO) dose requirements and hematocrit response in 17 patients receiving chronic hemodialysis at baseline and after 3 and 12 months of therapy with angiotensin-converting enzyme (ACE) inhibitors (12 enalapril, 5 captopril). No acute processes were present (infection, hemorrhage, inflammation) at time of starting ACE inhibitor therapy. Mean (+/- SD) intravenous EPO dosages at zero, 3, and 12 months were 6012 +/- 2575, 5800 +/- 2026, and 5660 +/- 2285 U 3 times/week (p=0.

Mycobacterium tuberculosis specimen contamination revisited: the role of laboratory environmental control in a pseudo-outbreak.

Objective: To investigate suspected pseudo-outbreaks of Mycobacterium tuberculosis (MTB) during August 1994 and July 1995 among patients who did not have clinical findings consistent with tuberculosis.

Design: Retrospective and prospective surveys of all clinical and laboratory data using standard epidemiological tools and DNA fingerprinting.

Setting: A university-affiliated community hospital.

Effectiveness of Selective Use of Intravenous Pyelography in Patients Presenting to the Emergency Department with Ureteral Colic.

Objective: To determine whether IV pyelography (IVP) is required routinely for all patients presenting to the ED with ureteral colic.

Methods: A randomized prospective study was conducted with 2 patient groups-a routine IVP group, in which all patients underwent IVP, and a selective IVP group, in which patients were treated, observed, and released without undergoing IVP unless they experienced continued symptoms. The study was performed in a large university-affiliated, community hospital ED.

Effectiveness of selective use of intravenous pyelography in patients presenting to the emergency department with ureteral colic.

Objective: To determine whether i.v. pyelography (IVP) is required routinely for all patients presenting to the ED with ureteral colic.

Hernioscopic retrieval of bowel for evaluation of viability during repair of a Richter's-type incarcerated femoral hernia.

During the repair of a Richter's type incarcerated right femoral hernia via an infrainguinal approach, the incarcerated loop of bowel retracted back into the abdominal cavity before the bowel could be adequately examined for viability. To avoid a laparotomy to identify and possibly resect the involved loop of bowel, a laparoscope was introduced into the open femoral sac. Pneumoperitoneum was obtained, and the involved loop of small bowel was identified via the laparoscope, grasped with a grasping forceps from a second trocar port, and brought out through the hernia sac.

Telephone follow-up for case finding of domestic violence in an emergency department.

Objective: To determine whether telephone follow-up of selected female patients seen in an urban ED would improve domestic violence (DV) case finding.

Methods: A prospective, cross-sectional study was conducted on consecutive female patients between the ages of 16 and 65 years treated in an urban trauma center during July and August 1995. Record review identified those patients with conditions suggesting increased risk for DV: injury; substance abuse; complaints or diagnoses related to stress, anxiety, depression, or panic attack; or complaints of headache, nonspecific abdominal pain, generalized fatigue, or numbness lasting > 1 week.

Doing it right the first time: quality improvement and the contaminant blood culture.

The aim of the project was to determine whether the rate of contaminant blood cultures could be reduced by using a team of dedicated phlebotomists. Comparisons were made between adult patients requiring blood cultures for suspected bacteremia on medical and surgical units before and after the introduction and withdrawal of a dedicated blood culture team. The results showed that a significant reduction in the contaminant blood culture rate was achieved by the blood culture team (P < 0.

Klebsiella and extended spectrum beta-lactamases.

During the past 14 years a rapid, world-wide increase in prevalence of Klebsiella pneumoniae resistant to late generation cephalosporins has occurred. A growing number of newly identified plasmid encoded beta-lactam hydrolyzing enzymes has broadened the spectrum of primitive beta-lactamases allowing inactivation of a wide variety of beta-lactam agents. The extrachromosomal genes which code for these enzymes often exist with genes expressing resistance to several other classes of antibacterial agents, potentially arming Klebsiella pneumoniae with resistance to all therapeutically available antibiotics.

Safety of intravenous glyceryl trinitrate in management of retained placenta.

A retrospective chart review of all anaesthesia consultations for retained placenta at 28 weeks' gestational age or more was performed to determine the safety and efficacy of intravenous glyceryl trinitrate therapy in the management of retained placenta. Of the 33 patients who received glyceryl trinitrate, 1 received a total dose of 50 micrograms and the remainder received 100 to 200 micrograms. All placentas were extracted within 4 minutes of the first bolus.