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111.
Improved management of infrainguinal bypass graft infection with methicillin-resistant Staphylococcus aureus 总被引:4,自引:0,他引:4
Chalmers RT Wolfe JH Cheshire NJ Stansby G Nicolaides AN Mansfield AO Barrett SP 《The British journal of surgery》1999,86(11):1433-1436
BACKGROUND: There is considerable debate over the management of infected infrainguinal grafts. This report describes recent experience in this field and documents the change in clinical practice needed to deal with methicillin-resistant Staphylococcus aureus (MRSA). METHODS: All infected infrainguinal grafts between January 1991 and July 1997 were reviewed. In the light of the findings, clinical practice was modified considerably. A further 1 year was audited prospectively up to August 1998. RESULTS: Twenty-six patients were treated for 27 infrainguinal graft infections (25 prosthetic, two vein). Twenty were treated by complete graft excision as the initial therapy; graft preservation was attempted in six patients. Before 1995, the infecting organisms were predominantly Pseudomonas aeruginosa or methicillin-sensitive staphylococci. Subsequently all 14 patients treated up to 1997 had infection with MRSA. The overall amputation rate was 17 of 26; ten amputations were in patients with MRSA. Four patients died, all with MRSA sepsis. As a result of this experience a policy of complete isolation was adopted for all patients infected with MRSA. In the 12 months since this policy was introduced, 77 infrainguinal grafts (61 vein, 16 prosthetic) have been inserted. Two grafts (3 per cent) have become infected, necessitating graft excision and amputation. CONCLUSION: MRSA infection of an infrainguinal graft is a serious complication with high associated amputation and mortality rates. Isolation and barrier nursing appeared to contain the problem. 相似文献
112.
Congenital midgut malrotation, a rare anatomic anomaly that can lead to duodenal or small bowel obstruction, rarely is recognized
beyond the first year of life. We report a case of unrecognized congenital midgut malrotation that resulted in midgut volvulus,
causing intestinal obstruction and requiring emergent reoperation after laparoscopic cholecystectomy. This unusual complication,
first reported in 1994, involved a 56-year-old man and resulted in cecal infarction recognized and treated on the second postoperative
day. This second case describes a less acute postoperative course, with multiple bouts of partial bowel obstruction leading
to two readmissions and finally resulting in a reexploration and definitive treatment on the 19th postoperative day.
Received: 16 February 1999/Accepted: 22 March 1999 相似文献
113.
Background: The complications of the gastric pouch in gastric bypass surgery are well known. Since the first report of this
surgery 30 years ago, new technical aspects that make it safer and more effective have been implemented. Methods: As a modification
of gastric bypass, the authors have performed 305 vertical banded gastroplasty-gastric bypass procedures. Two groups of patients
underwent the procedure: Group I (n = 206) without a limb of jejunum interposed between the gastric pouch and the excluded
stomach, and Group II (n = 99) with a limb of jejunum interposed between the pouch and the stomach. The results regarding
excess weight loss and complications of the gastric pouch during the first year after surgery were compared. Results: Age,
sex, initial weight, body mass index, and percentage of ideal weight were similar in both groups. Excess weight loss was also
similar. The complications in Group I were 1 leak, 3 left subphrenic abscesses, 2 erosive gastritis with bleeding, 1 stenosis
of the gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two patients in Group II developed bleeding
from the staple-line. Conclusions: These preliminary data suggest that complications of the gastric pouch can be reduced by
interposing a limb of jejunum between the pouch and the excluded stomach. This is an early experience; long-term results are
pending. 相似文献
114.
115.
Abrams P Schäfer W Tammela TL Barrett DM Hedlund H Rollema HJ Matos-Ferreira A Nordling J Bruskewitz R Andersen JT Hald T Miller P Kirby R Mustonen S Cannon A Jacobsen CA Gormley GJ Malice MP Bach MA 《The Journal of urology》1999,161(5):1513-1517
PURPOSE: We assess the effect of finasteride, a 5alpha-reductase inhibitor, on objective voiding parameters in men with lower urinary tract symptoms and benign prostatic enlargement on digital rectal examination (known as clinical benign prostatic enlargement) in a double-blind placebo controlled multicenter study using strict standard pressure flow study techniques. MATERIALS AND METHODS: A modification of the Abrams-Griffiths nomogram was used by 1 reader to ensure that all patients met objective criteria for bladder outlet obstruction at baseline. After performing a pressure flow study patients with obstruction were randomized 2:1 to receive 5 mg. finasteride (81) or placebo (40) daily. A second pressure flow study was performed at month 12. At baseline and month 12 free urinary flow studies and transrectal ultrasound were performed, and International Prostate Symptom Score questionnaires were completed. Patients were treated between May 1994 and July 1996. RESULTS: Finasteride caused a significant decrease (-8.1 cm. water) in detrusor pressure at maximum flow (p <0.05 versus placebo p = 0.02), increase (+1.1 ml. per second) in maximum flow rate (p <0.05 versus placebo p = 0.02) and decrease (-22.8%) in prostate volume (p <0.05 versus placebo p <0.001). Men with prostates larger than 40 cc had greater improvement in detrusor pressure at maximum flow (between group difference -14.5 cm. water, 95% confidence interval -26.2 to -2.6, p = 0.02) and maximum flow rate (mean treatment effect +1.6 ml. per second, 95% confidence interval -0.2 to 3.0, p = 0.02) compared to those with prostates 40 cc or less (between group differences not significant). CONCLUSIONS: Finasteride treatment resulted in improvements in urodynamic parameters, which were greater in men with large prostates. 相似文献
116.
The ability to discriminate perfect from imperfect mirror symmetry was examined at the fovea and at eccentricities out to 10 degrees in the nasal visual field. A 2-AFC method of constant stimuli was employed in which a bilaterally symmetric pattern was presented in one interval and a degraded version of this symmetric pattern in the other. The subject's task was to decide which interval contained the perfectly symmetric pattern. Pattern size was varied by changing the viewing distance. Probit analysis revealed the degree of asymmetry corresponding to 75% correct performance. Given sufficient size scaling, perfectly symmetric stimuli can be discriminated from degraded symmetric stimuli in extra-foveal vision. Spatial scaling with an E2 value similar to that for positional acuity was successful in removing the eccentricity dependence for the task. 相似文献
117.
118.
Rationale: Defining the mechanism of tolerance development to hallucinogenic drugs will help to explain their mechanism of action. Objectives: The present study was conducted to determine first, if tolerance develops to the discriminative stimulus (DS) properties
of the hallucinogen, 2,5 dimethoxy-4-iodo-amphetamine (DOI) and second, the mechanism mediating tolerance. Methods: Rats were trained to discriminate 0.75 mg/kg DOI from saline on a concurrent VI-30-min schedule of reinforcement with a
15-min time-out for incorrect responses. To evaluate tolerance development, rats were assigned to one of four groups and treated
with either chronic saline or chronic DOI. Prior to chronic treatment, two groups were tested for choice behavior following
vehicle administration while the remaining two groups were tested following the administration of 0.375 mg/kg DOI. One group
from each pre-test condition was injected with either saline or DOI (1 mg/kg) for 8 days. Twenty-four hours after the last
chronic injection the pre-test treatments were replicated. Using receptor autoradiography, the density of 5-HT2A and 5-HT2C receptors was measured in independent groups of rats that had received identical treatment conditions. Results: Animals receiving chronic DOI showed a 60% decrease in DOI lever responding (from 100% to 40%) when tested on 0.375 mg/kg
DOI, while animals receiving chronic saline showed no change in percent choice (100%) on the DOI lever. Significant changes
in binding were observed in 5-HT2A receptors but not 5-HT2C receptors. The results of tests with antagonists were consistent with the changes in binding. Conclusions: These results suggest that behavioral tolerance to DOI reflects neuroadaptive changes in 5-HT2A receptors.
Received: 17 July 1998 / Final version: 19 January 1999 相似文献
119.
Rationale: Previous research using an amphetamine (AM)-haloperidol (HA) drug- drug discrimination task has shown that predominant responding
on the HA-appropriate lever occurs 24 h after a single or multiple administrations of 10 mg/kg AM. Conversely, rebound responding
on the AM-appropriate lever occurs following single or multiple administrations of 1 mg/kg HA. HA-appropriate responding was
also observed 24 h following a single injection of AM using a three-lever, AM-vehicle-HA discrimination task. However, a single
administration of HA did not produce robust rebound responding on the AM-appropriate lever. The present studies seek to clarify
the discrepancy between responding following HA in the two- and three-choice tasks. Objective: Experiment 1 examined the extent of rebound responding that could be achieved following ten daily administrations of either
10 mg/kg AM or 1 mg/kg HA. Experiment 2 explored potential differences between the two- and three-choice tasks in characterizing
the post-HA cue. Methods: Animals were trained to discriminate 0.35 mg/kg AM, vehicle, and 0.033 mg/kg HA. In experiment 1, animals received ten daily
injections of 10 mg/kg AM, vehicle, or 1 mg/kg HA, and were tested 24 h after the final injection, and again 8, 15, and 22
days post-treatment. In experiment 2, animals were retrained and then treated daily with either vehicle or 1.0 mg/kg HA for
10 days, and then tested 24 h after the final injection, and again 5 and 11 days post-treatment, with either all three levers
or with only the AM- and HA-appropriate levers available. Results: In experiment 1, multiple injections of AM produced robust HA lever responding, which is consistent with results from previous
studies that used the two-choice, AM-HA discrimination task. However, multiple injections of HA did not produce predominant
responding on the AM-appropriate lever. In experiment 2, animals treated with either vehicle or HA responded predominantly
on the vehicle-appropriate lever when tested with all three levers present. When tested with the vehicle lever removed, however,
animals treated with vehicle responded predominantly on the HA-appropriate lever, whereas those treated with HA responded
predominantly on the AM-appropriate lever. Conclusions: These results suggest that the two-choice and three-choice task used here differ in how the post-HA withdrawal cue is characterized.
This finding emphasizes the importance of knowing the relative locations of the agonist-, vehicle-, and antagonist-produced
cues on the interoceptive stimulus continuum established by discrimination training.
Received: 3 December 1997/Final version: 16 November 1998 相似文献
120.
The serotonin3 (5-HT3) receptor plays an important role in the aminoprivic feeding model. Other neurochemical systems, including cholecystokinin (CCK) and dopamine (DA), are known to affect food intake. We pretreated rats systemically with tropisetron, a 5-HT3 receptor antagonist, alone and combined with antagonists of DA1 and DA2 receptors, and measured intake of an amino acid-imbalanced diet (IMB). As expected, tropisetron significantly increased intake of IMB. SCH-23390, a DA1 antagonist, increased IMB anorexia. When combined with tropisetron, DA2 antagonism with eticlopride reduced short-term intake of both the basal diet (BAS) and IMB. In the IMB model, specificity of 5-HT3-DA2 interactions, and of 5-HT3-CCK(A) interactions from previous studies, prompted investigation of CCK(A)-DA2 interactions; there appeared to be none. SKF-38393, a DA1 agonist, combined with the CCK(A) receptor antagonist, devazepide, increased BAS and tended to increase IMB intake. Thus, CCK(A)-DA1 interactions were not specific for IMB. These data suggest that DA1 receptor activity opposes IMB anorexia, possibly via an interaction with the 5-HT3 receptor. 相似文献