The microsurgical treatment of large and giant aneurysms of the internal carotid artery located parasphenoidally

Internal carotid aneurysms in the ophthalmic area presents a challenge in cerebrovascular neurosurgery. The study was undertaken to provide evidence for the application of intravascular aspiration during direct surgical interventions and to outline their variants used at the N. N. Burdenko Institute of Neurosurgery. The study included 4 (3 females and 1 male) patients with large and giant internal carotid aneurysms of parasphenoidal site who were treated at the Institute. Clipping of the aneurysmal neck was made by employing intravascular blood aspiration from the aneurysm. The technique proved to be effective in proximal monitoring the carotid artery at surgery. It substantially reduced aneurysmal blood flow and wall tension, thus favouring aneurysmal dissection to make clipping.     

Experimental-morphological and clinical basis of preventive methods for the intraoperative complications of the amputation of the lower extremity at the thigh level]

Using total quality management principles within a shared governance framework, this case study discusses how to design and implement a plan to achieve independent nursing practice when an employee has unique needs. This experience demonstrates the importance of looking at root causes, separating ability and compliance issues, using all available resources creatively, and planning for success.     

Perioperative risk factors affecting hospital stay and hospital costs in open heart surgery for patients > or = 65 years old

OBJECTIVE: Demographic changes, associated with increased demands for open heart surgery in the elderly, place increased burden on financial resources. To evaluate perioperative risk factors affecting incidence of hospital events and estimation of hospital charges, 2577 patients > or = 65 years (range 65-91), operated on from January 1991 to December 1994, were compared with a concurrent cohort of 2642 younger patients. METHODS: Statistical analysis, by surgical procedure, focused on hospital mortality, key postoperative complications affecting length of hospital stay and hospital charges. RESULTS: Overall hospital mortality was 4.7%, 3.5% in younger patients versus 6.1% in the older group (P < 0.01). Mortality was significantly lower in patients less than 65 years undergoing coronary artery bypass grafting (3% versus 5%, P < 0.01) and valve replacement (4% versus 9%, P = 0.01). Significant risk factors for hospital death in the elderly: diabetes (P < 0.01), hypertension (P < 0.01), myocardial infarction (P < 0.01) and congestive heart failure (P < 0.01). Significant postoperative events, more common in older patients, included prolonged ventilation (P < 0.01), congestive heart failure (P < 0.01), infection (P < 0.01), cerebrovascular accident (P < 0.01), and intra aortic balloon pump (P < 0.01). Incremental risk factors for morbidity in the elderly were: higher New York Heart Association class, congestive heart failure, emergent operation, and female gender. Mean length of hospital stay for the < 65 group was 15.3 versus > 19.5 days for the > 65 group (P < 0.01). Length of stay over 18 days positively correlated with increased morbidity in both age groups. For patients > or = 65 years of age, the average hospital charge for open heart surgery was 172% higher for patients with a length of stay greater than 18 days compared with 165% for patients less than 65 years of age. CONCLUSIONS: Higher operative mortality and longer length of stay in elderly patients, resulting in increased health care costs, was associated with more co-morbidities. These results suggest interventions designed to reduce congestive heart failure and other co-morbidities may improve patient's recovery and reduce costs.     

The OECD software tool for screening chemicals for persistence and long-range transport potential

We present the software implementation of The OECD P_OV & LRTP Screening Tool (The Tool) that is used to assess the environmental hazard of organic chemicals using metrics of overall persistence (P_OV) and long-range transport potential (LRTP). The Tool is designed to support decision making for chemical management and includes features that are recommended by the Organization for Economic Cooperation and Development (OECD) expert group on multimedia modeling. The Tool is useful for screening the environmental hazard potential of non-ionizing organic chemicals whose environmental partitioning can be described by absorptive capacities of environmental media estimated from partitioning between air, water and octanol in the laboratory. The software includes data storage functionality, and a user interface that is designed to facilitate simple data input and straightforward interpretation of the model results. The effect of uncertainties in input properties describing chemicals can be assessed with a Monte Carlo analysis. The software is evaluated and illustrated by comparing results from The Tool with those from other models and by evaluating four substances that are candidates for regulation or ban under the Stockholm Convention on Persistent Organic Pollutants.     

Rapid assessment of onchocerciasis prevalence and a model for selecting communities for ivermectin distribution in West Africa

A major obstacle to stem cell gene therapy is the extremely low efficiency of stem cell transduction. In vivo selection is a strategy for enriching a minor population of genetically modified bone marrow cells through the introduction of a drug resistance gene, followed by subsequent administration of the corresponding cytotoxic drug in vivo. Achieving persistent effects from in vivo selection is expected to require selection at the level of stem cells or, minimally, selection at the level of progenitors. Major limitations to in vivo selection are the nonhematologic toxicities of the cytotoxic drugs used and the resistance of stem cells and progenitors to killing by most cytotoxic agents. Experiments were performed in mice to evaluate whether the drugs used for selection in combination with multiple drug resistance gene 1 (MDR1) could have an enhanced effect on clonogenic progenitors if preceded by administration of the cytokine, stem cell factor (SCF). Single doses of taxol, navelbine, or vinblastine produced 10-fold reductions in the total number of mononuclear cells per femur, indicating a significant depletion of nonclonogenic precursor cells. However, for each of these agents, clonogenic progenitors, assayed as colony-forming unit cells and day-12 spleen colony-forming units, were relatively spared. Administration of SCF before taxol, navelbine, or vinblastine completely abrogated the progenitor-sparing phenomenon, because clonogenic progenitors were depleted as effectively as nonclonogenic precursor cells. Furthermore, the administration of SCF before drug administration allowed the dosages of taxol and vinblastine to be reduced by more than half, while retaining reductions in progenitor numbers that were unachievable using very high doses of the cytotoxic drug alone. Doxorubicin administration resulted in a 30- to 40-fold depletion in progenitors that was not significantly altered by preceding SCF administration. These results suggest that previous observations of in vivo selection using MDR1 gene transfer followed by taxol administration may have resulted from selection at the level of relatively mature, nonclonogenic precursor cells. Furthermore, these data suggest that cytokine prestimulation may be a useful strategy for improving the selection of drug-resistant clonogenic progenitors and, possibly, stem cells in vivo.     

The effect of chenotherapy on the reservoir function of the gallbladder in cholelithiasis patients]

The effect of chenodeoxycholic acid (CDCA) on the reservoir function of the gallbladder was studied in 46 patients with cholesterol cholelithiasis. There was a dependence between a clear increase of filling of the gallbladder in patients treated by this method with subsequent sharp reduction of its size and development of dyspepsia and diarrhea. In 14 patients increase of the gallbladder against the background of chemotherapy was not authentic but no dyspeptic phenomena occurred. Thus, decompensation of the reservoir function of the gallbladder in patients with cholelithiasis against the background of chemotherapy are manifested by a significant increase of the gallbladder size with subsequent emptying of bile into the duodenum and development of collagenous diarrhea.     

Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review

OBJECTIVE: Compare 5-year melanoma survival rates to rates in medical literature. DESIGN: Retrospective. SETTING: Hospital in Tijuana, Mexico. PATIENTS: White adult patients (N = 153) with superficial spreading and nodular melanoma, aged 25-72 years. INTERVENTION: Gerson's diet therapy: lactovegetarian; low sodium, fat and (temporarily) protein; high potassium, fluid, and nutrients (hourly raw vegetable/fruit juices). Metabolism increased by thyroid; calorie supply limited to 2600-3200 calories per day. Coffee enemas as needed for pain and appetite. MAIN OUTCOME MEASURE: 5-year survival rates by stage at admission. RESULTS: Of 14 patients with stages I and II (localized) melanoma, 100% survived for 5 years, compared with 79% of 15,798 reported by Balch. Of 17 with stage IIIA (regionally metastasized) melanoma, 82% were alive at 5 years, in contrast to 39% of 103 from Fachklinik Hornheide. Of 33 with combined stages IIIA + IIIB (regionally metastasized) melanoma, 70% lived 5 years, compared with 41% of 134 from Fachklinik Hornheide. We propose a new stage division: IVA (distant lymph, skin, and subcutaneous tissue metastases), and IVB (visceral metastases). Of 18 with stage IVA melanoma, 39% were alive at 5 years, compared with only 6% of 194 from the Eastern Cooperative Oncology Group. Survival impact was not assessed for stage IVB. Male and female survival rates were identical for stages I-IIIB, but stage IVA women had a strong survival advantage. CONCLUSIONS: The 5-year survival rates reported here are considerably higher than those reported elsewhere. Stage IIIA/B males had exceptionally high survival rates compared with those reported by other centers.