No description available.

No description available.

No description available.

No description available.

There is uncertainty in regard to the health implications of those persons who border between normal weight and morbid obesity. In this descriptive study, selected physiological responses to cholecystectomy in normal and overweight (20-40% above ideal weight) adults were investigated. Differences between the two groups were examined. In addition, this study determined if there are significant differences in situational variables related to the hospital stay of normal and overweight adults. A retrospective chart review was conducted on 59 normal (n = 22) and overweight (n = 37) adults who had experienced cholecystectomies. The outcome data, related to eight physiologic responses to surgery, included blood loss, purulent wound drainage, fever, pain, nausea, vomiting, intravenous therapy, and mobility. Data related to the hospital stay included length of stay, time in surgery, and time in postanesthesia care. Data analysis using t-tests demonstrated that the responses of normal and overweight subjects were not significantly different for the 14 research questions.

A computer graphics workstation was developed to geometrically plan scanned focussed ultrasound hyperthermia treatments, and is currently in clinical use at the Arizona Health Sciences Center. The workstation allows the user to base the treatment plan on any set of hard copy images of the patient's treatment anatomy by using a frame grabber to import these images into the workstation. Anatomical structures are outlined by the user, and a three dimensional image is reconstructed using these outlines. A geometric outline of the ultrasound power deposition field is then inserted into the reconstructed patient anatomy, along with thermocouple junction locations. The use of a custom foam mold and fiducial marker system enables the location of the anatomical features to be determined in the treatment system's coordinates. A scan size and orientation that sufficiently sonicates the treatment volume can then be determined in an interactive three dimensional environment.

The purpose of this study was to describe the relationship between intrinsic and extrinsic factors and central venous catheter infections in acutely ill patients. Intrinsic factors (inherent) included sex, age, diagnoses, surgical procedures, and medical history. Extrinsic factors (external) included central venous catheter variables and other invasive medical devices. Nosocomial central venous catheter infections were categorized as catheter related bacteremias and site infections. The nonramdonized convenience sample consisted of 30 subjects who had central venous catheters in place less than 48 hours and who were able to give informed consent. A descriptive design was used and Pearson Correlational Coefficients were computed to examine the relationships between intrinsic factors, extrinsic factors and central venous catheter infections. Two cases of catheter related bacteremia were identified. No cases of site infection were documented. No significant relationships between intrinsic factors and central venous catheter infections were found. Four extrinsic factors showed a significant relationship to redness, a sign of site infection.

Bacterial glycocalyx formations on the inner lumens of endotracheal tubes may be dislodged into the lower airway by suction catheter insertions or saline instillations. Repeated introduction of bacteria into the lower airway may overwhelm host defense mechanisms, leading to nosocomial pneumonia. Ten crossover subjects required intubation for 2 to 39 days. A range of 0-62,000 (mean 26,980) viable bacterial colonies per milliliter was dislodged from freshly removed endotracheal tubes by either catheter insertion or saline instillation. There was no significant difference in numbers of viable bacteria dislodged from endotracheal tubes by catheter insertion versus a 5 milliliter saline instillation. The large numbers of coated bacteria dislodged could be an underestimated infectious hazard, particularly as endotracheal suctioning is generally performed multiple times each day for intubated patients. As optional saline instillations have not improved endotracheal suctioning outcomes in previous studies, caregivers should consider deleting saline instillation during endotracheal suctioning.

An exploratory study design was used to describe the relationship between the degree of acute rejection and the presence of cardiac arrhythmias in cardiac transplant patients. The frequencies and types of cardiac arrhythmias were observed in relationship to the results of endomyocardial biopsy and the serum T cell levels. A retrospective primary review of records was conducted utilizing 42 cardiac transplant recipients with a total of 128 endomyocardial biopsy procedures, the unit of analysis. In general, more cardiac arrhythmias were recorded after endomyocarial biopsy than before and the majority were atrial type arrhythmias, followed by ventricular and junctional arrhythmias. The significant relationships occurred between conduction arrhythmias, both frequency and type, and acute rejection. However, very small numbers of conduction arrhythmias were reported. Previous relationships between cardiac arrhythmias in general and acute rejection were not supported, possibly due to the effects of cyclosporine (Sandimmune).

Pressure ulcers can result from having spinal surgery. Medical records of 142 spinal surgery patients were examined for incidence of pressure ulcers and to identify factors associated with ulcer development. Early stage pressure ulcers (persistent skin redness and/or blistering) were documented in 24.6% of the records. The mean surgery length for those acquiring pressure ulcers was 4.2 ± 1.6 hr, compared to 3.3 ± 1.5 hr for those who did not (p = 0.002). The average age of those developing pressure ulcers was 60.1 ± 13.8 yr, compared to 50.5 ± 16.3 yr for ulcer free patients (p = 0.002). Mean intraoperative blood loss was 1551 ± 1185 ml for those developing pressure ulcers, compared to 1081.6 ± 1104.2 ml for those who did not (p = 0.049). Finally, pressure ulcer development was associated with diabetes mellitus and a higher preoperative blood sugar value. These findings may help identify spinal surgery patients at risk for pressure ulcers.