The effect of antiseptic solution in central venous catheter care.

AIM: Intravenous catheters have become one of the essential tools of modern medicine. Preventive measures taken while the catheter is being inserted or in place can provide a significant reduction in catheter-related infections and bacteremia/sepsis.This study aims to evaluate whether the patient's age and gender, the presence of malignancy and coexisting diseases, catheter duration, use of total parenteral nutrition solution, blood products, and antibiotics as well as antiseptics applied while attaching the central venous catheter (chlorhexidine and povidone-iodine) affect the development of catheter colonization and catheter-related bloodstream infections in patients with central venous catheters. MATERIALS AND METHODS: Our study includes 50 cases which were admitted to Izmir Atatürk Training and Research Hospital, I. Surgical Clinic, hospitalized due to various reasons between the dates of January‒December 2010 and required catheter use. Patients were randomly assigned to one of the two operating rooms, in one of which the insertion site was disinfected with Poviiodeks® (10 % povidone-iodine) while in the other, (latter) Savlosol® (15 % cetrimide, 1.5 % Chlorhexidine-gluconate, ethanol) was used. RESULTS: Among many factors examined in our study, only the use of clorhexidine versus iodine povidon in skin antisepsis was found to be statistically significant in the reduction of CRBSI and CC (for CRBSI p=0.022 and for CC p=0.047). CONCLUSIONS: Our study concludes that skin antisepsis is the only determining factor in the prevention of blood infection and colonization due to central venous catheter application and the use of clorhexidine vs. povidon is proven to be statistically significant (Tab. 1, Ref. 27).

Hydatid cyst in abdominal incisional hernia.

Recurrence of hydatid cyst is one of the important complications of primary hydatid surgery. Here we present a very rare case of recurrent hydatid cyst inside an incisional hernial sac. A 50-year old male operated on for hydatid disease of the liver twice in 1998 and 2001 was admitted to our hospital for an abdominal mass formed under the old median incisional scar. On physical examination, a painless mass of 15 cm in diameter, stretched, hard and well bordered was palpated. There was also a fascial defect inferior to the mass. A herniated hydatid cyst was imaged with both of ultrasonography (US) and abdominal computed tomography (CT). As a surgical treatment hydatid cyst was excised totally together with primary repair of the fascial defect. The patient received preoperative Albendazole therapy, administered at a dose of 10 mg/kg body weight per day from 3 weeks before surgery to 6 months postoperatively. He had no problems in the 1-year follow up (Fig. 2, Ref. 19).

Esophageal dilation after laparoscopic adjustable gastric banding.

BACKGROUND: Esophageal dilation can occur after laparoscopic adjustable gastric banding (LAGB). There are few studies in the literature that describe the outcomes of patients with esophageal dilation. The aim of this article is to evaluate weight loss and symptomatic outcome in patients with esophageal dilation after LAGB. METHODS: We performed a retrospective chart review of all LAGBs performed at Columbia University Medical Center from March 2001 to December 2006. Patients with barium swallow (BaSw) at 1 year after surgery were evaluated for esophageal diameter. A diameter of 35 mm or greater was considered to be dilated. Data collected before surgery and at 6 months and 1, 2 and 3 years after surgery were weight, body mass index (BMI), status of co-morbidities, eating parameters, and esophageal dilation as evaluated by BaSw. RESULTS: Of 440 patients, 121 had follow-up with a clinic visit and BaSw performed at 1 year. Seventeen patients (10 women and 7 men) (14%) were found to have esophageal dilation with an average diameter of 40.9 +/- 4.6 mm. There were no significant differences in percent of excess weight lost at any time point; however, GERD symptoms and emesis were more frequent in patients with dilated esophagus than in those without dilation. Intolerance of bread, rice, meat, and pasta was not different at any time during the study. CONCLUSIONS: In our experience the incidence of esophageal dilation at 1 year after LAGB was 14%. The presence of dilation did not affect percent excess weight loss (%EWL). GERD symptoms and emesis are more frequent in patients who develop esophageal dilation.

Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite.

BACKGROUND: The optimal prosthesis for laparoscopic ventral hernia repair would combine excellent parietal surface tissue ingrowth with minimal visceral surface adhesiveness. Currently, few data are available from randomized trials comparing the commercially available prostheses. METHODS: In a pig model designed to incite adhesions, three 10 x 15-cm pieces of mesh (Proceed, Parietex Composite [PCO], and polypropylene [PPM]) were randomly positioned intraperitoneally in each of 10 animals using sutures and tack fixation. After a 28-day survival, the amount of shrinkage, the area and peel strength of visceral adhesions, the peak peel strength, the work required to separate mesh from the abdominal wall, and a coefficient representing the adhesiveness of tissue ingrowth were averaged for each type of mesh and then compared with the averages for the other prostheses. The histologic appearance of each prosthesis was documented. RESULTS: Proceed had more shrinkage (99.6 cm2) than PCO (105.8 cm2) or PPM (112 cm2), although the difference was not statistically significant. The mean area of adhesions to PCO (11%) was significantly less than for Proceed (48%; p < 0.008) or PPM (46%; p < 0.008). Adhesion peel strength was significantly less for PCO (5.9 N) than for Proceed (12.1 N; p < 0.02) or PPM (12.9 N; p < 0.02). According to a filmy-to-dense scale of 1 to 5, adhesions were more filmy with PCO (1.7) than with PPM (2.9) or Proceed (3.7) (p < 0.007). Peak peel strength from the abdominal wall was significantly higher for PCO (17.2 N) than for Proceed (10.7 N) or PPM (10 N; p < 0.002). The histology of each prosthesis showed a neoperitoneum only with PCO. CONCLUSIONS: With less shrinkage, fewer and less dense adhesions to the viscera, and significantly stronger abdominal wall adherence and tissue ingrowth at 28 days in this animal study, PCO was superior to both Proceed and PPM in all categories. Furthermore, PCO demonstrated all the favorable qualities needed in an optimal prosthesis for laparoscopic ventral hernia repair, including the rapid development of a neoperitoneum.

Laparoscopic repair of Morgagni hernia.

BACKGROUND: Foramen of Morgagni hernias are rare diaphragmatic hernias. They account for 3-5% of all diaphragmatic hernias and the majority of the cases are asymptomatic. They are caused by trauma, obesity or pregnancy. With the advancements of laparoscopic surgery, laparoscopic repair has become an excellent alternative to open repair for Morgagni hernias. We report five cases of Morgagni hernia repaired with the laparoscopic approach in conjunction with a review of the literature. PATIENTS: A retrospective review comprised five patients who had a Morgagni hernia repaired with a laparoscopic approach. Data from these patients were collected for the period between February 2001 and May 2005. RESULTS: The average age at operation was 61. The anatomic pathology was detected preoperatively using X-rays and computerized tomography (CT) scans in four of our patients. Hernia was detected incidentally in one patient during an elective cholecysectomy. Three hernias were right-sided and two were left-sided. The contents of the hernias were omentum and transverse colon in the majority of the patients. The hernia was repaired with a laparoscopic approach in all patients. Four patients had composite mesh repair and one patient had primary closure with nonabsorbable sutures. There were no postoperative complications and all patients tolerated laparoscopic repair. There were also no recurrences during follow-up. CONCLUSIONS: Laparoscopic repair is a candidate to be a standard treatment for Morgagni-type hernias. It is an effective and safe technique and can be performed by all compotent general surgeons with a certain learning curve. It has several advantages relative to the open operation.

Randomized crossover study of effect of resistance training on glycemic control, muscular strength, and cholesterol in type I diabetic men.

The goal of this study was to evaluate a program of resistance weight training on cardiovascular risk factors, blood glucose management, and overall strength in diabetic subjects. A randomized crossover design was performed on eight male type I (insulin-dependent) diabetic subjects (mean +/- SD age 31 +/- 3.5 yr, height 176 +/- 5.6 cm, body wt 80 +/- 15 kg, duration of diabetes 12.3 +/- 9.8 yr, and insulin dose 24 U NPH/day and 21 U regular/day). The program consisted of heavy-resistance weight training 3 days/wk for 10 wk, concentrating on the strengthening of major muscle groups through progressive resistance. Blood tests included total cholesterol, triglycerides, very-low-density lipoprotein and high-density lipoprotein cholesterol, and HbA1c. These tests were repeated at three time points during the program. Field-strength testing was performed before and after training. An improvement was seen in the squat (93.6% increase, P less than 0.0001) and bench press (58% increase, P less than 0.005). HbA1c and triglyceride levels showed no change during the resting portion of the experiment but showed a significant change with the training program: HbA1c 6.9 +/- 1.4 vs 5.8 +/- 0.9% (P = 0.05) and triglyceride 5.044 +/- 1.06 vs. 4.628 +/- 0.88 mM (P = 0.01). Self-monitored glucose (taken pre- and postexercise) showed a decrease from 7.85 +/- 3.13 to 7.05 +/- 2.91 mM (P = 0.0001). Very-low-density lipoprotein cholesterol and triglycerides did not change after training. Analysis of variance showed no significant differences over time from the three time points with regard to reductions in cardiovascular risk factors or HbA1c.(ABSTRACT TRUNCATED AT 250 WORDS)

Voluntary exercise improves glycemia in non-obese diabetic (NOD) mice.

The non-obese diabetic (NOD) mouse was used to investigate the effects of voluntary wheel running exercise on blood glucose levels, glycosylated hemoglobin, and longevity in Type 1 diabetes mellitus. In Experiment 1, diabetic and normoglycemic mice exercised 5 h/day, 5 days/week for 3 weeks matched with non-exercising controls. In diabetic animals a positive correlation was found between blood glucose and the number of revolutions performed (P < or = 0.02). Exercise also significantly lowered blood glucose between baseline and post-exercise in both diabetic and normoglycemic animals. In Experiment 2, mice exercised 2 h/day, 5 days/week. For the diabetic animals, glycosylated hemoglobin was lower than that of matched non-exercising diabetic animals at week 3 (11.1 +/- 0.6% vs. 15.0 +/- 1.6%, P < 0.001). Diabetic runners were able to train and significantly increased running in the first 4 weeks (P < 0.05). At the end of 9 weeks all 5 diabetic runners were alive, compared with 3 of 5 non-running diabetic animals. We conclude: (i) the NOD mouse is a useful model for the study of exercise in Type 1 diabetes, (ii) running exercise is associated with a drop in blood glucose, (iii) the amount of voluntary exercise performed correlates with blood glucose in diabetic animals, and (iv) diabetic mice will increase running distance in the first few weeks after diagnosis.

Laparoscopic repair of Morgagni hernia and paraesophageal hernia on the same patient.

Morgagni hernias have been recognized with increasing frequency as a source of abdominal pain and dyspnea in adults. Morgagni hernias are rarely accompanied by paraesophageal hernias. We report a case of Morgagni hernia associated with paraosephageal hernia, both repaired laparoscopically. On the 65-year-old woman patient, diaphragmatic defect and paraesophageal hernia were closed with primary sutures, and Hill-type gastropexy was performed successfully. The procedure lasted 115 min. The patient was discharged 5 days after surgical treatment and there were no complications following the operation. Primary closure with direct sutures is rapid, simple, and effective and can be combined with other laparoscopic procedures, as in our case. It can be performed by surgeons trained in intracorporeal suturing and knotting in all kinds of hospitals. The laparoscopic approach to Morgagni hernias minimizes trauma and shortens postoperative hospital stay, and patients have a comfortable postoperative period.

Physical and glycemic responses of women with gestational diabetes to a moderately intense exercise program.

Aerobic exercise machines are becoming more popular. Their use by women with gestational diabetes is reported, and their benefits in improving blood glucose management and in increasing maternal fitness without undue stress to the fetus are substantiated. Of equal benefit is the use of an exercise specialist to prescribe an individual exercise program, to increase the safety and effectiveness of the workout, to monitor maternal and fetal well-being, to record relevant data, and to provide feedback and information to the patient about the exercise session. The use of exercise specialists in the clinical setting should prove a useful adjunct to medical and dietary regimens for the woman with gestational diabetes.

Comparative evaluation of uterine response to exercise on five aerobic machines.

We evaluated the effect of five aerobic exercise machines on uterine activity during the third trimester of pregnancy. Uterine activity correlated with the type of exercise, but not with the level of exertion. At equivalent work loads, the bicycle ergometer led to uterine activity in 50% of sessions, the treadmill in 40%, the rowing ergometer in 10%, recumbent bicycle in 0%, and the upper arm ergometer in 0%. Therefore, the upper body ergometer and the recumbent bicycle appear to be the safest forms of aerobic exercise studied.

Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes.

We studied the impact of a training program on glucose tolerance in gestational diabetes mellitus. Women with gestational diabetes mellitus (N = 19) were randomized into either group I, a 6-week diet alone group (24 to 30 kcal/kg/24 hours; 20% protein, 40% carbohydrate, 40% fat), or group II, which followed the same diet plus exercise (20 minutes three times a week for 6 weeks). An arm ergometer was used to maintain heart rate in the training range. Glycemic response was monitored by glycosylated hemoglobin, a 50 gm oral glucose challenge with a fasting and 1-hour plasma glucose, and blood glucose self-monitoring, fasting and 1 hour after meals. Week 1 glycemic parameters were the same for both groups. Week 6 data (mean +/- SD) were as follows: group I glycosylated hemoglobin, 4.7% + 0.2% versus group II, 4.2% +/- 0.2%; p less than 0.001. The group I glucose challenge fasting value was 87.6 +/- 6.2 versus 70.1 +/- 6.6 mg/dl, p less than 0.001 for group II. The group I 1-hour plasma glucose challenge result was 187.5 +/- 12.9 mg/dl versus 105.9 +/- 18.9 mg/dl for group II, p less than 0.001. The glycemic levels diverged between the groups at week 4. We conclude that arm ergometer training is feasible in women with gestational diabetes mellitus and results in lower glycosylated hemoglobin, fasting, and 1-hour plasma glucose concentrations than diet alone. Arm ergometer training may provide a useful treatment option for women with gestational diabetes mellitus and may obviate insulin treatment.

Magnetic resonance imaging in pregnancies complicated by gestational diabetes predicts infant birthweight ratio and neonatal morbidity.

The use of magnetic resonance imaging (MRI) has been shown to be safe during pregnancy and can accurately assess fetal fat and rate of growth. The purpose of this study was to investigate with MRI the relationship between maternal weight, fat distribution, and glucose levels and neonatal birthweight ratio, percent fat, and infant outcome in pregnancies complicated by gestational diabetes. Twenty gestational diabetic women were studied at 36 to 38 weeks' gestation with hemoglobin A1c, a glucose tolerance test and maternal body fat by electrical impedance. MRI scans of the maternal upper arm and from her zyphoid process to her pubic symphysis, including all fetal components, were analyzed for percent fat of the mother's arm and trunk and her fetus' trunk. All variables were then related to infant outcome (birthweight, birthweight ratio, and neonatal morbidity). Maternal body composition was related to maternal weight (p = 0.012, r = 0.54), as was maternal arm fat (p < 0.005, r = 0.60). Arm fat did correlate with trunk fat, but trunk fat did not correlate was well with weight (p = NS). Although maternal Hb A1c correlated with maternal weight (p = 0.05, r = 0.43), it did not correlate with infant birthweight. In contrast, maternal mean glucose levels correlated with both maternal and infant weight and infant birthweight ratio (p = 0.05, r = 0.60; p = 0.05, r = 0.42; and p = 0.01, r = 0.64, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)