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  • 1
    Online Resource
    Online Resource
    Intra-Abdominal Abscesses: Emphasis on Image-Guided Diagnosis and Therapy
    SAGE Publications ; 1998
    In:  Journal of Intensive Care Medicine Vol. 13, No. 6 ( 1998-10), p. 320-328
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 13, No. 6 ( 1998-10), p. 320-328
    Type of Medium: Online Resource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1046/j.1525-1489.1998.00320.x
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1998
    detail.hit.zdb_id: 2001472-7
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  • 2
    Online Resource
    Online Resource
    Winner of the Best Paper Award from the Gold Medal Forum: Clinical Characteristics and Antibiotic Utilization in Surgical Patients with Clostridium difficile-Associated Diarrhea
    SAGE Publications ; 1999
    In:  The American Surgeon Vol. 65, No. 6 ( 1999-06), p. 507-512
    Details
    In: The American Surgeon, SAGE Publications, Vol. 65, No. 6 ( 1999-06), p. 507-512
    Abstract: Clostridium difficile-associated diarrhea (CDAD) remains a significant problem in surgical patients. To address this, we prospectively studied all episodes of treated CDAD in surgical inpatients at the University of Virginia hospital from December 1996 through March 1998. CDAD accounted for 3.2 per cent (32) of 1000 total infections. Compared with a randomly selected control group with other nosocomial infections, patients with CDAD had a longer period from the time of admission to diagnosis of infection (19 ± 4 versus 9 ± 1; P = 0.01), were more likely to be female (66% versus 37%; P = 0.009), and had a higher overall crude mortality (31% versus 11%; P = 0.01), although there were no deaths directly attributable to CDAD. Ciprofloxacin (19%) and cefoxitin (16%) were the most common individual antibiotics prescribed before the diagnosis of CDAD. The average time from completion of antibiotic therapy to diagnosis of CDAD was 7 ± 2 days (range, 0-58). Sixteen per cent (5 of 32) developed CDAD after administration of prophylactic perioperative antibiotics only. The high crude mortality rate associated with CDAD suggests that this may be a significant predictor of poor outcome among infected surgical patients. Antibiotics used commonly but not classically associated with CDAD frequently precipitate this infection. Finally, the use of prophylactic antibiotics is not without risk, as demonstrated by the significant percentage of CDAD occurring after routine administration of these agents.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313489906500603
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1999
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  • 3
    Online Resource
    Online Resource
    Trends in Nosocomial Pneumonia in Surgical Patients as We Approach the 21st Century: A Prospective Analysis
    SAGE Publications ; 1999
    In:  The American Surgeon Vol. 65, No. 8 ( 1999-08), p. 706-710
    Details
    In: The American Surgeon, SAGE Publications, Vol. 65, No. 8 ( 1999-08), p. 706-710
    Abstract: To compare outcome and prognostic factors of pneumonia in surgical patients, we prospectively studied all episodes of nosocomial infection at all sites in 1997 on the surgical services at a single hospital. Pneumonia accounted for 74 of 287 episodes of infection. The crude mortality for pneumonia was 31.1 versus 12.2 per cent for all other infections (P 〈 0.001). Pneumonia patients had a higher severity of illness compared with those with infections at other sites (18.7 ± 0.8 vs 14.0 ± 0.5; P 〈 0.001). Crude mortality remained higher in pneumonia patients when compared with an infected control group matched for severity of illness and age (31% vs 15%; P = 0.02). Staphylococcus aureus (15%) was the most common isolate, followed by Pseudomonas aeruginosa (9%). Resistant Gram-positive cocci accounted for 7 per cent of all isolates but was associated with a 60 per cent mortality vs 28 per cent with other organisms (not significant; P = 0.1). The Acute Physiology and Chronic Health Evaluation (APACHE) II score for patients with resistant Gram-positive cocci was 22 ± 1 versus 18 ± 1 with other organisms (P = 0.03). Nonsurvivors of pneumonia were older (58 ± 2 vs 51 ± 3; P = 0.03), had a higher APACHE II score (23 ± 1 vs 17 ± 1; P 〈 0.001), and were diagnosed later in their hospital course (18 ± 4 days vs 11 ± 1; P = 0.05) compared with survivors. Pneumonia-associated mortality in surgical patients remains high compared with other infections even when correcting for differences in severity of illness. Although resistant Gram-positive cocci appear to be increasing in frequency, they may represent markers of severe illness rather than true pathogens. Increasing age, severity of illness, and length of stay before diagnosis were all associated with a worse prognosis.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313489906500802
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1999
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  • 4
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    Online Resource
    Extremes of White Blood Cell Count do not Independently Predict Outcome among Surgical Patients with Infection
    SAGE Publications ; 2000
    In:  The American Surgeon Vol. 66, No. 12 ( 2000-12), p. 1124-1131
    Details
    In: The American Surgeon, SAGE Publications, Vol. 66, No. 12 ( 2000-12), p. 1124-1131
    Abstract: Historically patients with severely depressed or elevated white blood cell (WBC) counts during infection were felt to have worse outcomes. To test this assumption we prospectively analyzed all infections on the surgical services at the University of Virginia hospital between December 1, 1996 and April 1, 1999. Among 1737 infectious episodes 59 presented with leukopenia (WBC count ≤ 3,000 cells/μL) whereas 66 presented with leukemoid responses (WBC count ≥ 30,000 cells/μL). Compared with other infected patients leukopenic patients had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (18 ± 0.9 vs 12 ± 0.2, P 〈 0.0001) and mortality (23.7% vs 11.4%, P = 0.004). Patients with leukemoid responses also had higher APACHE II scores (21 ± 1.0 vs 12 ± 0.2, P 〈 0.0001) and mortality (30.3% vs 11.4%, P 〈 0.0001). Compared with a control group randomly matched (2:1) by age and APACHE II score, however, there was no significant difference in mortality associated with leukopenia or a leukemoid response. Furthermore logistic regression did not reveal leukopenia or leukemoid responses to be independent predictors of mortality (odds ratio for death with leukopenia = 1.57, 95% confidence interval = 0.63–3.91, P = 0.33; odds ratio for death with leukemoid response = 1.19, 95% confidence interval = 0.70–2.02, P = 0.53). Although very low or very high WBC counts may represent markers of severe illness in infected surgical patients they do not appear to be significant contributors to a worsened outcome.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313480006601207
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2000
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  • 5
    Online Resource
    Online Resource
    Intra-Abdominal Abscesses: Emphasis on Image-Guided Diagnosis and Therapy
    SAGE Publications ; 1998
    In:  Journal of Intensive Care Medicine Vol. 13, No. 6 ( 1998-11), p. 320-328
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 13, No. 6 ( 1998-11), p. 320-328
    Abstract: Infection of the peritoneal cavity can be divided into acute peritonitis and chronic abscess formation. While acute peritonitis is easier to diagnose and treatment is often straightforward, the diagnosis of an intra-abdominal abscess can be subtle and treatment can involve multiple diagnostic and therapeutic modalities. The advent of high-quality computed tomography and ultrasonography has revolutionized the care of these patients, and has allowed for the definitive management of these infections without open operation. We review the current techniques for the diagnosis, localization, and treatment of these serious infections, discuss important factors influencing the decision between percutaneous and operative approaches, and examine several other controversies In this challenging area.
    Type of Medium: Online Resource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1177/088506669801300606
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1998
    detail.hit.zdb_id: 2001472-7
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  • 6
    Online Resource
    Online Resource
    Techniques for Preserving Vertebral Artery Perfusion During Thoracic Aortic Stent Grafting Requiring Aortic Arch Landing
    SAGE Publications ; 2006
    In:  Vascular and Endovascular Surgery Vol. 40, No. 5 ( 2006-10), p. 367-373
    Details
    In: Vascular and Endovascular Surgery, SAGE Publications, Vol. 40, No. 5 ( 2006-10), p. 367-373
    Abstract: Thoracic endografting offers many advantages over open repair. However, delivery of the device can be difficult and may necessitate adjunctive procedures. We describe our techniques for preserving perfusion to the left subclavian artery despite endograft coverage to obtain a proximal seal zone. We reviewed our experience with the Talent thoracic stent graft (Medtronic, Santa Rosa, CA). From 1999 to 2003, 49 patients received this device (29 men, 20 women). Seventeen patients required adjunctive procedures to facilitate proximal graft placement. We performed left subclavian-to-left common carotid artery transposition (6), left common carotid-to-left subclavian artery bypass with ligation proximal to the vertebral artery (7), and left common carotid-to-left subclavian artery bypass with proximal coil embolization (4). Patients who had anatomy unfavorable to transposition or bypass with proximal ligation (large aneurysms or proximal vertebral artery origin) were treated with coil embolization of the proximal left subclavian artery in order to prevent subsequent type II endoleaks. Technical success rate of the carotid subclavian bypass was 100%. Patient follow-up ranged from 3 to 48 months with a mean of 12 months. Six patients had follow-up 〈 6 months owing to recent graft placement. Primary patency was 100%. No neurologic events occurred during the procedure or upon follow-up. One patient had a transient chyle leak that spontaneously resolved in 24 hours. Another patient had a phrenic nerve paresis that resolved after 3 weeks. We believe that it is important to maintain patency of the vertebral artery specifically when a patent right vertebral system and an intact basilar artery is not demonstrated. Furthermore, we describe a novel technique of coil embolization of the proximal left subclavian artery in conjunction with left common carotid-to-left subclavian artery bypass. This circumvents the need for potentially hazardous mediastinal dissection and ligation of the proximal left subclavian artery in cases of large proximal aneurysms or unfavorable vertebral artery anatomy.
    Type of Medium: Online Resource
    ISSN: 1538-5744 , 1938-9116
    URL: Article
    DOI: 10.1177/1538574406293735
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2006
    detail.hit.zdb_id: 2095223-5
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  • 7
    Online Resource
    Online Resource
    Longitudinal Outcomes of Women Undergoing Transcatheter Aortic Valve Replacement
    SAGE Publications ; 2019
    In:  Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery Vol. 14, No. 4 ( 2019-08), p. 311-320
    Details
    In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, SAGE Publications, Vol. 14, No. 4 ( 2019-08), p. 311-320
    Abstract: Recent data have suggested that women have a survival benefit at 1-year follow-up. However, long-term gender-based TAVR outcomes are lacking. Methods All patients undergoing isolated TAVR from 2011 to 2017 were included. Patients were stratified by gender. The primary outcomes of the study were 3-year mortality and 3-year hospital readmissions. Multivariable logistic regression analysis was used to evaluate the risk-adjusted impact of gender on TAVR outcomes. Results A total of 1,036 patients were divided into male ( n = 518) and female ( n = 518) cohorts. Women had a borderline significantly increased STS PROM (8.3% ± 5 vs. 7.7% ± 4.4; P = 0.05). The majority of procedures were performed under conscious sedation (male: 89% vs. female: 88%; P = 0.62) and via transfemoral access (male: 81.8% vs. female: 81.4%; P = 0.46). There was no difference in operative (30-day) mortality (male: 15 [3.3%] vs. female: 17 [3.7%] ; P = 0.77) or 30-day readmissions (male: 40 [10.8%] vs. female: 44 [12.2%] ; P = 0.56). Perioperative blood product usage was higher for women (male: 8.1% vs. female: 14.1%; P = 0.002). There was no significant difference in major vascular complications (male: 0.4% vs. female: 1.0%; P = 0.26) or major bleeding (male: 0.2% vs. female: 0.4%; P = 0.56). Permanent pacemaker placement was higher for males (11.6% vs. 7.0%; P = 0.01). On risk-adjusted multivariable analysis, gender was not a factor associated with mortality (HR 0.99 [0.76 to 1.30]; P = 0.99) or readmission (HR 0.90 [0.72 to 1.14] ; P = 0.42) at 5 years. Conclusions There was no difference in survival or readmissions on multivariable analysis for women undergoing TAVR at 3 years. Longitudinal multi-institutional data will be important to validate these findings.
    Type of Medium: Online Resource
    ISSN: 1556-9845 , 1559-0879
    URL: Article
    DOI: 10.1177/1556984519842943
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2223439-1
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