Amputation ; adverse effects ; Amputation Stumps ; physiopathology ; surgery ; Analgesics ; administration & dosage ; Chronic Pain ; etiology ; physiopathology ; therapy ; Combined Modality Therapy ; Female ; Humans ; Hypnosis ; methods ; Middle Aged ; Pain Management ; Phantom Limb ; etiology ; physiopathology ; therapy ; Reoperation ; Treatment Outcome ; Upper Extremity ; injuries ; surgery

Abscess ; diagnosis ; etiology ; therapy ; Antitubercular Agents ; therapeutic use ; DNA, Bacterial ; analysis ; Debridement ; methods ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Male ; Metacarpus ; Middle Aged ; Mycobacterium tuberculosis ; genetics ; isolation & purification ; Tuberculosis, Pulmonary ; complications ; drug therapy ; microbiology

OBJECTIVE: This controlled study was done to determine the protective effects of ischemic preconditioning (IP) on the liver of cats undergoing major liver resection.
SPECIFIC OBJECTIVE: To determine the effect of IP on alanine transaminase (ALT or SGPT) in cat*that will undergo major liver resection.
DESIGN: This study is a randomized controlled trial.
SETTING: LIST Health Sciences Research Laboratory.
PATIENTS/ PARTICIPANTS: This is an experimental study on the effects of ischemic preconditioning under hepatic inflow occlusion on the SGPT as a measure of morbidity in Felis catus (domestic cats) undergoing right hepatic lobectomy. Nine male cats, weighing 2.5-5kg, are equally allocated into any one of the following 3 study groups: Control group not subjected to ischemic preconditioning (C), Experimental group subjected to 1 1/2 minutes of ischemia followed by 1.5 minutes of reperfusion (El), Experimental group subjected to 5 minutes of ischemia followed by 5 minutes of reperfusion (E2).
RESULTS: There was no significant difference in the mean weight of cats in the 3 groups (p = 1.00). Comparing the pre and post result between using paired t-test, there was no significant difference in the baseline values (p = 0.14). However, there was a significant difference in the post result between the three groups (p < 0.001). The results showed that the mean post values significantly increased from baseline. The same result was noted in the El and E2 group where a significant increase was also noted with p values, 0.005 and 0.004, respectively. Comparing the mean difference in the pre and post values using ANOV A, there was a significant difference noted between the three groups as proven by all p values
CONCLUSION: In the past few years, interesting new data on the presence of ischemic preconditioning in various organs as an endogenous means to protect itself from ischemiahas been available. This study investigated and suggests that ischemic preconditioning may provide protection to the liver undergoing hepatic lobectomy.

Animal ; Alanine Transaminase ; Felis ; Ischemic Preconditioning ; Hepatectomy ; Liver ; Cats

INTRODUCTIONHand infections in patients with end-stage renal failure (ESRF) are more diffi cult to treat and have had the worse outcomes. This paper examines the epidemiology, bacteriology and outcomes of surgically managed upper limb infections in these vulnerable patients.

MATERIALS AND METHODSAll patients from a single centre with surgically-managed upper limb infections between 2001 and 2007 were reviewed. We collected epidemiological data on demographics, type and site of infection, bacteriology, surgical treatment, complications and mortality.

RESULTSForty-seven out of 803 (6%) patients with surgically managed upper limb infections in the study period had ESRF. The average age was 59 years. ESRF was secondary to diabetes in 88% of cases. Patients presented on average 7 days after onset of symptoms. Abscesses (34%), wet gangrene (26%) and osteomyelitis (11%) were the commonest infections. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest pathogen (29%), occurring either in isolation or with other organisms. Eighteen percent of single organisms cultured were gram-negative. Multiple organisms occurred in 29%. A median of 2 operations were required. Thirty-six percent of all cases required amputation. Twenty-fi ve percent of patients had a life-threatening event (myocardial infarction or septic shock) during treatment.

CONCLUSIONSESRF patients present late with severe upper limb infections. Nosocomial infections are common. Initial empirical antibiotic treatment should cover MRSA and gram-negative bacteria. Immediate referral to a hand surgery unit is recommended. Multi-disciplinary management of the patient with input from physicians and anaesthetists or intensivists in the perioperative period is necessary to optimise the patient for surgery and to manage active medical comorbidities and complications after surgery.

Adult ; Aged ; Aged, 80 and over ; Amputation ; Diabetes Complications ; Epidemiologic Studies ; Female ; Hand ; surgery ; Hand Injuries ; epidemiology ; etiology ; surgery ; Humans ; Kidney Failure, Chronic ; complications ; epidemiology ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Surgical Wound Infection ; drug therapy ; epidemiology ; etiology