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Sean J. Barnett M.S. M.D. Christopher Stanley B.S. Melanie Hanlon R.N. C.N.P. Robert Acton M.D. Daniel A. Saltzman M.D. Ph.D. Sayeed Ikramuddin M.D. Henry Buchwald M.D. Ph.D. 《Surgery for obesity and related diseases》2005,1(4):1609-398
PURPOSE: Obesity has become a health-care crisis in the United States. Adolescent obesity is now one of the most common childhood disorders, with 4.7 million American adolescents having a body mass index (BMI) greater than the 95th percentile. Most patients do not respond to diet modification or exercise programs and attention is now turning toward surgery as a source of weight loss in adolescents. Few studies have looked at the overall morbidity and mortality of weight loss surgery in this patient population. METHODS: This is a retrospective study of medical charts of 15 bariatric surgical procedures performed on 14 adolescents without known genetic syndromes associated with severe childhood obesity from 1971 to 2001 at the University of Minnesota. Procedures performed on these patients included vertical banded gastroplasty (n = 7), Roux-en-Y gastric bypass (n = 5), and jejunoileal bypass (n = 3). Jejunoileal bypass procedures were performed from 1971 to 1977, after which time this procedure was abandoned. Patient age ranged from 13 to 17 years (mean, 15.7 years). Mean follow-up time was 6 years, with 9 patients available for long-term follow-up. RESULTS: All procedures were performed using an open technique by 1 surgeon. There were no perioperative deaths; complications included 1 case of wound infection, 2 episodes of dumping syndrome that resolved without revision, 1 episode of hypoglycemia, and 1 case of short-term electrolyte imbalance in a patient who underwent jejunoileal bypass. The average BMI dropped from 58.5 +/- 13.7 to 32.1 +/- 9.7 kg/m(2) (P < .01)--a 45% reduction. CONCLUSIONS: Surgery for morbid obesity is safe and results in significant weight loss in adolescents who fail medical therapy. 相似文献
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Roberto Rivera-Luna Marta Zapata-Tarrés Aurora Medina-Sansón Enrique López-Aguilar Ana Niembro-Zúñiga J. Amador Zarco Alfonso Marhx-Bracho Fernando Rueda-Franco Leticia Bornstein-Quevedo 《Child's nervous system》2007,23(5):543-547
Objective The purpose of this study is to analyze clinical aspects and disease-free survival (DFS) in children less than 3 years of
age diagnosed with low-grade astrocytoma.
Methods In a period of 24 years (1980–2004), a total of 43 (5.4%) children were registered with these characteristics. Twenty-three
patients had pilocytic astrocytoma, 18 diffused, and 2 mixed. Thirty-one (72.1%) children had incomplete surgical tumor resection
and 12 (27.9%) had a complete tumor resection. Twelve (27.9%) patients had cranial radiotherapy and 17 (39.5%) received chemotherapy.
Overall survival was recorded in 23 (53%). DFS was 50% at 250 months of follow-up for the whole group. DFS for the supratentorial
group was 60% at 250 months, whereas, for the infratentorial, it was 22% at 120 months (p = 0.008).
Conclusion The only favorable prognostic pattern was the supratentorial presentation. Radiotherapy and chemotherapy did not alter the
outcome. 相似文献
17.
U. Lehmann G. Regel B. Ellendorf E. Rickels M. Lorenz H. Becker H. Tscherne 《Der Unfallchirurg》1997,100(9):705-710
Summary
A total of 208 multiple trauma patients with head injury (HI) were investigated who had been treated in the period from 1990
to 1995. The average age was 35.2 ± 17.7 years; the injury severity according to ISS was 30.2 ± 8.6 points; 20.5 % died as
a result of the HI; the mortality of all patients was 26.5 %. The Glasgow Coma Scale (GCS) was determined at an average of
22 min after trauma (8.0 ± 4.3 points) at the scene of accident. The patients were classified according to GCS into minor
HI (group 1: 14–15 points), moderate HI (group 2: 9–13 points) and severe HI (group 3: 3–8 points). Patient outcome was assessed
by the Glasgow Outcome Scale (GOS) and was classified as good (GOS 4 and 5) and poor (GOS 1, 2 and 3) outcome. At the latest,
2 h after trauma, a CT scan of the head (CCT) was done. The HI groups are compared regarding frequency of types of injury.
In all HI groups the fractures of the bony face occurred at the same frequency (36.0–38.9 %). The frequency of calotte fractures
(Kal-Fx) increased from group 1 (8.0 %) to 2 (19.2 %) and 3 (25.6 %); fractures of the skull base significantly differed between
group 1 (16.0 %), 2 (7.8 %) and 3 (33.4 %). Epidural hemorrhage (EDB) appeared only in group 2 (7.8 %) and 3 (6.7); subdural
hemorrhage was found in group 1 (2.7 %), 2 (7.8 %) and 3 (10.0 %). Subarachnoid hemorrhage (SAB) was significantly more frequently
seen, dependent on HI severity, in group 3 (26.7 %) compared to group 2 (11.7 %) and 1 (8.0 %). Intracerebral contusion (ICK)
significantly increased from group 1 (12.0 %) to 2 (27.3) and 3 (45.6 %). Brain swelling (BS) also significantly increased
from group 1 (8.0 %) to 2 (19.5 %) and 3 (49.0 %) and lesions of ventricles (VL) from group 1 (2.7 %) to 2 (11.7 %) and 3
(20.0 %). Midline shift (13.4 %) and signs of herniation (4.5 %) only occurred in group 3. The analysis of correlation/regression
and receiver operating characteristics was able to predict 79 % of patients' outcome accurately using GCS (r 0.54; P < 0.0001) alone, using CCT (r 0.65; P < 0.0001) 87 % were correctly predicted with significant variables Cal-Fx, EDB, SAB and BS. CCT with GCS (r 0.74; P < 0.0001) were able to predict 88 % accurately with significant variables Cal-Fx, EDB, BS and GCS. The combination of CCT
with GCS, age and ISS (r 0.78; P < 0.0001) was able to predict only 87 % correctly, although the r value was the highest; significant variables were Kal-Fx, EDB, BS, VL, GCS, age and ISS.
相似文献
18.
William R. Reinus M.D. Franz J. Wippold II M.D. Kavita K. Erickson M.D. 《Emergency radiology》1994,1(2):81-84
We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened
headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who
were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for
a positive CT than the rest of the sample (p<1.5 – 10−10). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia,
depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative
neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in
this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive
scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway and
the other three developed positive neurologic examinations within 24 hours. One died of causes unrelated to the intracranial
pathology. Positive neurologic examination, hypertension, history of amnesia, or a depressed sensorium provide reasonable
initial guidelines to select for CT patients with an acute headache. 相似文献
19.
M Daperno R Sostegni N Scaglione E Ercole C Rigazio R Rocca A Pera 《Digestive and liver disease》2004,36(1):21-28
BACKGROUND: Severe ulcerative colitis is potentially life threatening even though a policy of intensive medical management and early colectomy in recent years reduced mortality to almost zero. However, colectomy, with or without ileal-anal anastomosis, has its own problems (morbidity, pouchitis, cuffitis) and no reliable prognostic index of surgical outcome has been developed. Intravenous steroids are still the mainstay of medical therapy but their maximal duration before stating a 'treatment failure' has not been defined. AIM OF THE STUDY: To evaluate the effectiveness, safety and outcome of an intensive medical approach in a series of patients with severe ulcerative colitis. PATIENTS AND METHODS: One hundred and forty-nine episodes of severe ulcerative colitis in 115 patients admitted to a Gastroenterology Unit in a 7-year period were retrospectively evaluated. Intravenous glucocorticosteroids--methylprednisolone 1 mg/kg/day--and topical steroids were administered, and supportive treatments with intensive monitoring were extended to all the patients. Second-line strategies for steroid-refractoriness were prolonged glucocorticosteroids treatment, oral ciclosporin, infliximab or surgery. RESULTS: The median number of Truelove criteria at admission was 3 (range 2-5), median CRP 34 mg/l (range 10-196). Median follow-up after discharge was 49 months. In 84 (57%) episodes an early response was noted, while 65 (43%) did not respond within 10 days to the standard steroid treatment. In the non-responders group, 28 patients went into remission with a prolonged steroid treatment (slow responders); 15 patients were treated with ciclosporin (eight responders) and 6 with infliximab (four responders). A total of 24 colectomies was performed in this group of patients (in 21 cases within 30 days from admission). Slow responders showed lower albumin levels (P = 0.02), higher cumulative dose of glucocorticosteroids in the year prior to admission (P = 0.02) and higher age (P = 0.03), in comparison with early responders. Major complications were noted in four episodes which responded to medical treatment. Disease-related mortality was zero. CONCLUSIONS: Medical treatment and use of second-line therapies were effective in the present series of patients. A group of slow responders has been identified and, if an intensive medical monitoring is guaranteed, steroids can be safely prolonged after the first 10 days of treatment. Cumulatively, about 80% of the patients responded to short-term medical treatment, only 5% of the patients underwent colectomy in the follow-up period. Major adverse events were recorded in four patients, who had recovered completely after adequate medical treatment. 相似文献
20.
Dr. T. D. Szucs 《Der Onkologe》2005,11(2):139-151
Zusammenfassung In der Onkologie gewinnen medizinisch-ökonomische Aspekte eine immer größere Bedeutung. In Anbetracht des Anstiegs der Gesundheitsausgaben und der immer teureren Interventionen müssen Wege aufgezeigt werden, wie mit den vorhandenen finanziellen Mitteln Prioritäten gesetzt werden können. Die medizinische Ökonomie, eine vergleichsweise junge Wissenschaft, beschäftigt sich unter anderem mit der ökonomischen Bewertung medizinischer Technologien mit dem Ziel der Verbesserung der gesundheitspolitischen Entscheidungsfindung. Dieser Artikel beleuchtet die Grundlagen dieser Wissenschaft, einschließlich der ökonomischen Evaluation, im Kontext der internistischen Onkologie. Zweifelsohne wird die medizinische Ökonomie in Zukunft in der ärztlichen Fort- und Weiterbildung eine ähnlich wichtige Rolle spielen wie klinische Epidemiologie und evidenzbasierte Medizin. 相似文献