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11.
Accidental bronchial intubation An analysis of AIMS incident reports from 1988 to 1994 inclusive 总被引:2,自引:0,他引:2
Accidental bronchial intubation was examined in the first 3947 cases reported to the Australian Incident Monitoring Study and was found to have accounted for 154 (3.7%) of the total incidents reported. Most incidents were detected in the operating theatre (93.5%) and during maintenance of anaesthesia (77.9%), by unexplained oxygen desaturation alone (63.6%). Capnography remained normal or unremarkable during 88.5% of the episodes. One-third of cases were associated with head or neck surgery and possible flexion of the patient's head. A RAE tube was used in 20% of incidents, a greater frequency than occurred in the study overall. A third party was implicated in 36 (23.4%) of cases. Ninety per cent of cases were considered preventable. Major morbidity occurred in three cases and unplanned intensive care admission was required in a further five. Almost two-thirds (61.1%) of the incidents might have been avoided by the proposed markings on the tracheal tube. We conclude that when arterial desaturation occurs at any stage during anaesthesia the possibility of bronchial intubation must be considered. Asymmetrical ventilation may be difficult to detect clinically and in most cases there is no change in capnography. 相似文献
12.
Norberto Adame Jr. MD Bruce T. Horwood MD Daniel Caruso MD Ted Wallace MD Louis Velasco MD 《Academic emergency medicine》2006,13(1):114-116
Objectives: To determine whether the Mac‐technique test can detect kinking of the chest tube upon thoracostomy tube placement. Methods: This was a prospective observational study that was conducted October 2000 through October 2001 in an urban Level 1 trauma center. There were 103 consecutive nonrandomized adult trauma patients who required immediate tube thoracostomy during their initial resuscitation who were entered into the study. The Mac‐technique test was performed during standard tube thoracostomy insertion to the appropriate depth. The test involved grasping the external portion of the thoracostomy tube, turning it clockwise 180°, and then releasing the tube. If the tube spontaneously spun back to its original position, the test was considered positive, and the tube was considered kinked. If the tube did not spontaneously spin back and stayed in position upon release, the test was considered negative. Regardless of the results of this test, the tube was secured, and a postprocedure chest radiograph was obtained. The criterion standard for determining a kinked chest tube was its appearance on this chest radiograph. Results: A total of 103 chest tubes were placed by using the Mac‐technique test. The test was positive in eight placements; four tubes were kinked on chest radiograph. The Mac‐technique test was negative in 95 placements; four tubes were kinked on chest radiograph. The Mac technique had a sensitivity of 50% (95% confidence interval [CI] = 15.7% to 84.3%), a specificity of 95.8% (95% CI = 89.6% to 98.8%), a positive likelihood ratio of 11.9, a negative likelihood ratio of 0.52, and an odds ratio using Yates correction of 20.3 (95% CI = 4.1 to 102.1). Conclusions: On the basis of this study, a positive Mac‐technique test is useful to detect chest tubes that are likely to be kinked after insertion and before securing. 相似文献
13.
M. M. nal M. Hanhan B. Planci & . Tinar 《International journal of gynecological cancer》2004,14(4):595-599
The aim of the study was to determine the clinical characteristics and management of fallopian tube malignancies together with the results there unto that had been diagnosed and treated in our oncology department retrospectively. Twelve cases of fallopian tube malignancies, of a total of 2155 gynecologic malignancies (0.55%), that had been diagnosed in or referred to our hospital between January 1986 and December 2001 were evaluated retrospectively. Eight of 12 cases were diagnosed after surgical intervention in our department. Staging laparotomies were applied to all of the eight cases. Complementary surgeries of other four cases who were referred to our department were done according to the same principles of cytoreductive surgery. Staging of the cases was done according to Federation of International Gynecologists and Obstetricians (FIGO). Adjuvant chemotherapy was applied to all of the cases except two (10 cases, 83.3%). Second-look laparotomy (SLL) was applied to two of the cases. Mean age of the cases was 54.2 (range 35-72) years. Histopathology of the cases was as follows: serous adenocarcinoma in 10 cases (83.3%), endometrioid adenocarcinoma in one case (8.3%), and undifferentiated carcinoma in one case (8.3%). Adjuvant chemotherapy (PAC regimen to eight of the cases and PP regimen to two cases) was applied to 10 of the cases (83.3%). SLL was applied to two cases. Another case had died because of local recurrence at the 27th month of the follow-up. Mean follow-up period of the cases was 37.8 months (range 1-144 months). Fallopian tube malignancies are very rare malignancies. Diagnosis can be made generally peri- or postoperatively. More extensive clinical research must be performed in order to have definite etiologic, diagnostic, management modalities, and prognostic markers. 相似文献
14.
15.
Kazuro Sugi Kouichi Nawata Kazuhiro Ueda Yoshikazu Kaneda Sumihiko Nawata Atsunori Oga Kensuke Esato 《Surgery today》1997,27(7):666-668
We report herein the case of a 70-year-old man in whom a chest wall implantation of adenocarcinoma of the lung at the drainage
tube site was found 4 months after a right lower lobectomy with mediastinal lymph node dissection had been performed for adenocarcinoma
of the right lower lobe. The lesion was successfully treated by tumor extirpation. We believe that tumor seeding to the chest
wall occurred at the time of thoracotomy. To prevent such tumor seeding, the pleural cavity should be washed out routinely
with a massive volume of physiological saline solution prior to closure of the chest wall. 相似文献
16.
空管药物疗法治疗牙髓病和根尖周病疗效观察 总被引:1,自引:0,他引:1
用SMTD复合药物对牙髓病和根尖周病实施空管药物疗法。78例103颗获得完整随访资料患牙经两年观察,92.2%治愈率。文章介绍了治疗方法,讨论了空管药物疗法的愈合机理、优点、失败原因及其预防措施。 相似文献
17.
胆道支撑管显影材料的制备及体外细胞毒性评价 总被引:4,自引:0,他引:4
目的 探讨新型显影胆道支撑管材料制备的可行性,对构建出的材料进行体外细胞毒性评价和筛选。方法 选择具有X线下显影特性的基础材料A、B、C,分别与硅橡胶生胶共混炼,模压后分别得到相应的显影复合材料甲、乙、丙,经一段和二段硫化过程完成加工。采用MTT法作为体外细胞毒性评价的方法,测定参比对照材料和新材料的50%浓度的浸提液对小鼠成纤维细胞的增殖率的影响,确定细胞毒性级别。结果 新材料甲、乙、丙在x线下影像清晰。甲、乙材料的细胞毒性级别为零,丙材料细胞毒性级别为2。结论 构建出在X线下显影的弹性体材料可行。材料甲、乙是制造新型胆道支撑管的初选材料,材料丙无应用的价值。 相似文献
18.
报道13例应用显徽外科技术进行输卵管绝育术后吻合术。全部病例至少随访1年。13例术后行输卵管通液术,提示输卵菅通畅(100%),13例中11例妊娠(84.62%),并复习文献,对影响手术成功的诸多因素进行讨论。 相似文献
19.
M. Baekelandt M. Kockx F. Wesling & J. Gerris 《International journal of gynecological cancer》1993,3(2):65-71
An extensive review of the currently available literature on primary fallopian tube carcinoma is presented. The role of vaginal ultrasonography and the importance of an aggressive evaluation of every tubal deformity is stressed. A staging system which takes into account recent data on the biology of this malignancy is proposed. We emphasize the largely underestimated importance of early lymphatic spread of this disease, necessitating a thorough staging laparotomy with pelvic and para-aortic lymph node sampling in the apparent early stages. The need for adjuvant treatment is obvious, but until now no firm data exist as to what the optimal strategy should be. We recommend that until more representative studies are available, ovarian carcinoma protocols should be used in clinical practice. 相似文献
20.
A feasibility study was made to examine whether pressure measurements can be used to diagnose vascular obstructions in blood vessels. Distortion of a pressure wave due to an obstruction in an elastic tube was investigated theoretically and experimentally. Linear theory and the method of characteristics were employed in developing mathematical expressions for the distortion of the pressure wave. The quality of the models developed was examined by performing experiments on a latex tube with rigid obstructions. A nonlinear model using the method of characteristics was in good agreement with the experiment data for obstructions with any severity, while a linear model was applicable to small obstructions. The nonlinear model is proposed as a mathematical model for the detection of vascular obstructions by analysing pressure waves. 相似文献