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1.
Retrorenal colon: implications for percutaneous diskectomy 总被引:1,自引:0,他引:1
It has been recommended that computed tomography (CT) with the patient prone be performed in every patient undergoing percutaneous diskectomy; this would enable detection of a retrorenal location of the colon, which could interfere with the percutaneous procedure. In this evaluation of 346 prone CT studies, only one patient (0.29%) was found to have retrorenal or retropsoas bowel that would have been perforated at diskectomy. Because of this extremely low prevalence, the performance of prone CT in every patient undergoing percutaneous lumbar diskectomy is not believed to be necessary. 相似文献
2.
Financial Implications of Pancreas Transplant Complications: A Business Case for Quality Improvement
J. A. Cohn M. J. Englesbe Y. M. Ads J. L. Paruch S. J. Pelletier T. H. Welling C. J. Sonnenday J. C. Magee J. D. Punch D. A. Campbell Jr . R. S. Sung 《American journal of transplantation》2007,7(6):1656-1660
We quantified the financial implications of surgical complications following pancreas transplantation. We reviewed medical and financial records of 49 pancreas transplant recipients at the University of Michigan Health System (UMHS) between 1/6/2002 and 11/22/2004. The association of donor, transplant recipient and financial variables was assessed. The median costs to UMHS of procedures and follow-up were $92,917 for recipients without surgical complications versus $108,431 when a surgical complication occurred, a difference of $15,514 (p = 0.03). Median reimbursement by the payer was $17,363 higher in patients with a surgical complication (p = 0.001). Similar trends (higher insurer costs) were noted when stratifying by payer (public and private) and specific procedure (SPK and PAK). All parties (patient, physician, payer and medical center) should benefit from quality improvement, with payers having a financial interest in pancreas transplant surgical quality initiatives. 相似文献
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The effect of ceftriaxone on the anaerobic bacterial flora and the bacterial enzymatic activity in the intestinal tract 总被引:2,自引:0,他引:2
G. W. Welling Ph. D. Geke J. Meijer-Severs M. S. Gé Helmus Edith van Santen R. H. J. Tonk Hilly G. de Vries- Hospers M. D. Ph. D. D. van der Waaij M. D. Ph. D. 《Infection》1991,19(5):313-316
Summary The normal flora of the intestinal tract, mainly consisting of anaerobic bacteria, protects the host against colonization by pathogenic microorganisms. Antimicrobial treatment with ceftriaxone may influence the colonic microflora and as a consequence, the protective effect. Ten healthy volunteers received 1 g of ceftriaxone intramuscularly for five days. This resulted in a significant decrease (p<0.05) of the mean cultural counts (± SEM) of total anaerobes from 10.67 (0.11) (prior to treatment) to 9.02 (0.45) and 8.97 (0.46) at days 3 and 5, respectively (during treatment). After treatment (days 10 and 15–19), the cultural counts of anaerobes returned to 10.17 (0.16) and 10.44 (0.18), respectively. Bacterial enzymes may serve as an indicator of protective microflora. - aspartylpeptidase and deoxycholate hydrolase activity was determined in faecal supernatants of the volunteers and compared with anaerobic culturing. Both enzymatic activities show a significant correlation with the total number of anaerobes present at day 3 of ceftriaxone treatment. At day 5 and 8 only -aspartylpeptidase showed significant correlations with cultural counts of total anaerobes,Bacteroides spp. or bifidobacteria. At day 15 to 19 (ten to 14 days after treatment) -aspartylpeptidase showed only a significant correlation with the number ofBacteroides spp. This indicates that changes in the indigenous bacterial flora during and shortly after treatment with ceftriaxone can be monitored by determination of -aspartylpeptidase. Recovery of the intestinal flora is difficult to assess in this manner.
Einfluß von Ceftriaxon auf die anaerobe Flora und die bakterielle Enzymaktivität im Intestinaltrakt
Zusammenfassung Die normale Flora des Intestinaltraktes besteht vorweigend aus anaeroben Bakterien und schützt den Wirt gegen eine Kolonisation durch pathogene Mikroorganismen. Eine antimikrobielle Therapie mit Ceftriaxon kann die Mikroflora des Dickdarms beeinträchtigen und damit auch deren protektiven Effekt. Zehn gesunde Probanden erhielten fünf Tage lang 1 g Ceftriaxon intramuskulär appliziert. Dies führte zu einer signifikanten Abnahme der mittleren Koloniebildnerzahlen von 10,67 (SEM ± 0,11) vor Applikation auf 9,02 (± 0,45) nach drei und auf 8,97 (± 0,46) nach fünf Tagen (p<0,05). Nach zehn und 15 bis 19 Tagen im Anschluß an die Antibiotikagabe kehrten die Anaerobier-Koloniebildnerzahlen auf 10,17 (± 0,16) bzw. 10,44 (± 0,18) zurück. Bakterienenzyme können als Indikator für die protektive Mikroflora dienen. In Überständen von Stuhlproben der Probanden wurden -Aspartylpeptidase und Desoxycholat-Hydrolase bestimmt und mit den Anaerobier-Kulturen verglichen. Zwischen den Aktivitäten beider Enzyme und der am Tag 3 gemessenen Anaerobier-Gesamtzahl fand sich eine signifikante Korrelation. Am Tag 5 und Tag 8 zeigte nur die -Aspartylpeptidase eine signifikante Korrelation mit den Gesamt-Kolonie-bildnerzahlen der Anaerobier sowie mit den Zahlen vonBacteroides spp. oder Bifidobakterien. An den Tagen 15 bis 19 (zehn bis 14 Tage nach Antibiotikagabe) bestand nur zwischen der Zahl vonBacteroides spp. und -Aspartylpeptidase eine signifikante Korrelation. Nach Behandlung mit Ceftriaxon lassen sich folglich Veränderungen der bakteriellen Flora kurzfristig durch Bestimmung der -Aspartylpeptidase erfassen, weniger gut aber die Erholung der Darmflora.相似文献
6.
Welling RE 《Current surgery》2000,57(4):381-383
The aim of this report was to document the practice of vascular surgery for graduates of 4 general surgery training programs.Graduating residents from 1991 to 1995 were surveyed by phone to document the number of reconstructive vascular and dialysis access procedures that they performed during the most recent 12 months. Those who pursued additional training beyond general surgery or who did not successfully complete the certifying examination of the American Board of Surgery (ABS) were excluded. In addition, the Resident Review Committee for Surgery (RRC-S) defined category report for these same general surgeons during their residency was examined.Fifty-five percent (26 of 47) of the board-certified general surgeons do either reconstructive or dialysis access vascular surgery. The average number of procedures in the RRC-S defined category for this cohort was 76. During the focused 12 months, 1986 vascular procedures were done by these 26 surgeons (76 cases per surgeon).In certain regions of this country, a significant volume of vascular surgery is done by general surgeons who have an ABS primary certificate alone. The technique of control and repair of major arteries and veins, the consequences of distal organ ischemia, reperfusion injury, thrombosis, and embolization are important anatomic and physiologic principles that must be taught in the curriculum to general surgeons, regardless of their future surgical careers. (Curr Surg 57:381-383. Copyright 2000 by the Association of Program Directors in Surgery.) 相似文献
7.
Welling I Andersson IM Rosen G Räisänen J Mielo T Marttinen K Niemelä R 《The Annals of occupational hygiene》2000,44(3):219-225
The transportation of gaseous contaminant from a low and moderate low impulse (momentum<1 m s(-1)) source to the breathing zone was studied in a uniform air stream flow. Results of the effects of the direction and the velocity of principal air flow, convection due to a human body, arm movement of a human being and the type of source on the concentration profiles are presented. Three important results were obtained. Firstly, for a given low and moderate impulse low impulse contaminant source in the near field of a worker, his/her orientation relative to the principal air flow direction is the most important factor in reducing occupational exposure, with an air velocity of about 0.3 m s(-1). Secondly, the effect of convection resulting from body heat on air flow was lower than expected. Thirdly, arm movements influence contaminant dispersion, and should be included when models assessing exposure are developed. The present data can also be used to validate existing computational fluid dynamic (CFD) models. 相似文献
8.
A MacDonald GW Rylance D Asplin SK Hall IW Booth 《Archives of disease in childhood》1998,78(2):122-126
A 1993 MRC working group on phenylketonuria suggested standardising blood phenylalanine measurements by taking blood samples at the same time each day. Since it is not known how representative of a 24 hour period a single phenylalanine concentration is, the aim of this study was to investigate the 24 hour variability of plasma phenylalanine in well controlled children with phenylketonuria. Sixteen subjects, 12 girls and four boys aged 1 to 18 years, had hourly venous blood samples collected for 13 hours between 09.00 and 21.00 on one day. Serial skin puncture blood specimens were then collected at 24.00, 03.00, and 06.00 within the same 24 hour period. All food and drink was weighed. The median variation in plasma phenylalanine concentration was 155 mumol/l/day, with a minimum of 80 and a maximum of 280. The highest concentration occurred in the morning between 6.00 and 9.00 in 63% of subjects; the lowest occurred between midday and midnight in 94%. Concentrations < 100 mumol/l occurred in 46% of children below 11 years, three having concentrations < 30 mumol/l for two, six, and seven hours respectively. Three of five subjects had concentrations above the MRC guidelines for 24% of the period studied. Except in two subjects, the blood concentrations did not rise in response to phenylalanine consumption. However, the greater the quantity of protein substitute taken between waking and the 16.00 specimen, the larger the decrease in daytime phenylalanine concentration (r = -0.7030) (p < 0.005). There is therefore wide variability in phenylalanine concentrations in a 24 hour period in children with phenylketonuria which is not reflected in a single observation. Further study is needed to investigate the effects of timing of protein substitute on the stability of phenylalanine concentrations. 相似文献
9.
Patrick W. Slater D. Bradley Welling Joseph H. Goodman Michael E. Miner 《The Laryngoscope》1998,108(9):1408-1412
Objective: The purpose of the study was to demonstrate the utility of the middle fossa transpetrosal approach with anterior petrosectomy for difficult-to-access petroclival and pontine lesions. Study Design: Retrospective case review in academic tertiary referral center. Methods: Patients for inclusion had pontine and prepontine lesions of the petroclival region. Middle fossa transpetrosal approach with anterior petrosectomy with excision or biopsy of the lesion was performed. The main outcome measure was postoperative neurologic status including motor and cranial nerve function. Results: No patient experienced neuromuscular compromise or cranial nerve deficits as a direct result of the surgical procedure. Complications consisted of a subdural temporal lobe hemorrhage and one case of cerebrospinal fluid rhinorrhea. Conclusions: The middle fossa transpetrosal approach with anterior petrosectomy was utilized for five patients with petroclival or pontine tumors. In this small series, it served well to spare cranial nerves and allowed avoidance of serious vascular injury. To our knowledge, this is the first reported use of this procedure for pontine venous angiomas. 相似文献
10.
Shane J.T. Balthazaar Morten Sengelv Kim Bartholdy Lasse Malmqvist Martin Ballegaard Birgitte Hansen Jesper Hastrup Svendsen Anders Kruse Karen-Lise Welling Andrei V. Krassioukov Fin Biering-Srensen Tor Biering-Srensen 《The journal of spinal cord medicine》2022,45(4):631
ObjectiveTo investigate the incidence of cardiac arrhythmias at six months following traumatic spinal cord injury (SCI) and to compare the prevalence of arrhythmias between participants with cervical and thoracic SCI.DesignA prospective observational study using continuous twenty-four-hour Holter monitoring.SettingInpatient rehabilitation unit of a university research hospital and patient home setting.ParticipantsFifty-five participants with acute traumatic SCI were prospectively included. For each participant, the SCI was characterized according to the International Standards for Neurological Classification of SCI by the neurological level and severity according to the American Spinal Injury Association Impairment Scale.Outcome measuresComparisons between demographic characteristics and arrhythmogenic occurrences as early as possible after SCI (4 ± 2 days) followed by 1, 2, 3, 4 weeks and 6 month time points of Holter monitoring.ResultsBradycardia (heart rate [HR] <50 bpm) was present in 29% and 33% of the participants with cervical (C1–C8) and thoracic (T1–T12) SCI six months after SCI, respectively. The differences in episodes of bradycardia between the two groups were not significant (P < 0.54). The mean maximum HR increased significantly from 4 weeks to 6 months post-SCI (P < 0.001), however mean minimum and maximum HR were not significantly different between the groups at the six-month time point. There were no differences in many arrhythmias between recording periods or between groups at six months.ConclusionsAt the six-month timepoint following traumatic SCI, there were no significant differences in occurrences of arrhythmias between participants with cervical and thoracic SCI compared to the findings observed in the first month following SCI. 相似文献