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1.
《Anaesthesia and Intensive Care Medicine》2017,18(6):292-295
Neuromuscular diseases are relatively rare but it is important for both anaesthetists and intensivists to have a working knowledge of the common diseases, as they may complicate general anaesthesia and result in neurogenic respiratory failure. The most common neurological condition seen in the intensive care unit is that of critical illness neuropathy; this subject is covered elsewhere in the journal. The diseases most commonly encountered in general anaesthetic practice include motor neurone disease, Guillain-Barré syndrome, botulism, myasthenia gravis and the muscular dystrophies. 相似文献
2.
《Anaesthesia and Intensive Care Medicine》2014,15(6):263-266
Although relatively rare, neuromuscular disease is important to both anaesthetists and intensivists as it may complicate general anaesthesia and result in neurogenic respiratory failure. The most common diseases that will be encountered in a general anaesthetic practice include motor neurone disease, Guillain–Barré syndrome, botulism, myasthenia gravis and the muscular dystrophies. The clinical features and anaesthetic implications for these conditions are discussed. 相似文献
3.
Jones AD Maziarz R Gilster J Domreis J Deveney CW Sheppard BC 《American journal of surgery》2003,185(5):481-484
BACKGROUND: We wished to determine the type of diseases in patients who received bone marrow transplant (BMT) that potentially involve the general surgeon at our institution. METHODS: The records of 542 patients who underwent bone marrow transplant at Oregon Health and Sciences University between January 1990 and December 2000 were retrospectively reviewed. Gastrointestinal complications included in the study were gastrointestinal bleeding, venoocclusive disease of the liver, intestinal graft versus host disease, pneumatosis intestinalis, necrotizing enteritis, as well as other more common surgical diseases (eg, appendicitis). RESULTS: Gastrointestinal complications or surgical consultations were noted in 92 of 542 patients (17%). Of these, formal general surgical consultation was obtained in 48 patients (9%). The most common causes for surgical consult were cholecystitis (5), abdominal pain of unknown etiology (5), central line complications (5), small bowel obstruction (4), and appendicitis (4). Twenty-eight (58%) of these patients received an operation. Six patients (13%) died during the same hospitalization as their surgery consult. Forty-four patients with these gastrointestinal symptoms related to transplantation did not receive surgical consult. The mortality in this group was 45%. CONCLUSIONS: The majority of gastrointestinal complications after bone marrow transplant do not require surgical intervention. However, these conditions may overlap the more common reasons for surgical consult and must be identifiable by the general surgeon. Of patients who did require surgical intervention, it was primarily for common surgical diseases. 相似文献
4.
Damien Sène 《Joint, bone, spine : revue du rhumatisme》2018,85(5):553-559
Small fiber neuropathy, which affects the sensory Aδ and C fibers, is now a major diagnostic and therapeutic challenge. Nearly 7% of the general population have chronic neuropathic pain responsible for severe quality-of-life impairments. Awareness must therefore be raised among clinicians of the somatosensory and autonomic symptoms that can reveal small fiber neuropathy, appropriate diagnostic investigations, most common causes, and best treatment options for each patient profile. To help achieve this goal, the present review article discusses the clinical presentation of neuropathic pain and paresthesia and/or autonomic dysfunction due to involvement of nerves supplying exocrine glands and smooth muscle; normal findings from standard electrophysiological investigations; most informative diagnostic tests (epidermal nerve fiber density in a skin biopsy, laser-evoked potentials, heat- and cold-detection thresholds, electrochemical skin conductance); main causes, which consist chiefly of metabolic diseases (diabetes mellitus, glucose intolerance), dysimmunity syndromes (Sjögren's syndrome, sarcoidosis, monoclonal gammopathy), and genetic abnormalities (familial amyloidosis due to a transthyretin mutation, Fabry disease, sodium channel diseases); and the available symptomatic and etiological treatments. 相似文献
5.
Oral A Yigiter M Demirci E Yildirim ZK Kantarci M Salman AB 《Journal of pediatric surgery》2011,46(11):e5-e9
Undifferentiated embryonic liver sarcoma (UELS) is a rare highly malignant neoplasm that predominantly occurs in children between 5 and 10 years of age. The typical radiologic appearance on ultrasound and computed tomography of UELS shows a large septated mass having combined cystic and solid components. These radiographic features, however, are not specific to UELS and are shared by other more common and benign diseases of the liver. For example, cystic hydatid disease (CHD), caused by larvae of the Echinococcus tapeworm, is the most common indication for hepatic operations in children residing in endemic regions of the world. Undifferentiated embryonic liver sarcoma and CHD are 2 diseases that share overlapping presenting features of patient age, symptoms, and radiologic appearance. Surgeons who operate in Echinococcal endemic regions must be aware that not all hepatic cystic masses are necessarily CHD and may be other more rare malignant diseases such as UELS. 相似文献
6.
BACKGROUND: Arthrogryposis multiplex congenita (AMC) is a congenital symptom complex characterized by multiple joint contractures. AMC results from fetal akinesia due to extrinsic factors (oligohydramnios) or primary neurogenic or myopathic conditions of the fetus. METHODS: We retrospectively reviewed our perioperative experience in 12 patients with AMC. RESULTS: Intraoperative issues noted in our patients included difficulties with peripheral IV placement (n = 3), difficult tracheal intubation (n = 4), and intraoperative hyperthermia (n = 4). Difficulties with peripheral IV placement were more common in younger patients (2.3 +/- 0.6 vs 9.2 +/- 3.5 years). Although easy bag-valve-mask ventilation was present in all 12 patients, difficulty with tracheal intubation was noted in four patients. In these four patients, the airway was secured using an LMA (n = 3) or a facemask (n = 1). The patients in whom difficulties with tracheal intubation were encountered were older than patients in whom no difficulties were noted (11.0 +/- 2.9 vs 5.8 +/- 3.9 years). Four patients developed intraoperative temperatures > or =37 degrees C; however, there was no evidence of hypercarbia or tachycardia suggestive of malignant hyperthermia. Postoperative issues included stridor (n = 2) and postoperative atelectasis (n = 3). CONCLUSIONS: The perioperative care of patients with AMC should consider not only the physical manifestations of the disease process, but also the implications of the underlying neuromuscular disease. The most common perioperative issues included difficulties with airway management, problematic intravenous access, and intraoperative hyperthermia. 相似文献
7.
Somashekar G Krishna Brandon K Chu Alecia M Blaszczak Gokulakrishnan Balasubramanian Hisham Hussan Peter P Stanich Khalid Mumtaz Alice Hinton Darwin L Conwell 《World journal of gastrointestinal surgery》2021,13(2):141-152
BACKGROUNDGastrointestinal (GI) and liver diseases contribute to substantial inpatient morbidity, mortality, and healthcare resource utilization. Finding ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial importance. Thirty-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common GI ailments.AIMTo identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common GI and liver diseases in the United States.METHODSA cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common GI diseases. The 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcomes were mortality (index admission, calendar-year), hospitalization costs, and thirty-day readmission and secondary outcomes were predictors of thirty-day readmission.RESULTSFor the year 2013, the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for about $25 billion. The thirty-day readmission rates were highest for chronic liver disease (25.4%), Clostridium difficile (C. difficile) infection (23.6%), functional/motility disorders (18.5%), inflammatory bowel disease (16.3%), and GI bleeding (15.5%). The highest index and subsequent calendar-year hospitalization mortality rates were chronic liver disease (6.1% and 12.6%), C. difficile infection (2.3% and 6.1%), and GI bleeding (2.2% and 5.0%), respectively. Thirty-day readmission correlated with any subsequent admission mortality (r = 0.798, P = 0.001). Medicare/Medicaid insurances, ≥ 3 Elixhauser comorbidities, and length of stay > 3 d were significantly associated with thirty-day readmission for all the thirteen GI diseases.CONCLUSIONPreventable and non-chronic GI disease contributed to a significant economic and health burden comparable to chronic GI conditions, providing a window of opportunity for improving healthcare delivery in reducing its burden. 相似文献
8.
Background. To determine the response to mivacurium, we prospectivelystudied onset time and complete spontaneous recovery from mivacurium-inducedneuromuscular block in patients with Duchenne muscular dystrophy(DMD). Methods. Twelve boys with DMD, age 514 yr, seven of themwheelchair-bound, ASA IIIII, and 12 age- and sex-matchedcontrols (ASA I) were enrolled in the study. Anaesthesia wasinduced with fentanyl 23 µg kg1 and propofol34 mg kg1 titrated to effect, and maintained bycontinuous i.v. infusion of propofol 812 mg kg1and remifentanil as required. The lungs were ventilated withoxygen in air. Neuromuscular transmission was assessed by acceleromyographyusing train-of-four (TOF) stimulation every 15 s. After baselinereadings, a single dose of mivacurium 0.2 mg kg1 wasgiven. The following variables were recorded: (i) lag time;(ii) onset time; (iii) peak effect; (iv) recovery of first twitchfrom the TOF response to 10, 25 and 90% (T10, T25, T90) relativeto baseline; (v) recovery index (time between 25 and 75% recoveryof first twitch); and (vi) recovery time (time between 25% recoveryof first twitch and recovery of TOF ratio to 90%). For comparisonbetween the groups the MannWhitney U-test was applied. Results. There were no differences between the groups in lagtime, onset time and peak effect. However, all recorded recoveryindices were significantly (P<0.05) prolonged in the DMDgroup. The median (range) for time points T10, T25 and T90 inthe DMD and control group was 12.0 (816) vs 8.4 (515)min, 14.1 (920) vs 10.5 (717) min and 26.9 (1540)vs 15.9 (1223) min, respectively. The recovery indexand recovery time were similarly prolonged in the DMD group. Conclusions. These results support the assumption that mivacurium-inducedneuromuscular block is prolonged in patients with DMD.
This study was presented at the Annual Meeting of the AmericanSociety of Anaesthesiologists, Las Vegas, October 2004.
These authors contributed equally to this work. 相似文献
9.
《Annales fran?aises d'anesthèsie et de rèanimation》2014,33(11):587-589
In patients with neuromuscular diseases, the use of rocuronium in the general anesthesia rapid sequence induction provides safety intubation conditions, but induces a deep and prolonged neuromuscular blockade. We report dose reduction to 0.8 mg/kg for a 47-year-old female with Landouzy-Dejerine myopathy. Therefore, less dose of sugammadex was given to reverse the neuromuscular block. 相似文献
10.
310例慢性肾小球肾炎患者辨证规律研究 总被引:6,自引:0,他引:6
目的:通过对慢性肾小球肾炎患者(CKD2~3期)的中医证候分型、临床症状、中药疗效以及临床指标间相关性研究,探讨本病的中医证型分布特点,为进一步探索中药临床研究提供依据。方法:回顾性收集2008年~2011年入住我院肾病科的慢性肾小球肾炎患者的病史资料、中医临床症状、相关临床指标,运用统计分析方法研究慢性肾小球肾炎的中医辨证分型规律以及治疗方法。结果:(1)慢性肾小球肾炎的中医证型中以气阴两虚型、肝肾阴虚型常见;(2)脾肾阳虚型蛋白尿水平最高,差异具有统计学意义(P〈0.05);(3)脾肾阳虚型中药治疗有效率最低(66.7%)。结论:慢性肾小球肾炎的中医证候以气阴两虚最为常见,脾肾阳虚型蛋白尿水平最高,治疗有效率最低。 相似文献
11.
Zahra Soltani Azarakhsh Baghdadi Mohammad Nejadhosseinian Seyedeh Tahereh Faezi Bijan Shahbazkhani Seyed Ali Mousavi Kiarash Kazemi 《Reumatologia》2021,59(2):85
ObjectivesCeliac disease (CD) is one of the most common chronic diseases. Celiac disease has been associated with several autoimmune disorders, but the association with systemic lupus erythematosus (SLE) as a systemic autoimmune disease is still controversial. In this study, we aimed to determine the prevalence of biopsy-proven CD in patients with SLE, and to determine the clinical symptoms and laboratory data in these patients.Material and methodsIn a cross-sectional study, SLE patients at a referral clinic were evaluated for gastrointestinal symptoms between March and December 2016. Patients were evaluated by a gastroenterologist, and upper gastrointestinal endoscopy with intestinal biopsy was performed if deemed necessary. The clinical symptoms, laboratory data, and endoscopy results were recorded and compared between groups.ResultsIn total, 130 patients were evaluated in this study. Gastrointestinal symptoms were present in 40% of the patients. Endoscopy was performed in all SLE patients with gastrointestinal symptoms. Four patients (3%) were diagnosed as having CD based on biopsy results and response to a gluten-free diet. Anti-endomysium antibody (AEA) was found to be 100% sensitive and 99.2% specific for the diagnosis of CD in SLE patients, and anti-gliadin antibody (AGA) had a 50% sensitivity and 98% specificity. Patients with comorbid CD and SLE were significantly more likely to have diarrhea, abdominal pain, nausea/vomiting, recurrent oral aphthosis, and anemia.ConclusionsThe results of this study suggest that a significant association is present between CD and SLE. We found a prevalence of 3% for biopsy-proven CD in patients with SLE, which is five times the prevalence of CD in the general population. 相似文献
12.
Claire I. Daïen Amandine Tubery Mégane Beurai-Weber Guilhem du Cailar Marie-Christine Picot Audrey Jaussent François Roubille Jean-David Cohen Jacques Morel Jean Bousquet Pierre Fesler Bernard Combe 《Joint, bone, spine : revue du rhumatisme》2019,86(1):49-54
Objectives
EULAR recently proposed to screen multimorbidities in chronic inflammatory rheumatic diseases. The aims of the study were to define the most common multimorbidities in chronic inflammatory rheumatic diseases, compare the screening approach performed in the clinic with the recent EULAR recommendations, validate the points to consider for the systematic standardized multimorbidity screening proposed by EULAR and assess feasibility of such a screening in a daily clinic.Methods
Data were collected prospectively during a 1-day multimorbidity clinic. Diabetes, hypertension, CVD damage, chronic respiratory diseases, osteoporosis and preventive measures were assessed. The comparison with EULAR points to consider was performed retrospectively.Results
We included 200 consecutive patients (157 with rheumatoid arthritis, 37 spondyloarthritis, and 6 connective tissue diseases or vasculitis). The most common multimorbidities already diagnosed in our patients were hypertension (26%) and diabetes (7.5%). Screening showed that 61.5% (CI95%: 54.6%-67.9%) patients presented at least one undiagnosed or uncontrolled diseases: diabetes (6%), hypertension (20.6%), dyslipidemia (16.1%) valvulopathies (16.8%), peripheral artery disease (4.5%); carotid stenosis (6.5%) and aortic aneurysm (5.5%). Overall, 39.9% patients had incomplete cancer screening and 52.8% incomplete vaccine schedule. Undiagnosed pulmonary obstruction and risk of sleep apnea were suspected in 15.5% and 40.1% patients, respectively.Conclusion
This study underlines the relevance of a systematic screening of multimorbidities in chronic inflammatory rheumatic diseases and its feasibility in a 1-day clinic. Spirometry and sleep apnea screening should be added to EULAR points to consider. The long-term impact of such screening needs to be evaluated. 相似文献13.
The term lymphology includes both the physiology and the pathology of the lymphatic system. Many disciplines are involved in the study of the lymphatic system, to correctly diagnose lymphatic diseases and to ultimate provide the best available treatment for the patient. Lymphedema is one of the most common lymphatic diseases, potentially causing significant problems for the patient and for the health system in general. The aim of this article is to discuss the best placement and role for each discipline within an interdisciplinary team in order to provide an effective management of lymphedema and related lymphatic diseases. 相似文献
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15.
Whipple’s disease is a rare, chronic, systemic disorder caused by Tropheryma whipplei infection. The most common symptoms are weight loss, arthralgia, diarrhea and abdominal pain. Other organ involvement can also occur in the patients. Joint manifestations may mimic rheumatoid arthritis or spondyloarthritis. Arthalgia, arthritis, spondylodiscitis, bursitis and/or tenosynovitis are seen in the majority of the patients. This explains why some of the symptoms are misdiagnosed as those of rheumatic diseases. Understanding of Whipple’s disease is important for differential diagnostics of several rheumatic symptoms. 相似文献
16.
Sanger TD 《Current treatment options in neurology》2005,7(6):427-439
Opinion statement Hypertonia in children can be caused by many different diseases. The most common etiology is cerebral palsy. Spasticity and
dystonia are the most common types of hypertonia. There are few options for treatment, and usually treatment has an incomplete
effect. Therefore, it is necessary to prioritize goals in order to improve overall functional outcome. The use of any intervention
will require the ability to verify the magnitude and importance of the outcome in order to ensure that therapy is efficacious.
In general, a complex, flexible, and multifaceted approach will be necessary to improve the motor abilities of children with
hypertonia. 相似文献
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18.
下肢静脉高压是慢性静脉疾病的基础病理生理改变,而下肢肿胀是下肢静脉高压所致静脉疾病的常见病理改变及临床表现。从发病机制看,能诱发下肢静脉高压而导致下肢肿胀的疾病主要分为“血液倒流性病变”和“回流障碍性病变”两类病变。包括原发性深静脉瓣膜功能不全、下肢深静脉血栓形成、髂静脉压迫综合征、血栓形成后综合征等。引发下肢静脉高压肿胀病因不同,其干预手段也有所不同:(1)改变生活方式,避免久坐久站,平卧时抬高患肢,规律活动踝关节和小腿。(2)加压治疗,包括弹力袜、弹力绷带气压泵加压治疗。(3)药物治疗,如口服黄酮类、七叶皂苷类,马栗树籽提取物等静脉活性药物。(4)应用长效青霉素等抗炎药物进行长期抗炎治疗。 相似文献
19.
1148例新疆地区肾活检病理资料分析 总被引:1,自引:0,他引:1
目的:分析肾活检资料的地域、种族特点,为肾脏疾病的特异性诊治提供依据.方法:回顾性分析新疆医科大学第一附属医院1 148例肾活检病例的临床资料,进行统计学分析.结果:原发性肾小球肾炎占76.1%,其常见病理类型为非IgA肾病、IgA肾病;继发性肾小球肾炎占13.0%,其中以狼疮性肾炎最为常见;各病理类型分布在维吾尔族与... 相似文献
20.
《Surgical pathology clinics》2017,10(1):125-154
The sinonasal tract is frequently affected by nonneoplastic inflammatory diseases. Inflammatory lesions of the sinonasal tract can be divided into 3 main categories: chronic rhinosinusitis, which encompasses a heterogeneous group of entities, all of which result in mucosal inflammation with or without polyps-eosinophils; infectious diseases; and autoimmune diseases and vasculitides, which can result in midline necrosis and facial deformities. This article reviews the common inflammatory lesions of the sinonasal tract with emphasis on infectious diseases, vasculitis, iatrogenic, and diseases of unknown cause. Many of these lesions can result in midline destruction and result in facial deformity. 相似文献