共查询到20条相似文献,搜索用时 15 毫秒
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Koduri PR 《The Annals of thoracic surgery》2004,78(5):1888; author reply 1888
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J V van der Merwe 《Suid-Afrikaanse tydskrif vir geneeskunde》1981,59(21):741-746
A practical approach to the diagnosis of amenorrhea is presented. By utilizing a flow-chart 410 patients with amenorrhea were categorized in the following groups: (i) polycystic ovarian disease; (ii) hypergonadotrophic amenorrhoea; (iii) hyperprolactinaemic amenorrhoea; (iv) normogonadotrophic amenorrhoea; and (v) hypergonadotrophic amenorrhoea. This approach helps the practising physician to come to a logical aetiological diagnosis in each category and saves time as well as money. This approach depends on clinical as well as appropriate laboratory examinations, most of which can be done by the private practitioner. Only a minority of patients need sophisticated and costly examinations. 相似文献
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Osteogenesis Imperfecta (OI) is characterized by bone fragility. At least seven discrete types have been described ranging from mild disease to a lethal form. In a large number of cases, mutations in one of the two genes encoding type I collagen have been found. In forms recently described (types V, VI, VII), such mutations have been excluded. In two other forms, (Bruck, and osteoporosis - pseudoglioma syndromes) defects in other proteins have been characterized. In OI, bone fragility stems from: decreased bone mass, disturbed organization of bone tissue, and altered bone geometry (size and shape). Histologic studies have shown that increased bone turnover is the rule in OI bone. This justifies using bisphosphonates in order to reduce osteoclast mediated bone resorption. Initial results are encouraging. Cyclical intravenous pamidronate administration reduces bone pain and fracture incidence, and increases bone density and level of ambulation, with minimal side effects. Effects on bone include increase in size of vertebral bodies and thickening of cortical bone. These results allow for more efficacious corrective surgery using intramedullary rodding of the long bones and paravertegral instrumentation. Specific occupational and physiotherapy programs are integral parts of the treatment protocol. This multidisciplinary approach will prevail until strategies aiming at the correction of the basic defect(s) will have come to fruition. 相似文献
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Modern diagnostic strategy in ileus 总被引:1,自引:0,他引:1
Renzulli P Krähenbühl L Sadowski C al-Adili F Maurer CA Büchler MW 《Zentralblatt für Chirurgie》1998,123(12):1334-1339
During the last 4 years (11/93-11/97) 330 patients with acute bowel obstruction were treated and analysed retrospectively. 80% of the obstructions (n = 265) were in the small bowel and 20% (n = 65) in the large bowel localized. Adhesions were the main cause in 65.7% (n = 174) of all small bowel obstructions, and one third (35.1%, n = 61) of these patients were treated conservatively. In the large bowel, however, 37% were caused by obstructing colon carcinoma mainly localized in the rectosigmoid region. Mechanical bowel obstruction remains to be one of the most common emergencies in general surgery. A successful treatment is based on a rapid and correct diagnosis followed by an immediate surgical intervention if indicated. There are no reliable clinical, laboratory or radiological signs of bowel strangulation available. Preoperative diagnostic examinations should confirm bowel obstruction, determine its localization and origin and exclude other pathologies. Furthermore, it should help in selecting a patient subgroup with small bowel obstruction due to adhesions, which might be treated conservatively. Preoperative diagnostic procedures include case history, clinical examination, basic laboratory tests and a plain abdominal x-ray. In patients with suspected small bowel obstruction due to adhesions without any signs of strangulation a contrast medium follow-through study may be indicated. If the contrast medium fails to pass into the colon within 5 hours, a surgical exploration is recommended. In large bowel obstruction a contrast medium enema, a computed tomography or a colonoscopy are valuable diagnostic tools. 相似文献
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Background Partial splenectomy is sometimes used for children with hereditary spherocytosis (HS) to reduce hemolysis while retaining
some splenic immune function. Previous reports have described a partial splenic resection through a laparotomy incision. Whereas
laparoscopic total splenectomy for HS is well-established, laparoscopic partial splenectomy (LPS) has not been described.
The authors have developed a novel LPS technique that combines the benefits of partial splenectomy with those of a laparoscopic
approach.
Methods A chart review was conducted for three children with HS who underwent LPS, with approximately one-fourth of the spleen left
on the basis of the short gastric arterial supply.
Results The mean preoperative spleen size was 17.6 cm. The mean preoperative hemoglobin count was 100 g/l, and the postoperative hemoglobin
count was 133 g/l. All three patients reported reduced malaise and increased energy levels. There was no recurrent anemia
at the 1- to 2-year follow-up evaluation.
Conclusion The LPS procedure is a safe and effective approach to HS that resolves anemia, potentially retains some splenic immunity,
and confers the benefits of a minimal access technique. 相似文献
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D V Feliciano 《Seminars in thoracic and cardiovascular surgery》1992,4(3):156-162
The diagnosis of thoracic injuries is now accomplished by a combination of time-honored techniques and new modalities such as echocardiography, CT, and thoracoscopy. Operative approaches are reserved for exsanguination, significant false aneurysms, tamponade, and perforation of the main aerodigestive tracts. 相似文献
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Postoperative jaundice. An approach to a diagnostic dilemma 总被引:2,自引:0,他引:2
L Morgenstern 《American journal of surgery》1974,128(2):255-261
Surgical intervention is rarely indicated early in the course of postoperative jaundice. Mild to moderate hyperbilirubinemia is a frequent postoperative phenomenon which merits more observation than action. More severe jaundice may herald a catastrophic outcome due to factors outside the liver but reflected in progressive hepatocellular failure and often renal failure. Shock, sepsis, multiple transfusions, halogenated hydrocarbon anesthetics, and pre-existent liver disease are the factors most frequently associated with this condition. After three or four weeks more aggressive diagnostic measures are indicated, ranging from endoscopy with retrograde choledochopancreatography and transjugular hepatic biopsy and cholangiography to the measure of last resort, laparotomy. 相似文献
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MR-urography presents a new diagnostic approach to the urinary system, resulting in images comparable to those known from i.v.-urography. T2-weighted MR-urograms demonstrate static fluid without ionizing radiation or nephrotoxic contrast media. The excretory renal function can be examined by the use of gadolinium-enhanced T1-urography. The degree and cause of ureteric obstruction can be diagnosed with high sensitivity and specificity. On the other hand, urolithiasis is frequently misdiagnosed by MR-urography and, in this case, spiral CT should be used. Pediatric or pregnant patients can be examined as well as donors before and patients after renal transplantation. Furthermore, in case of a tumor MR-imaging, including MR-angiography, is a potential diagnostic "all-in-one" approach. 相似文献
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Pendjer I Obradović V Sobić-Saranović D Kozarević N Mikić A Petrović Z Dimitrijević M 《Acta chirurgica Iugoslavica》2004,51(1):69-75
The aim of this study is a research of single photon emission tomography (SPET) values with talium 201 and tehnetium 99m MIBI, comparing it with other methods CT, MRI and ultrasonography. In our investigation there were two groups of patients 24 treated with T1-201 and 17 with Tc-99m-MIBI. Before the therapy 7 patients had been tested with T1 201 and was 100% proved the sensibility, specificity, sensitivity and also 6 patients as really positive TP and 1 patient really negative TN. The same result was gotten in the group where TC 99m was used, where 3 of them were really positive and 1 negative. All discoveries were confirmed pathohistologically and leaning on this we determined the status of really positive and really negative patients. After the therapy there were 7 positive and 7 negative patients, and also one positive, and 2 negatives that were false, who were treated by thalium. On the basis of formula of sensibility these findings show that 77,8%, if it observed only a group of patients who were being tested after the therapy, while all sensibility of methode is 86.7%, where in the analise was included a group of patients at whom was registred the primary tumor. The specificity of the method for this group of patients after the therapy is 87.5%, and the whole 88.9% where the accuarsy is 82.4% in the group after therapy and the whole is 87.5%. 相似文献
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A diagnostic approach to erectile impotence using a sexual function questionnaire, nocturnal penile plethysmography, penile blood pressure measurement, cavernosograms, cystometrograms and plasma testosterone levels is presented. Case examples demonstrate the clinical value of these diagnostic tools. Psychogenic impotence should be diagnosed only after nocturnal penile plethysmography has demonstrated the presence of complete erections. 相似文献
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Hoerbelt R Keunecke L Grimm H Schwemmle K Padberg W 《The Annals of thoracic surgery》2003,75(4):1086-1090
BACKGROUND: Mediastinal tumors show a wide variability, and therefore, a standardized diagnostic and therapeutic workup is instrumental. We subdivided mediastinal tumors into nonlymphatic mediastinal tumors (NLMTs), most of which require surgical resection without need of preoperative histology, and mediastinal lymphadenopathy (MLA), requiring surgical biopsy for exact histologic classification. We investigated the accuracy of noninvasive diagnostic studies distinguishing between the two groups of MLA and NLMT. METHODS: A retrospective analysis was performed on patients who had previously undergone surgery on mediastinal tumors. Their data were statistically analyzed (chi2 test, logistic regression analysis), and the values of medical history, physical examination, laboratory tests, and computerized tomography scan discriminating between MLA and NLMT were assessed. RESULTS: Out of 299 patients included in the study, 242 (80.9%) had MLA and 57 (19.1%) had NLMT. Sensitivity and specificity of noninvasive investigations for differentiation of MLA and NLMT were 98.2% and 86.0%, respectively. Whereas the prevalence of thoracic symptoms such as shortness of breath, cough, or chest pain was similar in both groups (MLA, 165 [69.3%]; NLMT, 41 [69.5%]; p = 0.98), systemic symptoms, including fever, night sweats, or weight loss (MLA, 110 [49.8%]; NLMT, 17 [29.3%]; p < 0.01), and signs of inflammation, such as c-reactive protein, erythrocyte sedimentation rate, and leukocytosis (MLA, 202 [85.6%]; NLMT, 34 [57.6%]; p < 0.001), were significantly more common in MLA. CONCLUSIONS: Noninvasive diagnostic procedures, including medical history, physical examination, laboratory tests, and computerized tomographic scan, are highly sensitive in detecting MLAs that should undergo surgical biopsy. Our data suggest confirming all suspected NLMTs by fine needle aspiration (FNA) biopsy before surgery. 相似文献
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During a two year period, ninety-four patients underwent 103 rectal biopsies using the suction capsule technic (71 patients for diagnosis of Hirschsprung's disease and 23 to aid in the diagnosis of various neurologic storage disorders). In nine prospective and eighteen retrospective cases the suction biopsy accurately determined the diagnoses of Hirschsprung's disease. No false-positive or false-negative results were encountered. The technic is simple and safe, requiring neither an operating room nor general anesthesia. No complications were seen after this procedure. 相似文献
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T T Casey W H Rodgers J W Baxter J L Sawyers V H Reynolds D L Page 《American journal of surgery》1992,163(3):305-311
The clinical value of fine needle aspiration (FNA) of the breast is enhanced by incorporating into the cytologic diagnosis explicit comments on the level of diagnostic certainty. This stratification of diagnostic certainty is based predominantly on the cytologic features but occasionally also takes into consideration the clinical situation. Strong clinical and mammographic suspicion of mammary carcinoma associated with FNA, diagnostic of typical, intermediate to high-grade mammary carcinoma, warrants proceeding to definitive therapy without further diagnostic studies. False-positive results are virtually eliminated by placing cases with any uncertainty into a "probable" category, which does not support definitive therapy. In addition, oversimplified "benign versus malignant" approaches to FNA diagnoses ignore the heterogeneity of breast masses, with in situ and low-grade carcinomas warranting special clinical management and usually being placed in the "probable" category. Thus, malignant diagnoses are stratified into "definite" and "probable," with only the former supporting definitive therapy. Within our recent series of 1,005 FNAs of the breast, we were able to confirm the diagnosis in all 62 patients with a "definite" carcinoma diagnosis, and only 3 of 25 "probable" cancer diagnoses were benign at tissue biopsy. Thus, false-positive results were successfully avoided in the "definite" category. Furthermore, a much greater incidence of unusual and good prognosis tumor types were identified by the "probable" category. If the clinical setting is relatively suspicious only, a definitive diagnosis of cancer by FNA is rare and not necessary because the clinical question to be addressed is only whether to biopsy. This approach to FNA diagnosis, unlike the oversimplified "benign versus malignant" scheme, provides an approach that is more likely to result in optimal therapy for breast neoplasms, with low-grade or in situ carcinomas requiring special clinical management since these types of cancers are found predominantly in the "probably malignant" category. It also provides additional security against false-positive diagnoses by incorporating clinical level of certainty statements into FNA diagnostic categories, which more closely reflect the diversity and inherent complexity in the appropriate diagnosis and therapy of mammary carcinomas. 相似文献