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1.
ObjectivesTo investigate the influence of Coronavirus Disease 2019 on incidence of acute complex appendicitis and management of acute appendicitis. MethodsPatients undergoing acute appendicitis surgery in a single center during the COVID-19 epidemic from January to September 2020 and patients from January to September 2019 were taken as the epidemic group and control group respectively. The clinical characteristics and surgical pathological information were compared between the two groups. The primary outcome measure was complex appendicitis. ResultsA total of 235 patients were included in the study, containing 106 in the epidemic group and 129 in the control group. The patients in the epidemic group had a significantly longer interval from the onset of symptoms to registration (37.92 h vs 24.57 h, P = 0.028), from registration to admission (18.69 h vs 8.04 h, P < 0.001), and from admission to surgery (7.23 h vs 6.52 h, P = 0.016). The epidemic group had a higher incidence of suppurative appendicitis (86.8% vs 76.0%, P = 0.036) and a higher incidence of complex appendicitis (35.8% vs 19.4%, P = 0.005). ConclusionHigher incidence of acute complex appendicitis seemed to occur during COVID-19 outbreak. 相似文献
2.
Background Our objective is to study the gallbladder abnormalities on MR images associated with carcinoma of the pancreatic head.
Methods Thirty-six patients who had surgical resection of pancreatic head carcinoma were retrospectively analyzed regarding the appearance
of the tumor and gallbladder on MR imaging performed within one month before surgery. The changes of the gallbladder wall,
and the dimension of the gallbladder, cystic duct, pericholecystic region, and common bile duct (CBD) on MR imaging were noted.
Results About 92% (33/36) of patients had at least one gallbladder abnormality on MR imaging, including thickened gallbladder wall
(58%), gallbladder wall striation (19%), gallbladder wall severe enhancement (44%), enlarged gallbladder (33%), gallbladder
stone (19%), dilatation of cystic duct (67%), focally increased liver parenchymal enhancement adjacent to the gallbladder
(19%), and pericholecystic fluid (11%). 64% of patients had dilated CBD. The diameter of the cystic duct was correlated with
those of the CBD ( r = 0.45, P < 0.01) and gallbladder ( r = 0.56, P < 0.0001). Enlarged gallbladder, dilatation of the cystic duct, and CBD were correlated with chronic cholecystitis.
Conclusion Most patients with pancreatic head carcinoma show gallbladder abnormalities on MR imaging. Cystic duct dilatation follows
CBD dilatation and is the primary cause for dilated gallbladder and chronic cholecystitis in carcinoma of pancreatic head. 相似文献
3.
PurposeThe purpose of this study was to report the imaging presentation of hepatic metastases from hepatoid adenocarcinoma (HAC). MethodsWe retrospectively identified 11 patients (10 men and 1 woman; median age 66) with HAC liver metastasis who underwent contrast-enhanced computed tomography (CT) which included arterial phase and portal venous phase. Two radiologists analyzed the imaging parameters, which included the enhancement pattern on arterial and portal phase images, necrosis, venous thrombi, and overall imaging diagnosis, and arrived at a consensus. ResultsOn arterial phase, the liver lesions had global hyper-enhancement (n = 0), heterogeneous hyper-enhancement (63.6%; n = 7/11), peripheral hyper-enhancement (n = 0), iso-enhancement (n = 0/11), or hypo-enhancement (36.4%; n = 4/11). On portal venous phase, homogenous hypo-enhancement (18.2%; n = 2/11) and heterogenous hypo-enhancement (81.8%; n = 9/11) were observed. Venous thromboses occurred in four patients (36.4%; n = 4/11). The overall imaging diagnoses were “HCC-like” in seven patients (63.6%; n = 7/11), “indeterminable” in 1 patient (9.1%; n = 1/11), and “HCC-unlike” in three patients (27.3%; n = 3/11). ConclusionsThe imaging features of HAC liver metastasis were varied. Arterial phase enhancement coupled with venous phase washout (resembling HCC imaging features) was a major finding, but arterial phase hypo-enhancement (distinct from HCC imaging features) was also frequently encountered. 相似文献
4.
Aims The purpose of this study was to evaluate whether CMRI provides characteristic findings in patients with acute chest pain
suffering from ST-elevation-myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), acute myocarditis
or Tako-tsubo cardiomyopathy.
Patients and methods 230 consecutive patients with acute chest pain underwent cardiac catheterization followed by CMRI within median 5 days. Patients
were classified to suffer from STEMI ( n = 102), NSTEMI ( n = 89), acute myocarditis ( n = 27), or Tako-tsubo cardiomyopathy ( n = 12) on the synopsis of all clinical data. Wall motion abnormalities, late enhancement (LE), persistent microvascular obstruction
as well ventricular volumes and functions were assessed by CMRI.
Results Right and left ventricular volumes were significantly different between the groups and values were highest in patients with
acute myocarditis. Wall motion abnormalities were observed in 100% of STEMI, 75% of NSTEMI, 67% of acute myocarditis and 100%
of Tako-tsubo patients. There was a characteristic pattern of abnormal wall motion focused on midventricular-apical segments
in patients with Tako-tsubo cardiomyopathy, depending on the culprit vessel in patients with STEMI/NSTEMI and with a random
distribution in patients with acute myocarditis. LE was mainly subendocardial or transmural in patients with STEMI (93.2%)
or NSTEMI (62.9%). LE was diffuse, intramural or subepicardial in patients with acute myocarditis. No LE was observed in patients
with Tako-tsubo cardiomyopathy. Persistent microvascular obstruction was only visualized in patients with STEMI (33%) or NSTEMI
(6%).
Conclusions Cardiac magnetic resonance imaging provides characteristic patterns of LE, persistent microvascular obstruction and wall motion
abnormalities that allow a differentiation between patients with acute chest pain from coronary and non-coronary origin.
Supported in part by an unrestricted grant of Philips Medical Systems Best, The Netherlands, and Hamburg, Germany.
For paper handling: jochen.woehrle@uniklinik-ulm.de 相似文献
5.
Background: Our objective is to study the characteristics of extrapancreatic neural plexus invasion by pancreatic carcinoma on MR imaging.
Methods: 20 patients with both pancreatic carcinoma and extrapancreatic neural plexus invasion confirmed by pathology were recruited
in this study. MR imaging was performed within 1 month before surgery. On MR images, signal intensity at the site of potential
extrapancreatic neural plexus invasion, lymph nodes and tumor size were noted. The relationship of extrapancreatic neural
plexus invasion to these findings was analyzed. Results: Signs of extrapancreatic neural plexus invasion were depicted on MR imaging in 80% of patients, which included streaky and
strand-like signal intensity structure in fat tissue in 50% of patients and irregular masses adjacent to tumor in 30%. Signal
intensity at invasion site was similar to that of pancreatic carcinoma. The frequencies of patients with vascular invasion
and with lymph nodes larger than 5 mm were, respectively, 50% and 55%. Tumor diameter was 24 ± 7 mm on MR imaging. Extrapancreatic
neural plexus invasion was correlated with vascular invasion ( r = 0.58, P < 0.005), slightly related with lymphadenopathy ( r = 0.35, 0.1 > P > 0.05), but not related with tumor size. Conclusion: MR imaging is useful to depict extrapancreatic neural plexus invasion by pancreatic carcinoma. 相似文献
6.
PurposeTo prospectively compare multidetector-row CT (MDCT) and MR imaging (MRI) in the assessment of the ablative margin (AM) and index tumor immediately after radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) and assess whether non-contrast MRI with limited sequences (T1- and T2-weighted imaging only) was superior to a conventional MDCT protocol. MethodsA total of 33 consecutive patients with 42 HCCs were included in this study. Both MDCT and MR images were independently reviewed by two radiologists regarding the ability to visually discriminate between the AM and index tumor, and the AM status within ablation zones. The AM status was classified as AM-plus (AM completely surrounding the tumor), AM-zero (AM was partly discontinuous, without protrusion of the tumor), and AM-minus (AM was partly discontinuous, with protrusion of the tumor). During the follow-up period, the cumulative local tumor progression rates were analyzed using the Kaplan–Meier method and Cox proportional hazards model. To determine the added value of contrast-enhanced MR images, both reviewers separately evaluated the two sets (unenhanced and enhanced) of MR images. ResultsVisual discrimination between the AM and index tumor was possible in four (9.5%) and 34 (81%) of the 42 ablation zones using MDCT and MRI, respectively (p < 0.001). Thirty-eight and four cases were classified as AM-plus and AM-zero on MDCT images, respectively, whereas the ablation zones were categorized as AM-plus (n = 32), AM-zero (n = 9), and AM-minus (n = 1) when examining the MR images. The cumulative incidence of local tumor progression was significantly lower in cases with AM-plus on MRI (p = 0.007). Contrast-enhanced MRI had no added value for the assessment of the AM and index tumor. ConclusionMRI was superior to MDCT for the differential assessment of the AM and index tumor immediately after RF ablation for HCC. Non-contrast MRI was also superior to the conventional MDCT protocol. 相似文献
7.
Referral to palliative care units tends to be delayed. In Japan, the Cancer Control Act was established in 2006 to improve the quality of life of cancer patients by facilitating greater access to specialized palliative care services. The primary aims of this study were to clarify the family-perceived appropriateness of the timing of referral to palliative care units after the Cancer Control Act, and to determine the effects of the involvement of the palliative care team on the family-perceived referral timing. An additional aim of this study was to clarify the family-perceived usefulness of the palliative care team. A multicenter questionnaire survey was conducted on a sample of 661 bereaved family members of cancer patents who were admitted to palliative care units in Japan. A total of 451 responses were analyzed (response rate: 68%). Half of the bereaved family members regarded the timing of referrals to palliative care units as late or too late: too late (25%, n = 114), late (22%, n = 97), appropriate (47%, n = 212), early (2.4%, n = 11), and very early (1.8%, n = 8). Among 228 families who reported that patients had commented on the timing of referrals, about half reported that the patients said the timing of referral was late or too late: too late (23%, n = 52), late (21%, n = 49), appropriate (48%, n = 110), early (4.4%, n = 10), and very early (3.1%, n = 7). The families of patients with a palliative care team ( n = 191) tended to report less frequently that they believed the referral timing to be late or too late (43% vs. 51%, P = 0.073); they also reported significantly less frequently that the patients said that the referral timing was late or too late (36% vs. 52%, P = 0.037). The percentages of families who evaluated the palliative care team as useful or very useful were: 93% (symptom control), 90% (emotional support), 92% (family support), and 87% (care coordination). Half of the Japanese bereaved families of patients admitted to palliative care units regarded the timing of referrals as late or too late, and the rates identified in the survey were similar to those recorded before the Cancer Control Act. Involvement of the palliative care team, however, significantly correlated with lower family- and patient-perceived late referrals, and palliative care team activity was generally perceived as useful by the bereaved family members. Further dissemination of palliative care teams could contribute to better access to palliative care units and quality palliative care throughout the country. 相似文献
8.
目的 分析原发性输卵管癌(PFTC)超声、CT、MRI及PET/CT的影像学特征。 方法 回顾性分析32例经手术病理证实为PFTC患者的影像学图像及临床资料。 结果 32例PFTC患者中,单侧31例,双侧1例。伴对侧输卵管积水1例,伴同侧皮样囊肿1例,2例卵巢转移,1例结肠转移。超声表现为附件区梭形实质性低回声肿物( n=16)、不均质团块样肿物( n=4)、"腊肠型"囊性肿物( n=7)。CT表现为附件区实性肿块7例,囊肿块7例,囊实混合性肿块2例。MRI表现为类圆形等T1稍长T2信号( n=2)或稍短T1稍长T2信号结节( n=2)。PET/CT表现为附件区软组织密度肿块影( n=1)或附件区囊实混合密度( n=2)。 结论 超声可有效发现PFTC附件区肿物,并区别囊实性;CT、MRI及PET/CT有助于PFTC的定位。 相似文献
9.
Background:
Clinical evaluation of acute appendicitis is difficult in pregnant patients. Delay in diagnosis is associated with increased fetal mortality. The purpose of our study was to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women.
Methods:
We obtained sonograms in 22 pregnant women suspected of acute appendicitis. All sonograms were performed using graded-compression to detect an enlarged appendix. The sonographic criteria for acute appendicitis were detection of a noncompressible blindended and tubular multilayered structure of maximal diameter greater than 6 mm.
Results:
The sonographic findings were correlated with surgical findings in seven cases and clinical follow-up in 15 cases. Acute appendicitis was diagnosed by sonography in three of 22 patients, and in all but one was confirmed by surgical and pathologic findings. In the remaining 19 patients, 15 improved on clinical follow-up; three were shown to have a normal appendix at surgery and one had focal acute inflammation at the tip of the appendix.
Conclusions:
Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester. 相似文献
10.
Aims This prospective study was designed to determine the diagnostic value of adenosine stress cardiac magnetic resonance imaging
(CMRI) in patients referred to elective coronary angiography.
Methods and results Myocardial perfusion measurements at rest and adenosine stress were performed in 141 patients (105 men, 36 women, mean age
63.4 years) at 1.5 T with a Turbo Flash sequence. Stress-induced perfusion deficits were correlated to angiographic stenoses
≥75%. The overall sensitivity for CMRI depicting coronary artery disease (CAD) with relevant stenoses was 90.4%, the specificity
was 77.4%, the positive predictive value was 85.9%, the negative predictive value was 84.2% and the accuracy 85.2%. Subgroup
analysis was performed for 3-vessel disease ( n = 44, sensitivity 92.3%, specificity 75.0%), 2-vessel disease ( n = 43, sensitivity 92.6%, specificity 92.9%), 1-vessel disease ( n = 27, sensitivity 93.1%, specificity 71.4%) and patients without CAD ( n = 27, specificity 70.4%) as well as for patients with prior myocardial infarction ( n = 44, sensitivity 92.9%, specificity 86.7%), prior coronary artery bypass surgery ( n = 21, sensitivity 88.2%, specificity 66.7%), prior coronary interventions ( n = 88, sensitivity 91.9%, specificity 75.0%), or diabetics ( n = 27, sensitivity 90.5%, specificity 83.3%).
Conclusion Our study shows that stress perfusion CMRI can accurately predict relevant CAD and contributes to the identification of hemodynamic
relevant stenoses in patients scheduled for coronary angiography.
C. Doesch and A. Seeger have equally contributed to this publication. 相似文献
11.
Palliative sedation is undergoing extensive debate. The aims of this study were to describe the practice of palliative sedation at a specialized acute palliative care unit and to study whether patients who received palliative sedation differed from patients who did not. We performed a systematic retrospective analysis of the medical and nursing records of all 157 cancer patients who died at the acute palliative care unit between 2001 and 2005. Palliative sedation, defined as continuous deep sedation prior to death, was used for 43% of all deceased patients. In 87% of the sedated patients, it was started in the last two days before death. Sedated and nonsedated patients did not differ in survival after admission (eight days vs. seven days, P = 0.12). Sedated patients were younger (55 years vs. 59 years, P = 0.04) and more often had malignancies of the digestive tract ( P < 0.01). In both groups, common symptoms at admission were pain (79% vs. 87%, P = 0.23), constipation, (40% vs. 48%, P = 0.46), and dyspnea (32% vs. 29%, P = 0.77). On the day that palliative sedation was started, sedated patients more often suffered from dyspnea and delirium than nonsedated patients at a comparable day before death. The most important indications for palliative sedation were terminal restlessness (60%) and dyspnea (46%). We conclude that at the studied acute palliative care unit, patients who ultimately received palliative sedation did not have symptoms different than nonsedated patients at admission, but on the day at which the sedation was started, they suffered more often from delirium and dyspnea. 相似文献
12.
To summarize the results of all original cost-utility analyses (CUAs) in diagnostic cardiovascular imaging (CVI) and characterize
those technologies by estimates of their cost-effectiveness. We systematically searched the literature for original CVI CUAs
published between 2000 and 2008. Studies were classified according to several variables including anatomy of interest (e.g.
cerebrovascular, aorta, peripheral) and imaging modality under study (e.g. angiography, ultrasound). The results of each study,
expressed as cost of the intervention to number of quality-adjusted life years saved ratio (cost/QALY) were additionally classified
as favorable or not using 20,000,20,000, 50,000, and $100,000 per QALY thresholds. The distribution of results was assessed with
Chi Square or Fisher exact test, as indicated. Sixty-nine percent of all cardiovascular imaging CUAs were published between
2000 and 2008. Thirty-two studies reporting 82 cost/QALY ratios were included in the final sample. The most common vascular
areas studied were cerebrovascular ( n = 9) and cardiac ( n = 8). Sixty-six percent (21/32) of studies focused on sonography, followed by conventional angiography and CT (25%, n = 8, each). Twenty-nine (35.4%), 42 (51.2%), and 53 (64.6%) ratios were favorable at WTP $100,000 per QALY thresholds. The distribution of results was assessed with
Chi Square or Fisher exact test, as indicated. Sixty-nine percent of all cardiovascular imaging CUAs were published between
2000 and 2008. Thirty-two studies reporting 82 cost/QALY ratios were included in the final sample. The most common vascular
areas studied were cerebrovascular ( n = 9) and cardiac ( n = 8). Sixty-six percent (21/32) of studies focused on sonography, followed by conventional angiography and CT (25%, n = 8, each). Twenty-nine (35.4%), 42 (51.2%), and 53 (64.6%) ratios were favorable at WTP 20,000/QALY, 50,000/ QALY, and50,000/QALY, and
100,000/QALY, respectively. Thirty (36.6%) ratios compared one imaging test versus medical or surgical interventions; 26
(31.7%) ratios compared imaging to a different imaging test and another 26 (31.7%) to no intervention. Imaging interventions
were more likely ( P < 0.01) to be favorable when compared to observation, medical treatment or non-intervention than when compared to a different
imaging test at WTP $100,000/QALY. The diagnostic cardiovascular imaging literature has growth substantially. The studies
available have, in general, favorable cost-effectiveness profiles with major determinants relating to being compared against
observation, medical or no intervention instead of other imaging tests. 相似文献
13.
To evaluate the efficacy and safety of single-dose 2.0 g azithromycin (ZSR) in the treatment of acute exacerbation of chronic
obstructive pulmonary disease (AE-COPD), we retrospectively reviewed all patients with AE-COPD who were treated with ZSR.
In comparison with patients who received intravenous therapy for AE-COPD, the clinical cure rate, length of stay in hospital,
and medical costs were evaluated. A total of 29 patients thus were eligible for this study. Clinical cure rates of ZSR and
intravenous therapy for the treatment of AE-COPD were 83.3% ( n = 12) and 88.2% ( n = 17), respectively, between the groups ( P = 1.000). No severe adverse events were found in either group. The ZSR and intravenous groups averaged 9.9 and 12.5 days
of admission, respectively. Length of admission for clinical success cases was much shorter for patients who received ZSR
than patients who received intravenous therapy (6.2 vs. 11.9 days, P = 0.038). Medical costs were less for the group receiving ZSR than for the intravenous therapy group. We suggest ZSR can
achieve near-perfect compliance and could be one of the tools in the treatment of AE-COPD. 相似文献
14.
Background It remains uncertain why immunocompetent patients with bacterial community-acquired pneumonia (CAP) die, in spite of adequate
antibiotics.
Methods This is a secondary analysis of the CAPUCI database which was a prospective observational multicentre study. Two hundred and
twelve immunocompetent patients admitted to 33 Spanish ICUs for CAP were analyzed. Comparisons were made for lifestyle risk
factors, comorbidities and severity of illness. ICU mortality was the principal outcome variable.
Results Bacteremic CAP (43.3 vs. 21.1%) and empyema (11.5 vs. 2.2%) were more frequent ( P < 0.05) in patients with Streptococcus pneumoniae CAP. Higher rates of adequate empiric therapy (95.8 vs. 75.5%, P < 0.05) were observed in patients with S. pneumoniae CAP. Patients with non-pneumococcal CAP experienced more shock (66.7 vs. 50.8%, P < 0.05), and need for mechanical ventilation (83.3 vs. 61.5%, P < 0.05). ICU mortality was 20.7 and 28% [OR 1.49(0.74–2.98)] among immunocompetent patients with S. pneumoniae ( n = 122) and non-pneumococci ( n = 90), in spite of initial adequate antibiotic. Multivariable regression analysis in these 184 immunocompetent patients with
adequate empirical antibiotic treatment identified the following variables as independently associated with mortality: shock
(HR 13.03); acute renal failure (HR 4.79), and APACHE II score higher than 24 (HR 2.22).
Conclusions Mortality remains unacceptably high in immunocompetent patients admitted to the ICU with bacterial pneumonia, despite adequate
initial antibiotics and comorbidities management. Patients with shock, acute renal failure and APACHE II score higher than
24 should be considered for inclusion in trials of adjunctive therapy in order to improve CAP survival.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.
This article is discussed in the editorial available at: doi:. 相似文献
15.
BACKGROUND: Accurate and timely diagnosis of acute surgical disease in pregnant patient is challenging. Although magnetic resonance imaging (MRI) is the most accurate modality to diagnose acute appendicitis in pregnant patients, it is often used as a last resort because of high cost and long scan time. We performed this study to analyze differential diagnoses of appendix MRI and to investigate if there are any blood tests that can predict surgical condition in pregnant patients.METHODS: A retrospective, cross-sectional study was conducted on 46 pregnant patients who underwent non-enhanced appendix MRI in suspicion of acute appendicitis from 2010 to 2016. Differential diagnoses of appendix MRI were analyzed and blood tests were compared between those who had surgical and non-surgical disease.RESULTS: Appendix MRI differentiated two surgical disease; acute appendicitis and ovarian torsion; and various non-surgical conditions such as uterine myoma, hydronephrosis, ureterolithiasis and diverticulitis among clinically suspected acute appendicitis in pregnancy. The diagnostic accuracy of MRI for acute appendicitis in this study was 93.5%. Patients who had surgical disease showed significantly higher WBC count (≥11,000/mm 3), proportion of neutrophils in the WBC (≥79.9%), neutrophil-to-lymphocyte ratio (NLR≥6.4), levels of C-reactive protein (CRP≥1.82 mg/dL) and bilirubin (≥0.66 mg/dL ) than those who had non-surgical disease.CONCLUSION: MRI can reliably differentiate surgical conditions and several blood tests (WBC, proportion of neutrophils in the WBC, NLR, CRP, bilirubin) can help anticipate acute surgical condition among pregnant patients suspected to have acute appendicitis. 相似文献
16.
Purpose The safety of using heparin concomitantly with drotrecogin alfa (activated) {DrotAA} was explored in the XPRESS study. No
heparin effect on mortality was observed. Safety results from that study are explored in more detail.
Methods A randomized, double-blind trial of prophylactic heparin versus placebo in severe sepsis patients treated with DrotAA (24 μg/(kg h)
for 96 h) was conducted at 224 sites in 20 countries. Patients were randomized 1:1:2 to receive unfractionated heparin (UFH)
(5,000 Units twice daily) ( n = 511), low-molecular-weight heparin (LMWH) (enoxaparin, 40 mg per day) ( n = 493), or placebo ( n = 990) every 12 h during the DrotAA infusion.
Results Bleeding events during the DrotAA infusion period (Days 0–6) were higher in the heparin than placebo groups (10.8 vs. 8.1%;
p = 0.049), but serious bleeding events were similar (heparin 2.3% vs. placebo 2.5%; p = 0.72) and central nervous system (CNS) bleeds were rare in both groups (0.3 vs. 0.3%). Fewer heparin patients experienced
an ischemic stroke during infusion (0.3 vs. 1.3%; p = 0.018) and 28-day period (0.5 vs. 1.8%; p = 0.009).
Conclusions Coadministration of DrotAA with low-dose heparin in severe sepsis patients did not increase incidence of serious bleeding.
Fewer ischemic strokes in the heparin group suggest heparin cessation should be avoided during DrotAA infusion.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.
An erratum to this article can be found at 相似文献
17.
Background Acute appendicitis is the most common cause of abdominal surgical emergencies that present at the emergency department (ED). Although early phase of acute appendicitis cannot induce systemic inflammatory responses, it may induce proliferation immature granulocyte before leukocytosis is occurred. Based on this, we hypothesized that IG% may be beneficial for detecting appendicitis, in addition to classic inflammatory markers including the WBC count, a left shift in neutrophils, and CRP, at no additional cost. Methods A retrospective observational study was conducted in a tertiary‐care, university‐affiliated hospital emergency department in adults (>18 years old) with suspected appendicitis from January 1, 2015 to December 31, 2016. The diagnostic performance of IG% and other inflammatory markers, namely white blood cell (WBC) count, proportion of neutrophils, and C‐reactive protein (CRP), for acute appendicitis was evaluated. Results Of 403 patients, 204 (50.6%) were diagnosed with acute appendicitis and 45 (22.0%) had complicated appendicitis. All inflammatory markers, including WBC count, proportion of neutrophils, IG%, and CRP, were statistically different between the appendicitis and nonappendicitis group (P < .01). However, IG% was not clinically useful because the median IG% was the same (0.3 vs 0.3) between the appendicitis and nonappendicitis group. Moreover, the area under the curve for IG% was smaller than for other inflammatory markers (0.57, 0.51‐0.63, P < .02). Conclusion The diagnostic ability of IG% for appendicitis is insufficient, and it brings no additional benefit over other inflammatory markers. 相似文献
18.
Atherosclerotic plaque burden has a strong correlation with plaque vulnerability. Three-dimensional (3D) volumetric assessment
of atherosclerotic plaques has been suggested as an accurate method of quantifying plaque burden but has not been performed.
In this study we use high-resolution magnetic resonance (MR) imaging to compare 3D volume differences of asymptomatic and
acutely symptomatic carotid plaques (i.e. had cerebrovascular ischaemic symptoms within the previous 72 h of MR imaging).
One hundred patients (46 acutely symptomatic and 54 asymptomatic) with atherosclerotic carotid artery disease underwent carotid
MR imaging. Manual segmentation of plaque components was done to delineate lipid, fibrous tissue and plaque haemorrhage (PH).
3D-volume reconstruction of plaque components was done and used for comparison. Acutely symptomatic plaques had a lower normalized
wall index and normalized volume index than the asymptomatic group ( P = 0.04 and 0.01 respectively). Median percentage lipid volume was higher for asymptomatic plaques (28 vs. 5%, P = 0.004). However, the median percentage volume and prevalence of PH was higher in the acutely symptomatic group ( P = 0.01 and 0.02 respectively). Acutely symptomatic plaques have less lipid content immediately after the acute event than
asymptomatic plaques. This is most likely because of the escape of lipid-rich atheromatous debris into the blood stream at
the time of plaque rupture. Due to this paradox, “high” lipid content of a plaque may not be a reliable feature of estimating
its vulnerability immediately following the acute event. PH, which is prevalent and consistent in such plaques, may be a better
indicator of plaque vulnerability during that period. 相似文献
19.
To identify multi-detector computed tomographic (MDCT) features discriminating bicuspid aortic valves (BAVs) from tricuspid
aortic valves (TAVs) in patients with aortic valvular disease using surgical findings as reference. Forty-five patients underwent
ECG-gated cardiac MDCT scans prior to aortic valve replacement. Morphologic patterns of aortic valves on MDCT were classified
into: bicuspid without raphe (A), fused valve with a fish-mouth opening (B), fused valve without a fish-mouth opening (C),
and tricuspid without fusion (D). To differentiate congenital raphe of BAV from commissural fusion of TAV, MDCT features of
patterns B and C were evaluated. Diameters of the aortic root and ascending aorta between patients with BAVs and TAVs were
also compared. Patterns A ( n = 6) and B ( n = 6) were all bicuspid, in pattern C: 8 of 26 (30.8%) were bicuspid, and pattern D ( n = 7) were all tricuspid. In patterns B and C, uneven cusp size, round-shaped opening and midline calcification at leaflet
fusion were strongly associated with BAVs (all, P < 0.05). The mean length of leaflet fusion in BAVs was significantly larger than in TAVs (13.5 vs. 8.7 mm, P < 0.0001), with a cutoff value of 10.3 mm providing a sensitivity of 85.7%, a specificity of 83.3%, and an area under the
ROC curve of 0.90. In all patients, the mean diameter of the ascending aorta was larger in patients with BAVs than with TAVs
(43.3 vs. 39.7 mm, P < 0.05). MDCT features of uneven cusp size, round-shaped opening, midline calcification, longer leaflet fusion and larger
diameter of the ascending aorta can be helpful in distinguishing BAVs from TAVs. 相似文献
20.
Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five‐and‐a‐half‐year (2011–2016) audit of hospital‐wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals’ quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the ‘Worried’ category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the ‘Worried’ category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am–12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration. 相似文献
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