Biphasic systemic anaphylaxis: An inpatient and outpatient study

We attempted to ascertain the incidence of systemic biphasic anaphylactic reactions in both outpatients and inpatients. Madigan Army Medical Center is a large teaching facility. The Allergy Clinic staff sees approximately 20,000 patients per year, and an average of 27,000 allergy immunotherapy injections are administered each year. During the years 1988 to 1991 we collected data from a total of 35 patients who had experienced, during the 30-minute waiting period in the clinic, symptoms and signs consistent with anaphylaxis. A total of 44 anaphylactic reactions were noted, with only two (5%) involving a biphasic systemic pattern. All patients were observed and treated within the clinic until symptoms and signs had resolved. None of the patients were treated with or were presently using glucocorticosteroids during the time of their reactions. Of the reactions noted, 25 (57%) involved only cutaneous manifestations of anaphylaxis, three (7%) involved the laryngeal/upper airway area, eight (18%) involved bronchospasm alone, three (7%) involved the rhinoconjunctivae, and five (11%) involved more than one site or type. None of the patients experienced any symptoms or signs of cardiovascular compromise or collapse after allergy extract injections. During the years 1986 to 1992 a total of 59 patients were admitted to the medical ward or intensive care unit with the diagnosis of systemic anaphylaxis. Of 59 patients, four (7%) experienced a recurrent (biphasic) anaphylactic reaction without reexposure to the initial inciting agent. The remaining 55 patients (93%) did not experience any further systemic anaphylaxis after initial hospital admission and treatment. Two of the patients with biphasic anaphylaxis were first seen with hypotension and generalized urticaria. Of the remaining two patients, one had lip and tongue angioedema, and the other had urticaria only. The biphasic reaction involved antibiotics in two cases and food (shrimp) in the remaining two cases. Forty-two male patients and 17 female patients were included in the study. The age range of male patients was 6 months to 77 years and that of the female patients was 10 to 81 years. There were no deaths in this study. Of the causes for anaphylactic episodes 20 (34%) were drug- or medication-related, 12 (20%) were idiopathic, 13 (22%) were related to food, six (10%) were secondary to exercise, two (3%) were related to vaccine administration and three (3%) were secondary to Hymenoptera stings. The four remaining episodes were secondary to contrast dye administration, allergen skin test extract administration, horse serum administration, and allergen extract injection. We conclude that the incidence of biphasic anaphylactic events is lower than that reported in previously published studies. (J ALLERGY CLIN IMMUNOL 1994;93:977-85.)     

Differences in organization of psychological needs between inpatient and outpatient opiate addicts

A total of 117 inpatients and 114 outpatient drug addicts were administered the Adjective Check List; protocols were subjected to a hierarchical cluster analysis. Results showed two basic clusters for inpatients and one large cluster in the outpatient sample, each different in personality need organization. At discharge, patients who moved from Clusters I or II (inpatient) to Cluster III (outpatient) continued with outpatient treatment. None of the "independent" patients pursued outpatient treatment, while patients in the "emotionally dependent" cluster who pursued outpatient treatment eventually were placed on methadone maintenance. Results suggest that drug addicts who request inpatient or outpatient treatment may be a self-selected sample who differ in personality organization, which, in turn, may predict treatment follow-up in an aftercare setting.     

A prospective randomized trial of outpatient versus inpatient cardiac catheterization

To evaluate the safety and cost of outpatient cardiac catheterization, we conducted a randomized trial at three hospitals of outpatient (n = 192) as compared with inpatient (n = 189) cardiac catheterization in low-risk patients. Outpatients had the following complication rates as compared with inpatients: hematoma, 12 versus 8.5 percent; numbness or weakness of extremity, 0.5 versus 1.6 percent; cold or blue extremity, 1.6 versus 1.1 percent; and acute myocardial infarction, 1.6 versus 0.5 percent. None of these differences were statistically significant. No deaths or strokes occurred in either group. Twenty-three patients (12 percent) assigned to the outpatient group required hospitalization because of complications of catheterization. In the outpatient group, the relative risk for hematoma was 1.42 (95 percent confidence interval, 0.77 to 2.29), and the relative risk for myocardial infarction within one week was 2.95 (95 percent confidence interval, 0.3 to 28.1). There were no significant differences between the two groups in whether they resumed normal activities or in the rates of rehospitalization within one week of the procedure. Total catheterization-related charges per patient were $679 lower for outpatients, with a savings in total hospital charges (including charges for subsequent therapeutic procedures) of $885 per patient. We conclude that elective cardiac catheterization as an outpatient procedure for selected patients is feasible and safe. Given the small size of our sample, however, we urge caution in interpreting these findings, since they do not exclude a small increase in complication rates with outpatient cardiac catheterization.     

胎儿内镜手术对孕妇的近远期并发症

母胎医学对于提高围产儿的生存质量和提高出生人口素质具有重要意义,胎儿内镜手术是母胎医学的重要组成部分。虽然是微创手术,但无论对于胎儿还是孕妇来说,手术的风险始终存在。本文阐述了在胎儿内镜手术中,孕妇近远期并发症的发生率、病因、病理生理机制以及简要的处理,旨在手术矫正胎儿畸形的同时,最大限度地降低受术健康孕妇的风险。     

Combined inpatient and outpatient group psychotherapy: a therapeutic model for psychosomatics.

A special strategy of psychotherapeutic approach to psychosomatic patients is described including a 3-month period of inpatient and a 2-year period of outpatient group psychotherapy. Additional therapeutic procedures applied during the time of hospitalization are a special kind of sensitivity training ('sensual awareness' -- 'konzentrative Bewegungstherapie') and analytic ergotherapy. The therapeutic techniques used are psychoanalytic with special regard to the scenic figures which arise during the course of a session. The 'scenic function of the ego' represented in, e.g., certain body movements, sitting-arrangments, and talking-sequences offers the opportunity of a possible access to the often poor phantasy life of the psychosomatic patient, suffering from what we call the Pinocchio syndrome. The key structure of the model implies the arrangement fixed prior to the onset of therapy between patients and therapist, to stay together as a closed in- and outpatient group for 2 years. This enables the patients to take the risk of new emotional experiences under the cover of protected living conditions in the hospital, as well as the chance to check and confirm these experiences under the pressure of the regular social conditions they live in.     

高龄患者腹部手术并发症59例分析

目的 探讨高龄患者腹部手术围手术期并发症的处理，为临床腹部手术围手术期处理提供参考依据。方法 回顾性分析59例70岁以上腹部手术患者围手术期临床资料。结果 本组术后并发症主要发生在心血管系统31例、呼吸系统9例，切口感染7例，切口裂开2例，吻合口瘘、感染中毒性休克2例，脑血管意外2例，肾衰2例，急性胃粘膜损害出血2例。死于并发症6例。结论 高龄患者腹部手术的主要危险因素是心肺疾病，其次是手术创伤、手术时间、免疫力低下、急诊手术等。应根据老年人病理生理特点，充分做好术前准备，术后加强监测和支持，以降低手术并发症。