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The patient with peripheral arterial disease (PAD) poses a special problem. Not only are vascular surgeons interested in preventing the limb complications of PAD, but also the associated cardiac and neurological events that contribute greatly to the overall morbidity and mortality of their patients. Therefore, the control of atherosclerotic risk factors must be considered as important a therapeutic goal as surgical and endovascular control of limb ischemia. To accomplish this, the "complete" vascular surgeon must understand the common lipid abnormalities, their diagnosis, and treatment. The scientific literature on this subject is truly overwhelming in volume and scope, yet an overly simple "cook book" approach is not adequate or appropriate. This report summarizes current knowledge on this topic, providing sufficient essential detail for the reader to understand why, when, and how to administer which lipid-controlling agents to patients with PAD.  相似文献   

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Purpose. The increased use of opioids in the chronic treatment of pain, especially with oncologic patients, encourages the search for drugs with potent analgesic activity, but with minimal induced tolerance and cross-tolerance to morphine. Methods. Four agonist-antagonist opioid derivatives (buprenorphine, butorphanol, nalbuphine, and cyclorphan) were examined. Tolerance to the analgesic effect of the four drugs and their cross-tolerance effects with morphine were evaluated in ICR albino mice by the "hot plate method". Measurements of the analgesic effect were taken before and after chronic treatment (of 14 days duration) with these drugs, as well as morphine. Results. All tested drugs produced tolerance after 14 days of treatment. Chronic treatment with morphine reduced the effects of nalbuphine and cyclorphan, but not those of buprenorphine and butorphanol. After 14 days treatment with buprenorphine and cyclorphan, the analgesic action of morphine was reduced, but this reduction did not occur after butorphanol and nalbuphine treatments. Conclusion. Of the four agonist-antagonists tested, butorphanol seems to be least liikely to produce cross-tolerance with morphine. Received: May 15, 2000 / Accepted: April 13, 2001  相似文献   

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Anatomical and surgical details of the author's temporal approach to the temporomandibular joint (TMJ), the orbit, and the retromaxillary-infratemporal space are described using drawings and photographs taken during surgery. The approach is advocated because it gives any desirable access to the operating fields without leaving a visible scar in the face and because it preserves the condyle and, thereby, the integrity of the TMJ.  相似文献   

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Appelboam R  Hammond E 《Anaesthesia》2004,59(3):293-295
Viral gastroenteritis is usually a mild, self-limiting illness. We report a case of a previously well 74-year-old woman who suffered a grave complication of this common condition, and caused a significant outbreak of illness amongst staff involved in her care. This case highlights the risks of Hospital Acquired Infection and raises important infection control issues. It illustrates the hazards associated with exposure to potentially infectious secretions and presents a clear message to medical and nursing staff involved in the care of the acute surgical emergency.  相似文献   

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Selection of the best surgical procedure for the treatment of complete rectal prolapse is difficult amid the many different techniques for which excellent results are reported. A critical review is given. It is concluded that any surgical procedure with rectal mobilization and fixation as a standard maneuver will lead to a recurrence rate of 2% to 4%. Advocacy of additional maneuvers to make the procedure easier is acceptable if it does not lead to a higher complication rate. But to obtain a better result its benefit has to be proven, either by a large prospective double-blind study, or by tests from the colorectal laboratory. New surgical techniques for rectal prolapse should therefore be based, not only on a low recurrence and complication rate, but also on tests that evaluate the effect of the procedure on fecal continence.
Resumen Seleccionar el mejor procedimiento quirúrgico para el tratamiento del prolapso rectal completo es difícil, frente a las numerosas y diversas técnicas, cada una de las cuales reclama excelentes resultados. Se presenta una revisión crítica y se plantea la conclusión de que cualquier procedimiento quirúrgico que implique la movilización y fijación como maniobra estándar, da lugar a una tasa de recurrencia de 2–4%. Es aceptable preconizar maniobras adicionales para una más fácil realización del procedimiento mientras no resulten en incremento de la tasa de complicaciones. Para reclamar un mejor resultado, es necesario comprobar el beneficio mediante un estudio prospectivo y doble ciego mayor o por medio de pruebas funcionales en la laboratorio colorrectal. Las nuevas técnicas quirúrgicas para el tratamiento del prolapso rectal deben fundamentarse no sólo en bajas tasas de recurrencia y de complicaciones, sino también en pruebas funcionales que valoren objetivamente el efecto del procedimiento sobre la continencia fecal.

Résumé Choisir le meilleur procédé chirurgical pour traiter le prolapsus total du rectum est d'autant plus difficile qu'il existe de nombreuses méthodes thérapeutiques, toutes vantées dans la litérature pour être la meilleure. Une revue critique des ces procédés est faite. On conclue que toute méthode comportant une mobilisation et une fixation du rectum est suivie de récidive dans 2 à 4% des cas. Recommander des gestes supplémentaires pour faciliter la technique n'est acceptable que si le taux des complications n'augmente pas. Pour prouver que les résultats sont meilleurs, cependant, il faudrait soit réaliser une grande étude prosective à double insu, soit faire des comparaisons par des tests de laboratoire de physiologie colorectale. Des techniques nouvelles de chirurgie du prolapsus rectal devraient être basées non pas sur le taux de récidive ou de complication, mais aussi sur le résultats des tests qui démontrent son efficacité sur la continence fécale.
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ContextPharmacological therapy for relieving lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) has evolved during the past years. The possible benefits of combination therapies to prevent disease progression or to treat LUTS/BPH with concomitant overactive bladder (OAB) or erectile dysfunction (ED) are currently studied.ObjectivesTo review the evidence provided in clinical trials and to assess the current medical practice concerning the pharmacological treatment of men suffering from LUTS/BPH.Evidence acquisitionThis paper is based on a presentation during the symposium “The future of LUTS/BPH: management beyond the prostate” at the European Association of Urology's 2008 annual meeting. The results of a Web survey evaluating the opinion of urologists about treatment of LUTS/BPH patients were discussed and an update lecture on medical therapy for LUTS/BPH was given.Evidence synthesisMen who are highly bothered by their symptoms but with a low risk of disease progression can achieve fast relief of symptoms with α1-adrenoceptor (α1-AR) antagonist monotherapy. Those patients at risk for LUTS/BPH progression can benefit from additional 5α-reductase inhibitor therapy. Concomitant OAB symptoms in LUTS/BPH patients can be treated with a combination of an α1-AR antagonist and an antimuscarinic agent. An α1-AR antagonist combined with a phosphodiesterase-5 inhibitor might improve symptoms in men with lower urinary tract symptoms (LUTS) and concomitant ED.ConclusionsThe pharmacological treatment of LUTS/BPH patients should be adapted to their individual risk of progression and their individual symptom profile.  相似文献   

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Telepsychiatry, or videoconferencing in psychiatry has existed for around forty years in a number of countries. Factors contributing to its development include difficulties in physically accessing specialists or in mobilising certain categories of patients (children, elderly or disabled people). Still not widely developed in France, certain technological and demographic evolutions nevertheless make it increasingly necessary.  相似文献   

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An increase in the use of opioid derivatives in the treatment of pain syndrome in clinical practice, and especially in the treatment of cancer, has added impetus to the search for an agent which does not induce tolerance and cross-tolerance to other opiodis. The mydriatic effect of opioids in mice, the correlation between analgesia and mydriasis, and tolerance to the analgesic effect of morphine in mice were evaluated previously. In the present work, tolerance to the mydriatic effect of four agonist-antagonists and cross-tolerance to morphine were examined. Measurement of the pupillary diameter was performed using a binocular operating microscope. Tolerance and cross-tolerance to morphine were developed following a chronic use of buprenorphine, nalbuphine, and cyclorphan. After chronic injection of butorphanol, no tolerance or cross-tolerance to morphine was observed.  相似文献   

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