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51.
BACKGROUND: Over the past 10 years, 4 cases of spinal hydatid disease (3 men, 1 woman) were diagnosed and treated at our institution, with an average follow-up of 4 years. Hydatid disease of the spine is a rare condition with a poor prognosis that presents diagnostic and therapeutic challenges. METHODS: The patients were evaluated clinically, using the latest imaging modalities available in our institution. Decompressive surgeries were performed and the diagnosis was confirmed by histopathologic examination. All patients received long-term antihelminthic therapy with 400 mg of albendazole 3 times daily for 1 year. RESULTS: After surgery, all patients improved; however, over time, recurrence and residual disease were observed. Two patients had complete neurologic recovery at follow-up at 2 to 3 years, although there were radiographic signs of recurrence. The other 2 patients did not achieve complete neurologic recovery despite anterior decompression; they developed recurrent disease and the neurologic status deteriorated to spastic paraplegia. All patients refused further surgeries for recurrences and 2 patients died of complications of paraplegia. CONCLUSION: Diagnosis was challenging, eradication was difficult, and hydatid disease recurred in all 4 patients. In our experience, morbidity and mortality were high and prognosis was poor. 相似文献
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BACKGROUND PURPOSE: Image transmission is an integral part of telemedicine, allowing evaluation of patients at remote sites. We developed a simple method of wireless transmission of digital images to a hand-held computer (PDA) and evaluated its feasibility and diagnostic accuracy in patients with acute renal colic or renal trauma. MATERIALS AND METHODS: The CT images from 11 patients with suspected renal colic and one patient with renal trauma were transmitted using a cellular telephone with a wireless modem link to a PDA (Sony Clie 615C). A diagnostic interpretation was recorded for the presence/absence of an upper-tract stone, stone location, estimated stone size, and signs of upper-tract obstruction. Radiologic staging of trauma was provided in the patient with a renal injury. Comparison was made with the final dictated report of a staff radiologist. RESULTS: Ten CT sets of patients with renal colic were used for comparison, the remaining one being excluded because of ambiguity in the final radiology report. An average of 5.9+/-1.6 images, average size 32.2+/-5.2 kb (range 21-42 kb) for each patient were sent at an average speed of 1 kb/sec. Interpretation correctly identified stone presence in 80%, hydronephrosis in 100%, and perinephric stranding in 80% and stone size within 1+/-1 mm. A stage-3 renal trauma was correctly identified and staged. CONCLUSION: Wireless teleradiology to PDA units provides image quality sufficient for diagnostic interpretation. Anticipated improvements in wireless transmission and PDA screen image resolution will enhance the speed, quality, and quantity of images transmitted. Wireless teleradiology may facilitate convenient rapid evaluation of patients at remote sites. 相似文献
53.
Neurophysiological and behavioral studies have shown that perception and memory share neural substrates and functional properties. But are perception and the active working memory of a stimulus one and the same? To address this question in the spatial domain, we compared the percept and the working memory of the position of a target stimulus embedded within a surround of moving dots. Motion in a particular direction after the target's offset biased the memory of target location in the same direction. However, motion simultaneous with a high-contrast, perceptually strong target biased the percept of target location in the opposite direction. Thus, perception and working memory can be modified by motion in qualitatively different ways. Manipulations to strengthen the memory trace had no effect on the direction of the memory bias, indicating that memory signal strength can never equal that of the percept of a strong stimulus. However, the percept of a weak stimulus was biased in the direction of motion. Thus, although perception and working memory are not inherently different, they can differ behaviorally depending on the strength of the perceptual signal. Understanding how a changing surround biases neural representations in general, and postsensory processes in particular, can help one understand past reports of spatial mislocalization. 相似文献
54.
Irene H. Suh Mukul Mukherjee Bhavin C. Shah Dmitry Oleynikov Ka-Chun Siu 《Journal of robotic surgery》2012,6(4):301-309
Evaluation of the learning curve for robotic surgery has shown reduced errors and decreased task completion and training times compared with regular laparoscopic surgery. However, most training evaluations of robotic surgery have only addressed short-term retention after the completion of training. Our goal was to investigate the amount of surgical skills retained after 3?months of training with the da Vinci? Surgical System. Seven medical students without any surgical experience were recruited. Participants were trained with a 4-day training program of robotic surgical skills and underwent a series of retention tests at 1 day, 1 week, 1 month, and 3 months post-training. Data analysis included time to task completion, speed, distance traveled, and movement curvature by the instrument tip. Performance of the participants was graded using the modified Objective Structured Assessment of Technical Skills (OSATS) for robotic surgery. Participants filled out a survey after each training session by answering a set of questions. Time to task completion and the movement curvature was decreased from pre- to post-training and the performance was retained at all the corresponding retention periods: 1 day, 1 week, 1 month, and 3 months. The modified OSATS showed improvement from pre-test to post-test and this improvement was maintained during all the retention periods. Participants increased in self-confidence and mastery in performing robotic surgical tasks after training. Our novel comprehensive training program improved robot-assisted surgical performance and learning. All trainees retained their fundamental surgical skills for 3?months after receiving the training program. 相似文献
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Anahita Dua Arshish Dua Sapan S. Desai SreyReath Kuy Rishika Sharma Sarah E. Jechow Jason McMaster Bhavin Patel SreyRam Kuy 《American journal of surgery》2013
Background
During the reproductive years, women have a 4-fold higher prevalence of gallstones than men, making gallbladder disease a critically important topic in women's health. Among age-matched women and men hospitalized for cholecystitis, gender based differences in demographics, management, and economic and clinical outcomes were identified.Methods
A cross-sectional study was conducted using the Nationwide Inpatient Sample. Outcomes were mortality, complications, length of stay, and cost.Results
Women accounted for 65% of admissions for cholecystitis, with women more likely to have shorter time to surgery (1.6 vs 1.9 days) and laparoscopy (86 vs 76%) (P < .05). After cholecystectomy, women had lower mortality (.6% vs 1.1%), fewer complications (16.9 vs 24.1), shorter lengths of stay (4.2 vs 5.4 days), and lower costs ($10,556 vs $13,201) (P < .05). On multivariate analysis of age-matched patients, women had lower odds of mortality (odds ratio [OR], .75), complications (OR, .86), length of stay (OR, .95), and cost (OR, .93). Longer time to surgery and open cholecystectomy were independent predictors of worse outcomes.Conclusions
In cholecystitis and cholecystectomy, women have better clinical and economic outcomes then age-matched men. 相似文献59.
Patel BC Wayangankar SA Ngo E Chakrabarty S Bronze MS 《The American journal of the medical sciences》2012,344(4):332-334
ABSTRACT:: Clinically, retroperitoneal abscesses present insidiously and the diagnosis may be delayed. This, with inadequate drainage, may result in increased morbidity and mortality. Most cases result from a renal or gastrointestinal process, but in a small number of patients there is no identifiable source and the abscess is designated as "primary." Most retroperitoneal abscesses are polymicrobial, and cultures often reveal organisms such as Proteus mirabilis, Staphylococcus species, Peptostreptococcus, Enterococcus, Enterobacter, Escherichia coli and Bacteroides species. Fungal causes appear to be very rare, and in this study, a case of a patient with primary Candida glabrata retroperitoneal abscess is reported. 相似文献
60.
Daly DD El-Shurafa H Nanda NC Dumaswala B Dumaswala K Kumar N Mutluer FO 《Echocardiography (Mount Kisco, N.Y.)》2012,29(8):991-996
Cholelithiasis is a very common disease in the United States. Most cases remain asymptomatic but a fraction of these patients can develop serious complications such as cholecystitis which may lead to gallbladder perforation and gallbladder cancer which is much less common. Here, we present three cases of cholelithiasis where transthoracic echocardiography was performed routinely. In each case, echocardiography detected cholelithiasis which prompted three-dimensional (3D) echocardiographic evaluation. Three-dimensional echocardiography allowed for more comprehensive examination of the gallbladder shape, size, and wall thickening and the measurement and composition of the stones in three dimensions, measurement of stone volumes, and minimized shadowing produced by stone calcifications. These cases suggest that routine echocardiography has value in detecting gallstones and that 3D echocardiography has incremental value over two-dimensional echocardiography due to pyramidal data sets which allow sequential slicing through the gallbladder and full gallbladder examination without a technologist who is trained in gallbladder imaging. These pyramidal data sets can be further viewed and cropped by a radiologist specialized in abdominal ultrasound. 相似文献