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101.
AIMS: The aims of this review were to assess the reasons why patients were referred to a specialist dental paediatric unit and the quality of the referral letters received. MATERIAL AND METHOD: All patients referred to the paediatric consultation clinic at the Liverpool University Dental Hospital from January 2004 to July 2004 were included in the review. The reasons for their referral, as stated by the referring practitioners, were compared with the clinical findings from initial assessments in the consultation clinic and the quality of referral letters was assessed. RESULTS: Ninety-nine out of a total of 102 referrals were from general dental practitioners. Sixty were girls and 42 boys. Their mean age was 9.5 years. The commonest reason (25 patients) was for treatment under general anaesthesia. In 90 (88.2%) cases the main reason for referral stated in the letters was consistent with the findings of the clinical assessment in the consultant clinic. All 102 letters included the patient's name, address, date of birth and telephone number and 89 (87.3%) were dated. However, only 25 (24.5%) included any mention of medical history and fewer than 30% included details of any treatment provided by the referring practitioner. CONCLUSIONS: The vast majority of patients were referred for good reasons. The quality of the referral letters was generally poor. The use of a structured referral pro forma could improve the quality of the referral. 相似文献
102.
103.
Janey S.A. Pratt Allen Browne Nancy T. Browne Matias Bruzoni Megan Cohen Ashish Desai Thomas Inge Bradley C. Linden Samer G. Mattar Marc Michalsky David Podkameni Kirk W. Reichard Fatima Cody Stanford Meg H. Zeller Jeffrey Zitsman 《Surgery for obesity and related diseases》2018,14(7):882-901
The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009–2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities. 相似文献
104.
105.
Neurological complications remain an important cause of morbidity and mortality of patients following cardiopulmonary bypass (CPB). Microemboli, as well as cerebral hypoperfusion, are the main postulated mechanisms. This study demonstrates that the insertion of a dynamic bubble trap (DBT) into the curcuit reduces microbubbles in the arterial line and microembolic signals (MES) in the middle cerebral arteries (MCAs). We investigated 12 patients during coronary artery bypass grafting (CABG). The DBT was inserted between the arterial filter and the arterial cannula. For detection of microemboli before and after the DBT, a special ultrasound Doppler device was used. MES were detected by transcranial Doppler monitoring in both MCAs of the patients. Microbubbles and MES were counted during bypass. These data were compared to 12 patients who were operated in a previous period without the use of a DBT. There were no significant differences in both groups with respect to gender, age, crossclamp and bypass time and number of anastomoses. In the group without a DBT in the circuit, a mean of 6311 microbubbles per operation could be observed distal to the arterial filter, corresponding to 282 MES. After inclusion of a DBT, we could register, in the second group, 8496 microemboli proximal and 2915 distal of the DBT, corresponding to 89 MES per operation. The reduction rate of microbubbles in the tubing was 65.7%, corresponding to a reduction in MES of about 86.2%. We conclude that the insertion of a DBT in the arterial line of CPB circuit protects the cerebrovascular system from microembolic events, as demonstrated by lower MES counts. 相似文献
106.
Radiofrequency ablation of atrial flutter: a randomized controlled study of two anatomic approaches 总被引:1,自引:0,他引:1
Passman RS Kadish AH Dibs SR Engelstein ED Goldberger JJ 《Pacing and clinical electrophysiology : PACE》2004,27(1):83-88
Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the "septal" or "posterior" approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 +/- 30.3 versus 70.8 +/- 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice. 相似文献
107.
Anti–tumor necrosis factor alpha therapy (adalimumab) in Rasmussen's encephalitis: An open pilot study 下载免费PDF全文
Stanislas Lagarde Nathalie Villeneuve Agnès Trébuchon Elsa Kaphan Anne Lepine Aileen McGonigal Agathe Roubertie Marie‐Anne J. Barthez Valérie Trommsdorff Jérémie Lefranc Samer Wehbi Vincent des Portes Virginie Laguitton Pierre Quartier Didier Scavarda Bernard Giusiano Mathieu Milh Christine Bulteau Fabrice Bartolomei 《Epilepsia》2016,57(6):956-966
108.
Ioannis G Kyprianou Maged Nessim Samer Elsherbiny 《European journal of emergency medicine》2006,13(1):39-40
Spontaneous vertebral artery dissection is a condition that can have lethal consequences. The condition should be considered in young male patients who present with a stroke. At presentation, headaches, cerebral ischaemic episodes and oculosympathetic paresis are the most commonly encountered manifestations. The diagnosis is confirmed with angiography. Here, we present a middle-aged male gardener with rheumatoid arthritis and signs of vertebral artery dissection to highlight the importance of diagnosis and discuss the controversies in management. 相似文献
109.
Samer Tohme Christof Kaltenmeier Patrick Bou-Samra Patrick R. Varley Allan Tsung 《Annals of surgical oncology》2018,25(12):3427-3435
Aim
To identify factors associated with refusal of surgery in patients with early-stage pancreatic cancer and estimate the impact of this decision on survival.Methods
Using the National Cancer Data Base, 26,358 patients were identified with potentially resectable tumors (pretreatment clinical stage I: T1 or T2 N0M0). Multivariate models were employed to identify factors predicting failure to undergo surgery and assess the impact on survival.Results
Of early-stage patients who were recommended surgery, 7.8% (N?=?992) refused surgery for resectable early-stage pancreatic cancer. On multivariable analysis, patients were more likely to refuse surgery if they were older [odds ratio (OR)?=?1.18; 95% confidence interval (CI) 1.16–1.19], female (OR?=?1.52; 95% CI 1.33–1.73), African American (vs White, OR?=?1.79; 95% CI 1.37–2.34), on Medicare/Medicaid (vs private, OR?=?2.75; 95% CI 1.54–4.92) or had higher Charlson–Deyo score (2 vs 0, OR?=?1.33; 95% CI 1.03–1.72). Patients were also significantly more likely to refuse surgery if they were seen at a center that is not an academic/research program (OR 1.9; 95% CI 1.6–2.27). Patients who were recommended surgery but refused had significantly worse survival than those with stage I who received surgery [median survival 6.8 vs 24 months, Cox hazard ratio (HR) 3.41; 95% CI 3.12–3.60].Conclusions
The percentage of patients refusing surgery for operable early-stage pancreatic cancer has been decreasing in the last decade but remains a significant issue that affects survival. Disparities in refusal of surgery are independently associated with several variables including gender, race, and insurance. To mitigate national disparities in surgical care, future studies should focus on exploring potential reasons for refusal and developing communication interventions.110.
Thomas M. Hemmerling MD Samer Charabati MSc Cedrick Zaouter MD Carmelo Minardi MD Pierre A. Mathieu PhD 《Journal canadien d'anesthésie》2010,57(8):725-735