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21.
Sumon Nandi Steven Maschke Peter J. Evans Jeffrey N. Lawton 《Hand (New York, N.Y.)》2009,4(4):368-379
Elbow motion is essential for upper extremity function to position the hand in space. Unfortunately, the elbow joint is prone
to stiffness following a multitude of traumatic and atraumatic etiologies. Elbow stiffness can be diagnosed with a complete
history and physical exam, supplemented with appropriate imaging studies. The stiff elbow is challenging to treat, and thus,
its prevention is of paramount importance. When this approach fails, non-operative followed by operative treatment modalities
should be pursued. Upon initial presentation in those who have minimal contractures of 6-month duration or less, static and
dynamic splinting, serial casting, continuous passive motion, occupational/physical therapy, and manipulation are non-operative
treatment modalities that may be attempted. A stiff elbow that is refractory to non-operative management can be treated surgically,
either arthroscopically or open, to eliminate soft tissue or bony blocks to motion. In the future, efforts to prevent and
treat elbow stiffness may target the basic science mechanisms involved. Our purpose was to review the etiologies, classification,
evaluation, prevention, operative, and non-operative treatment of the stiff elbow. 相似文献
22.
Patrick N Smith Jeffrey R Balzer Mustafa H Khan Rick A Davis Donald Crammond William C Welch Peter Gerszten Robert J Sclabassi James D Kang William F Donaldson 《The spine journal》2007,7(1):83-87
BACKGROUND CONTEXT: Intraoperative somatosensory evoked potential (SSEP) monitoring has been shown to reduce the incidence of new postoperative neurological deficits in scoliosis surgery. However, its usefulness during cervical spine surgery remains a subject of debate. PURPOSE: To determine the utility of intraoperative SSEP monitoring in a specific patient population (those with cervical radiculopathy in the absence of myelopathy) who underwent anterior cervical discectomy and fusion (ACDF) surgery. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: A total of 1,039 nonmyelopathic patients who underwent single or multilevel ACDF surgery. The control group (462 patients) did not have intraoperative SSEP monitoring, whereas the monitored group (577 patients) had continuous intraoperative SSEP monitoring performed. OUTCOME MEASURE: A new postoperative neurological deficit. METHODS: SSEP tracings were reviewed for all 577 patients in the monitored group and all significant signal changes were noted. Medical records were reviewed for all 1,039 patients to determine if any new neurological deficits developed in the immediate postoperative period. RESULTS: None of the patients in the control group had any new postoperative neurological deficits. In the monitored group there were six instances of transient SSEP changes (1 due to suspected carotid artery compression; 5 thought to be due to transient hypotension) which resolved with the appropriate intraoperative intervention (repositioning of retractors; raising the arterial blood pressure). Upon waking up from anesthesia, one patient in the monitored group had a new neurological deficit (partial central cord syndrome) despite normal intraoperative SSEP signals. CONCLUSIONS: ACDF appears to be a safe surgical procedure with a low incidence of iatrogenic neurological injury. Transient SSEP signal changes, which improved with intraoperative interventions, were not associated with new postoperative neurological deficits. An intraoperative neurological deficit is possible despite normal SSEP signals. 相似文献
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Jeffrey N Baldwin David M Scott Sangeeta Agrawal Jean K Bartek R Ellen Davis-Hall Thomas P Reardon Edward M DeSimone 《Substance Abuse》2006,27(3):27-37
Alcohol and other drug (AOD) use behaviors of health professions students (HPS) were assessed by surveying both university-based HPS and other nursing programs in a Midwestern state in 1999. Response was 2,646 (56.4%) of surveyed students. Family history of alcohol-related and drug-related problems were reported by 39.8% and 13.9%, respectively, with 42.6% of respondents reporting one or both. Among nursing respondents, 48.1%, 19.2% and 51.1%, respectively, reported family problems with alcohol, drugs, or one or both. Past-year alcohol use was comparable to undergraduate college students (UCS) nationally (83%); heavy drinking, tobacco and recreational drug use by HPS were lower. Past year drug use was highest among medical students. Marijuana was the predominant illicit drug; medical students and males most often reported use. Health professions educational systems should proactively address student AOD prevention, education and assistance needs. 相似文献
26.
The first 150 words of the full text of this article appear below. Key points. . . [Full Text of this Article]
Nerve agents
AChE inhibitionOther cholinesterasesPhysical propertiesLatency and toxicityPharmacological propertiesClinical manifestationsTreatmentPyridostigmineAtropinePralidoxime
- Chemical personal protective equipment must be wornwhen in contact with contaminated casualties.
- Recognizing theclinical features of chemical warfare agent poisoning allowssupportive treatment and appropriate antidotes to be promptlyadministered.
- The mnemonic DUMBELS describes the muscarinicfeatures of the nerve agent poisoning toxidrome.
- There areeffective antidotes for poisoning with nerve agents, blood agents(metabolic poisons), botulinum toxin and kolokol-1.
- There areno specific antidotes for blistering agents (vesicants) andchoking agents.