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41.
42.
Björn-Christian Link Emre F. Yekebas Dean Bogoevski Asad Kutup Gerhard Adam Jakob R. Izbicki Gerrit Krupski 《Journal of gastrointestinal surgery》2007,11(2):166-170
Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity
and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be
burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g.,
nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable
option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic
biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous
transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The
procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous
transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending
on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an
alternative for treatment of symptomatic biliary leakage instead of immediate reoperation.
Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation). 相似文献
43.
Kristin Fraser Adam Peets Ian Walker Janet Tworek Michael Paget Bruce Wright & Kevin McLaughlin 《Medical education》2009,43(8):784-789
Context Prior research has demonstrated that residents have poor clinical skills in cardiology and respirology. It is not clear how these skills can be improved because the number of patients with suitable clinical findings whose cooperation might help residents to better develop these clinical skills is limited.
Objectives Our objective was to evaluate the effect of training on a cardiorespiratory simulator (CRS) on skills acquisition, retention and transfer.
Methods We randomly allocated 146 students to CRS training in either chest pain or dyspnoea and compared each student's performance on the clinical presentation in which he or she had received CRS training with performance on the control presentation.
Results Immediately after training, students were more accurate in identifying abnormal clinical findings on the CRS (70.0% versus 52.2%; d = 7.6, P < 0.0001) and showed improved diagnostic performance (72.1% versus 55.6%; d = 4.3, P = 0.0007) on the training clinical presentation. At the end of the course they were still better at identifying abnormal findings (57.1% versus 51.7%; d = 2.5, P = 0.004) and diagnosing correctly (50.0% versus 38.1%; d = 3.0, P = 0.002) on problems included in the training clinical presentation. However, they showed no difference between training and control presentations in diagnostic performance when required to transfer their skills between problems (45.9% versus 43.8%; P = 0.5) or in performance on multiple-choice questions (64.1% versus 63.6%; P = 0.8).
Conclusions Students can acquire and retain clinical skills with CRS training, but demonstrate limited ability to transfer these to other problems. Further studies are needed to explore ways of improving learning and transfer with CRS training. 相似文献
Objectives Our objective was to evaluate the effect of training on a cardiorespiratory simulator (CRS) on skills acquisition, retention and transfer.
Methods We randomly allocated 146 students to CRS training in either chest pain or dyspnoea and compared each student's performance on the clinical presentation in which he or she had received CRS training with performance on the control presentation.
Results Immediately after training, students were more accurate in identifying abnormal clinical findings on the CRS (70.0% versus 52.2%; d = 7.6, P < 0.0001) and showed improved diagnostic performance (72.1% versus 55.6%; d = 4.3, P = 0.0007) on the training clinical presentation. At the end of the course they were still better at identifying abnormal findings (57.1% versus 51.7%; d = 2.5, P = 0.004) and diagnosing correctly (50.0% versus 38.1%; d = 3.0, P = 0.002) on problems included in the training clinical presentation. However, they showed no difference between training and control presentations in diagnostic performance when required to transfer their skills between problems (45.9% versus 43.8%; P = 0.5) or in performance on multiple-choice questions (64.1% versus 63.6%; P = 0.8).
Conclusions Students can acquire and retain clinical skills with CRS training, but demonstrate limited ability to transfer these to other problems. Further studies are needed to explore ways of improving learning and transfer with CRS training. 相似文献
44.
45.
Botulinum Toxin A in the Treatment of Chromhidrosis 总被引:1,自引:0,他引:1
Wu Jessie M. Mamelak Adam J. MD † Nussbaum Rachel MD † McElgunn Patrick S. J. MD MBA † 《Dermatologic surgery》2005,31(8):963-965
Background. Chromhidrosis is an uncommon disorder characterized by secretion of colored sweat by apocrine glands, typically localized to the face or axilla. The current treatments available for chromhidrosis are time consuming and frequently ineffective.
Objective. Our purpose is to demonstrate a novel approach to the treatment of apocrine chromhidrosis.
Methods. We report a case of apocrine chromhidrosis successfully treated with botulinum toxin A (BTX-A; Botox).
Results. BTX-A therapy successfully controlled facial chromhidrosis, and the effects were visible at 19 weeks post-treatment. The therapeutic benefits may be attributed to its inhibitory effects on cholinergic stimulation, adrenergic stimulation, and substance P release, although further studies are necessary to elucidate the precise mechanism of action.
Conclusion. This report demonstrates a new therapeutic approach to patients suffering from chromhidrosis. 相似文献
Objective. Our purpose is to demonstrate a novel approach to the treatment of apocrine chromhidrosis.
Methods. We report a case of apocrine chromhidrosis successfully treated with botulinum toxin A (BTX-A; Botox).
Results. BTX-A therapy successfully controlled facial chromhidrosis, and the effects were visible at 19 weeks post-treatment. The therapeutic benefits may be attributed to its inhibitory effects on cholinergic stimulation, adrenergic stimulation, and substance P release, although further studies are necessary to elucidate the precise mechanism of action.
Conclusion. This report demonstrates a new therapeutic approach to patients suffering from chromhidrosis. 相似文献
46.
47.
Adam M Alessio Steve Kohlmyer Kelley Branch Grace Chen James Caldwell Paul Kinahan 《Journal of nuclear medicine》2007,48(5):794-801
In dual-modality PET/CT systems, the CT scan provides the attenuation map for PET attenuation correction. The current clinical practice of obtaining a single helical CT scan provides only a snapshot of the respiratory cycle, whereas PET occurs over multiple respiratory cycles. Misalignment of the attenuation map and emission image because of respiratory motion causes errors in the attenuation correction factors and artifacts in the attenuation-corrected PET image. To rectify this problem, we evaluated the use of cine CT, which acquires multiple low-dose CT images during a respiratory cycle. We evaluated the average and the intensity-maximum image of cine CT for cardiac PET attenuation correction. METHODS: Cine CT data and cardiac PET data were acquired from a cardiac phantom and from multiple patient studies. The conventional helical CT, cine CT, and PET data of an axially translating phantom were evaluated with and without respiratory motion. For the patient studies, we acquired 2 cine CT studies for each PET acquisition in a rest-stress (13)N-ammonia protocol. Three readers visually evaluated the alignment of 74 attenuation image sets versus the corresponding emission image and determined whether the alignment provided acceptable or unacceptable attenuation-corrected PET images. RESULTS: In the phantom study, the attenuation correction from helical CT caused a major artifactual defect in the lateral wall on the PET image. The attenuation correction from the average and from the intensity-maximum cine CT images reduced the defect by 20% and 60%, respectively. In the patient studies, 77% of the cases using the average of the cine CT images had acceptable alignment and 88% of the cases using the intensity maximum of the cine CT images had acceptable alignment. CONCLUSION: Cine CT offers an alternative to helical CT for compensating for respiratory motion in the attenuation correction of cardiac PET studies. Phantom studies suggest that the average and the intensity maximum of the cine CT images can reduce potential respiration-induced misalignment errors in attenuation correction. Patient studies reveal that cine CT provides acceptable alignment in most cases and suggest that the intensity-maximum cine image offers a more robust alternative to the average cine image. 相似文献
48.
D J Adam R A Fitridge S Raptis 《European journal of vascular and endovascular surgery》2005,30(5):516-519
OBJECTIVE: Intra-abdominal packing is a valuable adjunct in patients with abdominal trauma and uncontrollable bleeding but few data exist regarding early and late outcome associated with this technique in patients with ruptured abdominal aortic aneurysm (AAA). METHODS: Interrogation of a prospective vascular surgical database identified 23 patients (22 men; median age 69, range 59-82, years) with ruptured AAA who required intra-abdominal packing for control of coagulopathic haemorrhage after insertion of an aortic graft between January 1982 and December 2003. Co-morbidity, operative and outcome data were retrieved. RESULTS: Haemostasis was achieved and packs were removed within 48 h in 20 patients. In those patients who had a graft inserted, the peri-operative mortality rate was 12 of 23 (52%) patients (vs. 172 of 455 (38%) patients who were not packed, NS). Three (13%) patients developed early intra-abdominal sepsis, which was universally fatal: graft-enteric fistula, intra-abdominal abscess with necrotizing fasciitis of the abdominal wound, and infected retroperitoneal haematoma. Two of 11 (18%) survivors developed late graft-related infective complications: major aortic graft infection at 6 months and symptomatic infected para-anastomotic aortic false aneurysm at 39 months. Early and late intra-abdominal infective complications were significantly more common in patients who were packed than in those who were not (packed: five of 23, 22% vs. non-packed: five of 455, 1%; p < 0.001). CONCLUSION: These data demonstrate that intra-abdominal packing in coagulopathic patients with ruptured AAA can achieve an acceptable survival rate. However, this technique may be associated with an increased incidence of early and late intra-abdominal infective complications. 相似文献
49.
Y E Shen W G Sorenson D M Lewis S A Olenchock 《Biomedical and environmental sciences : BES》1990,3(3):353-363
Fourteen samples of settled dust from two factories processing rice and wheat straw near Shanghai, China, were examined by dilution plating for total bacteria, gram-negative bacteria, thermophilic actinomycetes, and fungi. They were also examined for aflatoxin, endotoxin, and potential to stimulate production of human interleukin 1 beta (IL-1 beta) and to consume complement. The concentrations of total microorganisms were consistently greater than 10(7) CFU/g and ranged from 10(7) to 10(9) CFU/g. In general, the level of microbial contamination was greater in the hay dust samples than in the rice dust samples, with bacteria being the most numerous microorganisms observed followed by molds, thermophilic actinomycetes, and yeasts. The predominant fungi were species of Aspergillus, Cladosporium, Penicillium, Trichosporon, and Cryptococcus. No significant levels of aflatoxin were observed and the isolates of A. flavus examined lack significant aflatoxigenic potential. The levels of microorganisms in these samples, the types of organisms found, and the inflammatory mediators such as endotoxin suggest that workers exposed to these dusts may be at risk for respiratory illness. 相似文献
50.
M L Selby R Riportella-Muller J R Sorenson D Quade K J Luchok 《Public health reports (Washington, D.C. : 1974)》1992,107(5):561-568
This study evaluated a method to increase physicians' participation in Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a preventive health care program for Medicaid eligible children. Use of EPSDT can improve children's health status and reduce health care costs. Although the potential benefits of EPSDT are clear, the program is underused; low rates of participation by private physicians contribute to underuse. This study targeted a population of 73 primary care physicians in six rural counties in North Carolina where the physician supply, their participation in EPSDT, and use of EPSDT were low. A mailed intervention packet attempted to address barriers to participation perceived by private providers. The packet consisted of a carefully constructed letter, an informative journal article, and an educational pamphlet. Participation in EPSDT screening increased from 15 to 25 private physicians (67 percent), at a cost, on average, of less than $30 per recruited provider. Suggestions are presented for adapting the intervention packet to other settings. 相似文献