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41.
The initial management of bladder outflow obstruction typically related to benign prostatic hyperplasia (BPH) falls to a large extent within the remit of general practice. Referral onwards to secondary care typically arises following the failure to respond to conservative measures or when complications have supervened; the most significant of which is urinary retention. In the hospital setting, anaesthesia, constipation and immobility are the common precipitants. What follows is a practical guide to the management of these situations and provides an overview of the conservative, medical, minimally invasive and surgical treatments available. 相似文献
42.
43.
Ibrahim Rencuzogullari Metin Cağdaş Suleyman Karakoyun Yavuz Karabağ Tufan Çınar 《The American journal of emergency medicine》2018,36(9):1722.e1-1722.e3
Venous thrombosis is recognized as one of the most important complications of nephrotic syndrome (NS). In patients with NS, venous thrombosis may develop in the renal veins, the deep veins of the lower limb, and the inferior vena cava. Here, we describe a case report of an NS patient with multiple venous thrombosis in the right renal vein, the left iliac vein, the vena cava inferior, the right atrium, and the pulmonary arteries. Moreover, we describe the successful treatment of multiple venous thrombosis with prolonged thrombolytic treatment in spite of an increased risk of bleeding due to renal biopsy. 相似文献
44.
Onur Tezel Umit Kaldirim Serkan Bilgic Suleyman Deniz Yusuf Emrah Eyi Selahattin Ozyurek Murat Durusu Nihal Tezel 《The American journal of emergency medicine》2014
Objectives
Dislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application.Methods
The study was planned to be prospective and randomized. As procedural sedation analgesia (SA), titration of ketamine 1 to 2 mg/kg was administered intravenously to group 1. Suprascapular nerve block (SNB) was applied under ultrasound guidance (USG) to group 2. Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test. The χ2 test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test, and a value of P < .05 was accepted as statistically significant.Results
The study comprised a total of 41 patients; 20 in the group 1 and 21 in the group 2. No statistically significant difference was determined between the groups in terms of age (P = .916), sex (P = .972), reduction success (P = .540), and patient-physician satisfaction (P = .198). The time spent in the emergency department (ED) by patients in the SA group was signficantly longer compared with the SNB group. No side effects were observed in the SNB group.Conclusions
Suprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations. 相似文献45.
46.
Complete mesocolic excision (CME) is being performed more frequently and has recently become an established oncologic surgical method for right hemicolectomy. Despite its advantages, such as its association with early mobilization, a short hospital stay, early bowel movement, mild postoperative pain, and good cosmesis, CME is technically demanding and carries the risk of severe complications. This study aims to compare the clinical, pathological, and oncological results of open and laparoscopic right hemicolectomy with CME.The data of 76 patients who underwent right hemicolectomy with CME and high vascular ligation were reviewed retrospectively. The patients were divided into 2 groups according to whether the open or laparoscopic technique was used.Thirty-two patients underwent open right hemicolectomy, and 44 patients underwent laparoscopic right hemicolectomy. The 2 groups were similar in age, sex, American Society of Anesthesiologists class, abdominal surgical history, tumor localization, and operation time. No significant differences were found regarding the specimen length, tumor size, harvested lymph nodes, number of metastatic lymph nodes, or tumor grade. According to the Clavien–Dindo classification system, the laparoscopic group had significantly fewer complications than did the open group (11.4% vs 31.2%; P = .04). The open group had a longer postoperative hospital stay than did the laparoscopic hemicolectomy group (9.9 ± 4.7 vs 7.2 ± 3.1 days; P = .002). In addition, the groups were similar with respect to disease-free survival (P = .14) and overall survival (P = .06).The data in this study demonstrated that no differences exist between the open and laparoscopic techniques concerning pathological and oncological results. However, significantly fewer complications and a shorter length of hospital stay were observed in the laparoscopic group than in the open group. Laparoscopic right hemicolectomy with CME and central vascular ligation is a safe and feasible surgical procedure and should be considered the standard technique for right-sided colon cancer. 相似文献
47.
目的观察rK39抗原酶联免疫吸附试验双抗原夹心法(ELISA夹心法)检测内脏利什曼病抗体用于内脏利什曼病诊断与宿主动物感染调查的可行性。方法采用ELISA夹心法与rK39免疫层析试条法(ICT)同步检测内脏利什曼病抗体。结果 5种家畜血清229份,7种鼠类标本238份,ELISA夹心法和rK39 ICT法抗体检测均阴性;接种利什曼原虫灰仓鼠、草原兔尾鼠标本33份,13份阳性,阳性率39.4%;塔里木兔标本119份,阳性7份,阳性率5.9%;非疫区儿童血清29份,全部阴性;疫区无内脏利什曼病症状人血清250份,4份两种方法均阳性,阳性率均为1.6%;住院内脏利什曼病病人血清67份,两种方法的阳性率分别为68.7%和67.2%。共检测人和其他动物标本965份,两种方法的阳性符合率98.6%,阴性符合率99.9%。ICT相同显色等级的阳性标本,ELISA跨10个滴度。结论 ELISA夹心法可检测多种动物内脏利什曼病抗体,抗体滴度具有定量意义。该方法适用于内脏利什曼病诊断、疗效观察和流行病学调查。 相似文献
48.
This interventional study was undertaken to assess the impact of physiotherapy education on the knowledge and attitudes of
physiotherapists (PTs) and physiotherapy students (PSs) toward euthanasia. The study, which was conducted during the period
between 2004 and 2005, included a total of 494 participants (311 PTs; 183 PSs) aged 18 to 52 y from the western and central
portions of Turkey, who responded to a self-report questionnaire (response rate, 96.4%) that was based on data from the literature.
Results indicated that PTs (48.9%) were more likely to approve of euthanasia than PSs (38.3%) (P<.05). The legalization of euthanasia was favored by 43.7% of PTs, compared with 29.5% of PSs (P<.05). On the other hand, PTs and PSs expressed similar views regarding euthanasia, including reasons for accepting or opposing
euthanasia and acceptable conditions for its use (P> .05). Overall results showed that sex and age had no effect on whether euthanasia was accepted (P> .05); religiousness was found to have the greatest effect on attitudes toward euthanasia (P<.05). The findings of the current study suggest that (1) the attitudes of PTs are different from those of PSs, and (2) the
Islamic point of view has a negative impact on the attitudes of PTs and PSs toward euthanasia. 相似文献
49.
Rheumatoid arthritis (RA) mostly follows a painful, progressively disabling course, and individuals with RA experience more
psychological distress than healthy individuals. The objective of the present study is to examine the prevalences of accompanying
anxiety and depression in RA cases. The study included 82 RA cases and 41 age- and sex-matched healthy volunteers as the control
group. Psychiatric examinations of all cases of the patient and control groups were performed according to DSM-IV criteria.
Hamilton Anxiety Scale or Hamilton Depression Scale was applied to those who were found to have anxiety or depression. Total
prevalence of anxiety, depression, and mixed anxiety-depressive disorder was found to be 70.8% (n=58) in the patient group and 7.3% (n=3) in the control group, and the difference was significant (p<0.001). Of the RA patients, 41.5% (n=34) was found to have depression, 13.4% (n=11) anxiety, and 15.9% (n=13) mixed anxiety-depressive disorder. The disease duration in patients with anxiety was shorter than the RA patient with
depression (p<0.05). The disease duration was positively correlated with the degree of depression and negatively correlated with the degree
of anxiety (r=0.341, p<0.05; r=−0.642, p<0.05, respectively). The results of our study suggest that prevalences of anxiety and mainly depression, increase in RA cases.
When the clinical picture in RA cases becomes complicated with anxiety or depression, some problems at patients’ adaptation
and response to treatment may be possible. RA cases should be monitored for accompanying anxiety or depression during follow-up. 相似文献
50.
Arman C Ergür I Atabey A Güvencer M Kiray A Korman E Tetik S 《Surgical and radiologic anatomy : SRA》2006,28(6):553-558
The maxilla is the key structure on facial formation and stability. The knowledge about maxillary thickness and dimensions is crucial during facial reconstruction including this bone. In this study, anthropometric measurements of anterior wall of the maxilla on the dry human skulls were aimed. Sixty maxillae of 30 adult dry skulls of West Anatolian people were evaluated. Four vertical lines were drawn between the piriform aperture and lateral border of the bone and six horizontal lines between the infra-orbital margin and the inferior border of the piriform aperture. After establishing the lines, maxillary thicknesses on the intersection points of the vertical and horizontal lines and the lengths of the vertical lines from the infra-orbital margin to alveolar arch were measured by using a fine caliper. It was found that the thickest point of the anterior wall of the maxillae is on the lateral of the infra-orbital margin (5.17 ± 2.27 mm), and thinnest one is on the inferior of the infra-orbital foramen (0.92 ± 1.06 mm). The length of the vertical line tangent to piriform aperture (47.66 ± 3.61 mm) is the longest. The corresponding data of the left and right maxillae were compared by Student’s t test. There was no significant difference between both sides. After collecting the data, a thickness map of anterior wall of the maxilla was drawn. This data may be helpful in clinic during osteotomies, bone reconstructions, screw, or other reconstruction apparatus applications on the maxilla. 相似文献