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41.
Levente Gáspár Zoltán Jónás László Kiss György Vereb Zoltán Csernátony 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2009,19(6):403-407
Background Coccygodynia can cause severe pain and disability in patients. There are contradictions in the literature regarding the final
results of coccygectomy for coccygodynia. We evaluated the long-term effects of coccygectomy on the intensity, characteristics,
and manifestation of pain caused by coccygodynia to determine the adequacy of operation among treatment modalities.
Materials and methods Thirty-four patients with coccygodynia were treated by coccygectomy. In 22 cases, trauma, and in one case childbirth was the
cause. 11 cases were regarded as idiopathic. The intensity, characteristics of pain, and the most painful activities were
evaluated at an average of 7.6 (3–18) years of follow-up time.
Results Before the operation, all 34 patients had pain while sitting, moreover, 26 of them had pain during standing, walking, at night
or a combination of these. 21 patients had intolerable or very intensive, mainly acute, sharp or burning pain. 11 patients
had dyschesia, 2 had dysuria and 6 had dyspareunia. At follow-up, 7 patients were completely free of pain, 15 others had moderate,
11 medium, and only one patient had severe, but none had intolerable pain. Only seven patients had acute, sharp or burning
pain postoperatively. The decrease of average pain score from 8.0 to 3.2 was significant (P < 10−12). The number of the patients with dyschesia and dyspareunia decreased from 11 to 7 and from 6 to 3, respectively. Two patients
had dysuria, but their complaints did not change after the operation. One of the two patients who needed reoperation had an
excellent final result, while the other remained unchanged. 12 and 16 patients (together 82%) regarded the final result of
the operation excellent and good, respectively. The condition of five others did not change, while one became worse. The patients
with younger age, smaller body mass index, and less co-morbidities had better final result. There were no serious complications.
Conclusion Coccygectomy for coccygodynia is a safe method to decrease the intensity of pain and other complaints of the patients. The
operation can be the choice of treatment if conservative measures fail. 相似文献
42.
Murat Hamit Aytar Fikret Doğulu Berker Cemil Ertan Ergün Gökhan Kurt Kemali Baykaner 《Child's nervous system》2007,23(6):719-721
Introduction Iniencephaly, a neural tube defect involving occiput and inion and combined with rachischisis of the cervical, thoracic spine,
and retroflexion position of the head is a very rare congenital abnormality of the fetus–newborn with a 0.1–10 of 10,000 prevalence.
This abnormality’s prognosis is thought to be dismal. This abnormality can be associated with other abnormalities such as
anencephaly, encephalocele, hydrocephalus, cyclopia, absence of the mandible, cleft lip and palate, cardiovascular disorders,
diaphragmatic hernia, renal abnormalities, overgrowth of the arms compared to the legs, and club food and gastrointestinal
atresia.
Discussion Most of the patients are dead born, and the others die in a few hours. There are only six previously documented long-term
survivors. In our case, our patient with iniencephalic signs and findings is still living. She is 2 years old now. We think
that this patient presents a mild form of iniencephaly. 相似文献
43.
44.
Stefan Ockert Hardy Schumacher Dittmar Böckler Katrin Malcherek Jochen Hansmann Jens Allenberg 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):725-730
Background and aims Since the introduction of endovascular aortic aneurysm repair (EVAR) for aortic aneurysms, the number of juxtarenal aortic
aneurysms (JRA) has been growing steadily due to selection bias (neck morphology for EVAR). This case-match study compares
the perioperative outcome and midterm results of suprarenally clamped JRA with infrarenal aortic aneurysms (AAA).
Methods From 1997 to 2004, patients who received open surgery with suprarenal clamping for JRA were included in the study and compared
to matched patients with infrarenal clamping (AAA). Measurements analyzed were the in-hospital mortality and morbidity. Midterm
results were obtained through clinical investigation and magnetic resonance angiography imaging.
Results Thirty-five patients (mean age, 68.4 years; 30 male and 5 female) received suprarenal cross-clamping for JRA. The overall
in-hospital mortality for JRA and for the controls (AAA) with elective aortic repair was 4.5% (6.1% JRA; 3% AAA, p = 0.058). The morbidity of JRA was elevated according to the rate of pulmonary complications (p = 0.021) and the need for re-operation (p = 0.019). The mean follow-up time was 2.3 years (range, 8–96 months). At follow-up, 28 patients (80%) from the JRA group
and 29 patients from the AAA group (82.9%) were alive.
Conclusion Open aortic surgery for JRA with the need for suprarenal cross-clamping shows a slightly elevated in-hospital mortality rate
without statistical significance and equal midterm mortality results in comparison with infrarenally clamped aortic aneurysms. 相似文献
45.
46.
Endotracheal intubation is required in 5–10% of all prehospital emergencies. Poor environmental conditions (e.g. limited space, poor or excessive lighting etc.), unfavorable patient-related factors (e.g. trauma, bleeding, pulmonary aspiration etc.) and the pressure of time make prehospital airway management a challenging procedure even for experienced emergency physicians. The incidence of difficult endotracheal intubation is significantly higher than in-hospital. Profound clinical practice, recognition and adequate treatment of complications of intubation, and ongoing clinical practice are essential for successful and responsible prehospital airway management. A brief physical examination helps to identify predictors for difficult intubation, thereby modifying treatment strategies. Every emergency physician must be closely familiar with at least one supraglottic airway device and the recent algorithms to manage the unanticipated difficult airway. 相似文献
47.
Thomas Höge 《Stress and health》2009,25(1):41-51
Against the theoretical background of the effort–recovery model and the action regulation theory, the author presents a cross‐sectional questionnaire study testing hypotheses about the relationship between work‐related time pressure, cognitive and emotional irritation, work–family conflict and psychosomatic complaints. Subjects were 576 female home care nurses. Results of a path analysis show that the relation of time pressure and psychosomatic complaints is partially mediated by experiencing a work–family conflict; also the relation of time pressure and work–family conflict is partially mediated by cognitive and emotional irritation. It is argued that cognitive and emotional irritation are fruitful concepts for a more comprehensive understanding of the relationship between work stressors and the development of strain‐based work–family conflict. Implications for the prevention of work–family conflict are outlined. Copyright © 2008 John Wiley & Sons, Ltd. 相似文献
48.
Man Bok Jeong Kristina Narfström Shin Ae Park Je Min Chae Kang Moon Seo 《Documenta ophthalmologica. Advances in ophthalmology》2009,119(2):79-88
The objective of this study is to compare the effects of three different anesthetic combinations on the electroretinogram
in the same animals under similar laboratory conditions. Thiopental–isoflurane (TI), medetomidine–ketamine (MK), and xylazine–ketamine
(XK) were used on each of 12 healthy miniature schnauzer dogs (MS) with a period of at least 3 weeks in between subsequent
anesthesia protocols, using the Dog Standard Protocol. The scotopic ERGs consisted of scotopic low stimulus strength (S) responses
designated S1, S2, S3, S4, and S5, at 1, 5, 10, 15, and 20 min after dark adaptation, respectively, and scotopic standard
stimulus strength (S-ST) responses. The photopic ERGs consisted of a photopic single flash (P) response and 31 Hz flicker
(P-FL) responses. For S-ST (2.5 cd s/m2), the amplitude of the a-wave using TI was significantly lower than that using MK (adjusted P = 0.05) and XK (adjusted P = 0.03), and the implicit time of the a-wave was significantly shorter than that using MK (adjusted P = 0.04). For P (2.5 cd s/m2), the amplitude of the b-wave using XK was significantly higher than that using MK (adjusted P = 0.01). The implicit times of the b-wave using TI was significantly longer and shorter than that of MK for S1, S2 and P-FL
and for S4 and S-ST, respectively, and than that of XK for S2 and P-FL and for S5 and S-ST, respectively. The results of the
present study showed that TI affected both the amplitude and the implicit time of the a-wave for S-ST and the implicit time
of the b-wave relatively more so than was the case when using XK or MK. Therefore, it appears that either XK or MK could be
advantageous to use rather than TI for clinical studies. 相似文献
49.
50.
Dittmar Böckler Hardy Schumacher Klaus Klemm Marcel Riemensperger Philipp Geisbüsch Drosos Kotelis Harry Rotert Jens-Rainer Allenberg 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):715-723
OBJECTIVES: to report our experience with hybrid vascular procedures in patients with pararenal and thoracoabdominal aortic pathologies. METHODS: 68 patients were treated for thoracoabdominal aortic pathologies between October 1999 and February 2004; 19 patients (16 men; mean age 68, range 40-79) with high risk for open thoracoabdominal repair were considered to be candidates for combined endovascular and open repair. Aortic pathologies included five thoracoabdominal Crawford I aneurysms, one postdissection expanding aneurysm, three symptomatic plaque ruptures (Crawford IV), five combined thoracic descending and infrarenal aneurysms with a healthy visceral segment, three juxtarenal or para-anastomotic aneurysms, and two patients with simultaneous open aortic arch replacement and a rendezvous maneuver for thoracic endografting. Commercially available endografts were implanted with standardized endovascular techniques after revascularization of visceral and renal arteries. RESULTS: Technical success was 95%. One patient developed a proximal type I endoleak after chronic expanding type B dissection and currently is waiting conversion. Nine patients underwent elective, five emergency and five urgent (within 24 h) repair. 17 operations were performed simultaneously, and 2 as a staged procedure. Postoperative complications include two retroperitoneal hemorrhages, and one patient required long-term ventilation with preexisting subglottic tracheal stenosis. Thirty-day mortality was 17% (one multiple organ failure, one secondary rupture after open aortic arch repair, one myocardial infarction). Paraplegia or acute renal failure were not observed. Total survival rate was to 83% with a mean follow-up of 30 months. CONCLUSIONS: Midterm results of combined endovascular and open procedures in the thoracoabdominal aorta are encouraging in selected high risk patients. Staged interventions may reduce morbidity. 相似文献