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To determine the relation between basic clinical characteristics and resource utilisation in paediatric intensive care, an open prospective study was performed. Resource utilisation was expressed using the therapeutic intervention score system (TISS) and length of stay (LOS), from which total resource utilisation per admission (TISSTOT) and average daily resource utilisation (TISSMEAN = TISSTOT/LOS) were obtained. Overall 593 admissions, totalling 3130 days, were included. Mortality was 8.4% and non-survivors accounted for 14.1% of overall resource utilisation. In non-survivors, TISSTOT and TISSMEAN were higher, whereas LOS was not different from survivors'. Severity of illness, surgical status, significant chronic comorbidity, emergency admission, and transfer status constituted the major predictive determinants of TISSTOT (r2 = 0.19) and TISSMEAN (r2 = 0.45) in multiple regression analysis. High resource utilisation in high risk patients was probably warranted, as effectiveness of prolonged intensive treatment was demonstrated. It is concluded that TISSTOT and TISSMEAN are appropriate, non-monetary measures of resource utilisation, a considerable proportion of which are determined by a concise set of basic clinical characteristics. 相似文献
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G Roseau L Palazzo T Rahme J A Paolaggi 《Gastroentérologie clinique et biologique》1992,16(10):787-790
The staging of rectosigmoid villous adenomas is difficult when based only on clinical or endoscopic findings, even when superficial biopsies are taken. Echoendoscopy (EE) with a 7.5 and 12 MHz transducer heads provides good visualization of these lesions. The role of EE in the staging of villous adenomas presenting as benign lesions was prospectively studied. Among 47 patients who had an echoendoscopic investigation for villous adenoma during a 18 month period, 25 had lesions believed to be benign based on clinical and endoscopic findings. In 23 patients (group I, superficial biopsies showed no malignancy; in 2 patients (group II), with 3 lesions, biopsies were positive for in situ carcinoma. Comparisons were made between echographic images and operative specimens. A complete EE investigation was possible in all cases. In group I, there was one tumor T3N+ that was diagnosed by EE only. Twelve other patients had neoplastic lesions limited to the mucosa or submucosa only, and 10 had benign lesions. The integrity of the muscularis propria was imaged in all cases but EE did not differentiate benign lesions from neoplastic lesions invading the mucosa. In group II, parietal staging was correct in 2 of 3 cases. In addition to clinical examination and endoscopic investigations, EE seems useful in the staging of large or high located villous adenomas as well as for the best therapeutic choice. 相似文献
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The testicular scintigraphic findings of nine patients with surgically and pathologically proved torsion of the testis of over 24 hours duration are reviewed. In the delayed blood-pool images each showed the classical avascular twisted testicle with a variable peripheral rim of hyperemia. In the dynamic blood-flow phase, eight revealed a perceptible increase of vascular perfusion in the scrotal region on the affected side, in addition to the testicular radionuclide angiogram peculiarities previously described for missed testicular torsion. This pattern of perfusion was seen only in torsion of over one day duration. A low salvage probability is expected in these cases. 相似文献
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Pancreatic transplant imaging 总被引:1,自引:0,他引:1
Yuh WT; Wiese JA; Abu-Yousef MM; Rezai K; Sato Y; Berbaum KS; Kao SC; Hunsicker LG; Corry RJ 《Radiology》1988,167(3):679-683
Forty-four clinical episodes of suspected (pancreas) transplant rejection in 17 pancreatic transplantation patients were reviewed retrospectively. The clinical impression of acute graft rejection, chronic rejection, or nonrejection in each episode was correlated with the results of 19 nuclear medicine, 12 ultrasound (US), and 44 magnetic resonance (MR) imaging studies. US was found to be a moderately sensitive (82%) method of detecting graft rejection. US also was effective in identifying intra- and peripancreatic fluid accumulations. Nuclear medicine imaging was also a sensitive technique (86%) and the only modality that provided physiologic information regarding graft perfusion. MR imaging allowed correct prediction of the presence or absence of graft rejection in 39 of 44 cases (sensitivity, 100%; specificity, 76%) and was an effective means of detecting pathologic fluid collections. Nuclear medicine, US, and MR imaging are all believed to be sensitive methods of detecting graft rejection and are complementary adjuncts to the clinical evaluation of pancreatic transplants. 相似文献