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111.
H Boralessa DR Goldhill K Tucker AJ Mortimer J Grant-Casey 《Annals of the Royal College of Surgeons of England》2009,91(7):599-605
INTRODUCTION
Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice.PATIENTS AND METHODS
NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards.RESULTS
Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1–14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more.CONCLUSIONS
Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence-based, transfusion threshold should be used and transfusion of more than one unit should only be given if essential to maintain haemoglobin concentrations above this threshold. 相似文献112.
WY Khoder AJ Becker B Schlenker S Tritschler PJ Bastian CG Stief 《European journal of medical research》2009,14(7):320-322
Introduction
Rectal polypectomy causes thinning (or even perforation) of the rectal wall in addition to thermic injury at the polypectomy site.Case report
We present a rare case of spontaneous rectal perforation after uncomplicated nerve sparing endoscopic extraperitoneal radical prostatectomy in a patient with a previous history of rectal polypectomy at the perforation site. The patient could be treated conservatively. There was complete healing of the fistula without any effect on functional results. This Conservative therapy for such rectal perforations is indicated if the patient''s general condition remains stable without any signs of infection.Conclusions
Polypectomy is an important risk factor for rectal perforation during nsEERPE. Adequate time interval should be given to allow healing and avoid adding further thermal wall damage which may obscure healing leading to complications like fistula. Conservative therapy for small missed rectal perforations constitutes an attractive, feasible and non invasive treatment entity. Following this principle we have not faced this complication in following similar cases. 相似文献113.
Cunnington M Ferber S Quartey G;International Lamotrigine Pregnancy Registry Scientific Advisory Committee 《Epilepsia》2007,48(6):1207-1210
Data from the International Lamotrigine Pregnancy Registry were analyzed to examine the effect of maximal first-trimester maternal dose of lamotrigine monotherapy on the risk of major birth defects (MBDs). Among 802 exposures, the frequency of MBDs was 2.7% (95% confidence interval [CI] 1.8-4.2%). The distribution of dose did not differ between infants with and those without MBDs (mean 248.3 milligrams per day [mg/day] and 278.9 mg/day, respectively, median 200 mg/day for both groups). A logistic regression analysis showed no difference in the risk of MBDs as a continuous function of dose (summary odds ratio [OR] per 100 mg increase =0.999, 95% CI 0.996-1.001). There was also no effect of dose, up to 400 mg/day, on the frequency of MBDs. 相似文献
114.
115.
W Allan Walker Eric C Martens Philip M Sherman Johanna W Lampe Meredith AJ Hullar Christine D Wu 《Nutrition reviews》2009,67(1):40-48
The extended abstracts in this report are based on presentations from the 11th Special Conference on Functional Foods for Health Promotion, cosponsored by the Technical Committee on Food Components for Health Promotion of the North American Branch of the International Life Sciences Institute (ILSI NA) and the American Society for Nutrition (ASN) at the Experimental Biology (EB) meeting in April 2008. Evidence that foods and their components offer health benefits beyond basic nutrition continues to captivate the interest of scientific communities, federal agencies, and the general public. The theme of the 2008 special conference was "Microbes and Health". It began with a general introduction and overview of how diet or dietary components can influence microbial growth and, ultimately, disease risk and overall health. Subsequent presentations provided fundamental information about how the food supply can set the landscape for gene expression in microbes and, ultimately, their influence on health (with some comments on how microbes might contribute to the obesity epidemic), child health and infections, role of microbes in cancer prevention, and effects of foods and their bioactive constituents as modifiers of microbes in the oral cavity. 相似文献
116.
Christine AE Schutgens Merel Schuring Toon AJ Voorham Alex Burdorf 《BMC public health》2009,9(1):197-11
Background
The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health. 相似文献117.
Windischberger C Cunnington R Lamm C Lanzenberger R Langenberger H Deecke L Bauer H Moser E 《Journal of neuroscience methods》2008,169(1):222-230
Conventional fMRI analyses assess the summary of temporal information in terms of the coefficients of temporal basis functions. Based on established finite impulse response (FIR) analysis methodology we show how spatiotemporal statistical parametric maps may be concatenated to form Brain Activation Movies (BAMs), dynamic activation maps representing the temporal evolution of brain activation throughout task performance. These BAMs enable comprehensive assessment of the dynamics in functional topology without restriction to predefined regions and without detailed information on the stimulus paradigm. We apply BAM visualization to two fMRI studies demonstrating the additional spatiotemporal information available compared to standard fMRI result presentation. Here we show that BAMs allow for unbiased data visualization providing dynamic activation maps without assumptions on the neural activity except reproducibility across trials. It may thus be useful in proceeding from static to dynamic brain mapping, widening the range of fMRI in neuroscience. In addition, BAMs might be helpful tools in visualizing the temporal evolution of activation in "real-time" for better and intuitive understanding of temporal processes in the human brain. 相似文献
118.
Antonina A Mikocka-Walus Deborah A Turnbull Jane M Andrews Nicole T Moulding Ian G Wilson Hugh AJ Harley David J Hetzel Gerald J Holtmann 《Clin Pract Epidemiol Ment Health》2008,4(1):15
Background
In independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources.Methods
Overall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed).Results
Each of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population.Conclusion
Patients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.119.
R E Brolin MD JH Gorman MD RC Gorman MD AJ Petschenik M D LJ Bradley MS RD HA Kenler PhD RP Cody Pb D 《Journal of gastrointestinal surgery》1998,2(5):436-442
Although iron, vltamm B12, and folate deficiency have been well documented after gastric bypass operations performed for morbid obesity, there is surprisingly
little information on either the natural course or the treatment of these deficiencies in Roux-en-Y gastric bypass (RYGB)
patients Durmg a l0-year period, a complete blood count and serum levels of iron, total iron-binding capacity, vltamin B12, and folate were obtained in 348 patients preoperatively and postoperatively at 6-month intervals for the first 2 years,
then annually thereafter The principal objectives of this study were to determine how readily patients who developed metabolic
deficiencies after Roux-en-Y gastric bypass responded to postoperative supplements of the deficient micronutrient and to learn
whether the risk of developmg these deficiencies decreases over time Hemoglobin and hematocrit levels were slgnificantly decreased
at all postoperative intervals in comparison to preoperative values Moreover, at each successive interval through 5 years,
hemoglobin and hematocrit were decreased signifiantly compared to the preceding interval Folate levels were significantly
increased compared to preoperative levels at all time intervals Iron and vltamin B12 levels were lower than preoperative measurements and remained relatively stable postoperatively Half of the low hemoglobin
levels were not associated with iron deficiency Taking multivltamin supplements resulted in a lower incidence of folate deficiency
but did not prevent iron or vitamin B12 deficiency Oral supplementation of iron and vitamin B12 corrected defiaencies in 43% and 81% of cases, respectively Folate deficiency was almost always corrected with multivitamins
alone No patient had symptoms that could be attributed to either vitamin B12 or folate deficiency Conversely, many patients had symptoms of iron deficiency and anenua Lack of symptoms of vitamin B12 and folate deficiency suggests that these deficiencies are not clinically important after RYGB Conversely, iron deficiency
and anemia are potentially serious problems after RYGB, particularly in younger women Hence we recommend prophylactic oral
iron supplements to premenopausal women who undergo RYGB 相似文献
120.
Hasegawa DK; Bennett AJ; Coccia PF; Ramsay NK; Nesbit ME; Krivit W; Edson JR 《Blood》1980,56(4):585-595
Factor V deficiency has been identified in 8 of 8 patients 7--20 yr of age, with Philadelphia-positive (Ph1+) chronic myelogenous leukemia (CML). In these 8 patients, factor V deficiency was not due to hepatic dysfunction, factor V inhibitors, or disseminated intravascular coagulation. In 3 patients, factor V activity rose 10%--12% (0.10--0.12 U/ml) after the infusion of 28--31 ml/kg body weight of fresh frozen plasma (FFP). The rise persisted less than 14 hr. The mean measured postinfusion rise in factor V was 18% of the expected rise calculated from the volume of FFP infused in the patients' plasma volume. In 4 patients, a small transient rise in factor V activity occurred after splenectomy or plateletpheresis. Factor V deficiency was completely corrected after a marked reduction in bone marrow cellularity in 2 patients with Ph1+ CML treated with extensive chemotherapy, total body irradiation, and bone marrow transplantation. Factor V deficiency was retrospectively observed in 6 of 20 patients, ages 20--80 yr, with Ph1+ CML and 3 of 6 patients with other myeloproliferative disorders. The factor V deficiency appears to be associated with the large myeloid- megakaryocytic cell mass characteristic of CML and other myeloproliferative disorders. 相似文献