胸外伤患者生命质量的影响因素研究

目的 探讨影响胸外伤后生命质量的相关因素。方法 选择太和县中医院胸外科2016年1月至2017年1月住院98例胸外伤患者,并同时选择同期95例正常体检者作为对照组,进行6个月生命质量调研与相关因素分析。结果 对比两组的生命质量状况,心理领域[(12.56±2.45)分vs.(13.78±1.78)分]、生理健康[(12.01±2.31)分vs.(14.98±2.10)分]和独立性领域[(11.29±2.67)分vs.(15.39±2.41)分]等方面对胸外伤患者生命质量的影响最大(t=-3.64、-9.13、-11.19),差异有统计学意义(P＜0.05)。胸外伤患者以消极情绪[(12.39±2.55)分vs.(8.76±2.19)分]、疼痛感[(12.97±2.10)分vs.(8.90±2.42)分]和治疗依赖[(11.59±2.65)分vs.(6.84±3.25)分]方面差距更为明显(t=11.52、14.98、13.87),差异有统计学意义(P＜0.05)。影响胸外伤患者生命质量因素的多元线性回归分析显示,外伤原因、病情程度、受伤后病程、积极情绪、消极应对、医疗配合度等为影响胸外伤生命质量的显著意义因素(t=3.01、0.91、-0.18、5.97、-0.94、2.75),差异有统计学意义(P＜0.05)。结论 胸伤后患者医疗诊治过程中不仅要重视患者生理方面的改变,同时患者心理和社会因素方面的障碍也要得到及时疏导和纠正,并进行早期的干预,从而提高患者伤后的生命质量。     

Cytomegalovirus infection in patients with glomerular diseases treated with cyclophosphamide: a single-center prospective study

International Urology and Nephrology - Cytomegalovirus infection is an important complication in immunocompromised patients. As few studies have shown that cyclophosphamide treatment is a risk...     

Idiopathic granulomatous mastitis with erythema nodosum: Is it a variant of clinical presentation indicating treatment resistance? A retrospective cohort study

Idiopathic granulomatous mastitis (IGM) rarely occurs with erythema nodosum (EN) as a systemic finding. However, the impact of their coexistence on disease severity and response to steroids has not been investigated yet. Patients diagnosed with IGM between September 2014 and October 2018 were divided into two groups according to the presence or absence of EN during the first admission retrospectively. The IGM was more severe in patients with EN as it was presented more often as bilateral and diffuse involvement of the breast. Findings of mastitis did not resolve with steroids in 50% of this group. Repetitive excisions and mastectomy with reconstructions were required to control the disease. Coexistence of EN and IGM was found to be related to bilateral and aggressive involvement, which could be associated with insufficient response to steroids. Associated patients should be informed in terms of the aggressive course, and surgery can be highlighted as a first‐line treatment.     

Evaluation of the role of L-arginine on spermatological parameters,seminal plasma nitric oxide levels and arginase enzyme activities in rams

The purpose of this study is to investigate the effects of L-arginine on spermatological parameters, seminal plasma nitric oxide levels and arginase enzyme activities. Fertile rams that are 2–3 years old and weighing 50–60 kg were used as material. The semen was collected by artificial vagina at 1st, 4th, 24th, 48th, 72nd, 96th and 120th hours for the control group before L-arginine administration. For treatment groups, L-arginine was administered intraperitoneally at a dose of 5 mg kg⁻¹ bw⁻¹ and semen was collected at the time point described for the control group. Spermatological characteristics of semen samples (semen volume, pH, sperm motility, concentration and abnormal sperm rate), seminal plasma nitric oxide levels and arginase enzyme activities were determined. Increased seminal plasma nitric oxide level (p < .01), seminal plasma arginase activity (p < .01), semen volume (p < .05), semen mass activity (p < .05), sperm motility (p < .05) and concentration (p < .01) and decreased abnormal sperm rate (p < .05 and p < .01) were observed by L-arginine administration. In conclusion, it may be concluded that L-arginine application in rams during the breeding season may have positive effects on rams' reproductive performance.     

Sensitivity and Specificity of Red Cell Distribution Width in Diagnosing Acute Mesenteric Ischemia in Patients with Abdominal Pain

Background

We investigated the utility of the red cell distribution width (RDW) in diagnosing acute mesenteric ischemia (AMI) in patients with abdominal pain.

Methods

The patients were divided into two groups in this retrospective case–control study: patients with AMI and patients with abdominal pain who did not require urgent surgery. Venous blood was collected from the patients upon admission to the emergency department, and abdominal computed tomography angiography was performed. The RDW and hematological and biochemical parameters of the groups were compared. The primary outcome was AMI among the patients with abdominal pain. The secondary outcome was mortality, complaint period, and size of ischemia/necrosis among the AMI patients.

Results

The RDW, white blood cell lactate dehydrogenase, and blood urea nitrogen of the patients with AMI were significantly different from those of the control group. When the average RDW (15.04 %) of the patients with AMI was used as a cut-off value, the sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood (?LR) were 40.8 %, 81.2 %, 2.17, and 0.73, respectively. When patients with AMI and anemia were included in the group, the sensitivity and specificity values did not change. There was no relation between the RDW and mortality, size of the ischemia/necrosis, and complaint period. Furthermore, there was no significant difference in the average RDW between the patients with ischemia/necrosis in the small intestine only and those with ischemia/necrosis in the colon.

Conclusion

The RDW on admission is of marginal help to diagnose AMI among patients with abdominal pain.     

The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury

Objective

To investigate the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on intractable neuropathic pain in patients with spinal cord injury (SCI).

Design

A single center, prospective, randomized, double-blinded, controlled study.

Setting

SCI rehabilitation unit of university rehabilitation center.

Participants

Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012.

Interventions

Ten daily treatment sessions of real or sham rTMS (30 trains of 10-Hz stimuli for a duration of 5 seconds; a total of 1500 pulses at intensity equal to 110% of the resting motor threshold) was applied over vertex using a figure-of-8-shaped coil.

Outcome measures

Pain was assessed with visual analog scale (VAS) at baseline and 10 days, 6 weeks and 6 months after the treatment. Patients’ satisfactions obtained using a 5-point Likert scale at 6 months.

Results

Both real and sham rTMS provided a significant reduction in the VAS scores (real rTMS group, P = 0.004; sham rTMS group, P = 0.020). Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS group. Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point (P > 0.05).

Conclusion

Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo. However, middle-term (over 6 weeks) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size.     

Hugging balloon angioplasty of right coronary artery

We report a case of “hugging balloon” dilatation of a giant right coronary artery using two dilatation catheters, a balloon “on a wire” and a balloon “rapid exchange” systems via a single guiding catheter. The necessity of larger PTCA balloon catheter (>4.0 mm) was stressed.     

Protective Factors Based Model for Screening for Posttraumatic Distress in Adolescents

Background

There is growing application of school-based screening to identify post-traumatic distress in students following exposure to trauma. The consensus method is based on self-report questionnaires that assess posttraumatic symptoms, functional impairment, depression or anxiety.

Objective

The current research explored the possibility of using a model, based on the assessment of protective factors, as a screening method for identifying youth who may suffer from posttraumatic distress and need professional help in the aftermath of war.

Method

Participants were 482 Israeli high-school students who were exposed to ongoing missile attacks during Operation Cast Lead in Gaza in 2008. The data collected included symptom scales and three protective factor scales assessing perceived self-efficacy, cognitive-emotion regulation and flexibility in the use of various coping strategies.

Results

The results showed that all three protective factors were significant predictors of symptom severity. The protective-factor-based model utilized logistic regression and receiver operating characteristics analysis. The model correctly classified 84 % of adolescents presenting with probable post traumatic stress disorder, identifying them as distressed. Cross-validation was conducted to assess the stability and reliability of the model, which were found to be acceptable.

Conclusion

The protective factors based model could be important as a part of preliminary triage before referral for intervention and for identification of distressed adolescents. School based screening which focuses on assessing protective factors may facilitate cooperation by both adolescent students and the education system.     

Emergency thyroidectomy: Due to acute respiratory failure

INTRODUCTION

Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention.

PRESENTATION OF CASE

A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cervical swelling progressively increased during the last 7 years and constituted severe respiratory failure which has become severe in the last one month. A giant nodular goiter of the left thyroid lobe extending retrosternally, causing tracheal compression, limiting the neck movements was detected with clinical examination and bedside ultrasound. Emergency thyroidectomy was planned. Fiberoptic-assisted awake nasal intubation was performed in the operating room. Emergency total thyroidectomy was performed for the life-threatening respiratory failure. Postoperative period was uneventful. She was transferred from intensive care unit to the ward on postoperative day 3 and was discharged from the hospital on the postoperative 7th day. Benign multinodular hyperplasia was reported on the histopathological report. Patient was included in routine follow-up.

DISCUSSION

In the present case tracheal destruction due to compression of the giant goiter was found in agreement with previous reports. Emergency thyroidectomy was performed after awake intubation since it is a common surgical option for the treatment of giant goiter causing severe airway obstruction.

CONCLUSION

Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.