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1.
Isolated patellofemoral arthritis is an increasingly recognized entity, and is usually associated with previous patellofemoral dysplasia or instability. Patellofemoral arthroplasty (PFA) has evolved significantly in recent years, both in terms of implant design and importantly in the understanding of appropriate patient selection. This review outlines the indications and investigations for PFA, provides a brief history of the development of contemporary implants, and presents the clinical outcomes for the prostheses most commonly used in the UK. In addition, it provides a detailed surgical technique for implantation of an onlay implant, with tips on how to optimize patellofemoral biomechanics and thus achieve a consistently good outcome. 相似文献
2.
RA O. Hempel 《Notfall & Rettungsmedizin》2007,10(5):367-371
Legal uncertainties for emergency vehicle drivers can be avoided when fundamental rules are established. In particular, differentiation of special rights and rights of way is essential. Inherent in both is the urgency necessary to save human lives. The right of way signaled by flashing blue lights and siren does not however justify traffic violations but signifies rather a request to other traffic participants. In contrast, special rights require no announcement and constitute a justifiable reason for traffic violations. Even so they do not allow that other traffic participants be endangered or harmed. Adherence to these basic principles can prevent legal misinterpretations as well as rigid adoption of inflexible standards of behavior. 相似文献
3.
RA Mag. Dr. C. Gepart 《Notfall & Rettungsmedizin》2007,10(4):289-292
Austria’s new Living Wills Act (Patientenverfügungsgesetz, or PatVG) that came into effect on 1st of June 2006, is the first law in Austria to regulate the controversial issue of living wills. The PatVG provides for a right to refuse future medical treatment by making an advance directive in the form of a living will that is either binding or “to be taken into consideration”. However, the establishment of a binding living will is governed by strict criteria as regards form and content, and both a medical doctor and a legal expert must be involved. Compliance with a living will is not allowed where there is a legal obligation to give medical treatment. There is also a legal obligation to give medical treatment in emergency situations where the time involved in looking for a living will could seriously endanger the health or the life of a patient. 相似文献
4.
Ohne Zusammenfassung 相似文献
5.
Both cyproterone acetate (CPA) and the gonadotrophin-releasing hormone
agonist (GnRHa) have been shown to be effective for the treatment of
hirsutism. We wished to compare the effectiveness of CPA in two standard
doses with GnRHa and add-back therapy and to compare the length of
remission after these treatments. A total of 60 hirsute hyperandrogenic
women was assigned to the following treatment groups: CPA 2 mg with 35
microg of ethinylestradiol for 21 days each month (Diane group), CPA 50 mg,
days 5-15, and ethinylestradiol 50 microg, days 5-25, each month (CPA
group) or Decapeptyl 3.75 mg i.m. every 28 days with the addition of
conjugated oestrogen 0.625 mg, days 1-21, and medroxyprogesterone acetate
10 mg, days 12-21 (GnRHa group). Hirsutism was graded by the
Ferriman-Gallwey-Lorenzo (FGL) index and anagen hair shaft diameters and
serum luteinizing hormone (LH) and testosterone were assessed before and
every 3 months during and after treatment. All women were treated for 1
year with 1 year follow-up. At baseline hirsutism and endocrine patterns
were similar in all groups. After one year of treatment, hirsutism
decreased in all groups but the changes were greater (P <0.05) in the
CPA and GnRHa groups than in the Diane group. Serum LH and testosterone
were lowest in the GnRHa group. After withdrawal, hirsutism increased
rapidly in the Diane and CPA groups and after 6 months, FGL scores and hair
shaft diameters were similar to pretreatment values. In the GnRHa group,
hirsutism increased more gradually and after 1 year of withdrawal, FGL
scores and hair diameters were significantly (P <0.05) less than
pretreatment values. Serum LH and testosterone increased rapidly in all
three groups reaching pretreatment values by 6 months. These data suggest
equal efficacy of the GnRHa and the high dose CPA regimen for the treatment
of hirsutism in hyperandrogenic women. GnRHa with add-back treatment
appears to result in a longer remission of hirsutism in comparison with
CPA.
相似文献
6.
7.
Maxillary sinusitis in adults: an evaluation of placebo-controlled double-blind trials 总被引:1,自引:0,他引:1
BACKGROUND: In general practice, acute sinusitis is frequently diagnosed
and treated with antibiotics. OBJECTIVE: This study aimed to determine the
evidence for the effectiveness of antibiotic treatment in acute maxillary
sinusitis in adults by assessing the methodological quality of
placebo-controlled double-blind randomized trials. METHOD: An evaluation by
four raters through a 35-item scoring-scale for internal and external
validity of all placebo-controlled double-blind randomized trials on acute
sinusitis found between January 1966 and July 1996. RESULTS: Eighty-five
trials were excluded because they were not placebo-controlled,
double-blind, randomized, or were carried out in patients with chronic
sinusitis or in children. The three remaining trials were performed in
different populations (one in general practice) between 1973 and 1978. Only
one study claimed superiority of antibiotic treatment. Different inclusion
criteria and major outcome measures were used by the authors. The
reliability of major outcome events was reported poorly or not at all and
in two studies outcome measures were clinically inappropriate. The studies
scored 30-62% of the maximum attainable score for internal validity and
10-20% for external validity. CONCLUSION: The effectiveness of antibiotic
treatment in acute maxillary sinusitis in a general practice population is
not based sufficiently on evidence.
相似文献
8.
J W Polson G M Halliday R M McAllen M J Coleman R A Dampney 《Journal of the autonomic nervous system》1992,38(2):117-137
The rostral ventrolateral medulla (RVLM) contains sympathoexcitatory neurons that exert a powerful control over the sympathetic outflow to the cardiovascular system. In the cat there is a concentration of such neurons (but not neurons subserving other functions) within a narrow longitudinal column in the RVLM termed the subretrofacial (SRF) nucleus. Furthermore, it has been suggested that there are subgroups of cells, located at different rostrocaudal levels of the SRF nucleus, that preferentially or exclusively control different vascular beds (e.g. in the kidney and hindlimb). The aim of this study was to map quantitatively the rostrocaudal distribution within the nucleus of different cell types, defined according to morphological and/or chemical criteria, and to correlate this with the regional vasomotor effects (in hindlimb and kidney) evoked by stimulation of SRF cells at the corresponding rostrocaudal levels. SRF cells were highly heterogeneous with respect to both their morphology and chemical properties. They varied greatly in size (equivalent diameter ranging from 10-40 microns) as well as in shape and orientation. An immunohistochemical examination using the avidin-biotin procedure revealed that many SRF cells (estimated 57% of all SRF cells) were immunoreactive for tyrosine hydroxylase (TH, a marker of catecholamine cells). In addition, there were SRF cells immunoreactive for neuropeptide Y (NPY, 11% of total), enkephalin (ENK, 16% of total), and serotonin (5HT, 10% of total), but not for substance P, galanin or somatostatin. Different cell types, defined according to their morphology and/or chemical properties, were unevenly distributed throughout the nucleus. In the most caudal part of the SRF nucleus, virtually all cells were TH-positive, and the large majority (estimated 80%) were NPY-positive, suggesting that many cells at this level contained both TH and NPY. In contrast, in the most rostral part of the SRF nucleus, only 30% of cells were TH-positive, and no NPY-positive cells were observed. Both 5HT- and ENK-positive cells were found throughout the rostrocaudal extent of the nucleus, but predominantly within its rostral part. Furthermore, TH-positive cells in the rostral SRF nucleus were on average significantly larger (mean equivalent diameter 18-43% greater) than TH/NPY-positive cells in the caudal part of the nucleus, but smaller than 5HT- or ENK-positive cells at the same level. Overall, rostral cells (regardless of their chemical type) were larger than caudal cells within the SRF nucleus (mean equivalent diameter 13-28% greater).(ABSTRACT TRUNCATED AT 400 WORDS) 相似文献
9.
10.