3 DIMENSIONAL CT

3 Dimensional Computed Tomography (3D CT), has proved to be an extremely useful tool in the evaluation of varied pathologies. In this article, we have attempted to briefly review the physical principles involved and to outline the technique of acquisition of 3D images.KEY WORDS: Acquisition, Bony pathology, 3D     

The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure

BACKGROUND: Because left ventricular assist devices have recently been approved by the Food and Drug Administration to support the circulation of patients with end-stage heart failure awaiting cardiac transplantation, these devices are increasingly being considered as a potential alternative to biologic cardiac replacement. The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial is a multicenter study supported by the National Heart, Lung, and Blood Institute to compare long-term implantation of left ventricular assist devices with optimal medical management for patients with end-stage heart failure who require, but do not qualify to receive cardiac transplantation. METHODS: We discuss the rationale for conducting REMATCH, the obstacles to designing this and other randomized surgical trials, the lessons learned in conducting the multicenter pilot study, and the features of the REMATCH study design (objectives, target population, treatments, end points, analysis, and trial organization). CONCLUSIONS: We consider what will be learned from REMATCH, expectations for expanding the use of left ventricular assist devices, and future directions for assessing clinical procedures.     

Clinical Presentation and Outcomes Associated with Different Treatment Modalities for Pediatric Bark Scorpion Envenomation

Introduction

Scorpion envenomation is potentially life-threatening and affects children in the Southwestern USA. An FDA-approved antivenom is available, but its high cost has led to use of off-label antivenom dosing or supportive care alone as alternatives to FDA-recommended dosing. This study sought to determine whether treatment approach influences outcomes in envenomated children.

Methods

A retrospective cohort study of children with grade III or IV scorpion envenomation evaluated in Phoenix Children’s Hospital ED between September 1, 2011, and March 31, 2014. Patients were grouped based on treatment: group 1, supportive care only; group 2, FDA-recommended dosing (3-vial initial dose); group 3, “off label” dosing (1–2 vial initial dose). Primary outcomes were ED length of stay and hospital admission. Secondary outcomes were mechanical ventilation and aspiration pneumonia.

Results

One hundred fifty-six patients were included with 58 patients in group 1, 16 patients in group 2, and 82 patients in group 3. Group 1 was significantly older than the antivenom groups (p < 0.001), and group 2 was younger than group 3 (p = 0.024). Envenomation grade was also different, with group 1 having fewer grade IV then groups 2 and 3 (p < 0.001). Three percent of group 1, 56 % of group 2, and 28 % of group 3 had respiratory distress (p < 0.001). ED LOS was not significantly different between groups. Hospital admission occurred in 3.4 % group 1, no group 2, and 8.5 % group 3 patients. Two intubations and two aspirations occurred in group 3.

Conclusions

In this study, clinical presentation appeared to influence treatment. Groups that received antivenom had a higher envenomation grade than the group that received supportive care. The FDA-recommended dosing group was younger and had more respiratory distress than those treated with initial doses of 1–2 vials. Outcomes were not significantly different between groups. Prospective studies may identify the ideal population for each treatment approach.

     

Use of a Loading Dose of Vitamin D for Treatment of Vitamin D Deficiency in Patients With Intestinal Failure

Vitamin D deficiency is common in patients with intestinal failure and short bowel syndrome who have been weaned of parenteral nutrition. Dietary supplementation with vitamin D is necessary to correct this deficiency. In certain cases, routine supplementation strategy may be ineffective. We report 3 cases of vitamin D deficiency in patients with intestinal failure who showed improvement in serum 25‐hydroxyvitamin D levels after supplementation with a loading dose of 20,000–40,000 IU vitamin D provided weekly.     

腹部手术后是否应用鼻胃管?

在许多医疗中心,腹部手术后在胃肠(GI)功能尚未完全恢复前预防性使用鼻胃管(NGI)已是一个诊疗常规。在腹部手术中使用鼻胃管可使术野有更好显露也已成为广泛共识。但在二十世纪80～90年代,许