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Background: There is a growing interest in the use of local anaesthesia for inguinal hernia repair. It certainly seems to
be an acceptable alternative for the elderly. Supporting intravenous sedation, however, still requires monitoring, anaesthetic
personnel and some preparations for the patient. Therefore we set up a feasibility study of hernia repair under local anaesthesia
without intravenous sedation or monitoring in elderly patients. Method: A total of 62 patients (aged 65 years or more) with
unilateral inguinal hernia received a Mesh Plug Repair. Prospectively collected data included procedure-related complications
and information on pain and quality of life as measured by Short Form 36. Results: No procedure-related complications were
noted. Comparing the preoperative scores, the SF-36 on day 14 (n=61) did not differ significantly. After a median follow-up of ten months (n=54), significantly higher scores were found for scales of physical and emotional role and pain (all p<0.05). Twenty-two patients reported some form of pain (40.7%). 94.4% of the patients would recommend the procedure when asked.
Conclusion: The results of this study indicated that Mesh Plug Repair performed under unmonitored local anaesthesia with no
intravenous sedation is a feasible alternative for elderly patients. It has advantages for the medical organization without
disadvantages for the patient. 相似文献
105.
双侧侧脑室外引流并脑脊液置换术治疗原发性脑室出血23例 总被引:2,自引:0,他引:2
我科自1995年1月至2005年1月共收治原发性脑室出血23例,经双侧侧脑室外引流并脑脊液置换术冶疗取得较好效果,现报道如下。 相似文献
106.
Raph Hamers Sander Bontemps Marjan van den Akker Ruy Souza Júlio Penaforte Niels Chavannes 《Primary care respiratory journal》2006,15(5):299-306
AIMS: The developing world is particularly at risk of an increasing health burden due to an increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) secondary to increasing tobacco consumption. However, research is scarce. The objectives of this study were to assess the current competence for diagnosing COPD in primary care in a resource-limited setting in Brazil, and to develop a local patient profile for case-finding. METHODS: 34 general practitioners (GPs) in five areas of northern Brazil recruited adult patients with principal complaints of cough and/or shortness of breath who then had spirometry (n = 142). RESULTS: For the dichotomous variable 'COPD' the degree of agreement between GP diagnosis (n = 64, 18.3%) and spirometric outcome (n = 36, 25.4%) was poor, with Kappa = 0.055 (SE 0.087) and DOR = 1.35. False-positive and false-negative diagnosis proportions were 19.8% and 75%, respectively. Independent risk factors were 'smoking history of more than five pack years' and 'presence of both dyspnoea and cough'. It requires the testing of 2.2 smokers with more than five pack years to detect one patient at risk. CONCLUSIONS: COPD is a common yet underdiagnosed disease in Brazilian primary care. Spirometry improves diagnostic competence and case-finding substantially. If applied in a pre-selected high-risk population, we believe spirometry can be a cost-effective diagnostic tool for case-finding in the resource-limited setting. This study provides important baseline information for effective guideline implementation. 相似文献
107.
Michael D. Cabana David Bruckman Susan L. Bratton Alex R. Kemper Noreen M. Clark 《The Journal of asthma》2003,40(7):741-749
Background. The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. Objective. To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. Design. We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from 01 1998 to 10 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. Results: A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. Conclusions. Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits. 相似文献
108.
Hidehito Sakaguchi Tetsuji Kawata Shigeki Taniguchi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(2):71-74
The surgical approach to ischemic mitral regurgitation with concomitant inferior left ventricular aneurysm remains uncertain
in terms of the indication for operation and the short-and long-term outcomes. We performed concomitant mitral valve repair,
left ventricular reconstruction, and aortic valve replacement on a 71-year-old male with severe ischemic mitral regurgitation,
inferior left ventricular aneurysm, and degenerative aortic regurgitation. Postoperative status was in New York Heart Association
functional class I without mitral regurgitation 8 months after operation. We discuss, and review the procedures reported in
the literature. 相似文献
109.
Repair of large midline incisional hernias with polypropylene mesh: Comparison of three operative techniques 总被引:9,自引:0,他引:9
de Vries Reilingh TS van Geldere D Langenhorst BLAM de Jong D van der Wilt GJ van Goor H Bleichrodt RP 《Hernia》2004,8(1):56-59
Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia — 25 women and 28 men, mean age 60.4 (range 28–94) — were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique. 相似文献
110.