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101.
Norberto Adame Jr. MD Bruce T. Horwood MD Daniel Caruso MD Ted Wallace MD Louis Velasco MD 《Academic emergency medicine》2006,13(1):114-116
Objectives: To determine whether the Mac‐technique test can detect kinking of the chest tube upon thoracostomy tube placement. Methods: This was a prospective observational study that was conducted October 2000 through October 2001 in an urban Level 1 trauma center. There were 103 consecutive nonrandomized adult trauma patients who required immediate tube thoracostomy during their initial resuscitation who were entered into the study. The Mac‐technique test was performed during standard tube thoracostomy insertion to the appropriate depth. The test involved grasping the external portion of the thoracostomy tube, turning it clockwise 180°, and then releasing the tube. If the tube spontaneously spun back to its original position, the test was considered positive, and the tube was considered kinked. If the tube did not spontaneously spin back and stayed in position upon release, the test was considered negative. Regardless of the results of this test, the tube was secured, and a postprocedure chest radiograph was obtained. The criterion standard for determining a kinked chest tube was its appearance on this chest radiograph. Results: A total of 103 chest tubes were placed by using the Mac‐technique test. The test was positive in eight placements; four tubes were kinked on chest radiograph. The Mac‐technique test was negative in 95 placements; four tubes were kinked on chest radiograph. The Mac technique had a sensitivity of 50% (95% confidence interval [CI] = 15.7% to 84.3%), a specificity of 95.8% (95% CI = 89.6% to 98.8%), a positive likelihood ratio of 11.9, a negative likelihood ratio of 0.52, and an odds ratio using Yates correction of 20.3 (95% CI = 4.1 to 102.1). Conclusions: On the basis of this study, a positive Mac‐technique test is useful to detect chest tubes that are likely to be kinked after insertion and before securing. 相似文献
102.
Takashi Toyonaga Eisei Nishino Toshio Dozaiku Chie Ueda Tomoomi Hirooka 《Digestive endoscopy》2007,19(Z1):S14-S18
The gastric vasculature responsible for intraoperative bleeding in endosocpic submucosal dissection (ESD) is the ramified vascular network occupying the middle of the submucosal layer and large vessels penetrating the muscle layer. Appropriate management for these vessels must be addressed. The trimming of the ramified vascular network can be safely performed with coagulation mode following shallow mucosal cutting. A large penetrating vessel usually requires precoagulation prior to dissection. These procedures are effectively performed with the water jet short needle knife (Flush knife). 相似文献
103.
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105.
Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline 总被引:4,自引:0,他引:4
G. Waldemar B. Dubois M. Emre J. Georges I. G. McKeith M. Rossor P. Scheltens P. Tariska B. Winblad 《European journal of neurology》2007,14(1):e1-e26
The aim of this international guideline on dementia was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It covers major aspects of diagnostic evaluation and treatment, with particular emphasis on the type of patient often referred to the specialist physician. The main focus is Alzheimer's disease, but many of the recommendations apply to dementia disorders in general. The task force working group considered and classified evidence from original research reports, meta-analysis, and systematic reviews, published before January 2006. The evidence was classified and consensus recommendations graded according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. The recommendations for clinical diagnosis, blood tests, neuroimaging, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, genetic testing, tissue biopsy, disclosure of diagnosis, treatment of Alzheimer's disease, and counselling and support for caregivers were all revised when compared with the previous EFNS guideline. New recommendations were added for the treatment of vascular dementia, Parkinson's disease dementia, and dementia with Lewy bodies, for monitoring treatment, for treatment of behavioural and psychological symptoms in dementia, and for legal issues. The specialist physician plays an important role together with primary care physicians in the multidisciplinary dementia teams, which have been established throughout Europe. This guideline may contribute to the definition of the role of the specialist physician in providing dementia health care. 相似文献
106.
重型颅脑损伤开颅术中急性脑膨出的防治 总被引:1,自引:0,他引:1
目的探讨重型颅脑损伤开颅术中急性脑膨出的原因及对策。方法对120例重型颅脑损伤开颅术中急性脑膨出的原因、对策及预后进行回顾性分析。结果(1)迟发血肿65例,其中同侧脑内血肿10例,硬膜外血肿8例,对侧硬膜外血肿21例,硬膜下血肿10例,脑内血肿9例,大脑纵裂血肿7例;(2)急性弥漫性脑肿胀40例;(3)外伤性大面积脑梗死15例;(4)复合伤患者有30例。合并胸部、腹部及四肢骨折,有明显的低血压和低血氧症状;(5)术中操作不当,误诊误治10例。结论重型颅脑损伤开颅术中急性脑膨出的主要原因有迟发性颅内血肿,弥漫性脑肿胀,严重脑水肿,广泛脑梗死,术中操作不当,对病情的误诊误治,麻醉问题等。根据不同的原因进行正确处理,可以降低急性脑膨出的重残率及病死率。 相似文献
107.
大肠海绵状血管瘤的诊治(附8例报告) 总被引:2,自引:0,他引:2
目的 探讨大肠海绵状血管瘤的临床特点、诊治原则和疗效。方法回顾1997年至2004年收治的8例大肠海绵状血管瘤患者的临床资料。结果8例患者平均年龄18岁.其中直肠海绵状血管瘤4例.直肠和乙状结肠海绵状血管瘤3例.金大肠海绵状血管瘤1例。临床表现为反复发作的无痛性便血和贫血。术前行电子结肠镜、腹部X线平片、气钡双重对比造影、CT和MRI等检查明确诊断。昕有患者均行于术治疗.平均随访36月(10~96月).全部治愈。结论增强对本病的认识.重视电亍二结肠镜仵大肠海绵状血管瘤的首诊作用.影像学检杏进一步确定病变部位和血管瘤的范围,手术治疗是有效的治疗手段。 相似文献
108.
对药品市场营销中代理环节监督管理的思考 总被引:1,自引:1,他引:0
随着我国药品分销市场的对外放开,传统的批发零售经营方式发生了根本变化,代理配送制将成为医药流通的主要方式.药监工作人员要准确掌握药品分销市场的现状及发展趋势,抓好药品市场营销中代理环节的监督管理. 相似文献
109.
本文对药品检验机构建立和完善质量体系的重要性,质量体系的内涵,建立和完善质量体系应注意的主要问题进行了分析并提出了建议。 相似文献
110.