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51.
Sixteen arteriovenous fistulas were created for parenteral nutrition. The complications included stenosis at the site of needling or at the site of vascular anastomosis. Two infections occurred from the surgical creation of a fistula. There were no infections related to fluid infusion. The advantage of the technique is simplicity of fluid administration and the absence of dressings and catheters between infusions.  相似文献   
52.
Rectal carcinoma can be treated by anterior resection with EEA anastomosis in order to preserve rectal continuity in those patients in whom anastomosis may be technically difficult. In our initial local experience however, the pelvic recurrence rate has been approximately three times as high as would be expected. The surgical results were good in those patients with Dukes' B lesions. The majority of failures occurred in those with Dukes' C lesions. When the preoperative assessment indicates the strong likelihood of a Dukes' C lesion, consideration of abdominoperineal resection must be given if cure is anticipated. Most surgeons will obtain a more complete pararectal tissue clearance with this procedure than with anterior resection. Those who wish to preserve rectal continuity with curative procedures for rectal carcinoma must become proficient at pararectal tissue clearance if a low rate of pelvic recurrence is to be achieved. The EEA stapler can enable safe anastomosis when these other factors have been accomplished. When cure is anticipated, it can only be provided for the majority of patients at initial surgical resection. The EEA stapler has a unique value in patients who have resectable rectal carcinoma, and yet have distal metastasis by the time initial surgery is performed. The preservation of rectal continuity in such patients is an excellent method of palliation.  相似文献   
53.
Primary motor disorders of the esophagus can be managed surgically with excellent results. Between the years 1972 and 1983, 40 patients were managed by us. The patients ranged in age from 14 to 79 years (mean 36.3 years). Thirty-six patients were managed primarily by the authors and 4 patients secondarily. The distribution of the hypodynamic states were achalasia in 29 patients, vigorous achalasia in 5 patients, and diffuse spasm in 1 patient, whereas the hyperdynamic states were squeeze syndrome in 2 patients, super-squeeze syndrome in 1 patient, and hypertensive lower esophageal sphincter in 2 patients. Of the 36 patients in hypodynamic states, 27 had a modified Heller myotomy and reconstruction of the gastroesophageal junction with a Belsey fundoplication and 9 had only a modified Heller myotomy. There was only one patient with reflux esophagitis. It occurred after myotomy and Belsey fundoplication for a hypertensive lower esophageal sphincter and hiatus hernia. Four patients were managed secondarily for complicated recurrent problems, one with a Belsey fundoplication and three with a jejunal interposition graft. We recommend myotomy, with or without a Belsey fundoplication, for management of primary motor disorders and avoidance of total Nissen fundoplication and a lengthening Collis gastroplasty.  相似文献   
54.
55.
Depression is viewed largely as a disorder in which attempts to control one's interpersonal environment have failed. Twenty depressed outpatients were randomly assigned to one of two treatment groups. Treatment for the experimental group consisted of: (1) training in social learning principles; (2) immediate feedback as to the perception of verbal interactions between patient and spouse; and (3) training in the construction and use of reciprocal behavioral contracts. Treatment for the comparison group varied as a function of the treatment agency (i.e. psychiatrist, general practitioner, social work agency etc.), but usually involved either medication, group therapy, individual psychotherapy, or some combination of these.

Results showed a significant change in problematic behaviors, in Depression Adjective Checklist scores and in the verbal communication style of the experimental group, but not in the comparison group.  相似文献   

56.
Nine patients with fresh burns were treated with povidone-iodine aerosol foam solution and matched with 9 patients with fresh burns of similar extent and distribution treated with silver sulphadiazine cream. Severe pain at the time of application of povidoneiodine was a constant complaint. The wounds of 7 patients treated with povidone-iodine had been colonized by bacteria by day 11 post burn, whereas the wounds of only 2 patients treated with silver sulpha-diazine had been colonized at the corresponding time. Gram-negative organisms appeared more frequently, earlier and in higher concentrations in the povidoneiodine treated patients (Pseudomonas aeruginosa, 4 patients), whereas Staphylococcus aureus was more frequent with silver sulphadiazine (4 patients). Five of the povidone-iodine treated patients had developed burn wound sepsis by day 11 post burn, whereas no silver sulphadiazine treated patient developed burn wound sepsis. For this reason, further evaluation of povidone-iodine foam as a prophylactic topical antibacterial for burns was abandoned.  相似文献   
57.
Mattress dust collected at monthly intervals for 2 1/2 yr was examined for mites. Both Dermatophagoides pteronyssinus and D. farinae were found. There was a significant association between the presence of live mites and the relative humidity (RH): Live mites were seen only when the RH had been greater than or equal to 50% for at least part of every day during the month of collection. There was a seasonal variation in that live mites were found only in the warmer months and not in the winter. However, the peak in the mite population was consistent neither for month nor for numbers: In 1977 a slight peak in mite numbers occurred in October, while in 1978 the peak was higher and occurred in July. Use of data from previously published studies to preduct mite levels may therefore be misleading.  相似文献   
58.
59.
We report the identification of delta 1-pyrroline 3-hydroxy 5-carboxylic acid (hydroxy PCA) in a previously reported patient with hyperprolinemia Type II. This compound had been called pseudo PCA in a previous report.  相似文献   
60.
A survey of 190 individuals from 31 Indian bands in British Columbia was conducted during the summer of 1976 using a specially designed questionnaire. Its aim was to obtain an “Indian view” of tuberculosis. There is a strikingly low level of knowledge regarding this disease among those under 30 years of age. There is also a widespread belief that tuberculosis is a disease of the past and presents no threat to the community health of native Indian people. Widespread resentment toward and mistrust of white health professionals was noted. The majority of people surveyed felt that increased Indian control of and participation in community health programs would be the best solution for the problems of tuberculosis control among the native Indian population of British Columbia.  相似文献   
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