Both systemic and local therapy, for conditions of the breast and unrelated to it, may produce manuno-graphic changes. Some of these are characteristic, such as the pattern of scarring seen in reduction mammo-plasty. In many other instances, however, the changes produced overlap features commonly seen in malignancy. A knowledge of the timing, natural history and spectrum of these changes will aid mammographic interpretation. 相似文献
The intubating conditions and neuromuscular blocking profile following 600 micrograms.kg-1 rocuronium (Org 9426) have been investigated in patients under various experimental conditions. They were compared with conditions following 1.5 mg.kg-1 suxamethonium, preceded by a precurarising dose (10 mg) of gallamine, and with those in a control group in the absence of a muscle relaxant. Rocuronium produced good to excellent intubating conditions at 60 as well as at 90 s after administration, even though there was only a partial blockade of the adductor pollicis muscle. Intubating conditions following suxamethonium were comparable with those after rocuronium. Half of the control patients could be intubated. The clinical duration and the recovery time of 600 micrograms.kg-1 of rocuronium were 24(4) and 9(3) min (mean(s.d.)), respectively. Rocuronium may have a major advantage over existing non-depolarising muscle relaxants due to the early presence of excellent intubating conditions. The results indicate that rocuronium may replace suxamethonium in procedures in which rapid sequence induction is required. 相似文献
The referral pattern of 140 Dutch patients with oral mucosal lesions, who had been referred to a Department of Oral & Maxillofacial Surgery and Oral Pathology, shows that patients with oral mucosal lesions consult the dentist as often as the family doctor as the first source of help or information. Furthermore, family doctors were much more used to refer patients with oral mucosal disease to medical specialists rather than to the dentist or the oral and maxillofacial surgeon. 相似文献
.We report five patients with Laurence-Moon-Bardet-Biedl syndrome (LMBBS) who had renal involvement. Intravenous pyelography
showed bilateral or unilateral calyceal clubbing and blunting in all patients. In addition, one patient had a parapelvic cyst
in the left kidney and another had bilateral lobulated renal outlines of the fetal type. One patient had a urinary concentrating
defect and two patients showed increased fractional sodium excretion. Estimated tubular phosphate reabsorption values were
in normal limits in all of five patients. No patient had a urine acidification defect, proteinuria, glycosuria, or hyperaminoaciduria.
One patient died from end-stage renal failure. The remaining four patients had normal serum creatinine values and estimated
creatinine clearances. 99mTechnetium-diethylenetriamine pentaacetate renal scanning showed prolonged and delayed concentration and delayed excretion
in three of the four patients who survived. A focal scar was determined on the left kidney of one of four patients by 99mtechnetium-dimercaptosuccinic acid renal scanning. All LMBBS cases with or without renal symptoms should be routinely evaluated
for renal abnormalities. Renal scanning is a valuable method, especially for determining the renal involvement in the early
stage of disease.
Received November 14, 1995; received in revised form and accepted May 23, 1996 相似文献
Background: Recent studies have documented the feasibility of ultrasonography (US) to diagnose acute colonic diverticulitis (ACD). This
prospective observational trial determined the sonomorphology of ACD and evaluated the diagnostic accuracy of routine US performed
on admission by surgeons in training.
Methods: Fifty-seven consecutive patients with a confirmed episode of ACD were entered into this study, and the sonomorphology of
the involved colon was assessed. US findings were compared to the results of the clinical evaluation and correlated to the
clinicopathological outcome.
Results: The sonomorphology of ACD was characterized by segmental inflammatory transformation of the colon averaging 9.9 ± 3.2 cm
(range, 6–20) in length and visualized as target phenomena of a mean 3.5 ± 0.8 cm (range, 2.4–4.8) width. Targets were caused
by hypoechogenic thickening of the colonic wall of an average 7.7 ± 2.6 mm (range, 4–18). In 40% of cases, a hyperechogenic
halo representing peridiverticulitis (average width, 2.3 ± 0.6; range, 1.2–3 cm) was noted. Diverticula were seen in almost
half of the cases. Of the 57 cases with confirmed ACD, the diagnosis was made by US in 48, for a global accuracy of 84.2%.
US was false negative in nine patients, suggesting perforated appendicitis in five cases and acute appendicitis in one (the
final diagnoses were perforated sigmoid diverticulitis in five cases and cecal diverticulitis in one case). In three patients,
US was nondiagnostic.
Conclusion: In the hands of sonographically trained surgeons, ultrasound is a useful modality to image acute colonic diverticulitis.
US reveals diagnostic sonomorphology in most cases of ACD and therefore facilitates early confirmation of the diagnosis and
assessment of severity.
Received: 3 October 1996/Accepted: 9 May 1997 相似文献
Study Objective: To test the hypothesis that slow administration of local anesthetic into the epidural space by gravity flow reduces the incidence of signs and symptoms of unintended injection.
Design: Prospective, randomized study.
Setting: Teaching hospital.
Patients: 600 ASA physical status I and II parturients scheduled for labor and delivery or elective cesarean section.
Interventions: After identification of the epidural space with pulsations of an air-fluid column, parturients for vaginal delivery (n = 380) were randomized to receive a test dose of 3 ml 3% 2-chloroprocaine with epinephrine 20 μg, two doses of 7 ml bupivacaine 0.03 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow (Group 1) given over 30 seconds or by bolus injection (Group 2) given over 5 seconds through the epidural needle; parturients for Cesarean delivery (n = 220) were randomized to receive a test dose and two doses of 6 ml lidocaine 2 % with sufentanil 1 μg/ml and epinephrine 2 μg/ml by either gravity flow or by bolus injection through the epidural needle. Changes in maternal heart rate (HR) and blood pressure, signs of intravascular injection, and adverse effects of epidural bupivacaine-sufentanil were recorded after each dose.
Measurements and Main Results: Gravity flow administration (Group 1) was associated with a smaller increase in mean maternal HR (p < 0.001), less hypotension (p < 0.01), sedation (p < 0.01), nausea (p = 0.01), and segmental spread (p < 0.0001) than were corresponding doses given by traditional bolus injection (Group 1) for vaginal or Cesarean deliveries. The incidence of systemic toxicity was zero of 300 (0%) with gravity flow and 4 of 300 (1.3%) by bolus injection, p = 0.12, Fisher's exact test. No patient in either group had an accidental intrathecal injection.
Conclusion: Gravity flow administration of local anesthetic-opioid solution during epidural block for obstetrics was associated with fewer signs of systemic drug absorption and cardiovascular perturbations than was the traditional bolus injection. This study supports the current opinion that slow administration of local anesthetic during epidural black contributes to fewer adverse events. 相似文献