Risk of insomnia and hypnotics use among emergency physicians

This study investigated the risk of insomnia and hypnotics use among emergency physicians. This cross-sectional study recruited physicians working in Taiwanese hospitals in 2015 and the general population as the participants. Data from 1,097 emergency physicians obtained from the National Health Insurance Research Database were grouped into the case group, whereas 14,112 nonemergency physicians and 4,388 people from the general population were categorized into the control groups. This study used logistic regression and conditional logistic regression to compare the risks of insomnia between emergency and nonemergency physicians and between emergency physicians and the general population, respectively. The prevalence of insomnia among emergency physicians, nonemergency physicians and general population was 5.56%, 4.08%, and 1.73%, respectively. Compared with nonemergency physicians and the general population, emergency physicians had a significantly higher risk of insomnia. The proportions of emergency physicians, nonemergency physicians, and general population using hypnotics were 19.96%, 18.24%, and 13.26%, respectively. Among emergency physicians who used hypnotics, 49.77%, 25.57%, and 24.66% used only benzodiazepines, only nonbenzodiazepines, and both benzodiazepines and nonbenzodiazepines, respectively. Nonpharmacological interventions to improve insomnia and reminder of safe use of hypnotics to emergency physicians can serve as references for hospitals in developing health-promoting activities.     

骨折与无骨折史患者的定量超声检查比较

目的：用定量超声方法对有骨折史的骨质疏松症患者进行骨量检查,方法用CUBA Clinical型定量骨密度超声仪对393例被疑为骨质疏松的患者进行检测,并根据病史按有无骨折中进行分组。分析二组患者宽频超声衰减（BUA）、超声速率（VOS）、强度指数（SI）与骨折次数的关系。结果：伴有骨折史的骨质疏松症虱的BUA、VOS、SI值都要比无骨折史的患者明显降低（P＝0．000）。结论定量超声值与骨折的发生次数呈负相关,其测定值越低,骨折的发生次数越多;骨的质量下降是造成骨质疏松骨折的主要原因。     

肝硬化患者肾脏血液动力学的研究

目的 研究肝硬化患者肾脏血液动力学的改变。方法 应用多普勒超声测定４２例肝硬化患者肾脏血液动力学指标。并分析这些指标与肝功能及平均动脉压之间的关系。结果 不同阶段的肝硬化患者肾内血管收缩程度有明显的差异。结论 肝硬化早期即有肾血管的收缩,肝功越差肾血管收缩越明显。肾血管的收缩是全身血液动力学改变的一部分。     

Effect of ultrasound exposure on sonicated microbubbles stability

The study of intlavenous myocedal coneest echocedo~ (IVMCE) is a hot topic in the Pursuit ofcoronap healt disease, and much achievement has beenmade in ash ultheound etwpment development and cont. .[if ~t agent improvement. Most colltrsst opllts such asMiunex, Ophson etc. are pIDduced by sonication, andcan be used as echogenic bacers of blood flow in WMCE.SOme studies have suggested, however, that the ndcrobubbles exposed to ultrasound are Open to mpture[']. Ihan effort to detendne the o…     

Der Wert der Duplexsonographie nach der orthotopen Lebertransplantation Erfahrungen an 44 Patienten

Zusammenfassung In einer prospektiven Untersuchung wurde an 44 Patienten (33 Männer, 11 Frauen) riach einer elektiven orthotopen Lebertransplantation die Duplexsonographie 196ma1 angewendet. Ziel der Untersuchung war es festzustellen, inwieweit and in welchem zeitlichen Zusammenhang sich die Parameter pulsatiler FluBindex (PFI) und Dämpfungsindex (DI) bei Komplikationen wie Abstoung und Cholangitis verändern. Der Duplex-Doppler-Ultraschall wurde im Mittel 5mal pro Patient durchgeführt. Die letzte Sonographie erfolgte am Entlassungstag. Bei den Messungen fiber der Leberarterie, der Pfortader und den Lebervenen wurden jeweils der PFI und der DI bestimmt. Die Ergebnisse der Indexuntersuchungen wurden mit dem klinischen Verlauf (Abstoung, Cholangitis) sowie mit den Resultaten von 88 Biopsiepräparaten der Lebertransplantate in Beziehung gesetzt. Bezüglich einer histologisch gesicherten AbstoBung ergab der PFI (über der Leberarterie gemessen) eine Sensitivität von 69,4 % and eine Spezifitdt von 72,2 %, der DI (über den Lebervenen gemessen) eine Sensitivität von 89,4% und eine Spezifitdt von 89,1 %. Wenn auch die einfach und beliebig oft anwendbare Untersuchungstechnik die bioptische Sicherung einer Rejektion nicht ersetzen kann, so ist sie in hohem Mae in der Lage, Indikationen zur Biopsie frühzeitig stellen zu lassen und ein Ansprechen auf eine Therapie kurzfristig und mit holier Genauigkeit anzuzeigen.

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Duplex sonography after orthotopic liver transplantation: findings in 44 patients

In a prospective study, 44 patients (11 women, 33 men) who had received orthotopic liver transplants underwent a total of 196 consecutive duplex Doppler ultrasound examinations. The aim of the study was to evaluate the correlation between the pulsatile flow index (PFI) and the damping index (DI) as far as complications as rejection or cholangitis were concerned. The patients were examined five times each on average. The PFI and DI were measured in the hepatic artery, the portal vein and the hepatic veins. The findings were compared with the clinical course (cholangitis, rejection) and the histomorphological diagnosis as determined in biopsy specimens. In biopsy-proven rejection episodes, the sensitivity of the PFI in the hepatic artery was 69.4%, the specificity 72.2%. The sensitivity of the DI in the hepatic vein was 89.4%, the specificity 89.1 %. Combining the two, specificity was more than 90%. PFI and DI in the portal vein bore no apparent relation to clinical course or histomorphological diagnosis. We found duplex Doppler ultrasound extremely beneficial in determining the timing and indication for liver biopsy. In addition, this simple examination, which can be performed as often as desired, accurately shows the transplanted liver's response to measures taken to counter rejection.

     

The symptom of headache in Emergency Departments. The experience of a neurology emergency department

Although the symptom of headache is a frequent cause of Emergency Department examinations, it is often considered to be of little clinical relevance in comparison with other emergencies and is usually treated only symptomatically. But how frequently does a simple headache mask a severe cerebral pathology? To answer this question, we studied a consecutive series of patients examined at the Neurology Emergency Department of Turin's Ospedale Molinette over a period of three months; the patients were then followed-up for more than two years in order to confirm the diagnoses.Of 215 cases of acute headache, 121 (56%) were essential and 94 (44%) symptomatic; of the latter, 18 (8.3%) were the only clinical manifestation of a severe cerebral pathology (10 hemorrhages, 2 ischemias, 6 tumours). In diagnosing these 18 cases, 72 EEG, 57 CT and 4 rachicentesis examinations were carried out and their diagnostic efficacy is here analysed. Our data show the importance of a careful evaluation of the symptom of headache in Emergency Departments and the need to send any doubtful cases to a facility specialised in coping with such emergencies.

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Sommario Il sintomo cefalea costituisce un frequente motivo di visita in Pronto Soccorso, spesso considerato di scarsa rilevanza clinica rispetto ad altre urgenze e per lo più trattato solo dal punto di vista sintomatico. Ma in quanti di questi casi una semplice cefalea nasconde una grave patologia cerebrale? A questo proposito abbiamo effettuato uno studio presso il Dipartimento di Emergenza di Neurologia dell'Ospedale Molinette di Torino su una serie consecutiva di pazienti che sono stati visitati per cefalea nell'arco di tre mesi, seguendoli quindi nel tempo con un follow-up di oltre due anni per la verifica diagnostica.Su 215 cefalee acute, le cefalee essenziali sono risultate 121 (56%), e quelle sintomatiche 94 (44%). Tra queste ultime, 18 (8,3%) erano l'unica manifestazione clinica di una grave patologia cerebrale (10 emorragie, 2 ischemie, 6 tumori). Per diagnosticare questi 18 casi sono stati eseguiti 72 EEG, 57 T.C e 4 rachicentesi; di questi esami viene quindi analizzata l'efficacia ai fini diagnostici. Da questi dati emerge quindi l'importanza di un'attenta valutazione del sintomo cefalea in Pronto Soccorso e la necessità di inviare, nei casi dubbi, il paziente in una struttura specializzata per queste emergenze.

     

The role of ultrasound in the assessment of the trauma patient

Ultrasound assessment of the patient with blunt abdominal trauma will enhance diagnostic accuracy and facilitate decision making about the need for urgent surgery. Numerous studies have reported the role of ultrasound in the assessment of the trauma patient. Focused ultrasound has been shown to compare in sensitivity to diagnostic peritoneal lavage and is helpful in assessing the need for a laparotomy. Ultrasound is safe, cheap and portable. The investigation is non-invasive and painless. The trauma ultrasound scan can be completed in under 3 minutes and should be performed during the initial trauma assessment. The technique is not difficult to learn. Advances in technology are likely to make portable ultrasound increasingly appropriate to rural clinical practice. Detection of haemoperitoneum will be more accurate when ultrasound is available in the early care of trauma on a 24 hour basis and, to achieve this, clinicians managing trauma will need to become competent in the application of the focused ultrasound exam.     

英脱利匹特增强超声多普勒血流信号作用的实验研究

目的：研究英脱利匹特增强超声多普勒血流信号的作用。方法：在１０ 只兔中应用经颅超声多普勒检测静脉推注４ 种不同剂量（０ ．２、０．５、１．０、２．０ｍｌ／ｋｇ）２０ ％ 英脱利匹特前后的动脉血流信号,并以等量的生理盐水作对照。结果：各种剂量２０ ％ 的英脱利匹特注射后多普勒血流信号强度明显增强, 平均比生理盐水及注射前血流信号强度高２６．８±９．７ｄＢ。注射生理盐水后多普勒血流信号强度未见明显改变。结论：静脉注射２０ ％ 英脱利匹特能够增强血流信号,提高多普勒检测的敏感性。     

超声照射对声振微泡稳定性的影响

目的与方法造影剂微泡浓度、大小是影响心肌声学显影最重要因素。本研究采用２×２×４析因分析法分析不同超声照射条件对造影剂微泡浓度及直径的影响,即声波频率、能量以及照射时间对微泡浓度、大小的单独及交互作用。为临床行静脉心肌声学造影检查时选择适宜的超声照射条件提供参考。结果能量越大、照射时间越长,微泡破坏越多,平均直径越小：照射频率对微泡浓度影响不大,但影响微泡大小,频率越高,微泡越小。结论为减少超声照射对微泡的破坏,提高心肌声学造影效果,应尽可能选用低能量、低频率超声波,并减少不必要的照射时间。     

Colour Doppler ultrasound assessment of the inferior vena cava in patients with Wilms' tumour

OBJECTIVE: To assess the diagnostic accuracy of colour flow Doppler ultrasound in diagnosing inferior vena caval (IVC) extension of tumour thrombus in patients with Wilms' tumour. MATERIALS AND METHODS: Over a 3-year period from June 1994 to June 1997, 74 patients with Wilms' tumour were referred to our institution. In this retrospective study we reviewed the preoperative colour flow Doppler ultrasound reports of 64 of these patients and compared the reports with the intra-operative findings in 51 patients who underwent surgery. RESULTS: Vena caval extension of tumour thrombus was present in 12 patients (18.7%) and in six of these patients (9.4%) there was also atrial extension of the tumour. Colour flow Doppler ultrasound correctly diagnosed IVC extension of tumour thrombus in nine patients and correctly predicted the cranial extent of the tumour thrombus in eight patients. CONCLUSION: Colour flow Doppler ultrasound has an overall positive predictive value of 73.4% in assessing IVC patency and correctly diagnosing IVC extension of tumour thrombus, in patients with Wilms' tumour. However, non-diagnostic ultrasound examinations can occur in over 20% of patients.