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Abstract Pericardial tamponade remains a diagnostic challenge
to the clinician especially when the patient is well compensated
hemodynamically. We report an unusual case
who sought medical help 1 month after having been
stabbed in his chest. An investigation revealed a perforation
of the myocardium and a pericardial tamponade.
The patient survived thanks to a large organized clot
that plugged the perforation. The patient was exposed
to increased risk due to delayed onset, recognition, and
therapy of the tamponade. Most reports on this subject
deal with acute pericardial tamponade. Only few cases
of delayed pericardial tamponade have been reported.
A review of the relevant literature and the therapeutic
approaches are discussed. 相似文献
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Sander P. G. Frankema Michael J. R. Edwards Ewout W. Steyerberg Arie B. van Vugt 《European Journal of Trauma》2002,28(6):355-364
Background: Evaluating the performance of a trauma system may be attempted by comparing outcome in different trauma populations. Controlling
for injury severity is a necessity for such evaluations. We compare two current models for doing so: the “Trauma and Injury
Severity Score” (TRISS) and “A Severity Characterization Of Trauma” (ASCOT).
Material and Methods: This study of high-energy trauma victims took place in Leiden, the Netherlands, between 1993 and 1998. Using the Hosmer-Lemeshow
(HL) test and receiver operator characteristic (ROC) analysis, the TRISS and ASCOT models were compared for calibration and
discrimination.
Results: 1,024 patients, with an average Injury Severity Score (ISS) of 13.5, were eligible for inclusion. Blunt trauma was the predominant
cause of injuries. Both models gave accurate, though pessimistic, results in predicting the actual number of fatalities (n
= 71). The HL test indicated a sufficient fit for the ASCOT model (p = 0.28) and an insufficient fit (p = 0.02) for TRISS.
The ROC curves were nearly identical (0.97). Including age as a linear variable, instead of using the current age groups,
resulted in an improved discriminative power of the models.
Conclusions: The ASCOT model proved superior over TRISS in its accuracy to estimate of survival chances. This difference was most evident
for victims with an estimated survival chance of 60–90%. Future national trauma researchers should therefore collect ASCOT
data. Improved ASCOT models could be developed, with age as a linear variable.
Received: April 25, 2002; revision accepted: September 17, 2002
Correspondence Address Prof. Arie B. van Vugt, MD, PhD, Department of General Surgery and Traumatology, Erasmus MC Rotterdam, Dr. Molewaterplein
40, Postbus 2040, 3000 CA Rotterdam, The Netherlands, Phone (+31/10) 463-5735, Fax -4757, e-mail: vanvugt@hlkd.azr.nl 相似文献
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Veena Rajaram Eric C Leuthardt Pratima K Singh Jeffrey G Ojemann Daniel J Brat Richard A Prayson Arie Perry 《Modern pathology》2004,17(1):9-14
Ependymomas are glial neoplasms whose clinical behavior is difficult to predict based on histology alone. Recently, a comparative genomic hybridization study identified frequent chromosome 9p and 13q losses in anaplastic ependymomas, suggesting that p16 and RB alterations may be involved in tumor progression. In order to test this hypothesis further, 101 myxopapillary, conventional, and anaplastic ependymomas (51 spinal and 50 intracranial tumors) were tested for RB and p16 deletions using fluorescence in situ hybridization. Clinical follow-up, ranging from 2 to 198 months (median 46 months), was obtained in 90 cases (91%). RB and p16 deletions were seen in 22 of 92 (24%) and 22 of 89 (25%) informative cases, respectively. Polysomies were more frequent in the grade I and II spinal tumors, consistent with prior reports of increased aneuploidy in such cases. No significant genetic associations were seen with tumor grade, recurrence, or death, suggesting that 9p and 13q deletions do not play a prominent role in the malignant progression of ependymomas, as has been implicated in other glioma subtypes. 相似文献
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