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1.
Josh Greenstein Devjani Das Josie Acuna Monica Kapoor Cara Brown Abbas Husain Brendan Lally Barry Hahn 《The American journal of emergency medicine》2019,37(2):313-316
Background
In the emergency department, rib fractures are a common finding in patients who sustain chest trauma. Rib fractures may be a sign of significant, underlying pathology, especially in the elderly patients where rib fractures are associated with significant morbidity and mortality. To date, no studies have evaluated the ability of ultrasound to detect rib fractures using cadaver models and subsequently use this model as a teaching tool.Objectives
The purpose of this study was to determine if it is possible to generate rib fractures on cadaver models which could be accurately identified using ultrasound.Methods
This was a cross-sectional study performed during one session at a cadaver lab. A single hemithorax from four adult cadavers were used as models. Single rib fractures on each of rib five through eight were created. Four subjects, blinded to the normal versus fractured ribs, were asked to identify the presence of a fracture on each rib.Results
A total of 8 of 16 potential ribs had fractured induced by study staff. Mean accuracy was 55% for all subjects. The overall sensitivity and specificity for detecting rib fractures was 50% (CI: 31.89–68.11) and 59.38% (CI: 35.69–73.55) respectively. The overall PPV and NPV was 55.17% and 54.29% respectively.Conclusions
In this pilot study, subjects were not able to detect induced rib fractures using ultrasound on cadaver models. The use of this model as a teaching tool in the detection of rib fractures requires further investigation. 相似文献2.
3.
Neonatal pain management is a challenge for the clinician. Research is just beginning to uncover the neonates' capability of expression of pain, explore pharmacologic management strategies, and identify the spectrum of intrusions that may precipitate pain or distress in the critically ill neonate. This article reviews the neonatal biologic, behavioral, and physiologic responses to pain and describes recommendations for clinical management and decision-making. 相似文献
4.
Sequential contrast-enhanced MR imaging of the penis 总被引:1,自引:0,他引:1
5.
Chlamydial etiology of acute lower respiratory tract infections in children in the Sudan 总被引:2,自引:0,他引:2
B Herrmann MAM Salih BE Yousif O Abdelwahab P-A Mårdh 《Acta paediatrica (Oslo, Norway : 1992)》1994,83(2):169-172
The role of Chlamydia pneumoniae in 110 Sudanese children with signs of acute lower respiratory tract infections (ALRI) was investigated. Four (3.6%) had evidence of C. pneumoniae infection, of whom 3 were culture-positive, while 1 had an antibody response suggesting a recent infection. IgG antibodies at a titer of ≥1:32 to C. pneumoniae, Chlamydia psittaci and Chlamydia trachomatis were detected in 27 (24.5%), 27 (24.5%) and 7 (6.4%) of the 110 ALRI cases, respectively. C. pneumoniae, C. trachomatis or C. psittaci were not detected in nasopharyngeal secretions from any of 110 patients when fluorescence-labeled specific monoclonal antibodies were used. In a seroepidemiological survey, 318 healthy Sudanese persons aged between 1 month and 67 years were studied for C. pneumoniae antibodies. 相似文献
6.
M L Ritchey K P Lally G M Haase S J Shochat P P Kelalis 《Journal of pediatric surgery》1992,27(5):612-615
Iatrogenic injury to the aorta or its major branches during nephrectomy for Wilms' tumor in children is rarely reported but may be more common than is currently acknowledged. We identified four patients with ligation of the superior mesenteric artery (SMA) that occurred during nephrectomy for nephroblastoma and another child in whom SMA thrombosis developed postoperatively. All of the tumors were on the left side. Interruption of the SMA was recognized intraoperatively in all four children, and primary repair was done. In three patients, appearance of the bowel remained normal before repair of the injury. Three of the arteries were repaired by primary reanastomosis, and one was joined with an interpositioned hypogastric artery graft. None of these patients had gastrointestinal complications postoperatively. In the fifth patient, SMA thrombosis developed after repair of an aortic tear during nephrectomy. This patient required subsequent small bowel resection for bowel infarction and died in the perioperative period. Every surgeon treating children with Wilms' tumor should be aware of the possibly distorted vascular anatomy and take precautions to avoid such a significant injury. Attempts at early ligation of the vessels may not be justified until the renal vasculature is clearly identified. 相似文献
7.
P. VON DEN DRIESCH C. STEFFAN A. ZÖBE O.P. HORNSTEIN 《Clinical and experimental dermatology》1994,19(3):274-277
We report the case of a 39-year-old female patient suffering from Sweet's syndrome after an upper respiratory tract infection. Cyclosporin A at a dose of 10 mg/kg per day was given as initial treatment. Skin lesions and general malaise resolved within 9 days. The cyclosporin dose was decreased within 21 days, without recurrence of the eruption. Cyclosporin is a potent inhibitor of T lymphocytes, but affects granulocyte and monocyte functions as well. Success of treatment in our case shows that cyclosporin represents an alternative to steroid treatment in patients with Sweet's syndrome. 相似文献
8.
Ultrastructure of sialadenoma papilliferum 总被引:1,自引:0,他引:1
Sialadenoma papilliferum is a rare tumor of salivary gland origin and has been reported in the parotid and minor salivary glands of the oral cavity. This tumor is morphologically similar to the papillary syringoadenoma of the sweat gland. We report the clinical and morphologic features of five cases and review the literature. Ultrastructural examination of case 1 revealed the predominant cell type to be an oncocytic cell. These cells contained numerous mitochondria, exhibited parallel filaments within the cell cytoplasm, and were attached by desmosomes. The neoplastic cells appear to exhibit characteristic features of various cell types of the salivary gland duct apparatus. 相似文献
9.
C F Brummitt K B Crossley M Falken D W Stickle R T Lally B F Woolfrey 《American journal of clinical pathology》1988,89(2):238-242
An elderly woman with Streptococcus pneumoniae meningitis relatively resistant (minimum inhibitory concentration, [MIC] = 0.12 micrograms/mL) to penicillin is reported. The occurrence of penicillin-resistant pneumococcal infections is reviewed and management discussed. Because of the importance of recognition of resistant pneumococci, a state-wide clinical laboratory survey was conducted to determine the accuracy of susceptibility testing for this isolate. Of 111 laboratories completing the survey, only 26 performed the 1-microgram oxacillin disk test as recommended by the National Committee for Laboratory Standards (NCCLS). When laboratories were analyzed according to hospital size, the proficiency in performing the proper susceptibility testing was 55% (6 of 11) for hospitals with more than 400 beds versus 3% (2 of 58) for hospitals with fewer than 100 beds (P less than 0.0001 by Fisher's exact test). This contrasts with reported surveys by the College of American Pathologists (CAP), and reasons for this are explored. Guidelines for laboratory testing of S. pneumoniae are reviewed, and additional study of clinical proficiency with attention to laboratory size is recommended. 相似文献
10.
Dynamic particle image velocimetry (PIV) was applied to the study of the flow field associated with prosthetic heart valves.
The results were compared with those of laser Doppler anemometry (LDA). Anatomically and antianatomically oriented Jyros (JR)
and St. Jude Medical (SJM) valves were compared in the mitral position to study the effects of valve design on the downstream
flow field. The experimental program used a dynamic PIV system utilizing high-speed, high-resolution video to map the true
time-resolved velocity field inside the simulated ventricle. This system was complemented by a study using the more traditional
LDA system for comparison. Based on the experimental data, the following general conclusions can be made. High-resolution
dynamic PIV can capture true chronological changes in the velocity and turbulence fields. It also produces very detailed velocity
and turbulence information comparable to the LDA results. In the vertical measuring plane that passes both the center of the
aortic and mitral valves (A-A section), the two valves (the SJM and the JR) show distinct circulatory flow patterns when the
valve is installed in the antianatomical orientation. Small differences in valve design can generate noticeable differences,
particularly during the accelerating flow phase. The SJM valve maintains a relatively high velocity through the central orifice;
the curved leaflets of the JR valve generate higher velocities with a divergent flow during the accelerating and peak flow
phases. In the velocity field directly below the mitral valve and normal to the previous measuring plane (B-B section), where
characteristic differences in valve design will be visible, symmetrical twin circulations were observed because of the divergent
nature of the flow generated by the two inclined half-disks installed in the antianatomical orientation. The SJM valve, with
a central downward flow near the valve, is contrasted with the JR valve, which has a peripheral downward circulation with
higher, turbulent stresses. 相似文献