Summary The venous architecture in donor flaps was observed in 17 fresh cadavers by injection of latex or ink into the vessels or by making corrosion-cast specimens. The pattern of the veins resembles that of the arteries, with the difference that there is another set of venous trunks which do not accompany the arteries. Because these trunks are of larger caliber, they are the main drainage route for flaps. There are three types of drainage based on the anatomical architecture: 1) the superficial trunk is the main drainage path; 2) the deep trunk is the main path; 3) both superficial and deep veins are involved. These morphological considerations are the basis for selection of veins for anastomosis in microsurgery. The axial veins in temporal, frontal and facial flaps on the dorsum of the hand and the foot usually loosely accompany the axial arteries. The characteristics of these vascular pedicules should be studied in transplant operation.
Bases anatomiques du drainage veineux des lambeaux cutanés libres
Résumé Le drainage veineux des lambeaux cutanés libres a été étudié sur 17 cadavres frais par injection de latex ou d'encre dans les vaisseaux, ou en réalisant des moulages par injection-corrosion. La distribution des veines ressemble à celle des artères à la différence près qu'il existe des troncs veineux qui n'accompagnent pas les artères. Ces troncs ont un calibre plus important et représentent une voie de drainage principale pour les lambeaux. On peut individualiser trois types de drainages basés sur l'architecture veineuse : 1. Le tronc superficiel est la principale voie de drainage ; 2. le tronc profond est la principale voie; 3. les veines superficielles et profondes sont impliquées simultanément. Ces considérations morphologiques sont les bases de la sélection des axes veineux pour les anastomoses en micro-chirurgie. Les veines axiales au niveau temporal, frontal et facial et pour les lambeaux de la face dorsale de la main et du pied sont habituellement relativement éloignées du trajet artériel. Les caractéristiques de ces pédicules veineux doivent être précisées pour la réalisation des lambeaux.
Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams.
Objective
Identify characteristics associated with pain and pain improvement among inpatients referred to PC.
Methods
Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement.
Results
Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P = 0.003).
Conclusion
Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement. 相似文献
Solitary fibrous tumours are infrequent neoplasms based in the pleura that are predominantly benign with malignant pathology and behaviour described in 10–36% of cases. Extrathoracic solitary fibrous tumours (ESFTs) have been considered separately to their intrathoracic counterparts and comprise a third of all solitary fibrous tumours. The extrathoracic location was identified as an adverse prognostic factor for local recurrence but not for metastatic disease. So far, there have not been any reports of solitary fibrous tumours demonstrating caval infiltration. We present a case of a benign ESFT infiltrating into the perirenal inferior vena cava. Together with extrauterine leiomyomas, ESFTs should also be considered as a differential diagnosis for the rare benign lesions invading the inferior vena cava. 相似文献
ABSTRACT. Free carnitine was significantly (p<0.001) reduced both in the ketotic (29.7±3.4 nmol/ml) and in the ketoacidotic (24.6±1.4 nmol/ml) groups when compared to controls (50.0±2.4 nmol/ml). At the same time, acylcarnitine values in the ketotic (21.2±2.4 nmol/ml) and ketoacidotic (25.4±2.3 nmol/ml) groups were significantly above the control value (4.71±0.6 nmol/ml). There was no significant difference between the two ketotic groups in carnitine derivatives. The abnormal distribution of plasma free and acylcarnitines could be reversed by insulin treatment. There was an inverse correlation between ketone body levels and free carnitine in the ketotic (r =-0.71, p<0.02) and ketoacidotic group (r =-0.71, p<0.05). However, there was no correlation between ketone bodies and acylcarnitine and between free carnitine and acylcarnitines. We concluded that the increased acylation was only partly responsible for the reduction of free carnitine in diabetic ketosis. 相似文献
Primary osteogenic sarcoma of the skull is an exceedingly rare condition. An adult male patient is described, who had a painless swelling in the right forehead that had rapidly enlarged in the previous 6 months. Radiological investigations showed a large destructive mass lesion involving the right side of the frontal bone with extension into the frontal sinus, causing marked extradural compression of brain parenchyma. Histopathological examination confirmed the lesion to be primary osteogenic sarcoma. 相似文献
Heart failure accounts for more hospitalizations among Medicarebeneficiaries than any other condition. Its symptoms, includingshortness of breath, fatigue, and edema, can be frighteningand diminish quality of life. Although treatment advances haveallowed patients to live longer with a better quality of life,heart failure remains a leading cause of death in the UnitedStates. Half of heart failure patients die within 5 years ofdiagnosis, and for many patients, death is sudden. Given theavailability of effective treatments, the prevalence of distressingsymptoms, and a persistent high risk of death that may occursuddenly, physicians must simultaneously treat the underlyingcondition while helping patients plan for future needs and completeadvance directives. Using the case of Mr R, a 74-year-old manwith heart failure, we illustrate ways that physicians can addressthese issues to improve the care of patients with heart failure,including symptom management and discussing advance directives,prognosis, and hospice care. By combining optimal medical managementwith palliative care, physicians can best care for heart failurepatients and their families.
Hospitalist systems make it increasingly common for responsibility for a patient to be passed from one physician to another. During such transfers, patients' outcomes and satisfaction can benefit from better communication between hospitalists and the primary care physicians whose patients they care for. We propose 6 principles to guide such communication, to ensure that critical information about patients is not lost and to optimize the quality of care. We also discuss special considerations for patients discharged to a skilled nursing facility or to home with home care. 相似文献