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Osvaldo Chiara Stefania Cimbanassi Alessio Pitidis Sergio Vesconi 《World journal of emergency surgery : WJES》2006,1(1):12-7
Preventable trauma deaths are defined as deaths which could be avoided if optimal care has been delivered. Studies on preventable
trauma deaths have been accomplished initially with panel reviews of pre-hospital and hospital charts. However, several investigators
questioned the reliability and validity of this method because of low reproducibility of implicit judgments when they are
made by different experts. Nevertheless, number of studies were published all around the world and ultimately gained some
credibility, particularly in regions where comparisons were made before and after trauma system implementation with a resultant
fall in mortality. During the last decade of century the method of comparing observed survival with probability of survival
calculated from large trauma registries has obtained popularity. Preventable trauma deaths were identified as deaths occurred
notwithstanding a high calculated probability of survival. In recent years, preventable trauma deaths studies have been replaced
by population-based studies, which use databases representative of overall population, therefore with high epidemiologic value.
These databases contain readily available information which carry out the advantage of objectivity and large numbers. Nowadays,
population-based researches provide the strongest evidence regarding the effectiveness of trauma systems and trauma centers
on patient outcomes. 相似文献
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M. Naumann A. Albanese F. Heinen G. Molenaers M. Relja 《European journal of neurology》2006,13(S4):35-40
Botulinum toxin serotype A (BoNT-A) has long heritage of use leading to confidence in its safety and efficacy. The application of BoNT-A does not lead to persistent histological changes in the nerve terminal or the target muscle. Clinical trials defined the safety and tolerability profile of BoNT-A across common therapeutic indications and showed an incidence of adverse events of approximately 25% in the BoNT-A-treated group compared with 15% in the control group. Focal weakness was the only adverse event to occur more often following BoNT-A treatment. Long-term BoNT-A administration has been assessed in various treatment settings, with the level and duration of BoNT-A efficacy response being maintained over repeated rounds of injection with no major safety concerns. The treatment of children with cerebral palsy often require long-term, repeated, multimuscle BoNT-A injections that lead to the administration of comparably higher toxin doses. Despite the high total body doses used, their distribution over multiple muscles and injection sites means that systemic side effects are rare. Recent formulation changes have reduced the incidence of antibody development following treatment with BOTOX® . These findings show long-term BoNT-A treatment to be both safe and efficacious for a wide variety of indications. 相似文献
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Alessio Pigazzi Minia Hellan Douglas R. Ewing Benjamin I. Paz Garth H. Ballantyne 《Journal of gastrointestinal surgery》2007,11(6):778-782
Laparoscopic colectomy is a difficult procedure with a long learning curve. We describe in this study our technique for right-
and left-sided laparoscopic medial-to-lateral colectomy. The medial approach involves division of the vascular pedicle first,
followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line
of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders
the dissection fast and safe. Our series of 50 consecutive laparoscopic colectomies supports this concept. We believe that
surgeons familiar with this technique will have an important tool in their armamentarium to circumvent some of the challenges
of laparoscopic colectomy. 相似文献
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Luigi Paolo Badano Maria C Albanese Paola De Biaggio Patrizia Rozbowsky Daniela Miani Claudio Fresco Paolo M Fioretti 《Journal of the American Society of Echocardiography》2004,17(3):253-261
Prevalence of isolated left ventricular (LV) diastolic dysfunction has been reported to be as high as one-third of all heart failure (HF) cases, with an increasing prevalence in the elderly population. However, there is a paucity of prospective data about the prevalence and prognosis of isolated LV diastolic dysfunction in an unselected population of patients hospitalized with HF. Therefore, we prospectively evaluated 179 consecutive patients discharged from our hospital with HF to assess the prevalence of systolic versus diastolic LV dysfunction among patients hospitalized with HF and to compare their demographics, clinical features, self-perceived quality of life (QOL), and 6-month readmission rate and mortality. Among them, 133 (59% men, median age 74 years) showed in sinus rhythm and had no significant primary valvular disease. LV diastolic dysfunction was diagnosed on the basis of the European Study Group on Diastolic HF echocardiographic criteria. QOL was assessed at hospital discharge and 6-month follow-up visit using the Minnesota Living with HF questionnaire. Survival of patients with HF was compared with that of age- and sex-matched general population. In all, 29 patients (22%) had isolated LV diastolic dysfunction and 102 (78%) had prevalent LV systolic dysfunction (ie, LV ejection fraction = 45%). There was no difference in age, sex, or New York Heart Association functional class between patients with LV diastolic or systolic dysfunction. QOL scores were similar between the 2 patient groups with HF both at discharge (39.4 and 34) and at 6-month visit (10.4 and 10.4). Both 6-month readmission rate (48% and 48%) and median inhospital length-of-stay during readmissions (10 days and 10 days) were similar between the 2 patient groups with HF. Finally, 6-month survival, adjusted for age and sex, was similar between patients with LV diastolic or systolic dysfunction (hazard ratio 0.68; 95% confidence interval 0.20-2.35). Using standardized echocardiographic criteria, isolated LV diastolic dysfunction among unselected patients hospitalized with HF was less than previously reported. Patients with HF and isolated diastolic dysfunction showed similar clinical symptoms, self-perceived QOL, readmission rate, and 6-month mortality to patients with prevalent LV systolic dysfunction. 相似文献
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Livio Presutti Matteo Alicandri Ciufelli Daniele Marchioni Domenico Villari Alessio Marchetti Francesco Mattioli 《Otolaryngology--head and neck surgery》2007,136(3):369-372
OBJECTIVE: The aim of this paper was to describe our surgical technique for the treatment of nasal septal perforations. STUDY AND DESIGN: We studied 31 patients with nasal septal perforation treated with an endoscope-assisted technique, based on a bilateral dissection of monopedicled mucosal flaps from the nasal fossa floor, sutured at the edge of the perforation previously unstuck, without any graft interposed between the two mucosal layers. RESULTS: In our experience with 31 patients, the use of this technique led to the persistent closing (with follow-up for at least one year) of 96.3% of the perforations smaller than 3 cm. CONCLUSIONS: Our technique has the advantage of an endonasal approach, without any external incision, and the use of monopedicled flaps from the nasal fossa floor without any graft interposition, avoiding any other surgical procedure and morbidity in the donor site of the graft. The use of nasal endoscopy permits superior precision in all surgical steps. SIGNIFICANCE: The high success rate in perforations smaller than 3 cm seems to confirm the effectiveness of this technique. 相似文献
10.
Adam M Alessio Steve Kohlmyer Kelley Branch Grace Chen James Caldwell Paul Kinahan 《Journal of nuclear medicine》2007,48(5):794-801
In dual-modality PET/CT systems, the CT scan provides the attenuation map for PET attenuation correction. The current clinical practice of obtaining a single helical CT scan provides only a snapshot of the respiratory cycle, whereas PET occurs over multiple respiratory cycles. Misalignment of the attenuation map and emission image because of respiratory motion causes errors in the attenuation correction factors and artifacts in the attenuation-corrected PET image. To rectify this problem, we evaluated the use of cine CT, which acquires multiple low-dose CT images during a respiratory cycle. We evaluated the average and the intensity-maximum image of cine CT for cardiac PET attenuation correction. METHODS: Cine CT data and cardiac PET data were acquired from a cardiac phantom and from multiple patient studies. The conventional helical CT, cine CT, and PET data of an axially translating phantom were evaluated with and without respiratory motion. For the patient studies, we acquired 2 cine CT studies for each PET acquisition in a rest-stress (13)N-ammonia protocol. Three readers visually evaluated the alignment of 74 attenuation image sets versus the corresponding emission image and determined whether the alignment provided acceptable or unacceptable attenuation-corrected PET images. RESULTS: In the phantom study, the attenuation correction from helical CT caused a major artifactual defect in the lateral wall on the PET image. The attenuation correction from the average and from the intensity-maximum cine CT images reduced the defect by 20% and 60%, respectively. In the patient studies, 77% of the cases using the average of the cine CT images had acceptable alignment and 88% of the cases using the intensity maximum of the cine CT images had acceptable alignment. CONCLUSION: Cine CT offers an alternative to helical CT for compensating for respiratory motion in the attenuation correction of cardiac PET studies. Phantom studies suggest that the average and the intensity maximum of the cine CT images can reduce potential respiration-induced misalignment errors in attenuation correction. Patient studies reveal that cine CT provides acceptable alignment in most cases and suggest that the intensity-maximum cine image offers a more robust alternative to the average cine image. 相似文献