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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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The significance of epithelial differentiation in mixed mesodermal tumors of the uterus. A clinicopathologic and immunohistochemical study 总被引:6,自引:0,他引:6
Mixed mesodermal tumors and carcinosarcomas of the uterus are classified as sarcomas. However, in other sites, malignant biphasic tumors may be classified as carcinomas, mesotheliomas, or sarcomas. In order to clarify their behavior and patterns of differentiation, we performed a clinicopathologic and immunohistochemical study of 22 cases aimed at analyzing the pattern of spread and histologic appearance of the metastasis, as well as the distribution of intermediate filaments in the primary tumor and the metastasis. Four monoclonal antibodies (Mabs) were used to detect epithelial lineage, three that recognize keratin (AE1/AE3, CAM5.2, MAK6) and one that recognizes epithelial membrane antigen (EMA). A Mab against vimentin was also used. Metastases involved the omentum, pelvic peritoneum, ovaries, fallopian tubes, pelvic or para-aortic lymph nodes, liver parenchyma, and tonsil. These metastases were composed of carcinoma only. Lymphatic/vascular invasion was identified in 11 cases; it consisted exclusively of carcinoma. In all 12 cases evaluated immunohistochemically, keratin and EMA were identified in the majority of the cells in the epithelial component and in a more focal distribution in the spindle cell component in 11 (92%). Vimentin was detected in the majority of spindle cells in nine cases (75%) and in a more focal distribution in the epithelial component in six cases (50%). In the spindle cell component, keratin and EMA were present in widely scattered individual spindle-shaped and rounded cells, within solid clusters of rounded cells, and in nests of cells with small lumens. The distribution of keratin, EMA, and vimentin in the metastases (carcinoma in all instances) was similar to the epithelial component in the primary tumor. Our findings indicate that the epithelial component of these tumors invades lymphatic/vascular spaces and metastasizes, whereas the spindle cell component has limited metastatic potential, if any. Since the behavior of these neoplasms is dictated by the epithelial element, we believe that mixed mesodermal tumors of the uterus should be classified as carcinomas rather than sarcomas. 相似文献