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1.
Clinical aspects of pelvic inflammatory disease 总被引:2,自引:0,他引:2
Pelvic inflammatory disease (PID) is a common and poorly managed condition.
Untreated or inadequately treated, it leads to tubal infertility, ectopic
pregnancy and chronic pelvic pain. Diagnostic difficulties are compounded
by the wide variety of clinical presentations and the insensitivity and
poor specificity of laboratory tests. Better recognition of mild and
atypical disease needs a high index of suspicion whenever young, sexually
active women present with gynaecological symptoms. Laparoscopy supplemented
by microbiological tests and fimbrial minibiopsy should be regarded as the
diagnostic 'gold standard' for research studies; new studies are required
to identify techniques which might reduce under- and over-diagnosis. Early
treatment reduces the risk of an adverse effect on fertility. Any
therapeutic regimen selected should be effective against the common
aetiological agents Chlamydia trachomatis, Neisseria gonorrhoeae, genital
mycoplasmas and aerobic and anaerobic bacteria. Since at least 60% of cases
of PID can be attributed to infection with a sexually transmitted organism,
partner notification forms an essential part of management.
相似文献
2.
Screening for early ovarian cancer 总被引:5,自引:0,他引:5
3.
4.
J F Payen L Bourdon H Reutenauer B Melin J F Le Bas P Stieglitz M Cure 《Medicine and science in sports and exercise》1992,24(4):420-425
An impairment of muscle energy metabolism has been suggested as a predisposing factor for, as well as a consequence of exertional heatstroke (EHS). Thirteen young men were investigated 6 months after a well-documented EHS using 31Phosphorus Magnetic Resonance Spectroscopy (31P-MRS). The relative concentrations of ATP, phosphocreatine (PCr), inorganic phosphate (Pi), phosphomonoesters (PME), and the intracellular pH (pHi) were determined at rest, during a graded standardized exercise protocol (360 active plantar flexions) and during recovery. Also the leg tissue blood flow was determined by venous occlusion plethysmography during the MRS procedure. Sixteen age-matched healthy male volunteers served as control group. In resting muscle, there were no significant differences between the groups as regards pHi, Pi/PCr, and ATP/PCr+Pi+PME ratios. During steady state exercise conditions, effective power outputs were similar for both groups at each level of exercise: 20, 35, and 50% of maximal voluntary contraction (MVC) of the calf muscle. No significant differences were shown between the two groups in Pi/PCr, pHi, or changes of leg blood flow at each level of exercise. At 50% MVC, Pi/PCr was 0.48 +/- 0.08 vs 0.47 +/- 0.05 (P = 0.96), pHi was 6.94 +/- 0.03 vs 6.99 +/- 0.02, respectively (P = 0.13). Finally, the rate of PCr resynthesis during recovery was not significantly different between the two groups: t1/2 PCr = 0.58 +/- 0.07 vs 0.50 +/- 0.05 min, respectively (P = 0.35). Therefore, no evidence of an impairment of muscle energy metabolism was shown in the EHS group during a standardized submaximal exercise using 31P-MRS performed 6 months after an EHS. 相似文献
5.
Old age is not an illness. However the incidence of cancer increases with age. The care of elderly persons with cancer has its own “technical” specificities that will lead to decide whether to apply or not, to adjust or not, cancer treatments in the most individual way possible. This implies a global and pluri-disciplinary approach of the elderly cancer patient. Among the actors of care, psycho-oncologists will have to explore the vast and little-known world of the behaviour of elderly cancer patients, their repercussions on the illness and the results of the treatments on the quality of life of the patients. That is what the “onco-more or less psychologist” expects from the “psycho-more or less oncologist”… 相似文献
6.
Incidence and determinants of moderate COPD (GOLD II) in male smokers aged 40–65 years: 5-year follow up
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Roeland MM Geijer Alfred PE Sachs Theo JM Verheij Philippe L Salom Jan-Willem J Lammers Arno W Hoes 《The British journal of general practice》2006,56(530):656-661
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major health problem with an estimated prevalence of 10-15% among smokers. The incidence of moderate COPD, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), is largely unknown. AIM: To determine the cumulative incidence of moderate COPD (forced expiratory volume in 1 second/forced vital capacity ratio [FEV1/FVC] <0.7 and FEV1 <80% predicted) and its association with patient characteristics in a cohort of male smokers. DESIGN: Prospective cohort study. SETTING: The city of IJsselstein, a small town in the Netherlands. METHOD: Smokers aged 40-65 years who were registered with local GPs, participated in a study to identify undetected COPD. Baseline measurements were taken in 1998 of 399 smokers with normal spirometry (n = 292) or mild COPD (FEV1/FVC <0.7 and FEV1 >or=80% predicted, n = 107) and follow-up measurements were conducted in 2003. RESULTS: After a mean follow-up of 5.2 years, 33 participants developed moderate COPD (GOLD II). This showed an estimated cumulative incidence of 8.3% (95% CI = 5.8 to 11.4) and a mean annual incidence of 1.6%. No participant developed severe airflow obstruction. The risk of developing moderate COPD in smokers with baseline mild COPD (GOLD I) was five times higher than in those with baseline normal spirometry (one in five versus one in 25). CONCLUSIONS: In a cohort of middle-aged male smokers, the estimated cumulative incidence of moderate COPD (GOLD II) over 5 years was relatively high (8.3%). Age, childhood smoking, cough, and one or more GP contacts for lower respiratory tract problems were independently associated with incident moderate COPD. 相似文献
7.
Chest radiography in general practice: indications, diagnostic yield and consequences for patient management
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Anouk M Speets Yolanda van der Graaf Arno W Hoes Sandra Kalmijn Alfred PE Sachs Matthieu JCM Rutten Jan Willem C Gratama Alexander D Montauban van Swijndregt Willem PThM Mali 《The British journal of general practice》2006,56(529):574-578
BACKGROUND: Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care. AIM: To assess the influence of CXR on patient management in general practice. DESIGN OF STUDY: Prospective cohort study. SETTING: Seventy-eight GPs and three general hospitals in the Netherlands. METHOD: Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR. RESULTS: Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%). CONCLUSION: Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test. 相似文献
8.
9.
A study of 11 patients with "double pylorus" revealed that a second channel between the gastric antrum and the duodenal bulb is the result of ulcer penetration. The fistula can be a sign of spontaneous recovery from ulcerative disease; the fistula occurred in conjunction with clinical improvement in the majority of the patients. The advantages of radiological vs. endoscopic diagnostic procedures are discussed. 相似文献
10.
L Patel PE Clayton ME Jenney JE Ferguson TJ David 《Archives of disease in childhood》1997,76(6):505-508
Cross sectional studies have reported impaired growth in children with atopic dermatitis. If this growth impairment is irreversible, it would be expected to adversely influence final height attainment. The standing heights and other anthropometric parameters were assessed in 35 adults with onset of atopic dermatitis before 5 years of age and a control group of 35 adults with adult onset contact dermatitis or psoriasis. There was no significant difference in the standing height SD score, mid-parental height SD score, sitting height SD score, subischial leg length SD score, nor body mass index between the atopic dermatitis and control groups. The standing height SD score was not significantly different among: (a) patients with atopic dermatitis affecting less than 50% of their body surface area and those with greater than 50% affected; (b) patients using the four different potency topical corticosteroids; and (c) patients with atopic dermatitis without asthma and those with coexisting asthma. It is concluded that short stature is not a feature of our group of adult patients with onset of atopic dermatitis before 5 years of age, continuing into adulthood, and severe enough to require specialist care. This suggests that if growth impairment occurs in childhood, it is likely to be temporary and reversible. 相似文献