ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Substantial gains have been made in both patient and graft survival during 20 years of transplanting kidneys at the University of Florida. The number of transplant recipients yearly has increased from six in 1966 to more than 100 in 1986. The use of immunosuppression reflects our evolving understanding of transplant immunology, with current morbidity and mortality rates considerably improved over those of the early years. This paper summarizes our transplantation experience over the past two decades.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The topical anesthetic solution TAC (tetracaine, adrenaline, cocaine) has gained widespread acceptance as the preferred local anesthetic for repairing skin lacerations in children. Despite this popularity, there are no universally accepted guidelines for its application. We report the case of a 6-month-old infant who had respiratory distress and seizures after TAC administration. In addition, we surveyed emergency departments within the state of Virginia regarding their guidelines for TAC application in children. Of the 91 hospitals surveyed, 32 (35%) currently administer TAC, and 14 (44%) of these have no guidelines regarding its use. Among the 20 (63%) with restrictions, there is wide variability in the way it is prescribed. TAC solution is a highly potent anesthetic agent with significant toxicity potential. Research into appropriate dosages, absorption, and actions needs to be undertaken before its widespread acceptance as the drug of choice for providing local anesthesia in children.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

During a four-year period, we saw 23 cases of child abuse with central nervous system involvement. Of these, five died and four were left with a substantial neurologic deficit as a result of injury. Of the 18 survivors, eight (44%) were removed from their home along with their siblings, one was placed in a sheltered environment with its mother, and nine (50%) were kept under surveillance. Six of the 12 patients with CT evidence of intracranial damage had no or minimal evidence of external cranial trauma. Although shaking as the major etiologic factor in neurologic impairment from child abuse has recently been questioned, our results implicate it as a common mechanism of injury. Every patient had a parent or guardian whose account of the mechanism of injury either changed from moment to moment or was inconsistent with the child's injury. Nine patients (39%) were known to have been seen previously by other physicians because of similar problems or other injuries consistent with child abuse. Early recognition of child abuse is paramount to saving not only the life of the affected child, but possibly the lives of siblings. Neurosurgeons should maintain a high index of suspicion for the diagnosis of child abuse.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Patients with malignant gliomas are at increased risk for deep vein thrombophlebitis (DVT) and pulmonary embolism (PE). Difficult anticoagulation in cancer patients undergoing surgery, chemotherapy, or radiotherapy limit the choices of therapy for DVT. Interruption of the inferior vena cava with a Greenfield filter is a safe method of treating patients who have malignant gliomas and DVT with PE. We studied 23 patients treated for malignant gliomas; 16 were men and seven were women, with a mean age of 51 years (range, 26 to 78). Five patients had DVT shown by noninvasive blood flow studies, and four subsequently had PE, as demonstrated by ventilation perfusion lung scan; in one patient PE was diagnosed at autopsy. Of the 23 patients, four with postoperative craniotomy had DVT and all four had PE. Two of the five patients who received preoperative chemotherapy had DVT and three had PE. All patients with PE had a Greenfield filter placed in the inferior vena cava via the internal jugular vein without adverse sequelae.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

An outbreak of hepatitis A in a neonatal intensive care unit was apparently attributable to blood transfusion. Several infants received aliquots from a single unit of packed red blood cells donated by an individual who subsequently became ill with hepatitis A. Although none of the infants became symptomatic, there was serologic evidence of recent exposure in four. Several staff and family members exposed to these infants became symptomatic. An adult patient who received platelets from this same unit developed elevated liver enzymes and his wife also showed serologic evidence of hepatitis A. These are the first reported cases of hepatitis A associated with a blood transfusion since implementation of alanine aminotransferase testing.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We retrospectively reviewed several risk factors for median sternotomy dehiscence in our cardiac surgery patients for a recent 18-month period. We studied these factors by univariate and multivariate analysis with respect to sternal dehiscence. Univariate analysis showed several factors to be significant: female sex (P = .03), obesity (P = .002), diabetes (P = .01), and prolonged postoperative ventilation (P = .006). Mammary artery bypass versus saphenous vein bypass only approached significance (14% vs 3%, P = .11). Multivariate analysis showed obesity (P = .002), diabetes (P = .041), and prolonged postoperative ventilation (P = .005) to be important. We conclude that obese diabetic women are at extremely high risk for sternotomy dehiscence, and mammary artery bypass in this high-risk population may be a relative contraindication.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We reviewed the roentgenographic findings in 15 patients who had endoscopic placement of a new type of esophageal prosthesis for obstruction caused by a malignant neoplasm. Each patient was evaluated with an esophagogram. Chest roentgenography and computerized tomography were used to confirm abnormalities seen on esophagography. The complication rate was 74% (11 cases), and included five cases of migration or malposition, two cases of perforation, and one case of obstruction. The recognition of postprocedural complications is paramount to their successful management. The complications associated with this new esophageal prosthesis are no different from those reported with the Celestin tube, though the frequency may be higher.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Plasma cholesterol was measured in 10,672 participants of a cholesterol screening program in Atlanta, Georgia. The participants were typically health conscious, as evidenced by the low prevalence of current cigarette smoking (13%), but more than 21% of the men and 33% of the women over age 50 had cholesterol levels in excess of 240 mg/dl, placing them at moderate to high risk for coronary artery disease. Results revealed a pronounced dose response relationship between cigarette smoking and cholesterol in men of all age groups and in women of premenopausal age, whereas levels were similar in ex-smokers and those who had never smoked. Risk analysis revealed a strong positive association between cholesterol and the prevalence of nonfatal myocardial infarctions. Notably, patients with newly diagnosed hypercholesterolemia reduced their cholesterol an average of 36 mg/dl under care of physicians. These results indicate that cholesterol screening coupled with physician follow-up and treatment can have a substantial impact in lowering cholesterol and its attendant risk of cardiovascular disease.

ISSN:0038-4348    

出版商:OVID    

年代:1989

数据来源: OVID