ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

To increase public awareness of the complexity of the issues surrounding care for the terminally ill, a county medical society and a local hospital council co-sponsored a public forum in October 1985. Panel members discussed the case of a terminally ill cancer patient from the medical, psychologic, economic, legal, and family perspectives. Panel members stressed the importance of helping the dying person to choose the preferred treatment and to achieve an emotionally satisfying death. The audience responded by pointing out the barriers to achieving death with dignity, which include poverty, lack of social support, and difficulty in facing and talking about death. In an evaluation questionnaire, the audience indicated that the emotional aspects and the communication problems involved in care for the terminally ill caused them more concern than the legal and ethical issues.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Physicians fail to recognize the early signs and symptoms of alcoholism in their patients. This results in delays in the proper diagnosis and treatment for alcoholism, the underlying cause for many common complaints. Reasons for missing the diagnosis include inadequate education opportunities for physicians in the field of chemical dependency, the physician's attitude toward alcoholics, and the alcoholic's own denial of his addiction. There are steps that physicians can take to increase their ability to identify alcoholism as the underlying cause of the patient's complaint.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

From 1977 to 1984, 87 above- and below-knee amputations were done on77patients for ischemic ulcerations and gangrene of the lower extremities. The overall three-month mortality was 14% and was mainly related to generalized atherosclerosis. Patients having infections with gas formations were more likely to be diabetic (80% vs 15%,P<.01), have clinical sepsis and a higher preoperative WBC (19,000 vs 12,600/cu mm,P<.01), and have a higher mortality (40% vs 12%,P<.05) than those with infections due to non-gas-forming organisms. Mixed bacterial flora were cultured from most wounds. We conclude that (1) infections with gas formation may be due to either clostridial or nonclostridial organisms, (2)‘ mortality is higher if gas accumulates and if the patient is diabetic, (3) gas is more likely to accumulate in infected extremities of diabetic patients, and (4) the combination of gas formation and diabetes is highly lethal.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We prospectively evaluated the incidence of bacteremia during fiberoptic bronchoalveolar lavage (BAL) and its relationship to postlavage symptoms in 12 volunteers. Qualitative and quantitative blood cultures were obtained before and during BAL. Three persons had qualitative blood cultures positive for organisms typical of normal skin flora. Quantitative blood cultures done simultaneously were negative. Approximately 42% of our subjects had postlavage symptoms, but no correlation was found between bacteremia and the occurrence of postlavage symptoms. Our results confirm the relative safety of BAL and the low incidence of BAL-associated bacteremia.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

From 1976 through 1984, the period covered in this report, we reviewed our total experience with gram-negative meningitis in adult patients, looking especially at how treatment and mortality had changed. Thirty-nine adults had 45 episodes of gram-negative meningitis. Twenty-five patients had had a dura-arachnoid disruption, 12 a septic episode, and two a bacterial mastoiditis. The overall mortality was 35.9%. Thirteen patients were treated with a full course of intrathecal antibiotics (five or more days) and eight patients with an abbreviated course (one or two doses). The use of chloramphenicol was associated with poor patient outcome, a finding consistent with both experimental and clinical findings of others.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Splenorrhaphy has become increasingly used for management of the traumatized spleen. This approach has been advocated to obviate the potential for fulminant postsplenectomy sepsis. We reviewed the records of 42 patients with penetrating or blunt trauma treated by splenectomy or splenorrhaphy at Norfolk General Hospital between 1979 and 1983. Twenty-six had splenectomy and 16 had splenorrhaphy. We evaluated age, sex, mechanism of injury, associated injuries, operative technique of splenorrhaphy, perioperative fluid requirements, and intraoperative and postoperative complications. Patients who had splenectomy had more associated injuries and more intraoperative hypotension, required more fluid replacement, and had more postoperative complications. Patients who had splenectomy were in a more unstable condition than, those having splenorrhaphy; 22 of the 26 had an unsalvageable spleen. There were no complications related to splenorrhaphy. In stable patients with a potentially salvageable injured spleen, an attempt should be made to repair it before resorting to splenectomy. No added risk appears to accrue from this approach.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We review 89 patients more than 75 years old who had major operations for various gynecologic malignancies. The recent routine use of perioperative intensive care decreased hospital mortality from 8.9% to 3.2%, and helped in decreasing and anticipating intraoperative and postoperative cardiorespiratory complications. Availability of visiting nurses since 1980 decreased the mean hospital stay from 30.2 to 24.4 days in patients who had radical vulvectomy. There were no deaths among 11 patients who subsequently had surgical reexploration for recurrent or new disease. Fifty-two of the 89 patients survived more than three years with no limitations resulting from the operations. When indicated, major surgical procedures for gynecologic malignancy in elderly women can be done safely, especially when the patient is evaluated and managed in a well staffed surgical intensive care unit.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In two nonoverlapping cohorts of consecutive patients receiving gastric bypass for obesity, we interviewed 100 patients one year after operation and 60 patients at three years. Weight loss among patients in both cohorts averaged 45 kg; all had improved physical and emotional health, had stable marriages, and had made satisfactory eating adjustments. Factors contributing to successful outcome include the technical skill and experience of the surgical team, adequate preoperative patient preparation, extensive postoperative instruction, medical and dietary follow-up, and patient support groups. Gastric bypass was found to be a safe, effective procedure without the medical morbidity associated with jejunoileal bypass.

ISSN:0038-4348    

出版商:OVID    

年代:1986

数据来源: OVID