ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

ABSTRACT:Emergency transport of pregnant women is increasing in frequency. The physiologic changes of pregnancy cause a gravid woman and her fetus to be particularly vulnerable during transport. As the uterus enlarges, it compresses the vena cava and the aorta of the mother when she is in the supine position. Aortocaval compression may lead to uteroplacental insufficiency, supine hypotension, and potentially cardiopulmonary arrest. In addition, aortocaval compression is associated with placental abruption. This report presents three cases that illustrate the tragic outcomes of transporting pregnant women in the supine position. Pregnant women should be transported in a position of lateral tilt.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A survey questionnaire was administered to employees of a public health agency regarding their involvement with smoking and other life-style behavior. Responses were analyzed and combined with sick leave data to determine the use of sick leave among employees who currently smoke, those who never smoked, and those who formerly smoked. Current smokers took significantly more sick leave than those who have never smoked (“nonsmokers”) or former smokers. Using an analysis of variance model, only smoking status, education level, and sex, among selected demographic variables, were significantly related to the amount of sick leave taken. Current smokers took excess sick leave (amounting to nearly $40,000) as compared with nonsmokers and ex-smokers combined over a 21-month period. This study also characterizes the relationship between smoking status and selected life-style behavior. Smokers were less active, less likely to use seat belts, less likely to believe that smoking is related to health, and more likely to be heavier and to eat a poor diet than their nonsmoking or former smoking counterparts. We make suggestions regarding the reduction of smoking and other deleterious behavior as a means of controlling costs and reducing employee morbidity.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In 1981, we reported a series of 75 major hepatic resections done over a ten-year period; 58 were for hepatic trauma, nine were for benign disease, and eight were for malignant disease. Since that report, the indications for major hepatic resection have changed, with a more conservative approach to hepatic trauma and a more aggressive approach toward hepatic tumors. In this update, we report 88 hepatic resections from Vanderbilt University Hospital and Metropolitan Nashville General Hospital; 32 were for trauma, 25 were for benign disorders, and 31 were for malignant disease. Since 1977, nine adults and four children have had hepatic resection for primary malignant tumors; there were six hepatocellular lesions, three hepatoblastomas, two malignant hemangioendotheliomas, one malignant hepatoma, and one intrahepatic cholangiocarcinoma. At the time of this writing, the four children have survived for 7.3, 6, 6, and 3.8 years (mean 5.7), and all are alive without evidence of recurrence. For the nine adults, survival has averaged 1.7 years, excluding one postoperative death. Three adult patients are alive at this writing, one of whom is a five-year survivor without evidence of disease. Seventeen adults and one child had hepatic resection for metastatic lesions. In the adults, the primary tumor was in the colon in 14 cases and in the small bowel, stomach, and an unknown site in one case each. The one child had a metastatic Wilms' tumor. Survival has averaged two years, with two long-term survivors (nine years). Six patients are alive at this time. Operative mortality for elective resection has decreased from 12% (2/17) in our earlier report to 3% (1/31) in this series, which has encouraged us to assume a more aggressive approach to the resection of malignant primary and metastatic liver tumors.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

ABSTRACT:We retrospectively reviewed the charts of 190 hospitalized patients who had human immunodeficiency virus (HIV) antibody testing at our medical center in 1986 and 1987. From 1986 to 1987, HIV antibody testing increased fourfold based on total hospital discharges. Nine patients (5%) tested positive by enzyme immunoassay and the Western blot method. No risk factor for HIV infection was identified in 30% of cases. Documentation of patients' consent for testing was found in 14% of cases. We conclude that HIV antibody testing of hospitalized patients has increased. However, the indication for testing is often not clear by chart review, and consent for testing is poorly documented in the absence of a formal hospital policy requiring consent before testing. Further physician education and establishment of hospital policies addressing these important aspects of HIV antibody testing are indicated.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To evaluate completeness of surgical excision, we studied the use of film screen mammography done immediately after excision of occult noncalcified breast lesions in 11 patients. The postoperative mammograms were well tolerated, and allowed high quality films to be obtained. Complete excision was documented in ten patients, and one patient had small artifacts that resolved on follow-up studies. Roentgenograms of the surgical specimen from ten patients showed a discrete lesion in only three. Histologic analysis revealed malignancy in two patients and benign changes in nine. These findings indicate that mammography done immediately after excision of occult noncalcified lesions is more reliable than roentgenograms of the specimen and may be a useful method for confirming extent of excision. This method may also eliminate the present delay of four to six weeks before adequate postoperative follow-up films can be obtained to evaluate excision.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID