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At least 541 records · Page 30Linked to original sources
PubMed1988

Future growth and development of hysteroscopy.

In less than two decades, hysteroscopy has evolved into a practical technique for the evaluation of the uterine cavity, with well-established indications such as evaluation of abnormal uterine bleeding and abnormal hysterograms as well as the treatment of intrauterine adhesions or the septate uterus, the removal of misplaced or embedded intrauterine devices, and the removal of submucous leiomyomas. As the use of hysteroscopy increases and more practitioners utilize it, new instrumentation and techniques are beginning to evolve, simplifying and facilitating not only a diagnostic examination, but also the more difficult and complex surgical interventions. Flexible endoscopes are being tested for possible use in the uterine cavity, and operative hysteroscopes with practical inflow and outflow accessory channels have been introduced. The accessory operative instrumentation has also been expanded and refined, and portable units for office examinations have been developed. The trend in the development of instrumentation is toward simplicity, effectiveness, and refinement in lenses with wider fields of view and accessory channels without compromising the total outer diameter of the endoscopes. As clinical applications expand as a result of increased use and proficiency in hysteroscopy, new applications undoubtedly will follow, such as closer study of the endometrium with and without additional magnification. This latter may permit a better understanding of the receptivity of the endometrium to the embryo, which may help in predicting successful nidations. Portable laser units with the capability to use the CO2 fiber undoubtedly will increase laser use through hysteroscopy, and in the near future, photodynamic therapy may become the best approach to the selective treatment of intrauterine lesions. The uterotubal junction will remain an attractive area for endoscopists to approach the fallopian tubes transcervically and eventually to accomplish tubal closure safely and effectively with the possibility of future reversibility. The hysteroscope will play an important role in new reproductive technologies, particularly those related to the gamete intrafallopian transfer via the uterine side and perhaps also for direct embryo transfers under visual control. The future of hysteroscopy thus is promising. The present diagnostic and therapeutic applications will not only become a standard of treatment but will expand as gynecologists will gain proficiency and confidence in this endoscopic method.

Endoscopes↗
PubMed1979

[Treatment of peritonitis in abdominal injuries].

According to the author's data, peritonitis occurred in 250 (20.8%) out of 1200 cases of abdominal injuries, 69 of these 250 patients died (27.6%). The main means combating this complication was an early surgical intervention. A complex of postoperative therapeutic procedures, aimed at the prophylaxis and treatment of peritonitis in these patients, is described.

Abdominal Injuries↗
PubMed1995

[Methods for preventing periodontal diseases and their validation].

The paper presents fundamentals of comprehensive prophylaxis of periodontal diseases, based on the author's own epidemiological, experimental, and clinical findings; confirms the principal of individual differentiated complex of interventions as the only effective method for prevention of chronic destructive diseases in the periodontium.

Adolescent↗
PubMedDate not supplied

[Congenital kyphosis with neurological disorders].

The paper outlines the results of examination and surgical treatment of a large group of patients with congenital sternolumbar kyphoses complicated by development of neurological symptoms. The results of radioopaque investigations showed there was a relationship of the magnitude of intracanal changes to the size of kyphotic deformity. The comparative study of the outcomes of surgical management of patients with congenital kyphoses demonstrated the high efficiency of interventions, whose complex included central spondylosis. This operation decreases spinal deformity, yields decompression of intracanal nervous structures and ensures further stability of the vertebral column.

Adolescent↗
PubMed1993

[Dermatoplasty in the treatment of necrotic mastitis and breast erysipelas].

The authors had 15 female patients aged from 20 to 35 years with various diseases of the breast which were marked by necrosis of the skin and subcutaneous fat with involvement of 18 to 100% of the breast surface. The necrosis was caused by phlegmonous and infiltrative abscess producing forms of mastitis in 18 and by erysipelas in 7 cases. Necrotic mastitis and erysipelas developed in the first 2 weeks after delivery, as a rule, in patients with marked concomitant diseases of the heart and vessels. The patients were hospitalized 7 to 29 days after the onset of the disease. The development of severe forms of breast diseases was promoted by intensive manual abstraction of milk from the breast and retromammary antibiotic-novocaine blockades. After an operative intervention a complex of therapeutic measures was applied including semisynthetic antibiotics, agents containing protein globulin fractions, and dry and native blood plasma, and artificial polyuria with preceding hemodilution was produced. All patients underwent dermatoplasty with the use of a free split perforated skin graft. Lactorrhea in the region of the granulations was not a contraindication for surgical closure of the wound. Perforation of the skin graft was regarded a forced measure because the secretion of milk led to inevitable rejection of the transplant. The applied treatment produced quite satisfactory cosmetic and functional results.

Abscess↗
PubMed1978

The effect of mercury derivatives of fluorescencein on allotransplant kidney in experiment.

Mercurascan (MSC), a mercury derivative of fluorescein, was studied as to its effect on the survival of allogeneic kidney grafts in dogs. A single perfusion of the donor's kidney with saline solution with MSC added in a ratio of 1 mg/100 ml was found to have significantly extended the graft survival time from 10.8 days (SE +/- 0.6) to 15.4 days (SE +/- 1.6). Graft survival time extension proved to be even more significant after a single dose of MSC given to the donor (0.5 mg/kg b.w.) and repeated administration of an equal MSC dose to the recipient twice weekly. Listed are detailed morphological changes in tissue specimens from the kidney, lymph nodes, spleen, and many other organs of a dog surviving for 42 days. A very moderate rejection lesion with merely tiny lymphocytic infiltrates was proved in the kidney. Lymph node structure was almost entirely obliterated with lymphoid tissue extinction. There was loss of white pulp in the spleen. The absence of morphological changes in the other organs suggested good tolerance of the preparation. More studies are called for to elucidate the complex MSC intervention in the process of rejection.

Animals↗
PubMed1994

Complement, neutrophils and free radicals: mediators of reperfusion injury.

Myocardial ischemia of sufficient duration produces irreversible myocardial injury and cell death. Associated with the direct ischemic insult, there is the indirect attack on the jeopardized tissue through activation of the complement system. The latter, occurring in response to ischemia, facilitates neutrophil-endothelial cell interactions, neutrophil migration into and across the vascular wall, along with the formation of cytotoxic oxygen metabolites and release of proteolytic enzymes. The neutrophil dependent actions participate in extending the tissue injury beyond that due to ischemia alone. The invading neutrophils injure the myocardial vasculature and sarcolemma through the generation of oxygen free radicals. Components of the complement system can damage tissue indirectly through formation of neutrophil chemoattractants as well as directly through assembly of the "membrane attack complex." Pharmacologic interventions that prevent complement activation, modulate neutrophil function or scavenge oxygen radicals, can reduce the extent of myocardial injury associated with ischemia reperfusion. The inflammatory reaction of cell injury mediated by neutrophil invasion of the affected tissue is an important site for pharmacologic intervention. Specific adhesive glycoprotein receptors are expressed on the neutrophil in conjunction with corresponding endothelial cell ligands. Recognition of these events has led to the development of specific antibodies having the potential to prevent cell-cell interactions essential for promoting and maintaining the inflammatory response. Therefore, neutrophil-independent extension of irreversible cell death that occurs upon reperfusion, is additive to the component of cell death attributed to the ischemic interval. As is the situation with any organ, function and cellular viability are dependent upon a blood supply, which if interrupted for a sufficiently long period, will lead to irreversible cellular changes and necrosis. Reperfusion is essential for arresting the otherwise progressive injury due to ischemia. The accelerated inflammatory response upon reperfusion contributes to an extension of the injury, a phenomenon known as "reperfusion" or "reoxygenation" injury.

Animals↗
PubMed1993

[Specialized medical care in diffuse peritonitis].

The authors present a report concerning the system of operational and medico-evacuation measures during the treatment of 168 patients with generalized peritonitis. During hospitalization the reactive phase was marked in 37 patients (22.1%), toxic and terminal--in 95 (56.5%) and 36 (21.4%) patients correspondingly. As a result of an adequate surgical and anesthetic intervention and complex therapy for generalized peritonitis the number of complications was diminished by 2.5 times (p 0.001), and lethal cases by 4.5 times (p 0.1). Realization of the principle of immediate specialized care is possible only in combination of adequate organizational and medical measures.

Adolescent↗
PubMed1995

[With problem of applying modern systems theories in clinical practice].

In this paper the tension between "practice" and "theory" is reflected concerning modern system theories and psychosocial practice. Focusing the limits of predictability and manageability these theories contrast with practitioners need for easy-to-use advices for acting. Reframing the well-known dilemma of the discrepancy between theory and practice the usefulness of the difference between theory and practice is accentuated. Others reflected these topic in more fundamental or philosophical way (cf. Krohn & Küppers 1990; Schiepek 1991; Schiepek, Fricke & Kaimer 1992; Willke 1989). In a more "pragmatic turn" attention is drawn to some methods of orientation and intervention in complex systems. System game and system competence are new ways in training and evaluating the management of complex systems.

Communication↗
PubMed1996

Identification and assessment of students with disabilities.

Students with disabilities or suspected disabilities are evaluated by schools to determine whether they are eligible for special education services and, if eligible, to determine what services will be provided. In many states, the results of this evaluation also affect how much funding assistance the school will receive to meet the students' special needs. Special education classification is not uniform across states or regions. Students with identical characteristics can be diagnosed as disabled in one state but not in another and may be reclassified when they move across state or school district lines. Most disabilities with a clear medical basis are recognized by the child's physician or parents soon after birth or during the preschool years. In contrast, the majority of students with disabilities are initially referred for evaluation by their classroom teacher (or parents) because of severe and chronic achievement or behavioral problems. There is evidence that the prevalence of some disabilities varies by age, the high-incidence disabilities such as learning disabilities and speech-language disabilities occur primarily at the mild level, the mild disabilities exist on broad continua in which there are no clear demarcations between those who have and those who do not have the disability, and even "mild" disabilities may constitute formidable barriers to academic progress and significantly limit career opportunities. Problems with the current classification system include stigma to the child, low reliability, poor correlation between categorization and treatment, obsolete assumptions still in use in treatment, and disproportionate representation of minority students. Both African-American and Hispanic students are disproportionately represented in special education but in opposite directions. The disproportionately high number of African Americans in special education reflects the fact that more African-American students than white students are diagnosed with mild mental retardation. Though poverty, cultural bias, and inherent differences have been suggested as reasons for this disproportionate representation, there are no compelling data that fully explain the phenomenon. In most states, classification of a student as disabled leads to increased funding from the state to the school district. This article suggests a revised funding system that weights four factors (number of deficits, degree of discrepancy, complexity of intervention, and intensity of intervention) in a regression equation that would yield a total amount of dollars available to support the special education of a particular student.

Adolescent↗
PubMed1997

Pathogenesis, clinical features and management of hidradenitis suppurativa.

Hidradenitis suppurativa is a chronic skin condition involving the apocrine glandular zones. Affected patients may present with acute abscesses, but the condition often progresses to a chronic state with persistent pain, sepsis, sinus tract and fistula formation, purulent discharge and dermal scarring. Treatment of patients with severe disease can be difficult and may require complex surgical intervention. This review encompasses the pathogenesis, clinical manifestations and management options for patients with hidradenitis suppurativa.

Axilla↗
PubMedDate not supplied

Using airway pressure.

This is the third part in the series Care is Critical which looks at the more complex technological interventions nurses may now have to deal with on general wards or in the community. This article looks at continuous positive airway pressure, an oxygen delivery system which can relieve significant respiratory distress in some cases. The first two were published on June 25.

Critical Care↗
PubMedDate not supplied

Cardiovascular assessment.

This is the fourth part in the series Care is Critical, which looks at the theory and practice of the more complex technological interventions nurses may now have to manage on general wards or in the community. This article is the first of two looking at cardiovascular assessment. The next part of this series will appear on September 24.

Aged↗
PubMed1998

Care of the critically ill client at home.

The high-tech homecare nurse is operationalizing the trend to bring critical care nursing and medical services directly to the homecare environment. With the continuing advancement in technologic capability, the role of this newly emerging critical care nurse clinician will grow in scope of practice. As the health care industry strives to create more cost-effective solutions to the nation's burden of health care delivery, the relocation of complex medical interventions to the homecare setting is one method of effecting a seamless health care delivery system, where quality of care is maintained while costs are controlled.

Clinical Competence↗
PubMedDate not supplied

Fluoroscopically guided suprapubic cystostomy in complex urologic cases.

PURPOSE: To evaluate the efficacy of percutaneous suprapubic cystostomies performed by the interventional radiologist for complex urologic cases. MATERIALS AND METHODS: A retrospective analysis was done of the 25 cases referred to the radiology department for suprapubic cystostomies. The patients were referred because of unsuccessful placement or malposition of a suprapubic cystostomy tube. The procedure was performed with the Seldinger technique by using a 21-gauge needle for initial antegrade puncture and subsequent tract dilation and placement of 10-24-F catheters. RESULTS: In 24 of 25 cases (96%) the suprapubic cystostomy was successfully performed. After suprapubic cystostomy, eight patients (32%) underwent additional ancillary procedures by urologists through the suprapubic tract. The only major complication was perivesical fluid collection in one patient (4%), which was subsequently drained. Seventeen patients (68%) had transient hematuria. CONCLUSION: Percutaneous suprapubic cystostomy performed under fluoroscopic control is an effective and safe procedure ideally suited for the interventional radiologist, especially in complex urologic cases.

Adolescent↗
PubMed1999

The Chiari/hydrosyringomyelia complex presenting in adults with myelomeningocoele: an indication for early intervention.

OBJECTIVE: To determine how adults with myelomeningocoele who develop the Chiari/hydrosyringomyelia complex present, and to determine if surgical intervention influences outcome in these patients. METHODS: A chart review of the 220 patients who attend a clinic for adults with spina bifida and hydrocephalus (CASBAH), and follow-up of the five cases with myelomeningocoele who had surgical intervention for associated symptomatic Chiari/hydrosyringomyelia complex. RESULTS: Bilateral upper limb weakness and wasting were the commonest presenting symptoms (four patients). Sensory disturbance (three patients) was also common, dysphagia (one) and ataxia (one) occurring less often. The median time to surgical intervention was 36 months. Two patients had a shunting procedure performed in isolation, two foramen magnum decompression in addition to a shunting procedure and one a foramen magnum decompression. Surgical intervention did not completely reverse problems attributed to the Chiari/hydrosyringomyelia complex in any of the cases. One patient died post-operatively. Of the four who survived one had some improvement in function post-operatively, two remained static and one had further mild deterioration. CONCLUSION: All adults with myelomeningocoele should be questioned about changes in upper limb function for early detection of Chiari/hydrosyringomyelia complex. Our results suggest that early intervention is needed if further deterioration is to be avoided, and to improve the chances of neurological and functional recovery.

Adult↗
PubMed2000

Crafting usable knowledge.

Current emphasis on evaluating interventions does not address the problems of dissemination and utilization of these interventions, particularly in complex settings such as schools. Research on interventions is of value, but its generalizability to specific contexts is limited. Further, little is known about actual use of empirically supported interventions in practice settings. These concerns suggest the following: (a) There is a need to examine the dissemination process, including practitioner education and the development of a consumer information mindset by researchers; (b) guidance about selecting interventions would benefit from a systematic problem-solving orientation; and (c) research training and methodology need to be augmented with strategies and techniques suitable for developing an empirical approach to practice. These issues are addressed with specific examples drawn from school-based practice.

Child↗