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At least 955 records · Page 53Linked to original sources
PubMed1991

[Determination of surgical risk in patients with acute cholecystitis].

On the basis of rich clinical experience and analysis of the case records of 445 patients who underwent operation in 1982-1988, the author calculates the risk of the operation in patients with acute cholecystitis according to the severity of their condition, the concomitant diseases and complications, the complex nature of the intervention which will be undertaken, the surgeon's rating, and other factors. The high efficacy of the calculations shown.

Acute Disease↗
PubMed1991

[Restoration of natural intestinal passage after Hartmann's operation].

From 1972 to 1988 restorative operations were carried out at the Institute of Proctology on 252 patients after resection of the colon by Hartmann's technique. Analysis showed that restoration of natural intestinal passage after Hartmann's operation for resection of the colon is a complex and dangerous surgical intervention. When undertaking such intervention, the surgeon should take into account not only the patient's wish to be relieved from the colostomy, but also correct appraisal of the possibility of accomplishing the restorative operation from the standpoint of the patients' somatic condition, the technical conditions for restoration of intestinal continuity, and his own professional possibilities. In cases of a short rectal stump, various modifications of Duhamel's operation are the most safe and technically executable method for restoration of the natural intestinal passage. Such restorative-reconstructive operations should be carried out in specialized coloproctological clinics.

Adolescent↗
PubMed1990

[Criteria of high caries risk in the targeted preventive-curative care of 16- to 35-year-olds. The Dresden prevention study].

Among 300 patients 16-35-yr-old 21 of them showed a high individual caries risk. Estimation of caries risk was based on the following criteria: caries experience, sugar consumption, fluoride application, dry mouth, plaque accumulation, secretion rate, buffer capacity and S. mutans and lactobacillus counts in saliva. In case of high caries risk a sure diagnosis and directed preventive-therapeutic intervention depend on a complex consideration of all the risk factors.

Adolescent↗
PubMed1990

[Cytomorphologic diagnosis of benign and malignant tumors of the blood vessels].

The aim of this work was to define the cytomorphologic patterns of the major cytologic forms of benign and malignant tumors of the blood vessels in order to define the criteria of the diagnosis of these tumors. Parallel cytologic investigations of puncture biopsy specimens and of histologic sections, obtained from 186 patients (156 ones with benign and 30 with malignant tumors) were carried out. Puncture biopsy specimens, impressions, and scrapings off the surface of section of the removed tumors were examined; the preparations were stained according to Kryukov-Pappenheim. Analysis of the findings of histologic and cytologic studies has shown that the features of the cytologic patterns of vessel tumor varieties, distinguished by the authors, helped correctly diagnose the benign or malignant nature of the process by examining the puncture biopsy specimens in 89.8% of cases and identify the histologic type in 41.5% of cases. The per cent shares of recognized benign and malignant tumors were similar: 89 and 90%, whereas the number of identified tumor types was higher in malignant cases than in benign ones: 51.8 vs. 39.5%. Therefore cytologic examinations of the vessel tumor puncture biopsy specimens should be an obligatory component in the complex diagnosis before surgical intervention.

Biopsy, Needle↗
PubMed1995

Streamlining the triage system for acute myocardial infarction.

The full benefits of thrombolytic therapy can be realized if and only if treatment is delivered as quickly as possible. Streamlining the triage system will not only increase the numbers of patients treated with thrombolytic therapy, it will ultimately reduce mortality and morbidity rates from acute myocardial infarction by limiting loss of heart muscle. Reducing the time to treatment, however, is a daunting task given that both patient and hospital delays contribute to the underutilization or inefficient use of thrombolytic therapy. In particular, patient delays can be difficult to attenuate, given that human behavior is complex and that designing interventions to change behavior is not only challenging but expensive. Results from the MITI registry show that the emergency medical system is the linchpin of an efficient triage system in that it is associated with reduced patient delays as well as reduced treatment delays. Clearly, patients with chest pain need to be aware of the need to take prompt action by calling 911. On the other hand, decisions to use these systems to acquire electrocardiograms or deliver thrombolytic treatment will be faced by increasing numbers of administrators and policy makers in the years to come. Without adequate community support to maintain and improve these systems, the full benefits of thrombolytic therapy cannot be attained.

Aged↗
PubMed1993

Building coalitions: a community wide approach for promoting farming health and safety.

1. The context of agriculture in the Midwest, given many smaller, family run operations, presents multiple and complex challenges; occupational health intervention strategies used in other industries are not immediately applicable. 2. Public health nurses in Minnesota's Occupational Health Nurses in Agricultural Communities project (OHNAC) are applying the strategies of community wide health promotion through community organizing for farm health and safety promotion. 3. The theoretical basis for community wide health promotion encompasses theory from several disciplines, and a five stage model for community organization in health promotion has been developed and tested. 4. At the root of tis approach to farm safety is the effort to change long held beliefs and community norms, especially the belief that farm injuries and fatalities are a necessary part of agricultural work.

Agriculture↗
PubMed1993

Manpower deficiencies in cardiovascular pathology. Implications for medical care of cardiovascular diseases.

The general shortage of pathology manpower has been well documented, but virtually no published data are available on cardiovascular pathologists. To address this situation, the Society for Cardiovascular Pathology surveyed all chairpersons of academic pathology departments, chiefs of academic clinical cardiovascular programs, including adult and pediatric cardiology and cardiovascular surgery, in the United States and Canada, regarding their perceptions of cardiovascular pathology manpower and the training and areas of expertise necessary for a competent cardiovascular pathologist. Of total respondents, 41% stated that their institution's department of pathology needed to add a cardiovascular pathologist, 39% of respondents replied that money and funding were available to hire an additional cardiovascular pathologist, yet only 19% stated that their institution intended to add a cardiovascular pathologist. In regard to career orientation, 77% of respondents wanted a cardiovascular pathologist capable of both diagnostic work and basic research. The survey results show a significant discrepancy between apparent institutional needs for cardiovascular pathologists and hiring plans, implying that there is a substantial shortage of cardiovascular pathologists. This deficiency in cardiovascular pathology manpower has important ramifications for the amount and quality of medical services that can be provided to clinical cardiovascular colleagues in an era of increasingly complex pathobiological information and interventional strategies in the prevention and treatment of cardiovascular diseases.

Cardiovascular Diseases↗
PubMedDate not supplied

Nitinol esophageal stents: new designs and clinical indications.

PURPOSE: To evaluate the clinical use of covered and noncovered, knitted nitinol stents in patients presenting new stent indications. METHODS: Self-expandable, knitted nitinol stents were implanted in four patients for treatment of dysphagia. In two patients who had malignant strictures and had esophago-respiratory fistulae and in one patient with an esophagocutaneous fistula, polytetrafluoroethylene (PTFE)-covered stents were implanted. One patient received a noncovered stent, but a retrograde approach through a percutaneous endoscopic gastrostomy (PEG) fistula had to be chosen for recanalization of an esophageal occlusion. Two patients received stents for treatment of benign strictures. RESULTS: Recanalization of the stricture and stent implantation were performed under fluoroscopic control without any procedure-related morbidity or mortality. Dysphagia improved in all patients and the esophageal fistulae could be sealed off by covered stents. During a maximum follow-up of 18 months, there was no stent migration or esophageal perforation. Complications observed were stent stenosis due to food impaction (1/4) and benign stent stenosis (2/2). Most complications could be treated by the interventional radiologist. CONCLUSION: Self-expandable, covered Nitinol stents provide an option for the treatment of dysphagia combined with esophageal fistulae. In combination with interventional radiology techniques, even complex strictures are accessible. For benign strictures, the value of stent treatment has not yet been proven.

Adult↗
PubMed1996

Summary of track D: social science: research, policy and action.

SCOPE: This review summarizes the main issues discussed during Track D, which examined the societal impact of HIV/AIDS, and responses to the epidemic by individuals, families, communities and societies worldwide. Micro- and macrolevel issues addressed included the development, implementation and evaluation of programmes for prevention and care; policy development and implementation; structural issues such as the impact of gender relations, development and migration on the development of the epidemic; and the social and economic impact of HIV/AIDS on affected societies and communities. RECURRENT THEMES: Presentations provided strong evidence that peer-led, community-based programmes offer particularly effective ways of working, and that participatory research involving affected communities provides useful results for the design and evaluation of programmes and policies. This is the case across settings, issues, populations and countries. FUTURE DIRECTIONS: Emerging needs include how best to ensure sustainability of national and international responses, how best to scale up successful interventions for wider reach, and how best to work with systematically marginalized, neglected groups and populations. Research priorities include the characterization of the multiple determinants of HIV-related vulnerability, and the evaluation of interventions that take these complex determinants as their starting point. A more coherent and strategic response requires less separation between the different constituencies involved in AIDS work, and the more sustained involvement of people living with HIV/AIDS themselves.

Community Health Services↗
PubMed1996

[Graft dysfunction, acute rejection and bronchiolitis obliterans in lung and heart-lung transplantation].

Three complications which influence both survival and quality of life in transplanted patients will be the object of this chapter. Graft dysfunction: this is a severe re-implantation oedema leading to inefficiency of the graft as regards haemostasis whether or not associated with haemodynamic complications. The liberation of free radicals and/or cytokines induced by ischemia-reperfusion of the graft plays an important role in the pathogenesis of this syndrome. Acute rejection: the mechanism is complex leading to the intervention of an immune response stimulated by the detection of allo-antigens. The clinical picture is often non-specific. Treatment requires boluses of methyl prednisolone completed by decreasing dose of corticosteroid therapy orally. The syndrome of bronchiolitis obliterans: this is a progressive failure of the airways. This syndrome occurs in the long term in 50% of patients and presents with progressive dyspnoea associated with persistent or recurrent cough. The pathogenesis is brought about principally by a chronic rejection with a specific cytotoxic reaction of T lymphocytes against the airway epithelium which expresses Class II major histocompatibility antigens. Attempts at curative treatment can be extremely deceptive and leads to, at best, a slowing in decline of respiratory function.

Acute Disease↗
PubMed1997

Seizure disorders in adults: evaluation and management of new onset seizures.

The adult patient with first-time seizures often presents to the primary care and urgent care settings. It is estimated that 1% of the population of the United States has a diagnosed seizure disorder, with more than 125,000 new cases identified each year. Because of the complexity of assessment and intervention required for the patient with seizures, it behooves the health care practitioner to be aware of diagnostic criteria, current management techniques, and evaluation of treatment protocols. This article discusses various types of seizures, offers information regarding a differential diagnosis, and addresses the implementation of pharmacologic therapies as well as ongoing care of the patient.

Activities of Daily Living↗
PubMedDate not supplied

Cardiovascular assessment--Part 2.

This is the fifth part of the Care is Critical series, which looks at the more complex assessments and technological interventions nurses may now have to deal with on general wards or in the community. This article aims to provide a more in-depth understanding of assessing patients' cardiovascular function in relation to low cardiac output states in two types of patients--the post-operative patient with hypovolaemia and the patient with chronic heart failure.

Critical Care↗
PubMed1998

[Surgical treatment of perforated gastroduodenal ulcer].

The surgical treatment tactics of patients with perforative gastroduodenal ulcer was substantiated, basing on the complex analysis done. Radical intervention, mainly organ preserving one, constitutes the operation.

Duodenal Ulcer↗
PubMedDate not supplied

Rehabilitation in women with breast cancer-special problems in hereditary diseases.

A rehabilitation program for women with high risk for breast cancer or known hereditary breast carcinoma is described. The rehabilitation uses complex and interdisciplinary therapeutic interventions to improve symptoms, functional deficits and disease and treatment related psychologic distress. An essential component of the rehabilitation is an educational program with up-to-date information about the possibilities and limitations of genetic testing and recommendations about primary and secondary prevention. Suggestions for risk reduction as primary prevention are discussed. This rehabilitation program should be implemented in an effective follow-up care for women genetically susceptible to breast cancer.

Breast Neoplasms↗
PubMed1991

The postoperative cardiac infant: physiologic basis for neonatal nursing interventions.

The care of the postoperative cardiovascular neonate is complex and multifaceted. A comprehensive understanding of physiology, pathology, and appropriate interventions is necessary for a successful outcome. The neonatal nurse plays a pivotal role in the collaborative management of these neonates to support delivery of quality care.

Body Temperature Regulation↗
PubMed1993

Role of beta 1, beta 2 integrins and ICAM-1 in lung injury after deposition of IgG and IgA immune complexes.

After intrapulmonary deposition of IgG or IgA immune complexes, injury has been recently shown to be CD18-dependent in both cases and E-selection-dependent only in the former case. In our studies further evaluation of the requirements for beta 1 and beta 2 integrins and intercellular adhesion molecule-1 (ICAM-1) has been undertaken. In the IgG immune complex model, which is neutrophil dependent, anti-CD11a reduced injury (as measured by changes in permeability and hemorrhage) by 61 and 43%, respectively, whereas a newly developed anti-CD11b produced minimal protection (16 and 19%, respectively). Treatment of rats with increasing doses (1.5- and 3.0-fold) of antibody to rat CD11b failed to demonstrate additional protective effects in this model of injury. Anti-ICAM-1 reduced the parameters of injury by 61 and 78%, respectively, while anti-VLA-4 reduced the injury parameters by 40 and 35%, respectively. There were reductions in lung content of myeloperoxidase, roughly corresponding to the protective effects of the interventions. In the IgA immune complex model of injury, in which lung macrophages appear to be the effector cells, anti-CD11a reduced the injury parameters (permeability and hemorrhage) by 36 and 33%, respectively, whereas anti-CD11b reduced the parameters of injury by 63 and 67%, respectively. In this model, anti-ICAM-1 reduced the parameters of injury by 61 and 56%, respectively, while anti-VLA-4 reduced the parameters by 77 and 62%, respectively. The cell content of bronchoalveolar lavage fluids revealed changes that have been shown to reflect protective interventions in both models of immune complex-induced injury. These findings suggest that, in IgG and IgA immune complex models of lung injury, both VLA-4 and ICAM-1 are required, although lymphocyte function-associated Ag-1 is the predominant beta 2 integrin requirement in the IgG immune complex-induced model of injury and Mac-1 is the predominant requirement for IgA immune complex-induced lung injury. Thus, engagement in the lung of adhesion molecules in a manner leading to injury depends on the nature of the inflammatory stimulus and the type of phagocytic cells involved in the development of injury.

Animals↗
PubMed1996

Comparison of angioscopy, intravascular ultrasound imaging and quantitative coronary angiography in predicting clinical outcome after coronary intervention in high risk patients.

OBJECTIVES: The purpose of this study was to identify qualitative or quantitative variables present on angioscopy, intravascular ultrasound imaging or quantitative coronary arteriography that were associated with adverse clinical outcome after coronary intervention in high risk patients. BACKGROUND: Patients with acute coronary syndromes and complex lesion morphology on angiography are at increased risk for acute complications after coronary angioplasty. Newer devices that primarily remove atheroma have not improved outcome over that of balloon angioplasty. Intravascular imaging can accurately identify intraluminal and intramural histopathologic features not adequately visualized during coronary arteriography and may provide mechanistic insight into the pathogenesis of abrupt closure and restenosis. METHODS: Sixty high risk patients with unstable coronary syndromes and complex lesions on angiography underwent angioscopy (n = 40) and intravascular ultrasound imaging (n = 46) during interventional procedures. In 26 patients, both angioscopy and intravascular ultrasound were performed in the same lesion. All patients underwent off-line quantitative coronary arteriography. Coronary interventions included balloon (n = 21) and excimer laser (n = 4) angioplasty, directional (n = 19) and rotational (n = 6) atherectomy and stent implantation (n = 11). Patients were followed up for 1 year for objective evidence for recurrent ischemia. RESULTS: Patients whose clinical presentation included rest angina or acute myocardial infarction or who received thrombolytic therapy within 24 h of procedure were significantly more likely to experience recurrent ischemia after intervention. Plaque rupture or thrombus on preprocedure angioscopy or angioscopic thrombus after intervention were also significantly associated with adverse outcome. Qualitative or quantitative variables on angiography, intravascular ultrasound or off-line quantitative arteriography were not associated with recurrent ischemia on univariate analysis. Multivariate predictors of recurrent ischemia were plaque rupture on preprocedure angioscopy (p < 0.05, odds ratio [OR] 10.15) and angioscopic thrombus after intervention (p < 0.05, OR 7.26). CONCLUSIONS: Angioscopic plaque rupture and thrombus were independently associated with adverse outcome in patients with complex lesions after interventional procedures. These features were not identified by either angiography or intravascular ultrasound.

Angioplasty, Balloon, Coronary↗