Asunto(s)
Hallazgos Incidentales , Neoplasias Pélvicas/diagnóstico , Neoplasias Pélvicas/cirugía , Tumores Fibrosos Solitarios/diagnóstico , Tumores Fibrosos Solitarios/cirugía , Terapia Combinada , Endosonografía , Femenino , Humanos , Ileostomía , Invasividad Neoplásica , Neoplasias Pélvicas/patología , Pronóstico , Recto/patología , Recto/cirugía , Reoperación , Tumores Fibrosos Solitarios/patología , Tomografía Computarizada por Rayos XRESUMEN
We review some of the most influential papers from 2012 in the different aspects of emergency medicine, such as prehospital medicine, resuscitation, early diagnosis and timely ED discharge and treatment. In particular, intramuscular benzodiazepines have been shown to be efficient in prehospital status epilepticus, epinephrines usefulness in cardiopulmonary resuscitation has been challenged, colloids have been shown to be deleterious in the treatment of severe sepsis and septic shock, the time window for thrombolysis in acute stroke will probably be extended, acute pyelonephritis treatment duration can be decreased, new D-dimers thresholds for older patients may prevent further diagnosis tests, and hs-Troponin may allow earlier discharge of low coronary risk patients.
Asunto(s)
Servicios Médicos de Urgencia/tendencias , Antibacterianos/uso terapéutico , Cuidados Críticos/métodos , Cuidados Críticos/tendencias , Servicios Médicos de Urgencia/métodos , Epinefrina/uso terapéutico , Paro Cardíaco/tratamiento farmacológico , Humanos , Pielonefritis/tratamiento farmacológico , Accidente Cerebrovascular/terapia , Troponina/uso terapéutico , Vasoconstrictores/uso terapéuticoRESUMEN
Small hospitals often lack the financial and personnel resources to realize innovative postoperative pain management concepts. This is not-as shown here-an absolute contradiction. The regular measurement of pain and its documentation by ward nurses as well as the appropriate prescription of analgesics play a key role in our concept. The joint establishment of guidelines, information sessions and the on-going dialog between the various professional groups guarantees the necessary consensus of all specialists involved in postoperative pain control. If an anesthetist is available 24 h a day, a nurse-based acute pain service (APS) becomes available for managing patients with patient-controlled analgesia (PCA) systems. The use of PCA and the performance of pain visits at regular intervals increase patient comfort and satisfaction. In addition, it can contribute to reduced hospitalization time in the context of fast-track rehabilitation programs. In our opinion, embedding the measures in a quality management program has a valuable catalytic effect, although implementation takes at least 1-2 years.
Asunto(s)
Hospitales Comunitarios/organización & administración , Dolor Postoperatorio/terapia , Analgesia Controlada por el Paciente , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Costos y Análisis de Costo , Hospitales Comunitarios/economía , Humanos , Modelos Organizacionales , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/enfermería , Garantía de la Calidad de Atención de SaludRESUMEN
We report an unusual case of concomitant necrobiosis lipoidica and silicotic granulomas in scars of phlebectomies on the legs, suggestive of a Koebner phenomenon.
Asunto(s)
Cicatriz/complicaciones , Granuloma de Cuerpo Extraño/complicaciones , Necrobiosis Lipoidea/complicaciones , Siliconas/efectos adversos , Enfermedades de la Piel/complicaciones , Várices/cirugía , Adulto , Atrofia , Cicatriz/patología , Femenino , Granuloma de Cuerpo Extraño/patología , Humanos , Necrobiosis Lipoidea/patología , Enfermedades de la Piel/patologíaRESUMEN
We have recently observed a strongly birefringent material of varying shapes and sizes in a benign breast cyst fluid specimen from a 52-yr-old woman with suspicious mammographic microcalcifications. The finding of calcium oxalate crystals in the breast cyst fluid should be regarded as a recognition of a particular type of calcification, easily overlooked with the conventional light microscopy. To date, we are unaware of any cytologic reports of this type of calcification in the breast.
Asunto(s)
Líquidos Corporales , Oxalato de Calcio/análisis , Enfermedad Fibroquística de la Mama , Cristalización , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Sixty-seven consecutive esophageal anastomoses were performed in a period from 1984 to 1987. 35 esophagoenterostomies performed in manual single layer suturing were compared with 32 esophagoenterostomies using mechanical stapling. After manual suturing there was a leak in 8.6%. After mechanical suturing anastomotic failure was seen in 6.2%. The analysis of mortality and morbidity indicate the use of mechanical staplers as a favorable alternative.
Asunto(s)
Esófago/cirugía , Gastrostomía/instrumentación , Yeyunostomía/instrumentación , Engrapadoras Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , PronósticoAsunto(s)
Calcinosis/complicaciones , Esclerodermia Localizada/complicaciones , Siderosis/complicaciones , Calcinosis/metabolismo , Calcio/metabolismo , Niño , Humanos , Hierro/metabolismo , Úlcera de la Pierna/etiología , Úlcera de la Pierna/metabolismo , Masculino , Persona de Mediana Edad , Fósforo/metabolismo , Esclerodermia Localizada/metabolismo , Siderosis/metabolismoRESUMEN
Injury to ligaments, which will eventually result in knee instability, requires operative treatment when the radiologic tilt exceeds 3 degrees. Therapy comprises anatomic reconstruction of the capsule, ligaments, and menisci. Postoperatively, a hinge cast (limited motion cast = LMC) is applied; a range of motion of 40 degrees does not endanger stability. Excellent subjective results were found in 90% of 80 cases with acute ligamentous lesion upon follow-up examination; 77 patients returned to work after an average of 5.3 weeks after removal of the LMC; range of motion was satisfactory with full stability in 69 patients.