Asunto(s)
Enfermedades de los Ganglios Basales/complicaciones , Corteza Cerebral , Disartria/etiología , Enfermedades Neurodegenerativas/complicaciones , Anciano , Enfermedades de los Ganglios Basales/diagnóstico , Progresión de la Enfermedad , Femenino , Humanos , Enfermedades Neurodegenerativas/diagnósticoAsunto(s)
Lateralidad Funcional , Degeneración Nerviosa/patología , Núcleo Olivar/patología , Adulto , Isquemia Encefálica/complicaciones , Isquemia Encefálica/patología , Tronco Encefálico/irrigación sanguínea , Tronco Encefálico/patología , Circulación Cerebrovascular/fisiología , Coma/etiología , Diagnóstico Diferencial , Femenino , Humanos , Hipertrofia/complicaciones , Hipertrofia/patología , Imagen por Resonancia Magnética , Mesencéfalo/irrigación sanguínea , Mesencéfalo/patología , Degeneración Nerviosa/complicaciones , Puente/irrigación sanguínea , Puente/patologíaRESUMEN
Since laparoscopic cholecystectomy rapidly became the gold standard, there is an increased morbidity of 1% to 3% for clinically significant bile leaks with this procedure, as compared with open cholecystectomy (<1%). The identification of subclinical bile leaks using cholescintigraphy occurs in the range from 31.4% to 40% after elective open cholecystectomy. At this writing, no studies exist that document the rate of subclinical bile leaks after elective laparoscopic cholecystectomy. In this study, 71 patients were evaluated using cholescintigraphy after elective laparoscopic cholecystectomy. This study represents the first prospective look at the rate of subclinical bile leaks after laparoscopic cholecystectomy in elective cases, and the findings show an overall incidence of 7.3%, as compared with historical reports of 30% to 44% for open cholecystectomy.
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Sistema Biliar/diagnóstico por imagen , Sistema Biliar/lesiones , Colecistectomía Laparoscópica/efectos adversos , Enfermedad Aguda , Bilis , Enfermedades de los Conductos Biliares/diagnóstico por imagen , Enfermedades de los Conductos Biliares/epidemiología , Enfermedades de los Conductos Biliares/etiología , Conductos Biliares/lesiones , Colecistitis/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Tiempo de Internación , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , CintigrafíaRESUMEN
The level of commitment in the analysis of clinical errors made in the emergency department (ED) is currently focused on organization and processes rather than on individual action. Four major cases of clinical errors made in the ED of a teaching hospital were investigated. Analysis suggested that the process of clinical decision making and the overreliance on the use of patterns during the cognitive process had a major role in causing the errors, rather than factors related to procedures or organization. It appears hard to design system changes and tactics to significantly reduce the probability of making errors associated with the cognitive process involved in clinical decision making. The authors have initiated a systematic analysis of errors made during the diagnostic workup in their ED, and the rate of clinically significant errors is tracked. A file is being created with the purpose to use it for teaching and orientation of all new staff.
Asunto(s)
Disección Aórtica/diagnóstico , Competencia Clínica , Errores Diagnósticos , Servicio de Urgencia en Hospital/normas , Embolia Pulmonar/diagnóstico , Anciano , Anciano de 80 o más Años , Disección Aórtica/mortalidad , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/mortalidad , Diagnóstico Diferencial , Errores Diagnósticos/estadística & datos numéricos , Medicina de Emergencia/métodos , Medicina de Emergencia/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales de Enseñanza/normas , Humanos , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/cirugía , Italia , Masculino , Persona de Mediana Edad , Embolia Pulmonar/mortalidad , Sistema de Registros , Medición de Riesgo , Tasa de SupervivenciaRESUMEN
Pseudoaneurysms of the splenic artery have been well described in association with pancreatic pseudocysts secondary to pancreatitis. We present a case of a ruptured splenic artery pseudoaneurysm 14 years after splenectomy for trauma which, at that time, was complicated by a subphrenic abscess.
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Aneurisma Roto/diagnóstico por imagen , Arteria Esplénica , Aneurisma Roto/complicaciones , Aneurisma Roto/cirugía , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , Radiografía , Rotura Espontánea , Esplenectomía , Rotura del Bazo/cirugía , Absceso Subfrénico/complicaciones , Factores de TiempoRESUMEN
OBJECTIVE: Zidovudine (ZDV) is an inhibitor of HIV replication that may have a beneficial effect on patients with AIDS dementia complex (ADC). However, little is known about the association between long-term ZDV treatment and severity of ADC, ZDV dose or clinical and laboratory response to therapy. DESIGN: An open study on ZDV administration in 30 consecutive patients with ADC. SETTING: An infectious diseases hospital. PATIENTS: Thirty consecutive patients followed-up for 12 months. INTERVENTIONS: Three oral ZDV doses were used: 1000 mg (nine patients), 750 mg (eight patients) and 500 mg (13 patients) per day, depending on haematological status. MAIN OUTCOME MEASURES: Clinical and neurological examinations, neuropsychological evaluations, high-field brain magnetic resonance imaging (MRI) and 99mTc-HM-PAO single photon emission computerized tomography (SPECT). RESULTS: A favourable clinical response, defined as reversal to a less severe ADC stage (Price and Brew's criteria), was observed after 1, 3, 6, 9 and 12 months in 15, 22, 25, 19 and 14 patients, respectively. Neither severity of ADC at entry nor ZDV dose correlated with response to treatment. Seven patients died during the 12-month follow-up. The only factor associated with longer survival was ADC severity at entry (12-month survival, 0.94 and 0.53, in patients in stages 1 or 2 and in stages 3 or 4, respectively; P < 0.01). After 6-12 months of ZDV treatment six patients who initially responded to therapy showed a relapse in initial ADC stage, and two patients a less severe neurological deterioration. Neuropsychological evaluations showed significant improvement in the Wisconsin Card-Sorting test (P = 0.006 for categories, P = 0.029 for perseverative errors), which is particularly sensitive to cognitive and frontal-lobe type functions. Brain MRI revealed a reduction of the extent of white matter lesions in six out of 13 patients, who also showed clinical improvement. SPECT scanning revealed a reduction in the extent of uptake defects concomitant with clinical response in nine out of 14 patients. CONCLUSIONS: ZDV is effective in most patients with mild to end-stage ADC, although the benefit is sometimes only transient; several relapses and deaths occurred after the sixth month of treatment.
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Complejo SIDA Demencia/tratamiento farmacológico , Zidovudina/uso terapéutico , Complejo SIDA Demencia/diagnóstico , Complejo SIDA Demencia/psicología , Adulto , Relación Dosis-Respuesta a Droga , Evaluación de Medicamentos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Zidovudina/administración & dosificaciónRESUMEN
This study concerns 20 patients with cerebrovascular disease in the course of oral contraception with estrogens/progestins. The assumption of oral contraceptives appears to be related to the cerebrovascular manifestations, which could be caused by alterations of the blood vessel walls or of the coagulative process induced by estrogens/progestins. The thrombogenic action of these substances could be enhanced by preexisting conditions such as protein C or protein S deficiency.