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BACKGROUND & PROBLEMS: Infant-transferring warmers provide a warm environment and emergency care facilities such ventilators for high-risk infants during transport. Accurate use of this warmer has been demonstrated to reduce rates of neonatal complications and increase rates of survival. This project found that, despite the complaints of nurses that warmers occasionally malfunctioned during the transfer process, warmer functions nearly always tested normal after use. Therefore, the researchers surveyed ward nurses to better understand the underlying reasons for these complaints. Results found that only 68.4% of those surveyed operated the warmer correctly. The reasons for improper use were analyzed and categorized as: Nurse-related factors - lack of warmer operating knowledge and experience in the clinic; System-related factors - lack of a standard operating procedure (SOP) and monitor/audit practices and an incomplete training protocol; Equipment-related factors - lack of an equipment preparation SOP and difficulties in setting the ventilator properly. PURPOSE: The purpose of this project was to achieve a 100% rate of proper warmer use among nurses. RESOLUTION: Through continuous clinical education, we created a standard operating procedure for warmer operation, created a video and poster for warmer users, simplified the equipment preparation SOP, and periodically monitored and checked results. RESULTS: After the intervention, 100% of the nurses were able to use the warmers correctly. Additionally, the rate of satisfaction for nursing-warmer use among the participating nurses increased from 51.4% to 80.6%. CONCLUSIONS: This project effectively increased the rate for correctly using transferring warmers among participating nurses and improved the quality of medical care.
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Servicios Médicos de Urgencia , Incubadoras para Lactantes , Mejoramiento de la Calidad , Humanos , Recién NacidoRESUMEN
OBJECTIVE: Primary fallopian tube carcinoma is one of the least common gynecological cancers and is difficult to diagnose preoperatively. We aimed to analyze the clinicopathological characteristics of this rare disease and to identify the prognostic factors predicting prognosis. MATERIALS AND METHODS: Twelve cases of primary fallopian tube carcinoma that had been diagnosed and treated in Kaohsiung Chang Gung Memorial Hospital between July 1986 and December 2005 were retrospectively reviewed. Factors, including age, gravidity, parity, stage, surgical intervention, pathological findings, relapse, and survival, were analyzed. RESULTS: The median age of the 12 cases was 54 years (range, 32-67 years), whereas the median follow-up time was 38 months. None of the 12 cases were diagnosed preoperatively. Preoperative diagnoses were adnexal mass of unknown nature in six (50%), tubo-ovarian abscess in three (25%), ovarian carcinoma in two (16.7%), and endometrioma in one (8.3%) cases. Two patients (16.7%) had experienced the typical symptom of watery vaginal discharge. Three patients (25%) were in Stage I, three (25%) in Stage II, four (33.3%) in Stage III, and two (16.7%) were unstaged. Nine patients had received postoperative platinum-based adjuvant chemotherapy. The 5-year disease-free survival rate was 64%. On evaluating the correlation between clinicopathological parameters and survival, only the Federation of Gynecology and Obstetrics stage (p=0.017) was a significant prognostic factor. CONCLUSION: Although preoperative diagnosis of fallopian tube carcinoma is difficult, still 16.7% of our patients experienced the typical symptom suggestive of tubal carcinoma. Prognostic factors associated with fallopian tube cancer were similar to those of epithelial ovarian cancer.
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Adenocarcinoma/diagnóstico , Neoplasias de las Trompas Uterinas/diagnóstico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Ciclofosfamida/administración & dosificación , Diagnóstico Diferencial , Supervivencia sin Enfermedad , Neoplasias de las Trompas Uterinas/tratamiento farmacológico , Neoplasias de las Trompas Uterinas/patología , Neoplasias de las Trompas Uterinas/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Estadificación de Neoplasias , Paclitaxel/administración & dosificación , Modelos de Riesgos Proporcionales , Estudios RetrospectivosRESUMEN
BACKGROUND: Ostene, a synthetic water-soluble bone hemostatic agent, is commercially available. In the current study, we evaluated the systemic and local effects of this copolymer in a rabbit model. METHODS: Eighteen rabbits underwent creation of a bony defect at right iliac crest. These rabbits were then evenly divided into 3 groups. In group 1, the defect surfaces were treated with bone wax; in group 2, the defect surfaces were treated with Ostene; in group 3, the defect surfaces were not treated with anything. Then, the animals underwent blood examinations, including WBC count, CRP, and ESR at 0, 1, 3, and 6 weeks, and were killed at 6 weeks for histologic examination. Another 6 rabbits (group 4) underwent the same surgical treatment of group 2 animals but had blood examinations of BUN and creatinine. RESULTS: The blood examinations showed that the WBC count, CRP, and ESR of all the animals in the first 3 groups were within normal limits in the postoperative periods. Microscopic examinations demonstrated residual bone wax and fibrotic tissue at the defect surfaces in group 1 animals. However, there was no Ostene at the defect surfaces in group 2 animals. The groups 2 and 3 animals showed no fibrotic tissue at the defect surfaces. The group 4 animals showed normal serum levels of BUN and creatinine in the postoperative periods. CONCLUSION: Ostene is absorbable and induces no systemic inflammation (including acute renal damage) and local inflammation in animal bodies.
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Enfermedades Óseas/cirugía , Sustitutos de Huesos/toxicidad , Procedimientos de Cirugía Plástica/métodos , Poloxámero/toxicidad , Polímeros/toxicidad , Animales , Biomarcadores/análisis , Biomarcadores/metabolismo , Sustitutos de Huesos/química , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , Modelos Animales de Enfermedad , Combinación de Medicamentos , Inflamación/inducido químicamente , Inflamación/fisiopatología , Enfermedades Renales/inducido químicamente , Enfermedades Renales/fisiopatología , Recuento de Leucocitos , Masculino , Palmitatos/uso terapéutico , Poloxámero/química , Polímeros/química , Conejos , Ceras/uso terapéuticoRESUMEN
BACKGROUND: Extracorporeal shock wave treatment has been used to treat many orthopedic disorders. However, the effect of extracorporeal shock waves on spinal fusion has not been reported. METHODS: Fifteen rabbits were used in this study. Spinal fusion was performed with decortication of bilateral L5 and L6 transverse processes, and placement of the bone chips onto the ipsilateral L5-L6 intertransverse space. The right L5 and L6 transverse processes in all animals were treated with 1000 impulses of ESWT at 14 kV (equivalent to 0.18 mJ/mm(2)) at 3 and 6 weeks after surgery. The left transverse processes did not receive ESWT, and were served as controls. Radiographic examinations of the spines were performed at 3, 6, and 12 weeks. Computed tomography was performed at 12 weeks. The rabbits were killed at 12 weeks, and the spinal segments were harvested for histomorphological examination. RESULTS: Radiographs of the tested rabbits taken at different post-ESWT stages demonstrated repairing effect of ESWT on the fusion gap of the treated (right) sides. Statistical analysis of the image studies indicated that 11 (73%) of 15 rabbits showed superior fusion mass on the ESWT (right) side than that of control (left) side (P < .001). The remaining 4 (27%) rabbits showed no discernable fusion difference between the ESWT side and the control side. Histomorphological examination showed good new bone formation in 9 fusion masses. All of these cases were noted on the ESWT (right) sides. Statistical analysis showed that ESWT sides had better new bone formation than the control sides (P = .001). CONCLUSIONS: Results of this study demonstrated that ESWT is effective in promoting spinal fusion in rabbits.
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Ondas de Choque de Alta Energía/uso terapéutico , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Osteogénesis/efectos de la radiación , Fusión Vertebral/métodos , Animales , Trasplante Óseo , Región Lumbosacra , Masculino , Modelos Animales , Osteogénesis/fisiología , Conejos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
We studied the vulnerability of the spinal cord to extracorporeal shock wave treatment (ESWT). In this experiment, 12 rabbits were divided into three groups (4 in each group). All animals underwent a preceding lumbar laminectomy at L4 1 week before ESWT. In group 1, 2000 impulses of high dose (0.62 mJ/mm2 energy flux density) shockwave energy were applied to the spinal cord at the laminectomy site. In group 2, 2000 impulses of low dose (0.18 mJ/mm2 energy flux density) shockwave energy were applied to the same site as group 1. Group 3 did not receive ESWT and served as a control. None of the rabbits in the study groups (groups 1 and 2) showed weakness or paralysis of the hind limbs throughout the entire post-ESWT period. The spinal cord at the L4 level of all animals was harvested on day 13 after laminectomy. On gross morphology, the cord from the study groups and the control group showed normal surface appearance. On microscopic examination, the cord from the control group was normal, whereas the cords from the study groups showed varying degrees of myelin damage and neuronal loss. These microscopic findings were dose-dependent. For the low-energy group (group 2), neuronal loss was insignificant compared to that in the control group. ESWT produced varying degrees of microscopic changes of the treated cords, but no neurological symptoms. The neuronal injury was dose-dependent and mild in the low-energy group.
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Ondas de Choque de Alta Energía/uso terapéutico , Traumatismos de la Médula Espinal/terapia , Análisis de Varianza , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta en la Radiación , Miembro Posterior/fisiopatología , Miembro Posterior/efectos de la radiación , Laminectomía/métodos , Masculino , Conejos , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/patología , Traumatismos de la Médula Espinal/fisiopatología , Sinaptofisina/metabolismoRESUMEN
Small cell carcinoma is predominantly found in the lung and only about 5% of small cell carcinoma cases have been noted to be extrapulmonary; these are commonly found in the esophagus, pancreas, skin, uterus, and breast. A head and neck origin for small cell carcinoma is extremely rare. Both pulmonary and extrapulmonary small cell carcinomas usually have a good response to chemotherapy initially, but a poor prognosis finally. We report here a case of small cell carcinoma of the nasopharynx. The patient underwent chemotherapy and irradiation for the disease, but died of lung metastasis 38 months later.
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Carcinoma de Células Pequeñas/patología , Neoplasias Nasofaríngeas/patología , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carmustina/uso terapéutico , Cisplatino/uso terapéutico , Ciclofosfamida/uso terapéutico , Etopósido/uso terapéutico , Resultado Fatal , Humanos , Masculino , Neoplasias Nasofaríngeas/tratamiento farmacológico , Radioterapia AdyuvanteRESUMEN
BACKGROUND: The establishment of an environment to force animals to inspire cigarette smoke is mandatory to study the true effects of smoking. This model has been used to study long-bone healing but has not yet been used to study spinal fusion. METHODS: Forty male rabbits were divided into four equal groups. All the animals underwent bilateral intertransverse-process fusion at L5-L6 using the 1995 fusion model of Boden et al. The first (C8-week) group did not undergo cigarette smoke inhalation and individual rabbits were killed at 8 weeks; the second (S8-week) group underwent intermittent cigarette smoke inhalation and individual rabbits were killed at 8 weeks; the third (C6-week) group did not undergo cigarette smoke inhalation, and animals were killed at 6 weeks; and the fourth (S6-week) group underwent intermittent smoke inhalation and group-included rabbits were killed at 6 weeks. Subsequent to the animals having been killed, the fusion masses were harvested for a series of studies including manual palpation, biomechanical testing, radiographic examination, and histologic analysis. RESULTS: Six rabbits died shortly after the operation. Of the remaining 34 rabbits, the lumbar spine specimen was harvested for study. Manual palpation, radiographic examination, and histologic analysis of the fusion masses revealed no statistically significant difference in fusion results between the control and the corresponding smoking group killed at either 8 weeks or 6 weeks. Biomechanical testing of the fusion masses also revealed no statistically significant difference in fusion results between the control and the smoking group killed at 8 weeks, although it did indicate that smoking resulted in a 44% decrease in mean flexion stiffness and a 32% decrease in mean extension stiffness among the animals killed at 6 weeks. The former (decrease in flexion stiffness) was statistically significant (p < 0.05). CONCLUSION: The results of the biomechanical testing conducted as a part of the current study demonstrate that acute cigarette smoke inhalation delays but does not prevent the spinal fusion process for rabbits.
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Fumar/fisiopatología , Fusión Vertebral , Traumatismos Vertebrales/fisiopatología , Traumatismos Vertebrales/cirugía , Cicatrización de Heridas , Animales , Fenómenos Biomecánicos , Vértebras Lumbares/lesiones , Masculino , Modelos Animales , Conejos , Factores de TiempoRESUMEN
Hemoglobin (Hb) electrophoresis is widely used in thalassemia screening. Most Hb variants express a specific abnormal band on the cellulose acetate membrane. The technique is useful in the diagnosis of the type of thalassemia but is not sensitive enough to detect alpha-thalassemia minor because the quantity of the HbH is too small to be expressed on the supporting medium. We used simple staining of blood smears rather than the sophisticated molecular method to detect HbH inclusions. To evaluate the effectiveness of this method, we used brilliant cresyl blue (BCB) staining of red blood cells in 509 patients with microcytosis and erythrocytosis caused by various conditions. The results indicate that BCB staining is useful in the identification of subjects who possess alpha-thalassemia traits. Coexisting conditions such as beta-thalassemia and iron-deficiency anemia did not affect the detection of the HbH inclusions with the use of BCB staining. We conclude that BCB staining is helpful and reliable as an auxiliary method of detecting HbH inclusions in the diagnosis of alpha-thalassemia traits, especially in places where medical resources are limited.
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Colorantes , Oxazinas , Coloración y Etiquetado/métodos , Talasemia alfa/diagnóstico , Estudios de Evaluación como Asunto , Humanos , Policitemia/diagnóstico , Sensibilidad y EspecificidadRESUMEN
Salivary duct carcinoma is a rare and invasive malignant tumour with rapid distant metastasis and dismal prognosis. Clinically, perineural invasion of the salivary duct carcinoma is commonly noted. Here, we present a case of salivary duct carcinoma of submandibular gland origin with perineural invasion of the trigeminal nerve proximal to the intracranium, that was well demonstrated by a magnetic resonance image (MRI) and was consistent with the clinical presentation. This case received radical resection and radiotherapy with inclusion of the skull base within the field. There was no tumour recurrence and distant metastasis 24 months post-operatively.
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Carcinoma Ductal/patología , Neoplasias de la Glándula Submandibular/patología , Nervio Trigémino/patología , Carcinoma Ductal/diagnóstico por imagen , Carcinoma Ductal/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Base del Cráneo , Neoplasias de la Glándula Submandibular/diagnóstico por imagen , Neoplasias de la Glándula Submandibular/radioterapia , Tomografía Computarizada por Rayos X , Nervio Trigémino/diagnóstico por imagenRESUMEN
Meckel's diverticulum is a common cause of low gastrointestinal bleeding in childhood. Conventional diagnostic methods including plain abdominal radiographs, abdominal ultrasound, technectium 99m pertechnetate scintigraphy, angiography, and exploratory laparotomy have several limitations. Here, we report that a case of Meckel's diverticulum in a 1-year-7-month-old boy presenting with intermittent episodes of painless low gastrointestinal bleeding for about one year. Despite the traditional studies, including plain abdominal films, abdominal ultrasound, rectosigmoidoscopy and repeated Tc-99m Meckel's scan, all showed negative finding, it was successfully diagnosed along with excision of Meckel's diverticulum by laparoscopy. The patient made a rapid recovery and discharged at 48 hours after the procedure. We emphasize that laparoscopy should be an alternative diagnostic and therapeutic modality of choice in patients suspected of Meckel's diverticulum, especially in pediatric patients who had negative results of all other work-ups.