RESUMO
Oculopharyngeal muscular dystrophy (OPMD) is an uncommon autosomal dominant disorder characterized by late onset and slow progression. Complications of OPMD include ptosis and progressive dysphagia leading to eventual malnutrition and aspiration. We report a rare case of OPMD complicating mechanical ventilator management following emergent surgery. OPMD and the resulting dysphagia contributed to multiple intubations, tracheostomy, aspiration pneumonia, and a prolonged hospital course. Awareness of the possibility of OPMD in intubated patients with a history of dysphagia is crucial for avoidance of complications.
Assuntos
Pé/irrigação sanguínea , Isquemia/cirurgia , Distrofias Musculares/complicações , Pneumonia Aspirativa/etiologia , Complicações Pós-Operatórias/etiologia , Respiração Artificial , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Humanos , Masculino , Distrofias Musculares/diagnóstico , Distrofias Musculares/genética , Pneumonia Aspirativa/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Desmame do Respirador/efeitos adversosRESUMO
With increasing pressure by third-party payers and federal reimbursement systems to reduce health care expenditures, cost-effective means to care for the resource intensive vascular surgical population must be explored. The challenge of meeting these cost-saving priorities while maintaining or improving quality of care can result in conflicting demands on surgeons, particularly in academic practices. The adaptation of an industrial management tool-the critical pathway method-to health care delivery is an attempt to reduce length of stay and improve efficiency. Utilization of vascular nurse practitioners, concentration of vascular patients into a dedicated unit, reduction in angiography through more aggressive use of the vascular laboratory, and optimal use of rehabilitation units and skilled nursing facilities are important adjuncts to reduce length of stay without sacrificing quality of care. This report describes the critical pathway method as implemented in a university teaching hospital, and the integration of other modalities in the care of vascular patients that has reduced length of stay by as much as 40% for some vascular surgical procedures.
Assuntos
Serviço Hospitalar de Cardiologia/economia , Procedimentos Clínicos , Procedimentos Cirúrgicos Vasculares/normas , Serviço Hospitalar de Cardiologia/normas , Administração de Caso , Redução de Custos , Análise Custo-Benefício , Custos Hospitalares , Hospitais Universitários/economia , Hospitais Universitários/normas , Humanos , Tempo de Internação/estatística & dados numéricos , Rhode Island , Doenças Vasculares/economia , Doenças Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/economiaRESUMO
Propp and Wilson's method of coupling from the past allows one to efficiently generate exact samples from attractive statistical distributions (e.g., the ferromagnetic Ising model). This method may be generalized to nonattractive distributions by the use of summary states, as first described by Huber. Using this method, we present exact samples from a frustrated antiferromagnetic triangular Ising model and the antiferromagnetic q=3 Potts model. We discuss the advantages and limitations of the method of summary states for practical sampling, paying particular attention to the slowing down of the algorithm at low temperature. In particular, we show that such slowing down can occur in the absence of a physical phase transition.
RESUMO
Activation of the surface of small diameter polyurethane vascular grafts using radiofrequency glow discharge (RFGD) and covalent linkage of cell attachment oligopeptides may improve graft patency. The effects of RFGD treatment were investigated on a polyurethane-polydimethylsiloxane (PU-PDMS) copolymer (Cardiothane-51; Kontron Cardiovascular, Inc., Everett, MA) membrane fabricated using the spray, phase-inversion technique. RFGD using H2O vapor was used to functionalize the membrane surface, reacted with 1',1 carbonyldiimidazole and covalently bound with oligopeptides (RGDS, RGES). Membranes not subjected to RFGD, either unmodified or with adsorbed fibronectin (Fn), vitro-nectin (Vn), RGDS, RGDV, and RGES, were used as controls. RFGD treated membrane surfaces were evaluated using electron spectroscopy for chemical analysis, which demonstrated a qualitative increase in nitrogen and silicon compared to unmodified PU-PDMS. Indirect confirmation of surface hydroxylation was provided by metallization with palladium and nickel, demonstrating uniform metallization of RFGD treated PU-PDMS surfaces. Human umbilical vein endothelial cells (HUVEC) were seeded at a density of 10(4) cells/cm2 and cell attachment assessed at 3 hr, 24 hr, and 7 days. Untreated PU-PDMS and membrane with adsorbed oligopeptides demonstrated poor HUVEC attachment at all intervals. Adsorbed Fn and Vn had significantly better early cell attachment and growth (p < 0.01). RFGD improved initial attachment and growth over non-RFGD treated controls (p < 0.01) for RGDS bound membranes, which performed as well as Fn controls (N.S.). PU-PDMS membranes can be modified using RFGD to covalently link oligopeptides. RFGD treatment alone, or with covalent linkage of cell attachment oligopeptides, improves HUVEC attachment and growth in a static environment.
Assuntos
Prótese Vascular , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/efeitos da radiação , Oligopeptídeos/farmacologia , Terapia por Radiofrequência , Sequência de Aminoácidos , Materiais Biocompatíveis , Adesão Celular/efeitos dos fármacos , Adesão Celular/efeitos da radiação , Divisão Celular , Linhagem Celular , Endotélio Vascular/citologia , Humanos , Técnicas In Vitro , Teste de Materiais , Dados de Sequência Molecular , Oligopeptídeos/química , Poliuretanos , Propriedades de SuperfícieRESUMO
Research in vascular exercise has demonstrated remarkable improvement in symptoms of claudication without more expensive and invasive interventions. During the past 5 years, 86 patients have graduated from The Brown University Supervised Vascular Exercise Program. Patients demonstrate a threefold improvement in maximum walking distance after 12 weeks of training. Information available on 22 patients at 1-year and 2-year follow-ups show walking distance is improved or maintained with continued training. Components of the program are presented in 3 phases. Phase 1 addresses the comprehensive nursing assessment, cardiac screening, and progressive treadmill testing. Phase II includes specific method of exercise prescription and educational needs of peripheral vascular disease patients. Phase III discusses the importance of maintenance and motivating patients to continue.
Assuntos
Terapia por Exercício/organização & administração , Claudicação Intermitente/terapia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Claudicação Intermitente/reabilitação , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Enfermagem em Reabilitação/organização & administração , Resultado do Tratamento , CaminhadaAssuntos
Antibióticos Antineoplásicos/uso terapêutico , Leucemia Linfoide/tratamento farmacológico , Adolescente , Adulto , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/efeitos adversos , Doenças da Medula Óssea/induzido quimicamente , Criança , Pré-Escolar , Tolerância a Medicamentos , Cardiopatias/induzido quimicamente , Humanos , Lactente , Leucemia Linfoide/mortalidade , Leucopenia/induzido quimicamente , Trombocitopenia/induzido quimicamenteAssuntos
Anemia Macrocítica/genética , Crescimento , Erros Inatos do Metabolismo/genética , Ácido Orótico/urina , Pirimidinas/metabolismo , Adulto , Carboxiliases/metabolismo , Aberrações Cromossômicas , Transtornos Cromossômicos , Ensaios Enzimáticos Clínicos , Eritrócitos/enzimologia , Genes Recessivos , Glucosiltransferases/metabolismo , Heterozigoto , Humanos , Lactente , Fígado/enzimologia , Ácido Orótico/metabolismo , Linhagem , Nucleotídeos de Uracila/metabolismo , Uridina/uso terapêuticoAssuntos
Gerenciamento Clínico , Desenvolvimento de Programas/normas , Continuidade da Assistência ao Paciente , Guias como Assunto , Humanos , Modelos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Técnicas de Planejamento , Avaliação de Processos em Cuidados de Saúde , Gestão da Qualidade Total , Estados UnidosAssuntos
Neoplasias/epidemiologia , Doença Aguda , Fatores Etários , Neoplasias Ósseas/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Leucemia Linfoide/epidemiologia , Leucemia Mieloide/epidemiologia , Linfoma/epidemiologia , Masculino , Neuroblastoma/epidemiologia , Prognóstico , Rabdomiossarcoma/epidemiologia , Estados Unidos , Tumor de Wilms/epidemiologiaRESUMO
The MiniBooNE Collaboration observes unexplained electronlike events in the reconstructed neutrino energy range from 200 to 475 MeV. With 6.46x10;{20} protons on target, 544 electronlike events are observed in this energy range, compared to an expectation of 415.2+/-43.4 events, corresponding to an excess of 128.8+/-20.4+/-38.3 events. The shape of the excess in several kinematic variables is consistent with being due to either nu_{e} and nu[over ]_{e} charged-current scattering or nu_{mu} neutral-current scattering with a photon in the final state. No significant excess of events is observed in the reconstructed neutrino energy range from 475 to 1250 MeV, where 408 events are observed compared to an expectation of 385.9+/-35.7 events.
RESUMO
The observation of neutrino oscillations is clear evidence for physics beyond the standard model. To make precise measurements of this phenomenon, neutrino oscillation experiments, including MiniBooNE, require an accurate description of neutrino charged current quasielastic (CCQE) cross sections to predict signal samples. Using a high-statistics sample of nu_(mu) CCQE events, MiniBooNE finds that a simple Fermi gas model, with appropriate adjustments, accurately characterizes the CCQE events observed in a carbon-based detector. The extracted parameters include an effective axial mass, M_(A)(eff)=1.23+/-0.20 GeV, that describes the four-momentum dependence of the axial-vector form factor of the nucleon, and a Pauli-suppression parameter, kappa=1.019+/-0.011. Such a modified Fermi gas model may also be used by future accelerator-based experiments measuring neutrino oscillations on nuclear targets.
RESUMO
The MiniBooNE Collaboration reports first results of a search for nu e appearance in a nu mu beam. With two largely independent analyses, we observe no significant excess of events above the background for reconstructed neutrino energies above 475 MeV. The data are consistent with no oscillations within a two-neutrino appearance-only oscillation model.
RESUMO
Although the risk of infection with hepatitis or HIV remains low, and the effectiveness of steps to reduce even this small risk is difficult to assess, the sequelae of the infection with either virus are often devastating. We described herein the use of a sterile Petri dish to inspect vascular anastomoses during arterial reconstructive operations. This simple, inexpensive precaution has been in use at the University of Cincinnati for two years and has proved so effective in preventing the contamination of operating room personnel with blood from a patient that it has recently become a routine part of all vascular reconstructive operations.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Mão de Obra em Saúde , Hepatite Viral Humana/prevenção & controle , Procedimentos Cirúrgicos Vasculares , Humanos , Métodos , Salas Cirúrgicas , Fatores de RiscoRESUMO
Potential complications of peritoneal dialysis catheters include ventral herniation, dialysate leakage, and catheter dysfunction. Using local anesthesia and a paramedian, muscle-splitting approach, we have significantly reduced the morbidity of the procedure. Security of fascial closure and identification of the peritoneum, even in obese patients, has been facilitated through this technique.
Assuntos
Cateterismo/métodos , Cavidade Peritoneal , Diálise Peritoneal Ambulatorial Contínua , Cateteres de Demora , Humanos , Diálise Peritoneal Ambulatorial Contínua/métodosRESUMO
We report a case of successful surgical management of a potentially life-threatening complication of aortoiliac stent placement. A 59-year-old man who had Leriche syndrome underwent bilateral iliac artery and infrarenal aortic stent placement at another institution. His history was significant for retroperitoneal lymph node dissection at 19 years of age for testicular cancer. One week after stent placement, the patient was readmitted with abdominal pain, poor oral intake, and diffuse intermittent tenderness. Evaluation with computed tomographic scanning and endoscopy was unremarkable, and the patient was discharged. He was admitted to our institution 1 week later with persistent abdominal pain. A computed tomographic scan of the abdomen revealed a large pseudoaneurysm of the abdominal aorta. The patient underwent urgent exploration, and exclusion of his infrarenal aorta was achieved with aortobifemoral bypass grafting. After the operation, the patient's course was complicated by a large paraduodenal hematoma, which resulted in a gastric outlet obstruction, which was managed without operation. This case illustrates a potential life-threatening complication of extensive stent placement for aortoiliac occlusive disease. Injury to the abdominal aorta must be considered in a symptomatic patient after the placement of stents in the aortoiliac region, beyond the immediate periprocedural period.