RESUMEN
We evaluated 160 electrocardiograms taken after placement of central venous catheters (CVC) to determine their locations. Usable recordings were obtained in 154 patients. Subsequent radiographs revealed 30 misplaced catheters. Twenty-five of those were detected by CVC electrocardiograms. There were five false positive and five false negative traces. The sensitivity of CVC electrocardiography was 96%, the specificity 83.3%, and the total predictive power 93.5%. Electrocardiograms obtained from guide-wires were of significantly better quality than those from 0.9% NaCl filled catheters. The technique is accurate, safe and easy to learn. It may reduce the need for routine radiographic control to less than 10% of patients.
Asunto(s)
Cateterismo Venoso Central/métodos , Electrocardiografía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Electrocardiografía/instrumentación , Diseño de Equipo , Falla de Equipo , Humanos , Venas Yugulares , Persona de Mediana Edad , Radiografía Torácica , Sensibilidad y Especificidad , Vena Subclavia , Vena Cava SuperiorRESUMEN
A case translunate, transmetacarpal, scapho-radial fracture with perilunate dislocation occurred as a young man drove his motorcycle into the side of a car. Closed reduction was performed initially. Open reduction was performed with a screw in the lunate. Eighteen months later the screw was removed and after two and a half years x-rays revealed no signs of avascular necrosis or arthrosis. The patient fully recovered. This case stresses the necessity of open reduction in cases of complicated carpal fracture dislocations.
Asunto(s)
Huesos del Carpo/lesiones , Fracturas Óseas/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Metacarpo/lesiones , Accidentes de Tránsito , Adolescente , Huesos del Carpo/diagnóstico por imagen , Estudios de Seguimiento , Fracturas Óseas/complicaciones , Fracturas Óseas/cirugía , Humanos , Luxaciones Articulares/complicaciones , Luxaciones Articulares/cirugía , Masculino , Metacarpo/diagnóstico por imagen , RadiografíaRESUMEN
Thirty-five patients with postoperative ileus were given one g metronidazole suppositories three times daily. The patients were divided into four groups according to the operative procedure. The postoperative bowel motility was assessed as the time at which bowel sounds and evacuation occurred. One group of patients differed significantly from the others with regard to the time taken for the bowel function to become normal. No significant difference existed in the serum concentrations of metronidazole between the groups. Absorption of the first suppository was slower in our patients than in normal subjects, but thereafter concentrations followed the theoretic concentration curve for healthy subjects on the same dose regimen. Steady state, indicating normal absorption, was attained before bowel function returned to normal. The reason for the slower absorption of the first suppository is probably that the patients were confined to bed.