RESUMO
INTENTION: Thorax trauma (TT) is associated with a high rate of pulmonary failure and increased mortality. To prevent these complications, the German trauma system recommends intubation and chest tube insertion at the scene of the accident, even in cases without acute respiratory dysfunction. Due to the possible life threatening complications of the therapy, the emergency surgeon should be able to correctly identify a TT at the scene. Therefore, we retrospectively compared the evaluation of chest trauma by the emergency surgeon with objective injury severity according to the Abbreviated Injury Scale (AIS). METHOD: Data from 2,392 patients (aged 39+/-1 years, Injury Severity Score 27+/-0.3) were taken from the multiple trauma database of the German Trauma Society. The evaluation of TT (absent, light, medium, severe) by the emergency surgeon was compared with objective injury severity (AIS=0: absent, 0>AIS<3: light, AIS=3: medium, AIS>3: severe). If the difference between the subjective and objective injury severity increased or decreased two and more levels, a substantial misclassification was assumed. The influence of the estimate on outcome was tested by comparing the predicted (TRISS-method) with the observed fatalities. RESULTS: Absence of TT was estimated correctly in 62%, light in 24%, medium in 40% and severe TT in 46% of cases. Thus a correct estimate of TT was made for 49% of the patients. The chest injury severity was substantially overrated by the emergency surgeon in 20% and substantially underestimated in 17% of cases. In patients with the correct classification at the scene, a total of 81% received a chest tube. Of these patients, only 50% received their chest tube at the scene. Of the patients with an initially overlooked TT, only 37% received a chest tube and nearly all were placed in the emergency room. The number of fatalities was lower than predicted in all groups, even in patients with correctly estimated severe TT (observed: 34%, estimated: 42+/-2%), and also in patients with initially overlooked TT (observed: 16%, estimated: 24+/-2%). CONCLUSION: Due to the high rate of misclassification and possible severe complications caused by therapy, and without having any benefit in terms of outcome, intubation and chest tube insertion should not be carried out in vital, stable patients.
Assuntos
Traumatismo Múltiplo/diagnóstico , Traumatismos Torácicos/diagnóstico , Traumatologia , Adulto , Diagnóstico Diferencial , Emergências , Serviços Médicos de Emergência , Feminino , Humanos , Intubação Intratraqueal , Masculino , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/terapia , Índice de Gravidade de Doença , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/terapia , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
In the majority of patients hepatocellular carcinoma (HCC) is associated with liver cirrhosis. Advanced or decompensated liver cirrhosis, comorbidity and multicentricity make 70-80% of HCCs inoperable at the time of diagnosis. Therefore, percutaneous ethanol injection (PEI) and radiofrequency thermal ablation (RFTA) are non-surgical therapeutic options for patients with small HCCs. In patients with advanced tumor stage transarterial chemoembolization (TACE) and its variants showed no survival benefit on the basis of randomized trials. In several studies, however, combined treatment strategies like TACE and PEI or RFTA after occlusion of tumor blood supply in the treatment of advanced HCC seems to result in a survival benefit. All HCC patients should be included in randomized treatment studies.
Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Etanol/administração & dosagem , Hipertermia Induzida , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/mortalidade , Terapia Combinada , Humanos , Injeções Intralesionais , Neoplasias Hepáticas/mortalidade , Taxa de SobrevidaRESUMO
BACKGROUND: It has been hypothesized that changes in heating systems and insulation of homes in developed countries have generated an indoor climate favorable to organisms that excrete allergens inducing sensitization and allergic disease. The purpose of this study was to determine the influence of the installation of highly insulated windows and central heating systems on indoor climate, and mite-allergen (Der f 1) and mold spore concentrations. METHODS: The bedrooms of 98 apartments were examined before and 7 months (mean) after installation of insulated windows and central heating systems. The air-exchange rate, temperature, and humidity were measured. In settled dust on carpets and mattresses, the number of colony-forming mold spores and the Der f 1 concentration were determined. The inhabitants completed a questionnaire about their lifestyles and housing conditions. RESULTS: The air-exchange rate decreased from geometric mean 0.73 to 0.52 per hour (P=0.029). Temperature (mean 13.4 vs 17.5 degrees C, P<0.001), and absolute humidity (mean 4.6 g vs 6.2 g H2O/kg air, P<0.001) increased. Relative humidity remained nearly unchanged (mean 47.6 vs 49.1%). Der f 1 concentrations on carpets (geometric mean 0.65 vs 1.28 microg/g dust, P < 0.001) and mattresses (geometric mean 1.56 vs 2.40 microg/g, P=0.002) increased. Among the fungi that were analyzed, only the thermotolerant species Aspergillus fumigatus increased (geometric mean 20 vs. 60 colony-forming units/g carpet dust, P = 0.02). CONCLUSIONS: The findings of this study suggest that the installation of insulated windows and central heating systems is associated with an increase of Der f 1 concentrations in carpet and mattress dust and of A. fumigatus in carpet dust in apartment bedrooms.
Assuntos
Poluição do Ar em Ambientes Fechados/análise , Alérgenos/análise , Glicoproteínas/análise , Habitação , Esporos Fúngicos/isolamento & purificação , Animais , Antígenos de Dermatophagoides , Leitos/microbiologia , Microbiologia Ambiental , Calefação/efeitos adversos , Umidade/efeitos adversos , Ácaros/química , TemperaturaRESUMO
In spite of procedures such as CT angiography, MR angiography, and rotation angiography, panangiography is still indispensable in therapeutic planning for cerebral aneurysms. It is the only method that provides exact details about the size, anatomic localization, and multiplicity of aneurysms as well as relation to surrounding vessels, the presence of an aneurysmal neck, and for the evaluation of the collateral circulation required to answer the question if endovascular therapy is possible. In addition, panangiography still exhibits the highest selectivity in the detection of cerebral aneurysms.
Assuntos
Angiografia/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Circulação Cerebrovascular , Circulação Colateral , Humanos , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Evaluation of MRI in radiotherapy of humeroscapular periarthritis. PATIENTS AND METHODS: Seventy-seven patients with humeroscapular periarthritis prospectively underwent MRI before radiotherapy. RESULTS: Six months after radiotherapy, 34% of the patients had achieved complete pain relief, 35% major pain relief. Twenty percent had only slight improvement and 12% no improvement. Positive correlation of radiotherapy outcome and MRI findings could be shown for acute tendinitis, erosions, and complete and incomplete ruptures of the supraspinatus tendon. CONCLUSIONS: Radiotherapy is highly effective in the treatment of humeroscapular periarthritis. The indication can be improved using MRI.
Assuntos
Periartrite/radioterapia , Fótons/uso terapêutico , Articulação do Ombro/efeitos da radiação , Idoso , Campos Eletromagnéticos , Feminino , Seguimentos , Humanos , Úmero/efeitos da radiação , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Escápula/efeitos da radiação , Resultado do TratamentoRESUMO
The purpose of this work was to evaluate the enhancement of different concentrations of gadolinium (Gd), ytterbium (Yb) and iodine in vitro and in vivo. Comparisons were made of the enhancement (HU) of Gd, Yb and iodine in concentrations ranging from 0.1 to 30 mg/ml. In vivo dynamic CT studies were performed in ten dogs with 0.5 M Gd, Yb and iodine. Time-density curves were achieved in aorta and liver. The in vitro studies confirmed a decrease in the enhancement in this order: Gd (120 kV) > Gd (137 kV) > Yb (120 kV) > Yb (137 kV) > iodine (120 kV) > iodine (137 kV). The specific enhancement of Gd was 40.8 (120 kV), of Yb 34.2 and of iodine 29.6 HU. The enhancement of the liver decreases from 21 HU (Gd) to 19 HU (Yb) and 12 HU (iodine). Gd and Yb achieved a higher aortal enhancement than iodine (190 vs 157 HU) All contrast media were well tolerated. Equimolar concentrations of Gd and Yb show a higher in vitro contrast and enhancement than iodine.
Assuntos
Meios de Contraste , Tomografia Computadorizada por Raios X , Animais , Aortografia , Cães , Gadolínio , Gadolínio DTPA , Iodo , Fígado/diagnóstico por imagem , Compostos Organometálicos , Ácido Pentético/análogos & derivados , Imagens de Fantasmas , ItérbioRESUMO
We report an eight years old boy presenting with a pyogenic granuloma of the scalp, generalized alopecia, descamative plates in the neck, trunk and limbs and nail involvement. Cultures for fungus of all these lesions disclosed Microspore canis. The patient was treated with oral griseofulvin, miconazole and topical tolnaftate. Five years later and after several incomplete treatments, the patient returns with a fistulous mass of 15 x 8 cm in the dorsal area whose culture revealed Microspore canis. The mass was excised and oral ketoconazole was indicated. After three months of follow up, the patient was lost from control.
Assuntos
Microsporum/isolamento & purificação , Micetoma/microbiologia , Antifúngicos/uso terapêutico , Criança , Humanos , Masculino , Micetoma/tratamento farmacológico , Micetoma/patologia , Onicomicose/microbiologiaRESUMO
Monostotic Paget's disease has a well known appearance in radiography. Only in exceptions is a further diagnostic procedure necessary. The value of MRI and scintigraphy is demonstrated on an osteolytic lesion of the tibia.
Assuntos
Imageamento por Ressonância Magnética , Osteíte Deformante/diagnóstico , Osteólise/diagnóstico , Cintilografia , Tíbia , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Tíbia/patologiaAssuntos
Meios de Contraste/administração & dosagem , Iohexol/análogos & derivados , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Meios de Contraste/farmacocinética , Relação Dose-Resposta a Droga , Feminino , Humanos , Iohexol/administração & dosagem , Iohexol/farmacocinética , Masculino , Pessoa de Meia-IdadeAssuntos
Neoplasias Hepáticas/secundário , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sistemas de Informação em RadiologiaRESUMO
20 patients with hepatocellular carcinomas (HCC) and 18 patients with tumours of the biliary passages and gallbladder (CAC)) were examined via angio-CT without table increment and via spiral CT. Evaluation of the time-density curve of angio-CT showed more rapid and greater enhancement in case of HCC, whereas CAC were characterised by slower and lesser contrast medium uptake than the surrounding hepatic tissue. Superior differential diagnostic information was obtained via angio-CT, whereas spiral CT yields the best information on extent and number of hepatic tumours.
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Neoplasias da Mama , Linfoma , Neoplasias Primárias Múltiplas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/uso terapêutico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Humanos , Linfoma/diagnóstico , Linfoma/tratamento farmacológico , Imageamento por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Transplante de Células-Tronco , Tomografia Computadorizada por Raios X , Vincristina/uso terapêuticoAssuntos
Aneurisma/complicações , Hidronefrose/etiologia , Hipertensão Renovascular/etiologia , Artéria Renal , Aneurisma/diagnóstico , Angiografia Digital , Doença Crônica , Feminino , Humanos , Hidronefrose/diagnóstico , Hipertensão Renovascular/diagnóstico , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
In general, renal artery aneurysms occur very rarely. This study reports on a 9-cm renal artery aneurysm which was erroneously thought to be a renal cyst, and which, as a result of depression of the renal parenchym and the ureteropelvic junction, led to arterial hypertension and consecutive, reduced function hydronephrosis.
Assuntos
Aneurisma/complicações , Hidronefrose/etiologia , Hipertensão Renovascular/etiologia , Artéria Renal , Aneurisma/diagnóstico por imagem , Angiografia Digital , Erros de Diagnóstico , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , UltrassonografiaRESUMO
Se estudiaron 78 muestras de uñas de manos y pies de 74 pacientes con diagnóstico de onimicosis. Para la obtención de la muestra se raspó la lámina interna de la uña, excepcionalmente la lámina externa y se efectuó el examen microscópico directo ya sea en koh-20 porciento-tinta parker 51 azul permanente o con koh-20 porciento-chloroback e. Todas las muestras fueron sembradas en agar sabouraud dextrosado, agar lactrimel y agar selectivo para dermatofitos (dim) e incubadas a 28ºC por 10-15 días. De las muestras estudiadas, en el 79,5 porciento se observaron hongos al examen microscópico directo, aislándose estos en el 61,5 porciento de los cultivos. La frecuencia de agentes de onimicosis fue: c. albicans (43,75 porciento), t. rubrum (31,25 prociento) y t. mentagrophytes (10,42 porciento). C.albicans se aisló en el 70,8 porciento de las onimicosis en manos de mujeres. T.rubrum se aisló en un 50 y 25 porciento de hombres y mujeres respectivamente. En pie se aisló en el 52,9 porciento y en mano en un 19,3 porciento. S. brevicaulis fue aislado en un solo caso
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Adulto , Arthrodermataceae/isolamento & purificação , Fungos/isolamento & purificação , Onicomicose/microbiologia , Candida albicans/isolamento & purificação , Trichophyton/isolamento & purificação , Leveduras/isolamento & purificaçãoRESUMO
We report six patients with Kerion Celsi due to Trichophyton verrucosum. Five of the patients were hospitalized with the diagnosis of Staphylococcal abscess. This confusion is due to that highly suppurative and inflammatory nature of the infection. Griseofulvin is the antimicrobial of choice for treatment, associated with imidazolics and corticosteroids to prevent alopecia. The authors suggest that an adequate use of simple microbiological diagnostic tests in the diagnosis of pyodermitis in rural children, may prevent unnecessary hospitalizations and permanent hair loss.
Assuntos
Dermatomicoses/diagnóstico , Dermatoses do Couro Cabeludo/diagnóstico , Criança , Pré-Escolar , Dermatomicoses/tratamento farmacológico , Feminino , Griseofulvina/uso terapêutico , Humanos , Masculino , TrichophytonRESUMO
Se presentan dos casos de onixis por sarcoptes scabei; el primero concomitante con síndrome de Down y el segundo en lactante. Caso 1: ácaro test positico en piel y en uña con alteraciones. Se efectúa tratamiento con vaselina azufrada al 5 por ciento por 8 meses (1 en piel y 7 en uña). El ácaro test es negativo post tratamiento. No se encontró asociación bacteriana ni micótica. Caso 2: lactante de 10 meses con ácaro test positivo en piel y uñas con alteración clínica. Portadora de un Cushing secundario por bronconeumonía y diarrea
Assuntos
Humanos , Masculino , Feminino , Lactente , Infestações por Ácaros/complicações , Sarcoptes scabiei/patogenicidade , Unhas Encravadas/complicações , Betametasona/efeitos adversos , Betametasona/uso terapêutico , Síndrome de Down , Contagem de Ovos de Parasitas , Vaselina/uso terapêutico , População Rural , Síndrome de Cushing/etiologia , Unhas Encravadas/diagnóstico , Unhas Encravadas/etiologia , Unhas Encravadas/tratamento farmacológicoRESUMO
Se realizó estudio microbiológico de raspado uretral de 142 pacientes de sexo masculino que consultaron al policlínico de Venéreas del Hospital Base de Valdivia durante 1989, los cuales fueron enviados al Instituto de Microbiología Clínica de la Universidad Austral de Chile con diagnóstico clínico de uretritis. La prevalencia de Uretritis Gonocócicas (UG) y Uretritis no Gonocócica (UNG) fue de un 50 por ciento para ambos tipos. U. urealyticum fue aislado en el 38 por ciento de los casos de UG y en el 59.2 por ciento de las UNG. Además se evaluó la efectividad del tratamiento de las uretritis por U. urealyticum con tetraciclina en base a tres esquemas: 2g/día durante 7 días, 2 g/día durante 14 días y 2 g/dia durante 21 días. Por este motivo, se seleccionaron 59 pacientes con uretritis por U. urealyticum, obteniéndose un 57,6 por ciento de éxito en el total de los pacientes estudiados. La mayor efectividad en el tratamiento fue para el esquema de 21 días (77.8 por ciento) además a medida que aumentó la edad de los pacientes la efectividad fue disminuyendo y cuando U. urealyticum se encontró asociado a otros microorganismos se obtuvo un mayor éxito en los tratamientos
Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Ureaplasma urealyticum/isolamento & purificação , Uretrite/microbiologia , Esquema de Medicação , Eritromicina/administração & dosagem , Estado Civil , Neisseria gonorrhoeae/isolamento & purificação , Tetraciclina/administração & dosagem , Ureaplasma urealyticum/efeitos dos fármacos , Ureaplasma urealyticum/patogenicidadeRESUMO
From 1985 to 1987 we obtained urethral samples from 453 patients with a clinical diagnosis of urethritis. N gonorrhoeae was isolated in 55%, a rate that increased along the study period. The most common other agent was U urealyticum alone or in combination with other organisms. Among 82 patients, the incidence of chlamydia trachomatis was 19%. The proportion of Beta-lactamase producing strains among N gonorrhoeae varied form 7% in 1985 to 13% in 87 and 3% in 1988.
Assuntos
Neisseria gonorrhoeae/isolamento & purificação , Ureaplasma/isolamento & purificação , Uretrite/microbiologia , Adolescente , Adulto , Violeta Genciana , Humanos , Masculino , Pessoa de Meia-Idade , FenazinasRESUMO
The presence of Chlamydia trachomatis was studied by the direct immunofluorescence test, as also was that of Neisseria gonorrhoeae, Mycoplasma and Ureaplasma by the standard methods, in 82 patients with urethral discharge. Ch. trachomatis was found in 19.5% (16) of the cases and in 11 of them (68.8%) there was association with the other bacteria investigated. This eleven patients presented a scanty gelatinous discharge.