RESUMO
Systemic Gardnerella infections are rare and usually associated with surgical instrumentation of the genitourinary tract. We present a case of symptomatic and transient Gardnerella bacteremia in a man with AIDS after a traumatic urinary catheter insertion.
Assuntos
Bacteriemia/diagnóstico , Gardnerella/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Hospedeiro Imunocomprometido , Cateterismo Urinário/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriemia/etiologia , Gardnerella/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por HIV/complicações , Infecções por HIV/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologiaRESUMO
Safe and appropriate health care, especially in urgent or emergency situations, is the expectation of the public throughout the developed world. Achieving this goal requires appropriate levels of medical and other staff, appropriate training, and sensible working hours. Too often the brunt of such care, especially in out-of-hours situations, is borne by medical residents, who--to make matters worse--are frequently poorly supervised by more senior and experienced staff. Many jurisdictions have been alerted to this problem and are striving to correct it. However, the variation in attempts to restrict the actual hours worked by residents to "safe" levels is enormous, and all too often there is no consensus as to what should be put in place to achieve safe patient care. This paper sets out the current position for Europe, North America, and Australia.
Assuntos
Competência Clínica/normas , Internato e Residência/legislação & jurisprudência , Segurança do Paciente/normas , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Austrália , Canadá , Comparação Transcultural , Europa (Continente) , União Europeia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Internato e Residência/organização & administração , Internato e Residência/tendências , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/tendências , Estados UnidosRESUMO
The purpose of this study was to evaluate consecutive shoulder arthroscopies for the presence or absence of a space between the biceps tendon and the supraspinatus as an indicator of a full-thickness rotator cuff tear. We performed 588 consecutive shoulder arthroscopies in the lateral decubitus position, and the presence or absence of a space between the rotator cuff (supraspinatus) and the biceps tendon was recorded immediately upon entering and insufflating the joint. Of the 588 patients, 174 (30%) were found to have full-thickness rotator cuff tears. Of these 174 patients, 171 had absence of the space between the biceps and the supraspinatus, for a sensitivity of 98%. Of the 414 patients in whom no full-thickness tear was present, 4 had absence of the space, for a specificity of 99%. The 4 patients with a false-negative result had adhesive capsulitis. During shoulder arthroscopy, a normal interval exists between the supraspinatus and biceps tendons as a result of joint insufflation. Loss of this interval is both highly sensitive (98%) and specific (99%) for a full-thickness rotator cuff tear. The space between the rotator cuff and the biceps tendon can be a reliable adjunct for verification of a full-thickness rotator cuff tear immediately upon entering the shoulder joint but should not be used in place of a full arthroscopic evaluation of the cuff.
Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador , Manguito Rotador/cirurgia , Traumatismos dos Tendões/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Coortes , Estudos de Avaliação como Assunto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Lesões do Ombro , Articulação do Ombro/cirurgia , Traumatismos dos Tendões/cirurgiaRESUMO
The synthetic neurotoxicant 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induces a Parkinsonian-like syndrome in humans and nonhuman primates, and also causes movement disorders in rodents, fish, amphibians and lizards. To date, the effects of MPTP have not been characterized in snakes. In this study, the behavioral and biochemical effects of MPTP were assessed in the black ratsnake Elaphe o. obsoleta and the banded watersnake Nerodia f. fasciata--species that display contrasting behavioral sensitivities to dopaminergic antagonists and to amphibian toxins. We report that MPTP induces depletion of norepinephrine and serotonin in fore, mid and hindbrain regions and depletion of dopamine in fore and midbrain regions in E.o. obsoleta. MPTP also induced a marked reduction in righting ability in E.o. obsoleta. In N.f. fasciata, norepinephrine and dopamine were depleted by MPTP in all three brain regions and serotonin was only significantly reduced in the forebrain. In contrast to E.o. obsoleta, N.f. fasciata demonstrated no behavioral disorders. This study demonstrates a behavioral and biochemical sensitivity to MPTP in E.o. obsoleta that differs from that in N.f. fasciata. The differential sensitivities to monoaminergic modulation may be related to the contrasting diets of these species.
