53 research outputs found
Dysfunctional loop ileostomy after low anterior resection for rectal cancer in the presence of Meckel’s diverticulum: a case report
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.
BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700
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Scintigraphy for Brain Tumors
Parmenides said that what cannot be thought, cannot be, therefore, what can be, can be thought. So it was that ancient Greek philosophers had thought of the atoms, and particularly, the radioactive atoms we use in Nuclear Medicine. Indeed, Democritos in the sixth century bc formulated the idea of the atoms as the indestructible smaller elements of the universe that combine among themselves to form the visible world; he thought of atoms on a philosophical basis as the explanation of the changes in the environment, which occur without the perishment of matter. Rearrangements of “atoms” could explain the changes around us and inside us. Two centuries later, Epicuros, as if anticipating the discovery of the radioactive atoms, introduced the idea of the “unstable” atom, which, after a period of instability, takes its final stable form. More than 2,000 years later, when science overtook these frontiers, John Dalton knew Democritos’ Atomic Theory of Matter and used it to explain chemical experiments. If the atom (=not possible to cut) can be cut and split into parts, it is not Democritos’ fault. Today we understand that by “atoms” Democritos actually meant the “quarks” or the “strings,” or perhaps some other, yet to be discovered, elemental particles. As for Henri Beckerel and Marie Curie, who were among the first to deal with radioactivity and the “unstable” or “radioactive atoms,” it is not known if they knew that the theoretical father of Nuclear Science was Epicuros. In Nuclear Medicine, we use the “radioactive atoms,” which are the “atoms” meant by Democritos (as applied by Dalton), in their unstable form, which was anticipated by Epicuros, for imaging of tissues or diseases and for therapy of malignant or benign diseases
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Radioantibodies for the Diagnosis and Treatment of Cancer; Radioimmunoimaging (RAI) and Radioimmunotherapy (RAT)
Angiotensin-Converting Enzyme-Inhibited Renography for the Diagnosis of Ischemic Kidneys
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Effect of illness on serum growth hormone response to intravenous glucose
Intravenous glucose was given to nine control patients, 16 ill patients without malignancy, and 20 patients with localized or metastatic malignancy to study hGH responses. All of the controls showed normal hGH suppression 1 hr after glucose. A paradoxical rise in hGH levels 1 hr after glucose was observed in the group of ill patients without tumors (
p < 0.05) and the group with malignancy (
p < 0.05) when each group was compared with the control group. Elevated plasma cortisol levels and a severe degree of illness correlated positively with the paradoxical hGH response, while plasma free fatty acids and insulin showed no correlation. These studies suggest that hGH levels may paradoxically rise soon after intravenous glucose in ill patients with or without malignant disease, and the paradoxical response is not specifically related to etiology but rather is a result of the stress of significant illness acting on the hypothalamus-anterior pituitary
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Interaction of cyclosporine A and nonsteroidal anti-inflammatory drugs on renal function in patients with rheumatoid arthritis
purpose: To determine the additive renal effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclosporine A (CYA) in patients with rheumatoid arthritis (RA) and to determine the effects of CYA on active RA.
patients and methods: Eleven patients with RA refractory to other agents were treated separately for 2-week periods with an NSAID (sulindac or naproxen), CYA (5 mg/kg/d), and NSAID plus CYA in combination (NSAID/CYA). The NSAID/CYA combination was continued for an additional 20 weeks. Clinical parameters of RA, electrolytes, renal function, and the renin-aldosterone system were evaluated at each interval to determine the potential interaction of these two agents.
results: Combined therapy was effective in suppressing many measures of active RA in 9 of the 11 patients. Adverse drug reactions were common, but withdrawals were limited to hirsutism (one) and peripheral neuropathy (one).
In about half of the patients, CYA or NSAID resulted in a decrease in the glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), with a mild reduction in the filtration fraction. With NSAID or CYA, early morning renin-aldosterone system values were mildly suppressed, and their response to ambulation/intravenous (IV) furosemide was not blunted.
When combined, NSAID/CYA caused more marked reductions of GFR and ERPF at 2 weeks, and this persisted at 20 weeks. The morning renin-aldosterone system values during administration of NSAID/CYA were suppressed, with an added blunted response to ambulation/IV furosemide.
conclusion: As previously suspected, the impairment of renal function when CYA and NSAID are combined is greater than that obtained with either agent alone. This hemodynamic effect was reversible and appeared to be, at least in part, due to renal vasoconstriction
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The value of radionuclide scanning in early diagnosis of intestinal infarction
Small focal areas of intestinal infarction were produced experimentally in mice by two techniques: (1) intussusception and (2) suture strangulation of a loop of jejunum. The radionuclide technetium 99m diphosphonate (
99mTc-diphosphonate) was subsequently administered intravenously, and abdominal scans were obtained. The scans demonstrated focal infarcted lesions accurately, and every positive scan was associated with an area of infarction, as demonstrated by pathologic examination. However, negative scans did not definitely exclude an area of infarction: in the intussuception study there were five false negative scans in 25 animals, and in the loop ligation study there were two false negative scans in 28 animals. The technique may have clinical application in such intestinal diseases as necrotizing enterocolitis in infancy in which early diagnosis of small areas of necrosis is currently difficult by clinical and radiologic methods
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