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The risk of transmission of infection during GI endos-copy is estimated at 1 case per 1.8 million procedures. The ASGE published a national multisociety guideline in 2003 for the cleaning and high-level disinfection of GI endoscop...
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The risk of transmission of infection during GI endos-copy is estimated at 1 case per 1.8 million procedures. The ASGE published a national multisociety guideline in 2003 for the cleaning and high-level disinfection of GI endoscopes. There are no reported cases of transmission of infection when these guidelines have been followed. In the absence of defective equipment, the reported cases of transmission of infection appear to have resulted from failure to adhere to currently accepted guidelines for the high-level disinfection of endoscopes.
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Recent attention has been called to the interpretation of studies of antiinfective agents demonstrating effects on the QTc interval. It seems that the effects of many of these agents on the QTc interval are small, but in some pati...
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Recent attention has been called to the interpretation of studies of antiinfective agents demonstrating effects on the QTc interval. It seems that the effects of many of these agents on the QTc interval are small, but in some patient populations, these drugs may cause morbidity and mortality related to TdP. It would be beneficial to researchers and clinicians alike for the FDA to standardize the types of studies designed to assess the QTc interval prolongation potential of a drug, methodologies, and interpretation criteria. To this end, it would increase the efficiency of the drug-approval process, give regulatory agencies and clinicians guidance, and increase patient safety. In summary we congratulate Dr. Frothingham for attempting to address the challenging issue of postmarketing safety surveillance. A critical review of his analysis of fluoroquinolone-associated TdP as well as other data on this potentially life-threatening adverse event support the following conclusions: Information from spontaneous reports is generally useful as an early warning system for excess adverse events, but reporting rates are not synonymous with incidence rates. The deficiencies of Dr. Frothingham's analysis lead to serious questions regarding the validity of both the numerators and denominators used in the incidence calculations (e.g., exclusion of European results, use ot extrapolated outpatient prescriptions, failure to account for inpatient versus outpatient utilization, failure to apply the appropriate statistical test to a rarely occurring, adverse event) and call into question conclusions about the relative risk of TdP with different fluoroquinolones. The association between which of the fluoroquinolones was administered to high-risk patients, which is important in the multiple-hit hypothesis, remains nebulous (e.g., failure to separate cases by route of drug administration and failure to identify which fluoroquinolones were given to patients with electrolyte abnormalities, concurrent QT interval-prolonging drugs, comorbid disease states). Preclinical and clinical trial data, as well as data from phase IV studies, indicate that levofloxacin, moxifloxacin, and gatifloxacin prolong the QTc interval, and the potential for TdP to develop as a result is rare and is influenced by many independent variables (e.g., concurrent drug administration of class Ia and III antiarrhythmic agents). These results should make clear that assessment of the cardiotoxicity of any new drug must take into account information (and its limitations) from several sources: preclinical studies that test effects on mechanisms underlying potential toxic reactions, controlled toxicodynamic studies in human volunteers safety results from controlled clinical trials, findings from phase IV studies, and postmarketing surveillance that includes spontaneously reported adverse events. One message that must not be lost in this discussion over the use of this reporting system to calculate incidences to incriminate certain agents is its overall importance, over time, in assisting governing bodies and clinicians alike in identifying compounds that may place certain patient populations at risk. It is imperative that clinicians not only submit adverse event reports to the FDA, but provide complete and accurate information. For moxifloxacin, levofloxacin, and gatifloxacin, the point must be clear that these agents should not be used in patients with risk factors predisposing them to TdP.
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OBJECTIVE: The purpose of this study was to examine and compare the four combination of pulse oximeters (POs) and monitoring sites, the Nihon Kohden BSS-9800 (N), the Masimo SET Radical (M), the Nellcor N550 D-25 (N-D) and the Nel...
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OBJECTIVE: The purpose of this study was to examine and compare the four combination of pulse oximeters (POs) and monitoring sites, the Nihon Kohden BSS-9800 (N), the Masimo SET Radical (M), the Nellcor N550 D-25 (N-D) and the Nellcor N550 Max-Fast (N-MF) in patients with peripheral hypoperfusion. METHODS: About 20 adult patients undergoing cardiac surgery using mild hypothermic cardiopulmonary bypass (CPB) were studied prospectively. PO sensors were applied on fingers in N, M and N-D, while on the forehead in N-MF. RESULTS: PO failure was defined as failure to show no SpO2 value or incorrect SpO2 values. PO failure occurred in 12 patients with N, ten patients with M, four patients with N-D and ten patients with N-MF, respectively (p < 0.05 N-D vs. N, M, N-MF). The duration of PO failure was 19 +/- 30% of aortic cross-clamping with N, 29 +/- 33% with M, 10 +/- 26% with N-D and 43 +/- 57% with N-MF, respectively (p < 0.05 N-D vs. M and N-MF). CONCLUSIONS: The results suggested that N-D is most useful among four combinations of POs and monitoring sites tested in this study for monitoring SpO2 during hypoperfusion. The superiority of N-MF during hypoperfusion was not evident in the present study.
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Removing the broken pedicular screw after spinal hardware failure is usually problematic. A specially designed simple screwdriver and easy removal technique of broken pedicular screw with this screwdriver are described in this article.
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In the early days of the treatment of erectile dysfunction (ED) penile prosthesis played a prominent role and subsequently intracavernosal injections were at the vanguard of the management of the patient with ED. The advent of the...
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In the early days of the treatment of erectile dysfunction (ED) penile prosthesis played a prominent role and subsequently intracavernosal injections were at the vanguard of the management of the patient with ED. The advent of the phosphodiesterase inhibitors (PDEi), promising all things to all men (and women), appeared to relegate non-oral or indeed non-drug options to the background. It would appear that both options are becoming increasingly important in the continuum of treatments for the patient with ED. Why is this the case? And where does the pharmaceutical industry come into this, if at all?In urological research and treatment it often takes some time to identify and/or accept the obvious. One example particularly pertinent to the topic of this article is the realisation that even 'nerve-sparing' prostatic surgery causes a substantial degree of collateral damage, even in the hands of the most skilled robotic surgeon; the 'acceptance' phase. Equally, we are no longer in denial about the potential (or should it be the limitations) of PDEi. The efficacy of this class of agent depends on some degree of neuronal activity and a reasonably efficient vascular bed within the corporal tissue. In many patients with ED both of these physiological systems will have ."sufficient residual integrity to allow the production of a full erectile response.
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EDITOR: Extubation failure is defined as the need for rein-stitution of ventilatory support within 24-72 h of planned endotracheal tube removal. It occurs in 2?5% of extubated patients. Many causes, such as an imbalance between re...
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EDITOR: Extubation failure is defined as the need for rein-stitution of ventilatory support within 24-72 h of planned endotracheal tube removal. It occurs in 2?5% of extubated patients. Many causes, such as an imbalance between respiratory muscle capacity and work of breathing, upper airway obstruction, excess respiratory secretions, inadequate cough, encephalopathy and cardiac dysfunction, have been stated in the literature . In patients on mechanical ventilation for exacerbations of chronic obstructive pulmonary disease (COPD), no exact extubation failure rates are known; however, occurrence rates will probably not be very low. Furthermore, the institution of non-invasive pressure ventilation for extubation failure has not been proven to be safe . In COPD, the decision for reintubation is difficult and will be weighed against the chances of successful treatment of underlying causes. In case the respiratory reserve is marginal, reintubation sometimes will be foregone. We present a case of a 71-yr-old female with COPD and non-small cell lung cancer in which advanced COPD was suspected to be the major reason for extubation failure, but careful examination led to an unexpected and treatable underlying disorder.
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Sir: We have been following the scientific literature on the use of activated protein C (APC) [1, 2], the negative selective interpretation of the data , and the responses to this interpretation . We would like to add to this deba...
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Sir: We have been following the scientific literature on the use of activated protein C (APC) [1, 2], the negative selective interpretation of the data , and the responses to this interpretation . We would like to add to this debate by presenting our data regarding the use of APC in severe tropical infections, on which there is no published literature currently. Malaria, leptospirosis and dengue can lead to refractory multi-organ failure. A total of ten such patients have received APC in our ICU since the drug became available in India. Table 1 shows the details of these patients. All ten needed invasive mechanical ventilation, nine had refractory shock and required catacholamines, and all ten had azotaemia, with eight needing renal replacement therapy for anuria.
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Grunbaum claims that the remedial failure of a treatment's characteristic factors is the generic, objective property of a placebo. He stipulates that a treatment is placebic if this remedial failure exacerbates the target disorder...
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Grunbaum claims that the remedial failure of a treatment's characteristic factors is the generic, objective property of a placebo. He stipulates that a treatment is placebic if this remedial failure exacerbates the target disorder. This stipulation can subsume as placebic effects that might be solely pharmacological, e.g., paradoxical reactions to certain psychiatric drugs. If that exacerbation can be explained pharmacologically, then we might question whether Grunbaum's definitional scheme captures the core identity of what we usually intend by the placebo concept. I propose that this core identity is best captured by a symbolic meaning hypothesis in which psychological factors exert the determinative influence.
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Between 1987-2002, omental free-tissue transfer was used in 11 patients, aged 6-65 years (mean age, 37.6). The omentum was used for the treatment of brachial plexus injury pain (3 cases), Romberg's disease (1 case), defects of the...
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Between 1987-2002, omental free-tissue transfer was used in 11 patients, aged 6-65 years (mean age, 37.6). The omentum was used for the treatment of brachial plexus injury pain (3 cases), Romberg's disease (1 case), defects of the extremities occurring with chronic obstructive arterial disease (2 cases), posttraumatic lesions (3 cases), and following oncological resections (2 cases). In 2 cases, omental tissue represented the secondary option, after the failure of muscular tissue transfer. In 2 patients, the omental tissue transfer helped to preserve the knee. There was 1 failure, followed by amputation of the thigh. Two patients died from their underlying disease 10 and 36 months, respectively, after the operation.
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