Johnsengolden0828
246 weak. We identify 27% de false negatives for CRMN in detecting choledocusd lithiasis.
The CPRM and ERCP had a moderate correlation according to the Kappa index detecting dilatation and choledocus calculi in our patients. The number of false negatives for choledocolithiasis by CPRM leads us to seek in other prospective aleatory studies like endoscopic biliiopancreatic ultrasonopgraphy to compare the CPRM in patients with intermediate probability for choledocolithiasis.
The CPRM and ERCP had a moderate correlation according to the Kappa index detecting dilatation and choledocus calculi in our patients. The number of false negatives for choledocolithiasis by CPRM leads us to seek in other prospective aleatory studies like endoscopic biliiopancreatic ultrasonopgraphy to compare the CPRM in patients with intermediate probability for choledocolithiasis.
To determine the prevalence of irritable bowel syndrome and functional dyspepsia in medical students from a private university in Lima, Peru. Furthermore, to determine the associated factors with these diseases.
Observational descriptive and retrospective cross sectional study. Medical students from a private university in Lima were surveyed using a Rome III questionnaire for functional disorders and the STEPwise auto survey for defining the variables of alcohol and tobacco. For data analysis the Stata 11.0 program was used.
Of the 608 students, 543 answered the questionnaire. The prevalence of Irritable Bowel Syndrome was 12.4%, 16.9% of dyspepsia, and of both diseases simultaneously, a prevalence of 7.1% was found. Alcohol consumption in the total population was 89.4% and 29.0% of tobacco. Association between both disorders was found (OR 10.47, 95% CI 5.08 to 21.55; p < 0.001), dyspepsia was associated with sex (OR 0.16, 95% CI 0.07 to 0.36 p < 0.001), with alcohol consumption (OR 5.22, 95% CI 23.99 1,13- p = 0.034) and with irritable bowel syndrome (OR 9.88, 95% CI 4.78 to 20.46 p <0.001). Both conditions together were associated with sex (OR 0.20, 95% CI from 0.06 to 0.60 p = 0.004) and daily consumption of tobacco (OR 3.23, 95% CI 1.17 to 8.89 p = 0.023).
A prevalence of 12.4% of Irritable Bowel Syndrome and 16.9% of dyspepsia was determined. An overlap of 7.1% of these diseases was reported.
A prevalence of 12.4% of Irritable Bowel Syndrome and 16.9% of dyspepsia was determined. An overlap of 7.1% of these diseases was reported.There is evidence of substantial benefit of cardiac rehabilitation (CR) for patients with low exercise capacity at admission. Nevertheless, some patients are not able to perform an initial exercise stress test (EST). We aimed to describe this group using data of 1094 consecutive patients after a cardiac event (71±7 years, 78% men) enrolled in nine centres for inpatient CR. We analysed sociodemographic and clinical variables (e.g. cardiovascular risk factors, comorbidities, complications at admission), amount of therapy (e.g. exercise training, nursing care) and the results of the initial and the final 6-min walking test (6MWT) with respect to the application of an EST. Fifteen per cent of patients did not undergo an EST (non-EST group). this website In multivariable analysis, the probability of obtaining an EST was higher for men [odds ratio (OR) 1.89, P=0.01], a 6MWT (per 10 m, OR 1.07, P less then 0.01) and lower for patients with diabetes mellitus (OR 0.48, P less then 0.01), NYHA-class III/IV (OR 0.27, P less then 0.01), osteoarthritis (OR 0.39, P less then 0.01) and a longer hospital stay (per 5 days, OR 0.87, P=0.02). The non-EST group received fewer therapy units of exercise training, but more units of nursing care and physiotherapy than the EST group. However, there were no significant differences between both groups in the increase of the 6MWT during CR (123 vs. 108 m, P=0.122). The present study confirms the feasibility of an EST at the start of CR as an indicator of disease severity. Nevertheless, patients without EST benefit from CR even if exercising less. Thus, there is a justified need for individualized, comprehensive and interdisciplinary CR.Hypercoagulability can pose a significant problem in microsurgical reconstruction. Here, the authors provide a comprehensive review of macrovascular and microvascular clotting phenomena from the unique viewpoint of two microsurgeons and a hematologist. The authors review the literature surrounding prevention of microvascular clots and provide an extensive discussion of hereditary thrombophilia. link2 The authors also make explicit recommendations regarding the utility of thrombophilia testing and preoperative and perioperative management strategies for patients with hypercoagulability.
After studying this article, the participant should be able to 1. Identify the anatomy of both the vascular supply and the innervation to the breast to design the appropriate pedicle in breast reduction. 2. Understand various approaches to breast reduction to be able to maximize both functional and aesthetic results. 3. Understand each step in the operative procedure to be able to provide consistent predictable results in breast reduction.
The objective with breast reduction surgery is to reposition the nipple, remove excess parenchyma, and tailor the skin to fit the new shape. This is a CME article meant to provide an overview of principles while trying not to provide a single practitioner viewpoint. The article includes a brief history, a review of the anatomy, and patient selection. The preoperative markings and operative technique for both inverted-T and vertical approaches are detailed. Postoperative care and potential complications are included.
The objective with breast reduction surgery is to reposition the nipple, remove excess parenchyma, and tailor the skin to fit the new shape. This is a CME article meant to provide an overview of principles while trying not to provide a single practitioner viewpoint. The article includes a brief history, a review of the anatomy, and patient selection. The preoperative markings and operative technique for both inverted-T and vertical approaches are detailed. Postoperative care and potential complications are included.
Split-thickness skin grafting is the current gold standard for treatment of major traumatic skin loss. However, split-thickness skin grafting is limited by donor-skin availability, especially in large burns. In addition, the donor-site wound is associated with pain and scarring. Multiple techniques have been developed in the past to overcome these limitations but have been unable to achieve clinical relevance. In this study, the authors examine the novel emerging skin grafting techniques, aiming to improve the utility of split-thickness skin grafting.
An extensive literature review was conducted on PubMed, MEDLINE, and Google Scholar to look for new skin grafting techniques. Special focus was given to techniques with potential for large expansion ratio and decreased donor-site pain.
The new modalities of modified skin grafting technique, discussed in this article, include (1) Xpansion Micrografting System, (2) fractional skin harvesting, (3) epidermal suction blister grafting, and (4) ReCell technology. These techniques are able to achieve significantly increased expansion ratios compared with conventional split-thickness skin grafting and also have decreased donor-site morbidity.
These techniques can be used separately or in conjunction with split-thickness skin grafting to overcome the associated pitfalls. Further studies and clinical trials are needed to define the utility of these procedures and where they fit into routine clinical practice.
These techniques can be used separately or in conjunction with split-thickness skin grafting to overcome the associated pitfalls. Further studies and clinical trials are needed to define the utility of these procedures and where they fit into routine clinical practice.
Elicitation of eye closure and other movements via electrical stimulation may provide effective treatment for facial paralysis. The authors performed a human feasibility study to determine whether transcutaneous neural stimulation can elicit a blink in individuals with acute facial palsy and to obtain feedback from participants regarding the tolerability of surface electrical stimulation for daily blink restoration.
Forty individuals with acute unilateral facial paralysis, HB grades 4 through 6, were prospectively studied between 6 and 60 days of onset. Unilateral stimulation of zygomatic facial nerve branches to elicit eye blink was achieved with brief bipolar, charge-balanced pulse trains, delivered transcutaneously by adhesive electrode placement; results were recorded on a high-speed video camera. The relationship between stimulation parameters and cutaneous sensation was analyzed using the Wong-Baker Faces Pain Rating Scale.
Complete eye closure was achieved in 55 percent of participants using stimulation parameters reported as tolerable. In those individuals, initial eye twitch was observed at an average current of 4.6 mA (±1.7; average pulse width of 0.7 ms, 100 to 150 Hz), with complete closure requiring a mean of 7.2 mA (±2.6).
Transcutaneous facial nerve stimulation may artificially elicit eye blink in a majority of patients with acute facial paralysis. Although individuals varied widely in their reported degrees of discomfort from blink-eliciting stimulation, most of them indicated that such stimulation would be tolerable if it could restore eye closure. These patients would therefore benefit from a biomimetic device to facilitate eye closure until the recovery process is complete.
Therapeutic, IV.
Therapeutic, IV.
Vascular anomalies and related conditions cause overgrowth of tissues. The purpose of this study was to determine the efficacy and safety of liposuction techniques for pediatric overgrowth diseases. Patients treated between 2007 and 2015 who had follow-up were reviewed. Seventeen patients were included; the median age was 12.7 years. link3 The causes of overgrowth included infiltrating lipomatosis (n = 7), capillary malformation (n = 6), hemihypertrophy (n = 1), infantile hemangioma (n = 1), lipedema (n = 1), and macrocephaly-capillary malformation (n = 1). Forty-seven percent had enlargement of an extremity, 41 percent had facial hypertrophy, and 12 percent had expansion of the trunk. All subjects had a reduction in the size of the overgrown area and improved quality of life. Suction-assisted tissue removal is an effective technique for reducing the volume of the subcutaneous compartment for patients with pediatric overgrowth diseases.
Therapeutic, IV.
Therapeutic, IV.
Routine admission following primary cleft palate repair is the standard of care at most institutions. Insurance companies have demonstrated increasing resistance to hospitalization longer than a "short stay"(23 hour) observation period following palatoplasty. The purpose of this study was to identify factors related to length of stay following palate repair.
Retrospective chart review was conducted for 100 consecutive patients undergoing primary cleft palate repair from May 2009 to February 2013. Demographic and perioperative data were collected and two-sample Student t-test, univariate and multivariable linear regression models were performed to assess for correlation with longer length of stay.
Mean age at the time of surgery was 12.6 months. Median length of stay was 39 hours; all 100 patients had >23 hours length of stay. Seventy-three percent of patients required intravenous fluids greater than 23 hours after admission. Postoperative intravenous narcotics were required in 92 percent of patients after transfer to the post-surgical floor, and the last dose was given on average 19.
