ABSTRACT
In 1955, Allen and Masters describe a painful syndrome which associates traumatic delivery to laceration found on the posterior leaf of the broad ligament. Herniation through this defect is a rare entity, accounted for about 4-7% of all internal hernias. Normally, it involves the small bowel. The authors present the case of a multiparous woman admitted at emergency for constipation and abdominal pain. The CT scan showed an extremely rare case of internal hernia of the sigmoid colon, fallopian tube and left ovary through a large defect of the broad ligament. The patient underwent a full laparoscopic surgery that allowed the reduction of the hernia and the suture of the defect with very good outcome.
Subject(s)
Abdominal Pain/etiology , Acute Pain/etiology , Broad Ligament/injuries , Fallopian Tube Diseases/etiology , Hernia/etiology , Lacerations/complications , Ovarian Diseases/etiology , Sigmoid Diseases/etiology , Adult , Female , Humans , SyndromeABSTRACT
The application of homeopathic treatment quickly becomes a matter of ideological confrontation; however, homeopathy is steadily gaining in sympathy in the population. Although the possible effectiveness and the modes of action are currently not scientifically elucidated and the study situation regarding homeopathic treatment in psychiatry is still manageable, there is a whole series of positive evidence for the effects of homeopathic remedies for mental disorders, such as depression, anxiety disorders and addiction. The most important studies are presented and the most important arguments are weighed up with respect to the pros and cons. It is clear that homoeopathic remedies can only be used as an add-on and not alone. These remedies belong in the hands of physicians experienced in homeopathic and psychiatric psychopharmacology. It would be advisable to at least try out homeopathy for the well-being of the patient not only in the case of very mild disorders but also in severe chronic cases, since due to the generally good tolerability, no avoidable disadvantage should result.
Subject(s)
Homeopathy , Mental Disorders , Psychiatry , Homeopathy/standards , Humans , Mental Disorders/therapy , Psychiatry/methodsABSTRACT
Ballistic trauma is not the prerogative of battlefields and currently extends to civil environments. Any surgeon or emergency room can be faced with such trauma whose management requires an understanding of wound ballistics. The aim of this retrospective is reviewing the management of ballistic trauma within the C.H.U. Saint-Pierre hospital over a period of ten years. Data recorded included demographics data, lesions, clinical parameters, imaging, treatment and outcome. It appears that the wounds of the members have a low mortality rate but a significant rate of complications. Patients should be managed according to the ATLS protocol and according hemodynamic stability and location of the injury, benefit from imaging. Unstable patients will be operated in emergency, stable patients will be treated according to the extent of damage and the type of fracture either conservatively or by external fixator and intramedullary centromedullary. Debridement and antibiotics are recommended as a nerve exploration if there is a peripheral paralysis. The management of trauma in our sample appear not optimal in light of the literature especially in terms of setting the vascular point of debridement, antibiotic and nerve repair resulting in significant consequences. Two management protocols according to patients' hemodynamic status are offered.
La traumatologie balistique n'est pas l'apanage des champs de bataille et s'étend actuellement de plus en plus aux milieux civils. Tout chirurgien ou urgentiste peut se trouver confronté à de tels traumatismes dont la prise en charge est spécifique et nécessite notamment une connaissance en balistique lésionnelle. Cette étude consiste en une revue rétrospective de la prise en charge des traumatismes balistiques au sein du C.H.U. Saint-Pierre sur une période de dix ans. Les données démographiques, lésionnelles, cliniques, d'imagerie, de traitement et de suivi ont été collectées. A l'analyse des dossiers, il ressort que les plaies des membres ont un faible taux de mortalité, mais un taux de complications non négligeable. Les patients doivent être pris en charge selon le protocole ATLS puis selon la stabilité hémodynamique et la localisation du traumatisme, bénéficier d'une imagerie. Les patients instables seront opérés en urgence sans imagerie, les patients stables présentant des traumatismes osseux seront traités selon l'importance des lésions et du type de fracture soit de manière conservatrice, soit par fixateur externe ou enclouage centro-médullaire. Un débridement et une antibiothérapie sont recommandés ainsi qu'une exploration nerveuse s'il existe une paralysie périphérique. La prise en charge des traumatismes dans notre échantillon n'apparait pas optimale à la lumière de la littérature notamment en termes de mise au point vasculaire, de débridement, d'antibiothérapie et de réparation nerveuse. Deux protocoles de prise en charge selon l'état hémodynamique du patient sont proposés afin d'optimaliser la prise en charge.
ABSTRACT
Mass spectrometric measurements of size and composition of diesel exhaust particles have been performed under various conditions: chassis dynamometer tests, field measurements near a German motorway, and individual car chasing. Nucleation particles consisting of volatile sulfate and organic material could be detected both at the chassis dynamometer test facility and during individual car chasing. We found evidence that if nucleation occurs, sulfuric acid/water is the nucleating agent. Low-volatile organics species condense only on the preexisting sulfuric acid/water clusters. Nucleation was found to depend strongly on various parameters such as exhaust dilution conditions, fuel sulfur content, and engine load. The latter determines the fraction of the fuel sulfur that is converted to sulfuric acid. The organic compounds (volatile and low-volatile) condense only on preexisting particles, such as both sulfuric acid nucleation particles and larger accumulation mode soot particles. On the latter, sulfuric acid also condenses, if the conditions for nucleation are not given. The overall ratio of sulfate to organic (volatile and low-volatile) is also strongly dependent on the engine load. It was found that the production of nucleation particles even at high engine load can be suppressed by using low-sulfur fuel.
Subject(s)
Air Pollutants/analysis , Vehicle Emissions/analysis , Carbon/analysis , Environmental Monitoring/methods , Mass Spectrometry , Particle SizeABSTRACT
Modern advances in stroke research, diagnosis, and management cast increasing hope for stroke patients. What was once a disorder with a pessimistic prognosis has become a treatable disease. Expert nursing is required to care for a stroke patient through the manifold stages of treatment and recovery. This article presents salient information on stroke epidemiology, classification, pathogenesis, and symptomatology. Investigative options, treatment modalities, stroke rehabilitation aspects, and future trends are discussed. Moreover, nursing practice guidelines for risk factor modification, acute phase interventions, rehabilitation interventions, and patient/caregiver education are presented.
Subject(s)
Cerebrovascular Disorders , Activities of Daily Living , Anticoagulants/therapeutic use , Cerebrovascular Disorders/classification , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/therapy , Disabled Persons/classification , Emergency Treatment/methods , Fibrinolytic Agents/therapeutic use , Humans , Nursing Assessment/methods , Patient Care Planning , Practice Guidelines as Topic , Primary Prevention/methods , Risk FactorsABSTRACT
Recent scientific data suggest that there is a "window of opportunity" between the onset of brain ischemia and irreversible neuronal death. Although neurons can withstand complete absence of blood flow for only minutes, collateral circulation typically surrounds the "core" of the stroke. In these brain regions known as the ischemic penumbra, brain tissue can survive for several hours following stroke onset. Recent studies suggest that neuroprotective agents would give these viable neurons the chance for recovery. This article reviews the mechanisms of ischemic neuronal injury, mechanism of action of neuroprotective agents, current neuroprotective clinical trials, and guidelines for patient care management.
Subject(s)
Brain Ischemia/drug therapy , Neuroprotective Agents/therapeutic use , Acute Disease , Brain Ischemia/etiology , Brain Ischemia/nursing , Brain Ischemia/physiopathology , Cerebrovascular Circulation , Collateral Circulation , Disease Management , Humans , Neuroprotective Agents/pharmacology , Practice Guidelines as TopicABSTRACT
Acute ischemic stroke is a complex, heterogeneous and debilitating disorder, which leads to death or disability. Recent research into the mechanism of stroke has identified a relatively short window of opportunity, during which a population of neurons surrounding the ischemic core remain viable for a number of hours following stroke onset. These penumbral neurons can be salvaged if treatment is begun within 3-6 hours following the onset of ischemia. This understanding of stroke mechanisms has lead to the development of promising new therapies currently under study. To maximize the potential benefits of these new therapies, neurologists, neuroscience nurses and other healthcare professionals need to assume the responsibility of effectively implementing treatment and to educate their peers and the public about the symptoms of stroke and the need to seek immediate medical assistance.
