RESUMO
Recombinant factor VIIa (rFVIIa) is used in patients with hemophilia who had developed inhibitors. A hemostatic effect has been demonstrated following the administration of rFVIIa in patients after trauma and bleeding. Currently, there is no widely accepted guideline for off-label rFVIIa usage in bleeding patients. We planned to review the rFVIIa utilization practice in our institution and develop policies and guidelines for future rFVIIa use. We acquired the medical records of 55 patients who received rFVIIa at our institution during 2003-2004. Patient charts were reviewed regarding their rFVIIa administration and indications, dose and frequency, cost, pre-rFVIIa blood component usage, utilization of hematology services and outcome were analyzed. Underlying liver disease with coagulopathy was the commonest (47%) indication for rFVIIa use. Recombinant FVIIa was successful (69%) in correcting laboratory parameters of coagulopathy, but did not alter outcome. Twenty-six of the 55 patients (47%) died during the same admission from their underlying diseases. Apart from two trauma patients, no one died from bleeding. We conclude that unregulated continuous administration of rFVIIa in bleeding/coagulopathic patients did not alter outcome. Closer monitoring of rFVIIa usage, including hematology consultation and enforcement of pre-rFVIIa blood component usage would optimize cost-effectiveness.
Assuntos
Transtornos da Coagulação Sanguínea/terapia , Fator VII/administração & dosagem , Hemorragia/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/mortalidade , Transfusão de Componentes Sanguíneos/efeitos adversos , Esquema de Medicação , Fator VII/efeitos adversos , Fator VIIa , Feminino , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Psychotic depression is characterized by greater severity, higher rate of recurrence, greater incapacitation, more frequent hospitalization, and longer episodes than nonpsychotic depression. The use of combined tricyclic antidepressants (TCAs) and neuroleptic therapy, as well as electroconvulsive therapy, has proven effectiveness in the treatment of psychotic depression. Although it is limited, evidence for efficacy of selective serontonin reuptake inhibitors both alone and in combination with antipsychotics in psychotic depression suggests that these strategies may provide a desirable alternative to the traditional TCA- neuroleptic therapy. These treatments, in addition to the continual introduction of new psychotropic agents suggest that the prospect of future research in this area is promising.
Assuntos
Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológico , Quimioterapia Combinada , Humanos , Psicotrópicos/uso terapêuticoRESUMO
Cook County Hospital is a large, municipal teaching hospital with multiple academic affiliations. We sought to provide uniform infection control orientation and screening for students because many had no previous training in body substance isolation systems or infection control and trainees may be more likely to be exposed to hospital-acquired infections because of their inexperience. Each student or visiting resident must complete an educational program once each year. The program consists of a pretest, a video, and group discussion, with examples of needle-disposal boxes and protective gear, information about ways to avoid needlesticks and mucosal splashes, what to do if a contact occurs, and information on isolation and tuberculosis. The session ends with a posttest, which is then retained on file. All trainees are also required to provide a "certificate of compliance" with the hospital's infectious disease serology screening program, which includes measles, rubella, and hepatitis B surface antigen testing, as well as tuberculin skin testing. Trainees must provide an updated form annually. The program is costly, both in dollars and in personnel time, for visiting students and the hospital. Tuberculin skin test screening detected a cluster of purified protein derivative skin test conversions in medical students.
Assuntos
Estágio Clínico , Hospitais de Ensino/organização & administração , Controle de Infecções/métodos , Capacitação em Serviço/organização & administração , Chicago , Comportamento Cooperativo , Currículo , Humanos , Controle de Infecções/economia , Capacitação em Serviço/economia , Programas de Rastreamento , Desenvolvimento de Programas , Testes Cutâneos , Apoio ao Desenvolvimento de Recursos Humanos/economia , Precauções UniversaisRESUMO
The heterogeneity of human breast carcinoma appears to be a cumulative interrelationship of genetic and environmental factors that may be identifiable with a high risk for carcinogenesis. Until breast cancer prevention is realized, one-stage total ductal-glandular mastectomy with immediate reconstruction may be offered as an alternative to simple mastectomy for women at high risk for developing cancer. This technique affords the complete extirpation of breast tissue at a deep plane with flaps that are identical in thickness to those elevated in classic mastectomies for invasive cancer. Breast reconstruction with submuscular prostheses in a one-stage procedure gives an aesthetically acceptable result. The role of ductal-glandular mastectomy as prophylaxis for invasive carcinoma warrants future prospective trials.
Assuntos
Mama/cirurgia , Mastectomia/métodos , Cirurgia Plástica , Adulto , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Próteses e Implantes , Risco , Fatores de TempoRESUMO
This report describes a newborn boy with cleft palate and congenital trismus preventing normal feeding. After surgical division of the fibrous bands between the maxillary and mandibular alveolar ridge, oral feedings progressed without difficulty. Historical reports of congenital oral bands are reviewed.
Assuntos
Processo Alveolar/patologia , Fissura Palatina/patologia , Trismo/congênito , Humanos , Lactente , Doenças Maxilomandibulares/congênito , Masculino , Síndrome , Aderências Teciduais/congênitoRESUMO
A case of basal cell carcinoma originated in a long-standing stasis ulcer on the lower extremity and then metastasized to the dermis and subcutaneous tissue of the thigh. The literature on metastasizing basal cell carcinoma is reviewed.
Assuntos
Carcinoma Basocelular/secundário , Úlcera da Perna/complicações , Neoplasias Cutâneas/secundário , Idoso , População Negra , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/patologia , Feminino , Humanos , Úlcera da Perna/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologiaRESUMO
A review of the cases of major inflammatory disease of the breast seen during an 11-year period found that 49 (77%) of the 64 cases that required hospitalization were not associated with pregnancy or lactation. In such cases, an aggressive surgical approach including excision of central nipple ducts revealed a variant of mammary duct ectasia in 13 of the 14 patients operated on. We believe that when surgery is required for treatment of mastitis, it should include nipple duct excision.
Assuntos
Doenças Mamárias/patologia , Mastite/patologia , Adolescente , Adulto , Idoso , Doenças Mamárias/cirurgia , Feminino , Humanos , Lactação , Mastite/cirurgia , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/cirurgiaRESUMO
The risk of postsplenectomy sepsis in children is well established. The risk of sepsis following splenectomy in the adult remains unknown. This study provides data on this important subject. All adults (ages 16--91) who underwent splenectomies in three hospitals of the Louisiana State University Medical Center between 1965 and 1975 were identified. There were 298 patients included in the study. Postsplenectomy information was collected on 256 patients. The mean period of observation was 45 months (960 patient years). There were seven deaths from fulminant sepsis (incidence rate: 2.7%). Data were collected on 250 patients who had either a gastrectomy or cholecystectomy without splenectomy. The mean period of observation was 61 months (1270 patient years). There were no deaths due to fulminant sepsis (p less than 0.05). When postsplenectomy sepsis was compared with the risk of sepsis in the population at large (0.001%), the difference is significant (p less than 0.001). In the subgroup of 69 patients with hematologic or malignant disease, there were three deaths from sepsis (4.3%). In 187 patients with no underlying diseases, four patients developed sepsis, which is an incidence of 2.2% (p less than 0.05 when compared with the population at large and control group). The risk of sepsis appears to be greater in patients with chronic disease, but has no relationship to age. These data speak for the conservation of splenic tissue when possible.
Assuntos
Infecções Bacterianas/etiologia , Esplenectomia/efeitos adversos , Adolescente , Adulto , Idoso , Colecistectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Estudos Retrospectivos , Estômago/cirurgia , Fatores de TempoRESUMO
Polyuria and polydipsia developed in two cases during amphotericin B therapy for deep mycoses. Neither patient could concentrate his urine in response to water deprivation or exogenous vasopressin. Other causes of vasopressin-resistant nephrogenic diabetes insipidus were not present. Three months after amphotericin B therapy had been discontinued, concentrating ability improved toward normal. A third patient was further observed and demonstrated normal diluting capacity but impaired free-water reabsorption, suggesting a distal tubular defect consistent with nephrogenic diabetes insipidus. Four months after discontinuing therapy, renal concentrating ability was normal. Amphotericin B can induce a reversible form of nephrogenic diabetes insipidus.