Recurrent ulceration after operation for peptic ulcer: results after gastroenterostomy, gastrectomy and vagotomy in 64 cases.
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Biomedical subjects
Publications and source records attributed to J E Thompson.
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Cecal diverticulitis is a rare entity and remains a difficult diagnostic problem. A retrospective review was undertaken of 16 patients (11 men, 5 women; average age, 33.2 years) with a pathologic diagnosis of cecal or right colon diverticulosis who received treatment from 1979 to the present. Preoperative symptoms were difficult to distinguish from appendicitis. The majority complained of right lower quadrant pain and tenderness. Diagnostic studies were not helpful. Preoperative diagnosis was appendicitis in 88% (14 of 16) and correct in 1 patient (6%). At exploratory celiotomy, the surgeon was able to make the diagnosis of cecal diverticulitis in 9 (60%) of the 15 patients in whom the correct diagnosis had not been made preoperatively. Neoplasm was suspected in 5 patients, and an appendiceal abscess was suspected in 1. Treatment was colectomy in 9 and local excision in 4 patients. In 3 patients, the inflamed diverticulum was left in situ at initial exploration; all underwent later excision, one of these urgently for sepsis. No patient died; however, one anastomotic leak requiring reoperation occurred. On the basis of this experience, we recommend excisional therapy in all cases in which the intraoperative diagnosis is certain. Suspicion of a neoplastic process continues to prompt colectomy in an emergency setting.
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Identifying what it is about the way nurse-midwives care for women that might contribute to healthy outcomes for women and infants requires clear definition of that care process. This article describes our efforts to define the theoretical construct of the nurse-midwifery care process. These efforts culminated in the development of a middle range descriptive theory of nurse-midwifery care. We share those efforts with others in the hopes of encouraging dialogue and the testing of this theory in a variety of clinical settings.
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Women's health throughout the world is adversely affected by low status and literacy, poor nutrition, environmental toxins, violence, and other social, cultural, and economic factors. The majority of maternal deaths and disability occur in the developing nations of the world, such as Africa, where being born female is often a tragedy. The International Confederation of Midwives and the American College of Nurse-Midwives have nearly a century of commitment to making pregnancies and births safer and women's lives better. The shared vision of women as persons who are due full human rights guides the efforts of nurses and midwives in their global efforts of working with women and childbearing families and promoting health for all.
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