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PubMed1975

The place of frozen section in the practical management of melanoma.

A selective policy is proposed for the use of frozen section in suspected melanoma which provides maximal help while minimizing false frozen section diagnosis. It is based on the fact that suspected melanomas fall into two broad groups which present different problems in diagnosis and management. A raised lesion is likely to be a highly malignant melanoma or a lesion of non-naevoid cells. Differentiation is readily made on frozen section and allows immediate radical excision. A flat pigmented lesion is usually of obvious naevoid origin, and the problem is whether early malignant change has occurred. It is better managed by urgent paraffin section to avoid sampling error. Frozen section has a place in the management of a single doubtful node in a patient being managed by a 'watch' policy.

Biopsy↗
PubMed1994

Practical management of post-thyroidectomy hematoma.

Thyroid diseases and surgery for thyroid neoplasms are both very common. Several complications of thyroidectomy are well known. Some of these are quite disturbing, such as recurrent laryngeal nerve injury and permanent hypoparathyroidism. However, postoperative hematoma often in the recovery room may be fatal. Close observation and early intervention are of utmost necessity in the post-thyroidectomy period. In a series of 600 thyroidectomies performed over a period of 11 years, eight patients developed postoperative hematoma. Seven of them underwent re-exploration, while one patient was treated conservatively. Two patients had second re-exploration for hematoma reaccumulation. All patients recovered very well after re-exploration except one elderly patient who required ventilatory support due to poor pulmonary reserve; after a week of ventilatory support and a tracheostomy, she too recovered well. One patient had the hematoma re-explored as late as 24 hours after the operation, while the remainder were re-explored within 4-6 hours after the initial procedure. Because of the extent of edema of the larynx and pharyngeal wall, it is very important that a senior, experienced person perform intubation in these patients. It is also very important to recognize that when the patients lie down flat, they may develop acute airway distress; hence, one must be prepared to intubate them emergently. We recommend close recovery room observation after thyroidectomy and early exploration and evacuation of hematoma in all patients who develop postoperative hematoma. A conservative approach may be considered in selected patients with minimal hematoma and no progression. However, it generally takes a long time for the hematoma to resorb. A better understanding of the complications of thyroidectomy will minimize morbidity and make thyroidectomy a safer procedure and a surgical triumph.

Adolescent↗
PubMed2006

On-farm management practices to minimise off-site movement of pesticides from furrow irrigation.

Off-site movement of pesticides from furrow-irrigated agriculture has been a concern in the Ord River Irrigation Area, Western Australia. This paper reports on the effectiveness of incorporation of pesticides by cultivator or power harrows before irrigating, and spraying pesticides only onto beds to minimise off-site transport. Incorporation of pesticides by power harrows prior to irrigation was found to be more effective in decreasing the off-site transport of a more strongly sorbed pesticide, endosulfan. The average load of total endosulfan (alpha + beta + sulfate) decreased by 74% (P < 0.01) from 11.41 g ha(-1) from the conventionally treated bays to 2.96 g ha(-1) from the incorporated irrigation bays. The total average load of atrazine leaving the irrigation bays was decreased by 81% (P < 0.05) from 87.82 g ha(-1) under the conventional practice of spraying the whole field to 16.95 g ha(-1) by spraying the beds only. A reduction of 52% in total average load of metolachlor was observed following incorporation with power harrows, but this was not significant. Incorporation by cultivator or by power harrows decreased the total load of atrazine or metolachlor leaving the irrigation bays over the whole irrigation period, but these treatments were not shown to be statistically significant, which may have been due to the limited number of field replicates. Incorporation of strongly sorbed pesticides (e.g. endosulfan) prior to irrigation significantly decreased the off-site transport of these pesticides in a furrow irrigation system and may be a useful practice to minimise off-site transport of other similar pesticides. Minimising off-site transport of weakly sorbed pesticides (e.g. atrazine and metolachlor) from a furrow irrigation system is more difficult. The nature of furrow irrigation makes it highly conducive to pesticide transport, particularly of weakly sorbed pesticides, and further work is needed to develop strategies to minimise the movement of this group of pesticides to water bodies.

Acetamides↗
PubMed1983

Practical management of amblyopia.

Our knowledge on the mechanism of amblyopia has gained in recent years from concerted research efforts in basic science and clinical laboratories. Different clinical forms of amblyopia are reviewed and their diagnostic and therapeutic significance discussed. In spite of etiologic differences there are pathophysiological similarities. The value of the time proven constant occlusion treatment of the sound eye remains unchallenged even though minor modifications have become necessary to prevent occlusion amblyopia in infants and young children. Part-time occlusion and penalization are of ancillary value but cannot be considered equal in effectiveness to constant occlusion. Due to increasing public awareness there is a trend toward earlier diagnosis and thus successful treatment of amblyopia. However, more efforts must be directed toward including newborns in visual screening examinations.

Amblyopia↗
PubMed1994

The practical management of artifact in computerised physiological data.

Computerised physiological data contains artifact that needs to be identified and possibly removed. Whilst computers may eventually satisfactorily perform this function, at present only manual removal is possible for the majority of intensive care computer groups. We assessed the effects of artifact and its removal on the physiological data of 3 patients. Artifact was manually removed from 7 days of data in 4 parameters (heart rate, respiratory rate, systolic blood pressure [sbp] and transcutaneous oxygen [tcpO2]) by 3 independent observers. Six hour time periods were analysed. Median and mean values before and after the manual removal of artifact were compared. Overall 6.5% of data was removed as artifact. This was greatest for tcpO2 (9.9%) and sbp (10.6%), with smaller amounts for respiratory rate (2.8%) and heart rate (2.4%). Sbp showed a marked difference in the amount of data removed between patients, whereas tcpO2 data contained quite large volumes of artifact, but this was fairly consistent between patients. Removal of artifact affected mean values more than median values. One observer considered that both physiological and non-physiological artifact should be removed, whereas the other two observers removed only non-physiological artifact. Agreement in results between the latter was good. Our results suggest that inter-observer variability should have a minimal effect on values, once rules identifying the type of artifact to be removed are agreed. Removal of artifact did not have a clinically significant effect on results, but may be an important consideration in the statistical analysis of computerised physiological data.

Artifacts↗
PubMed1978

[Practical management of parenteral nutrition (author's transl)].

Three different plans of parenteral nutrition are available: (1) postoperative water and electrolyte substitution; (2) basic parenteral nutrion; (3) total parenteral nutrition. The decision for one of these plans depends on the duration of necessary parenteral support and on the patient's situation. ad 1: solution with electrolytes, 40 ml/kg body weight/day ad 2: solution with electrolytes, amino acids (25 g/day) and carbohydrates (125 g/day) in a 75 kg patient ad 3: solution with electrolytes, amino acids (1 g/kg body weight/day) and carbohydrates (5 g/kg body weight/day).

Amino Acids↗
PubMed2003

[Indications and practical management of parenteral iron therapy].

Absolute or functional iron deficiency is a common problem in chronic disease which may lead to iron-deficient erythropoesis. Moreover, lack of available iron is the most common reason for unresponsiveness to epoetin in patients on chronic dialysis. Measurements of serum ferritin, transferrin saturation and percentage of hypochromic red blood cells allow the assessment of iron status. Lack of iron resorption and dose-dependent side-effects limit oral supplementation in a number of patients. Several iron preparations are available for intravenous substitution, especially the newly registered iron-saccharose offers safe and reliable iron supplementation and reduces the risk of anaphylaxis and iron toxicity. This review discusses new guidelines concerning diagnosis of iron status, indication for therapy and application of intravenous iron preparation.

Administration, Oral↗
PubMed2003

Measuring plant diversity in the tall threetip sagebrush steppe: influence of previous grazing management practices.

In July 2000, a 490-ha wildfire burned a portion of a long-term grazing study that had been established in 1924 at the US Sheep Experiment Station north of Dubois, Idaho, USA. Earlier vegetation measurements in this tall threetip sagebrush (Artemisia tripartita spp. tripartita) bunchgrass plant community documented significant changes in vegetation due to grazing and the timing of grazing by sheep. A study was initiated in May 2001 using 12 multiscale modified Whittaker plots to determine the consequences of previous grazing practices on postfire vegetation composition. Because there was only one wildfire and it did not burn all of the original plots, the treatments are not replicated in time or space. We reduce the potential effects of psuedoreplication by confining our discussion to the sample area only. There were a total of 84 species in the sampled areas with 69 in the spring-grazed area and 70 each in the fall- and ungrazed areas. Vegetation within plots was equally rich and even with similar numbers of abundant species. The spring-grazed plots, however, had half as much plant cover as the fall- and ungrazed plots and the spring-grazed plots had the largest proportion of plant cover composed of introduced (27%) and annual (34%) plants. The fall-grazed plots had the highest proportion of native perennial grasses (43%) and the lowest proportion of native annual forbs (1%). The ungrazed plots had the lowest proportion of introduced plants (4%) and the highest proportion of native perennial forbs (66%). The vegetation of spring-grazed plots is in a degraded condition for the environment and further degradation may continue, with or without continued grazing or some other disturbance. If ecosystem condition was based solely on plant diversity and only a count of species numbers was used to determine plant diversity, this research would have falsely concluded that grazing and timing of grazing did not impact the condition of the ecosystem.

Agriculture↗
PubMed1979

Practical management of venous injury during pelvic surgery for urologic disease.

There is a selection of techniques (ligation, lateral suture repair, venous patch graft, end to end repair, and vein replacement graft) which can be adopted to deal with venous injury during pelvic surgery for urologic disease. Technical details of the various methods of repair are described for the benefit of the urologist who occasionally finds himself with a major venous injury and no vascular surgeon available to help.

Humans↗
PubMed1985

Practical management of hypertension.

Presented in this monograph is a dynamic concept of hypertensive diseases. We all are aware that the appallingly high morbidity and mortality from the consequences of hypertensive diseases can be drastically reduced with antihypertensive therapy, provided that the patients with hypertension are recognized and that they continue to remain on effective therapeutic programs following their evaluation. Inherent in this concept of "preventive cardiology" is the acknowledgment that evaluation of the hypertensive patient provides a baseline for a lifelong program for the management of a chronic disease. Therefore, discussed herein is the rationale for the evaluation of the findings obtained from the patient's history, physical examination, laboratory studies, and the pathophysiological concepts of the vascular disease and the cardiac involvement. These considerations should permit judicious selection of an effective treatment program.

Angiography↗