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At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

[Surgery unit for epilepsy].

INTRODUCTION: Only few medically refractory epileptic patients are evaluated for surgical treatment, in spite of the good results obtained at the Centers where epilepsy surgery is performed. OBJECTIVE: We are presenting the way the Gregorio Marañón Hospital Epilepsy Surgery Unit functions and their casuistry. PATIENTS AND METHODS: This Unit is composed by members of the Services of Neurosurgery, Neurology, Neurophysiology, Neuroradiology, Psychology, Neuropediatry, Nuclear Medicine and Neuroanestesiology. Patients are studied by means of protocols. RESULTS: Twenty cases were operated upon. The procedures were temporal lobectomy in 9 cases, amygdalo-hipocampectomy in 4, frontal lobectomy in 3, frontal topectomy in 2, partial hemispherectomy in 1 and vagal nerve stimulation in 1. In 16 of the 19 surgery specimen there were some pathological abnormalities. In the short follow-up 13 patients are seizures free experience significant improvement.

Epilepsy↗
PubMed1976

[Aorto-coronary by-pass. Personal experience based on 342 cases operated on between April 1971 and December 1974 (author's transl)].

The authors report on the casuistry of aorto-coronary by-pass operations they performed between April 1971 and December 1974, discussing the criteria which indicate the necessity of operating, the principles of the operative techniques, and the results obtained. Out of a total of 342 operated cases, there was an operative mortality (within 30 days) of 3% in isolated by-pass cases, and 4% if one includes associated operations. In 3,5% of patients, postoperative necrosis was present. Almost the same values were found in the smaller group (66 cases) which underwent urgent by-pass operations. The authors consider that the aorto-coronary by-pass operation is a very useful treatment, both for stable and unstable angina, as long as the anatomo-functional conditions exist.

Adult↗
PubMedDate not supplied

[Emergencies in gastroesophageal varices hemorrhage in the patient with portal hypertension].

High gastrointestinal hemorrhage represents the more frequent (12-71.1%) and heavy complication of hepatic cirrhosis and correlates to portal hypertension; it is weighed by global mortality which sways from 30 to 50%. High gastrointestinal hemorrhage gives, therefore, a serious of diagnostic and therapeutic problems not easy to guide for at least 3 reasons: numerous causes of bleeding; hepatic failure; the marigold possible therapies. Aim of this work is to clarify some diagnostic and therapeutic features about high gastrointestinal hemorrhage in cirrhotic patient, because such eventuality often presents dramatic aspects, which endangers the patient's life. Our experience shows a casuistry referred to the period of time which goes from 1987 to 1998 and that comprehend 143 examined patients: 91 of theme have been submitted to medical treatment (endoscopic sclerotherapy, glupressin e/o somatostatin); in 52 cases it has been possible to realize a surgical treatment, different from the elective therapy (33 pz) and emergency therapy. Immediate hemostatic effect obtained in both the conditions, has been satisfying with best results at a distance of three years and five years given by devascularization. As matter stands our preference of the devascularization surgical treatment, it seems appropriate to pay attention to the operation of mesocaval anastomosis which, either in Our very brief experience (3 cases) or by international literature, seems to offer encouraging results.

Adult↗
PubMed2000

Bioethical considerations in cancer prevention and early detection practice and research.

PURPOSE/OBJECTIVES: To review current ethical issues in cancer prevention and early detection, discuss some of the key methods and theories in contemporary bioethics, present clinical scenarios that illustrate moral problems that nurses may encounter, and show how the theories and methods can assist ethical decision making. DATA SOURCES: Published articles, abstracts, and books; case studies developed from clinical experience and literary sources. DATA SYNTHESIS: Oncology nurses face a host of ethical considerations when providing cancer prevention and early detection education and services and when conducting research in this arena. A variety of ethical methods and theories--including principlism, casuistry, utilitarianism, rights-based theories, virtue ethics, ethics of care, and communitarian ethics--may assist nurses in tackling ethical challenges. CONCLUSIONS: The growing field of cancer prevention and early detection raises a number of moral issues that have implications for oncology nursing. Because no single method or theory provides a complete account of bioethics, ethical problem solving should be approached using a variety of methods and theories whereby they can be coherently and appropriately applied together. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to increase their awareness of ethical issues related to cancer prevention and control and consider them when planning patient care and research programs.

Bioethics↗
PubMedDate not supplied

[Hemorrhagic emergency due to esophagogastric varices in the portal hypertension patient].

High gastrointestinal hemorrhage represents the more frequent (12-71.1%) and heavy complication of hepatic cirrhosis and correlates to portal hypertension; it is weighed by global mortality which sways from 30 to 50%. High gastrointestinal hemorrhage gives, therefore, a serious of diagnostic and therapeutic problems not easy to guide for at least 3 reasons: numerous causes of bleeding; hepatic failure; the marigold possible therapies. Aim of this work is to clarify some diagnostic and therapeutic features about high gastrointestinal hemorrhage in cirrhotic patient, because such eventuality often presents dramatic aspects, which endangers the patient's life. Our experience shows a casuistry referred to the period of time which goes from 1987 to 1998 and that comprehend 143 examined patients: 91 of them have been submitted to medical treatment (endoscopic sclerotherapy, glupressin e/o somatostatin); in 52 cases it has been possible to realize a surgical treatment, different from the elective therapy (33 pz) and emergency therapy. Immediate hemostatic effect obtained in both the conditions, has been satisfying with best results at a distance of three years and five years given by devascularization. As matter stands our preference of the devascularization surgical treatment, it seems appropriate to pay attention to the operation of mesocaval anastomosis which, either in our very brief experience (3 cases) or by international literature, seems to offer encouraging results.

Combined Modality Therapy↗
PubMed1999

[Traumatic asphyxia with an unusual etiology. Case report].

The authors present a casuistry of the injury endangering the life, which was caused by the unusual mechanism. The injured person was pulled inside of a conveyer and while shifting, not only his arm and physical (brachial) plexus was damaged, but he was also and especially, strangled by his clothes and he was seriously asphyxiated, which origin was in the first phase unexplainable.

Accidents, Occupational↗
PubMed2001

[Generalized convulsive status epilepticus: analysis apropos of 57 cases].

BACKGROUND: The generalized convulsive status epilepticus (GCSE) is a medical emergency with a high morbimortality rate. We analyzed the casuistry in our hospital and we assessed the causes related to mortality. PATIENTS AND METHODS: This is a retrospective study of 57 cases of GCSE that took place between january 1992 to december 1998. The variables studied were mortality among groups according to age, previous epilepsy and the duration of the convulsive episode. RESULTS: We found male prevalence (63.2%). The 49.2% of patients didn't have previous history of epilepsy. In 38.6% of cases the treatment dose was insufficient and in 61.4% it was delated. The mortality rate was 36.8% with a higher significance in patients older than 65 (p < 0.02), without previous history of epilepsy (p < 0.001) and in episodes lasting more than 4 hours (p < 0.05). Only 12.9% of patients received prehospital treatment. CONCLUSIONS: The mortality of GCSE is very high. The initial treatment is inadequate. We must establish a premature and adequate protocol, with optim pharmacological doses and a good coordination with intensive care units.

Adolescent↗
PubMed2001

The role of diagnostic hysteroscopy in infertile women.

BACKGROUND: Anomalies of the uterus are considered one of the reasons for infertility in women. For this reason we believe diagnostic hysteroscopy is fundamental in screening for infertility. The aim of this study was to verify the incidence of uterine anomalies in sterile couples and evaluate the efficacy of diagnostic hysteroscopy in subjects with possible alterations in this organ. METHODS: From July through December 2000, 296 hysteroscopies were carried out at the Centro di Sterilità e di Fecondazione Assistita of Perugia University. Of these 223 entered the study because of infertility in couples. The exam was always done between the 7th and 11th day of the cycle using a Hamou 5 mm hysteroscope, without anaesthesia. The uterus was dilated by introducing physiological solution at 50 mmHg pressure. The criteria adopted for hysteroscopic findings were based on: a) cervical canal; b) uterine cavity; c) endometrium, and visualization of the ostium tubae. RESULTS: Of the 223 women who underwent hysteroscopy screening for infertility 17 (7.62%) had uterine anomalies. Of these 1 was in the cervical canal, 4 had anomalies in both the uterus and cervix, and the remaining 12 had only uterine cavity anomalies. The presence of neoformations was the most commonly found alteration. CONCLUSIONS: From the results of this study we conclude that diagnostic is a very important method for investigating the reasons for infertility in a couple. From our casuistry the incidence of uterine anomaly is 7.62%. We therefore suggest hysteroscopy be included among the 1st and 2nd level exams for female infertility.

Adult↗
PubMed1991

Natural resources for morality: commentary.

Loewy makes an extraordinary and audacious claim. He does not only reject virtue ethics, casuistry, the "Kantian injunction of respect for persons based on their capacity for self-legislation," and the utilitarian greatest good as possible groundings for clinical ethics. He even offers another grounding that he qualifies explicitly as "universally acceptable." Of course we have to analyze what it is that he offers. But prior to that, we must analyze what he means by "grounding." Grounding suggests an evidence that can neither be rationally grounded again nor rationally questioned but that other concepts can be rationally grounded upon. And it is at least doubtful whether the alternatives he quotes are groundings in that strict sense....

Altruism↗
PubMed1991

Why we need a theory of suffering, and lots of other theories as well: commentary.

In the first section of his article, "The Role of Suffering and Community in Clinical Ethics," Erich Loewy sketches a theory of suffering. His conviction is that clinical medical ethics is not clearly rooted in theory and is inadequately grounded because of this. While acknowledging the merits of virtue ethics and casuistry, Loewy quickly dispenses with them, as contenders for this theoretical basis. Kantianism and utilitarianism are likewise rejected as "a universally acceptable grounding for ethics." In their place, Loewy proposes that "a deeper and more universal grounding can be found in the capacity of sentient beings to suffer." It is on this capacity to suffer that he builds his hierarchies of moral value, including primary, secondary, and symbolic worth. This theory of suffering should be welcomed. It promises to expand our awareness of clinical experience, and moral life generally, away from autonomy, utility, or virtue orientations toward attention to suffering and our response to it. Such a theory can give us a revitalized language to probe the issues of medical ethics. This should lead us to a careful reading of Loewy's larger work on which this article is based. Yet my enthusiasm is tempered by Loewy's noncritical acceptance of a peculiar, yet pervasive, understanding of the role and use of theory in ethics....

Animal Rights↗
PubMed2001

Atypical course of the median nerve.

Work in the form of anatomical casuistry is presenting and describing the atypical course of the median nerve found in both upper limbs of one of the cadavers in the Department of Anatomy of Medical Faculty of Comenius University in Bratislava. This atypical course was found during the students' dissection of the peripheral nerves and vessels. This non-standard course of the median nerve is compared with standard course described in anatomical literature and atlases, and confronted with the possible variations of the median nerve and its course described by the available literature. (Fig. 4, Ref. 4.)

Humans↗
PubMed1975

Untraditional glucose fermenting actinomycetes as human pathogens. Part I: Actinomyces naselundii as a cause of abdominal actinomycosis.

Actinomyces naeslundii was proved as a primary pathogen in the case of a fulminant abdominal infection of a 74 aged woman. The preliminary diagnosis of actinomycosis based on direct microscopical findings of microgranules in the pus was confirmed by the results of cultivation and casuistry in addition. The case was of a typical course for actinomycosis and penicillin following surgery was of life saving effect for the patient who was dismissed asymptomatic after 55 days of hospitalization. Actinomycotic microgranules were demonstrated in the pus from the natural infection and from experimentally infected mice and the causative agent Actinomyces naeslundii TR 91/67 was defined. Nevertheless it was concluded that the judgment of the pathogenicity of Actinomyces naeslundii and of the other members of the heterogenous group of etiological agents of human actinomycosis still remains a matter of delicacy in any actual case of their isolation. In practice however, the presumption of actinomycotic etiology of an actual infection may be supported in retrospect by the dramatical effect of penicillin without regard to the presence of concomitant microflora not necessarily sensitive to penicillin.

Abdomen, Acute↗
PubMedDate not supplied

[Incidence of dengue in children and adolescents].

A descriptive study of children and adolescents that got sick with dengue in the health area served by "José Martí" polyclinics in Santiago de Cuba from May to August 1997 was conducted to determine the incidence of this affection in these age groups. It was observed that dengue was more frequent in males aged 5-11 years. Bronchial asthma, epilepsy and congenital cardiopathy were the most common previous affections found. The incidence of the disease in the casuistry was low, with well-nourished males without histories of chronic processes and good clinical recovery prevailing. Only one case was classified as hemorrhagic dengue.

Adolescent↗
PubMed1975

[The problem of apparent schizophrenic symptoms in juveniles].

In the clinic we frequently come across cases of indistinct accentuated schizophrenic behaviour in youth. We mention here a casuistry which can be considered as a juvenile asthenic denial syndrome with coenaesthetic symptoms. This picture can be differentiated from coenaesthetic schizophrenia, hebephrenia, neurotic symptoms and physical psychoses which can be proven. The problem of differential diagnosis is considered with particular regard to progressive diagnosis.

Adolescent↗
PubMedDate not supplied

[Incidence of cerebral vascular accident].

The incidence of the patient who has got cerebral vascular stroke in the internment of the medical services of the district hospitals (level 1) is, in general, and in other Portuguese hospitals, very large and takes great part of the resources, physical space, team's time of caring/treatment and costs per service. This kind of stroke happens in an advanced aged group with polimorf and chronical pathologic situation, concerning a serious prognostic. A retrospective and statistical study was done in the service of medicine from all internments cases in five years, (1990-1994) in the Hospital Candido Figueiredo, Tondela. This study concentrates this incidence in age, sex, death-rate, haemorragic and ischemia CVS and cerebral haemorrage but separately. 647 cases were studied from the existent registration in this hospital. In our casuistry, the ischemia CVS was present in 91.8% but compared to the total amount of internments it was 10.44% in average. It was in the female sex that we notice a higher frequency and the prognostic was more serious and the death-rate incidence was also higher in this sex. The ischaemial CVS's death-rate was in average 29.83%. This kind of patient demand (from a logistic point of view) a large number off beds, the interdisciplinary support of an internist, a neurologist, a neuro-surgeon, a neuroradiologist, a psychiatrist, a physiologist, a geriatrist, a phsychologist, a social assistant, specialized nurses in physical rehabilitation.

Female↗
PubMedDate not supplied

[Modern variant of hanging: use of a time-programmed winch].

Hanging is one of the most frequent types of suicide. Descriptions of unusual ligatures can be read about again and again. The paper reports the suicide of a 41-year-old electrician, who, using an electric winch, hung himself in nearly free suspension. The winch that was secured to the timberwork of the attic had been programmed by an electric time clock, the toggle switch of the remote control was fixed in the on-position using adhesive tape. The man had handcuffed his hands behind his back against any attempts to save himself. The noose was partly cushioned with a bike tube with the obvious aim of reducing the pain. Due to the state, in which he was found and the results of the post-mortem examination, a third party responsibility was excluded. The case shows that not only certain types of knots and nooses can be associated with various occupational groups, but the choice of a special strangulation device can possibly also come from the occupational sphere. As a modern variation of hanging, the presented casuistry can partly complete the familiar documentation of historical cases with the use of block and tackle and similar constructions.

Adult↗
PubMed2002

[Characteristics and indications of topiramate].

AIM: To evaluate the efficiency of topiramate (TPM), an antiepileptic medication (AEM) which possesses multiple mechanisms of action and good pharmacokinetics, in the different types of childhood epilepsy and to make an appraisal of its value in migraines, bipolar disorder, eating disorders and neuropathic pain, according to studies that have been published. To do so, we have made use of an analysis of the literature, together with a multi centre study conducted in Spain and personal casuistry. METHOD: We consider the percentage of seizure free patients and of patients who responded (reduction of 50% or above in the frequency of the seizures) in childhood epilepsy, partial epilepsy, generalized tonic clonic seizures, absence seizures, tonic seizures, patients with diverse types of seizures, juvenile myoclonic epilepsy, Lennox Gastaut syndrome, falling sickness and GTCS, West s syndrome and Dravet s syndrome. With monotherapy, in partial epilepsy, between 39 and 54% of patients treated were seizure free. TPM has also proved to be efficient in experiments with animals, as a neuroprotector, and in clinical trials, in type I bipolar disorder, eating disorders, neuropathic pain and migraine. CONCLUSIONS: TPM is an AEM offering a wide therapeutic spectrum that has proved to be efficient in clinical trials, expansion phases and observational studies, as an associated drug in partial epilepsy, generalized epilepsy, Lennox Gastaut syndrome, West s syndrome and Dravet s syndrome. It has proved to be more efficient in monotherapy, in partial epilepsy, as a first line AEM. TPM has also proved to be useful in mood disorders, eating disorders, neuropathic pain and tremor in observational studies, although this efficiency has not been backed up by clinical trials. In migraine and in clinical trials TPM has shown its efficiency. Its neuroprotective effect opens up new therapeutic perspectives.

Animals↗