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Meningoccocal meningitis complicated with subdural effusion: a report of two infant cases
Victor Perez-Pico,1 Eduardo Llausas-Magana,1 Angel Leon-Ramirez,1 Giordano Perez-Gaxiola,2 and Nidia Leon-Sicairos.3
Journal of Infection in Developing Countries , 2007,
Abstract: Neisseria meningitidis is a major cause of invasive bacterial infection in children of all ages. Children less than 1 year of age are at greater risk of invasive disease than older children. In endemic countries, the invasive meningococcal infections are a leading cause of bacterial meningitis in older children and adults but it is particularly rare in newborns and infants less than 1 year old. Besides meningitis, hemorrhagic skin findings have been described as part of the typical case scenario. In this report, we present two cases of meningococcal meningitis occurring in children under the age of 3 months in a non-endemic setting. Both patients did not manifest any skin lesions but had subdural effusion, an unusual complication for meningococcal meningitis.
Inverted Takotsubo-Like Left Ventricular Dysfunction with Pulmonary Oedema Developed after Caesarean Delivery Complicated by Massive Haemorrhage in a Severe Preeclamptic Parturient with a Prolonged Painful Labour
Hyejin Jeong,Seongheon Lee,Cheolwon Jeong,Jongun Lee,Seongtae Jeong,Sungsu Chung,Kyungyeon Yoo
Case Reports in Anesthesiology , 2011, DOI: 10.1155/2011/164720
Abstract: Inverted takotsubo cardiomyopathy (TTC), a variant of stress-induced cardiomyopathy, features transient myocardial dysfunction characterized by a hyperdynamic left ventricular apex and akinesia of the base. Herein, we describe a 38-year-old primigravida with severe preeclampsia who had active labour for 4 h followed by an emergency caesarean delivery. She developed postpartum haemorrhage due to uterine atony complicated by pulmonary oedema, which was managed with large-volume infusion and hysterectomy. Her haemodynamic instability was associated with cardiac biomarkers indicative of diffuse myocardial injury and echocardiographic findings of an “inverted” TTC. The patient was almost fully recovered one month later. Our case shows that a reversible inverted TTC may result from a prolonged painful labour. TTC should be listed in the differential diagnosis of the patient presenting with pulmonary oedema of unknown origin, especially in patients with severe preeclampsia.
合并大动脉炎产妇行剖宫产术的围术期管理
Anesthesia management of caesarean section for pregnant women complicated with Takayasu’s arteritis
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孙杰,曾鸿,王永清,赵扬玉
- , 2016, DOI: 10.3969/j.issn.1671-167X.2016.04.035
Abstract: 大动脉炎(Takayasu’s disease)是一种好发于亚洲育龄期妇女的未明确病因的罕见、原发性全身血管慢性肉芽肿性血管炎,年发病率为2~3人/百万人(男女患病率比为1∶8.5),又称Takayasu病或无脉症,病因不明,可能与遗传因素有关,主要累及主动脉及其分支,其组织病理学特点为主动脉及其分支血管内膜增殖、纤维化,动脉壁中层的弹力纤维层变性。血管炎症导致血管壁增厚、狭窄、狭窄后扩张、动脉瘤和血栓形成。该病最终可导致主动脉及其主要分支大血管闭塞或形成动脉瘤,进展很难预测,但大部分患者病程进展较为缓慢,视网膜炎、继发性高血压、主动脉返流和动脉瘤等常预示该病预后较差。该病的药物治疗主要为控制血管炎症和控制高血压[1]。妊娠合并大动脉炎的情况鲜有报道,本文现报道4例妊娠合并大动脉炎患者的围术期管理,并进行文献回顾。
Takayasu’s arteritis is a rare, idiopathic, chronic inflammatory disease. Its course is unpredictable, but slow progression is usual, leading to stenosis, occlusion, or aneurismal degeneration of the aorta or its major branches. We present the anesthesia management of pregnancy in four women admitted to Peking University Third Hospital for caesarean section from year 2006 to 2015 complicated with Takayasu’s arteritis and review this disease with special reference to natural history, diagnostic criteria, classification, prognostic factors, and anesthesia considerations. Anesthesiological data were retrospectively analyzed for clinical manifestations, anesthesia process, perioperative complications, and pregnancy outcome. One patient received only epidural anesthesia, while the other three patients received combined spinal and epidural anesthesia (CSEA). Surgeries for all the four patients were successful with stable vital signs. We found comprehensive examinations including whether the disease was in the active phase and the clinical classification of the disease before conception was recommended for patients diagnosed with Takayasu’s arteritis. CSEA and continuous epidural block could be both used as anesthesiological method in patients with Takayasu’s arteritis. During the surgery, to avoid rapid hemodynamic fluctuations and protect the major organs’ function is very essential to allow for a satisfactory outcome.
CAESAREAN SECTION
HABIBA SHARAF ALI,NEELOFER SALEEM,FARAH AGHA
The Professional Medical Journal , 2010,
Abstract: Objective: To determine what surgical techniques are used by obstetricians in Pakistan for caesarean section operations and tocompare it with the recommendation, proposal and guidelines of Royal College of Obstetrician and Gynecologist (RCOG) and CochraneReviews. Methods: A questionnaire was set up regarding surgical technique used during caesarean section and one hundred obstetricianswere part of study. Setting: Hospitals in two large cities of Pakistan i.e. Karachi and Rawalpindi were requested to fill them. Period: Jan 2009 to June 2009. Result: Substantial and remarkable and difference noted in the practice of caesarean section among the obstetricians. Certain practices and procedures performed by our obstetrician are same as proved to be beneficial and valuable based on evidence andrecommended by the RCOG and Cochrane Data on pregnancy. Conclusion: We observed that our obstetricians follow different surgical techniques for performing caesarean section. Some of the techniques follow recommendations by RCOG and provide to effective and beneficial by cochrane data.
Dipoles, unintentional antennas and EMC
Berend Danker
Serbian Journal of Electrical Engineering , 2008, DOI: 10.2298/sjee0801031b
Abstract: Radiated emissions from equipment commonly originate from electronic circuits that act as electric dipoles created by the signal voltage between the signal conductors or as magnetic dipoles formed by the signal current flowing in a loop. Direct emission is mostly small, but circuits often couple to long conductors or large wiring loops which act as antennas and are efficient radiators. A comparable situation exists when short dipole antennas or small wiring loops receive ambient noise (susceptibility). Usually the amplitude of noise sources or the susceptibility of circuits is an invariable. The dipole strength increases with the distance between the conductors and the area. Shielding and proper grounding decreases the interaction via unintentional antennas. Short-circuiting and the insertion of lossy ferrite cores reduce the efficiency of unintentional antennas.
Preseptal Cellulitis and Subdural Empyema as a Complication of Frontal Sinusitis  [cached]
Nuri Bayram,Fad?l Vardar,Ta?k?n Yurtseven,Sait E?rilmez
Cocuk Enfeksiyon Dergisi , 2010,
Abstract: Acute bacterial sinusitis in children can be complicated by orbital or periorbital cellulitis, and epidural, subdural, or brain abscesses. Despite advances in imaging and the availability of antibiotics, subdural empyema remains a disease process that carries significant morbidity and mortality. Subdural empyema is usually accepted as a neurosurgical emergency that requires drainage. However, prompt initiation of proper antibiotics with close observation and follow-up of the patient saves the patient from invasive cranial and sinus surgery and their potential complications. Early diagnosis and proper treatment (including surgery where needed) decrease mortality in patients with this disease.We report a 12 years old male patient who developed periorbital cellulitis and left sided subdural empyema and was healed by prompt institution of proper antibiotics without surgery.
Case Report: Rare Presentations of Accidental Subdural Block in Labor Epidural Anesthesia  [PDF]
Jing Song, Atit Shah, Sujatha Ramachandran
Open Journal of Anesthesiology (OJAnes) , 2012, DOI: 10.4236/ojanes.2012.24032
Abstract: The incidence of accidental injection or catheterization of the subdural space during performance of a neuroaxial block has recently increased. It can occur even when an experienced practitioner performs the neuraxial procedure. The presentation of numerous unexplainable clinical signs in the process of continuous epidural anesthesia, which do not fit the clinical picture of subarachnoid or intravascular injection, should envoke a high suspicion for unintentional subdural block. We report two cases of patients who achieved prolonged labor analgesia via epidural technique with only half the initial loading dose of local anesthetic. Both patients also had short episodes of hypotension. Additionally, one patient presented with severe hypoxemia and mild motor block of both upper and lower extremities. The other patient presented with transit unresponsiveness without motor block. Both patients rapidly responded to vasopressors. Desaturation in one patient, however, was persistent lasting for more than four hours. Her bedside chest X-ray was inconclusive “possible pulmonary edema” and the follow up Chest CT Scan on the second day revealed aspiration pneumonia. Based on the clinical findings, these two cases were suggestive of subdural block with cranial nerve involvement.
Unintentional non-adherence to chronic prescription medications: How unintentional is it really?
Abhijit S Gadkari, Colleen A McHorney
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-98
Abstract: We conducted a cross-sectional survey of adults with asthma, hypertension, diabetes, hyperlipidemia, osteoporosis, or depression from the Harris Interactive Chronic Illness Panel. The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease. They answered three questions on unintentional non-adherence (forgot, ran out, being careless), 11 questions on intentional non-adherence, and three multi-item scales assessing perceived need for medication (k?=?10), perceived medication concerns (k?=?6), and perceived medication affordability (k?=?4). Logistic regression was used to model predictors of each unintentional non-adherence behavior. Baron and Kenny’s regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence. Bootstrapping was employed to confirm the statistical significance of these results.For the index disease, 62% forgot to take a medication, 37% had run out of the medication, and 23% were careless about taking the medication. Common multivariate predictors (p?<?.001) of the three behaviors were: (1) lower perceived need for medications; (2) more medication affordability problems; (3) worse self-rated health; (4) diabetes or osteoporosis (relative to hypertension); and (5) younger age. Unique statistically-significant predictors of the three behaviors were: (a) ‘forgot to take medications’ - greater concerns about the index medication and male gender; (b) ‘run out of medications’ - non-white race, asthma, and higher number of total prescription medications; (c) ‘being careless’ - greater medication concerns. Mediational tests confirmed the hypothesis that the effect of medication beliefs (perceived need, concerns, and affordability) on intentional non-adherence is mediated through unintentional non-adherence.For our study sample, unintentional non-adherence does
Intracranial aneurysms causing spontaneous acute subdural hematoma  [cached]
Shenoy S,Kumar M,Raja A
Neurology India , 2003,
Abstract: Acute subdural hematoma is an uncommon presentation of the rupture of an intracranial aneurysm. We report two cases of intracranial aneurysms causing spontaneous acute subdural hematoma.
Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria
AD Geidam, BM Audu, BM Kawuwa, JY Obed
Annals of African Medicine , 2009,
Abstract: Objective : To determine the trend and indications for the use of caesarean delivery in our environment. Method : A retrospective review of the caesarean sections performed at University of Maiduguri Teaching Hospital from January 2000 to December 2005 inclusive. Results : During the study period, there were 10,097 deliveries and 1192 caesarean sections giving a caesarean section rate of 11.8%. The major maternal indications were cephalopelvic disproportion (15.5%), previous caesarean section (14.7%), eclampsia (7.2%), failed induction of labor (5.5%), and placenta previa (5.1%). Fetal distress (9.6%), breech presentation (4.7%), fetal macrosomia (4.3%), and pregnancy complicated by multiple fetuses (4.2%) were the major fetal indications. The caesarean section rate showed a steady increase over the years (7.20% in 2000-13.95% in 2005), but yearly analysis of the demographic characteristics, type of caesarean section, and the major indications did not reveal any consistent changes to account for the rising trend except for the increasing frequency of fetal distress as an indication of caesarean section over the years, which was also not statistically significant (c[2] =8.08; P=0.12). The overall perinatal mortality in the study population was found to be 72.7/1000 birth and despite the rising rate of caesarean section, the perinatal outcomes did not improve over the years. Conclusion : Trial of vaginal birth after caesarean section in appropriate cases and use of cardiotocography for continuous fetal heart rate monitoring in labor with confirmation of suspected fetal distress through fetal blood acid--base study are recommended. A prospective study may reveal some of the other reasons for the increasing caesarean section rate.
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