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The role of percutaneous transluminal angioplasty in treating advanced peripheral vascular disease is unknown. The authors therefore reviewed the experience of Sunnybrook Medical Centre in Toronto with 85 consecutive patients who had rest pain, ulceration, pregangrene or gangrene as a result of peripheral vascular disease and who underwent percutaneous transluminal angioplasty. Seventy-four percent were smokers and 91% were at increased risk due to one or more of the following: coronary or cerebral ischemic disease, diabetes mellitus, obesity and hypertension. Thirty-six patients underwent dilatation of iliac lesions, 46 of superficial femoral or popliteal and 3 of more distal lesions. In nine patients angioplasty was repeated on the same lesion. In 16 patients, the procedure was technically unsatisfactory. The morbidity and 30-day mortality were 5% and 2%, respectively. When the procedure was technically satisfactory, surgery was avoided and the limb was salvaged at 1, 2 and 5 years in 69%, 62% and 54% of cases, respectively (life-table analysis). The authors conclude that percutaneous transluminal angioplasty is acceptable treatment for patients with advanced peripheral vascular disease, because the morbidity and mortality are low and the long-term results are good.
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PMID:Transluminal angioplasty: results in high-risk patients with advanced peripheral vascular disease. 315 87

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.
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PMID:[Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL]. 317 19

Pulmonary embolism following postoperative deep venous thrombosis is a very serious complication with a high mortality rate. Though this disorder has been thought to be rare in Japanese, its occurrence seems to be increasing recently because of changes in eating habits, increase of average age and the frequent practice of venous catheterization. Two cases of the pulmonary embolism following deep venous thrombosis after surgery are reported, and possible causes of the deep venous thrombosis are discussed. Case 1: A 48 year-old obese female was operated on for a posterior fossa dural arteriovenous malformation. On the 4th postoperative day, she developed a pain and swelling in the left leg and low back pain. On the 18th postoperative day, she fell into a state of shock following the sudden onset of a severe back pain and respiratory distress. After diagnosis of the pulmonary embolism, she was immediately treated with urokinase, warfarin and aspirin. Her obesity was considered to be one of the risk factors of the postoperative deep venous thrombosis. Case 2: A 62 year-old female with a ruptured cerebral aneurysm could not get out of bed because of postoperative mental disturbance. A central venous pressure catheter was inserted into the right femoral vein for two weeks postoperatively. One month after surgery, she complained of swelling and a dull pain in the right leg without cardiorespiratory symptoms. Lung perfusion scintigraphy showed asymptomatic pulmonary embolism. She was treated immediately. Both long bed rest and femoral venous catheterization were considered as risk factors possibly leading to deep venous thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative pulmonary embolism in neurosurgical practice: report of two cases]. 321 Dec 80

The purpose of this study was to compare the effect of the Z-track intramuscular injection technique with the effect of the stand and intramuscular injection technique on the severity of discomfort and lesions at the injection site. The subjects of the study were 20 patients with only early tuberculosis excluding another abnormalities (a skin rash, allergy to topical use of alcohol, jaundice, edema, neurosensory abnormality, coagulation defects, obesity and thin). Data collection was done from Feb. 1 to March 15, 1988 by means of Korean Pain Measurement Tool, Visual Analogue Scale, and Objective measures of injection site lesions. The results of this study were as follows: 1) Hypothesis 1; "The severity of subject discomfort is less following administration of the Z-track intramuscular injection technique than following administration injection technique." was not supported. 2) Hypothesis 2; "The degrees of severity subject discomfort is less following administration of the Z-track intramuscular injection technique than following administration of the standard intramuscular injection technique." was not supported. 3) Hypothesis 3; "The severity of injection sites lesions is less following administration of the Z-track intramuscular injection technique than following administration of the standard intramuscular injection techniques." was not supported. 4) The terms that were selected included factor II (mild-moderate pain) of Ratio Scale Measuring Pain using Korean Pain Terms. In conclusion; it was found that there was not a difference from the severity of subject discomfort between two groups, but the degrees of severity of subject discomfort about following administration of the Z-track intramuscular injection was tended to be declined. Therefore further studies suggest that the Z-track intramuscular injection technique can decrease the severity of discomfort in persons receiving frequently intramuscular injections. First of all, it is necessary to be developed an effect tool of dis comfort measurement for the intramuscular injection in Korean.
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PMID:[Comparison of two intramuscular injection technics on the severity of discomfort and lesions at the injection site]. 323 Jul 58

The etiology of osteoarthritis, the most common articular disorder, is still unknown. Epidemiologic studies demonstrate a relationship to aging and to certain occupations; relationships to obesity as an etiologic factor remain controversial. An inverse relationship of osteoarthritis and bony density has been observed. Medical management is primarily symptomatic; surgery, particularly of the hip or knee, restores function and relieves pain at late stages of the disease. Investigational trials of specific therapeutic agents suggest possible forthcoming interventions to prevent, retard, or reverse the disease process.
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PMID:Primary osteoarthritis: epidemiology, clinical aspects, and general management. 331 40

The spectrum of rheumatic diseases seen in Saudi Arabia appeared to be broadly similar to that seen in the West although interesting differences were noted. Rheumatoid arthritis was the predominant inflammatory joint disease, but was less severe. Ankylosing spondylitis is probably rare among the Saudis. Brucellosis was an important cause of acute back pain. Osteoarthritis was characterized by frequent involvement of the knee while the hip was rarely involved. Environmental factors may be responsible for this disease pattern. Regional pain syndromes, associated with obesity, bad posture, and poor physical fitness were also frequent problems.
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PMID:The spectrum of rheumatic diseases in Saudi Arabia. 349 52

This paper gives a description of the behavioural approach, behaviour therapy, and behavioural medicine in a medical and general hospital setting and describes the intimate link between behaviour and illness, showing how knowledge of the way learning takes place and influences behaviour can lead to a better understanding of the aetiology of illness and thus to appropriate treatment. A behavioural approach can be applied to the understanding and treatment of medical problems associated with sphincteric disturbances, such as childhood encopresis and urinary retention, as well as to the improvement of patient compliance and to the better management of pain. In the field of preventive medicine this approach is of importance in modifying behaviour associated with cardiovascular disorders, obesity, and smoking.
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PMID:The behavioural approach in medical practice. 353 96

The first 200 consecutive laparoscopic sterilizations at the Churchill Hospital, Oxford, using local anesthesia and Filshie clips, are presented in detail. 4 or 5 operations were scheduled per half day, with a gynecologist-surgeon, an anesthetist, and 4 nurses. Most patients received only local anesthesia, with care to reach the peritoneal layer; those with anxiety also received midazolam. Lignocaine was dropped on the clip sites. The laparoscope was a 7 mm Storz. After the procedure, gas was expelled with the Valsalva maneuver, and No. 1 silk sutures were applied where necessary. Vaginal manipulation was needed in 38 women for retroverted uterus. Other difficulties included adhesions precluding completion of the operation in 1 and obesity in another, and in 10 others minor adhesions, or omentum or bowel overlying the field. Postoperative complaints included pain in 148 treated with iv or oral analgesics, vomiting in 10, hypotension in 8. 194 of the women returned questionnaires about the experience, and 91% of these said they would recommend laparoscopic sterilization under local anesthesia to a friend. It was felt that elimination of preoperative pain medication, used in the first few patients, as well as early mobilization, sped up recovery. The specific pain complaints were fewer than those in several reports, possibly because of the gentler handling entailed in a procedure done by local, rather than general, anesthesia.
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PMID:Two hundred out-patient laparoscopic clip sterilizations using local anaesthesia. 358 Mar 29

Clinical criteria for diagnosis of osteoarthritis are not yet formally established; at present, diagnosis is usually made through physical and radiologic examination and evaluation of synovial fluid. Severe trauma and possibly repeated microtrauma, excessive activity, inactivity, and obesity are believed to aggravate symptoms. Treatment objectives are to reduce pain and improve, or at least preserve, function. Antiinflammatory agents provide relief for many patients, although gastrointestinal reactions may accompany their use. Antispasmodics may be helpful for pain caused by muscle spasm, and intraarticular injections of depocorticosteroids are useful for inflammation. Agents that provide analgesia are an appropriate part of the therapeutic program. Patients should be taught to protect weakened joints through use of orthotics, strengthening exercises, and proper body movement and posture. A supportive physician who encourages a healthy life-style and positive outlook will see better physical as well as emotional results with these patients.
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PMID:Osteoarthritis. Aggravating factors and therapeutic measures. 373 93

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic recordkeeping system of the Department of Anaesthesia and the computer-based register of diagnoses of in-patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty-three cases of aspiration were retrieved from the file of anaesthetic records and four from the in-patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e.g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e.g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x-ray. Fifteen patients (17%) needed mechanical ventilation, and four died.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. 375 72


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