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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We measured the haemodynamic effects of changing from the supine position to the lateral decubitus (lateral) position, and then to the kidney rest lateral decubitus (kidney) position in 12 patients undergoing nephrectomy under isoflurane anaesthesia. Eight control patients undergoing pulmonary surgery remained in the lateral position. The lateral position produced no significant changes. In the kidney position, however, significant reductions occurred in the mean arterial (P < 0.01), right atrial (P < 0.05) and pulmonary artery wedge pressures (P < 0.01). There were also significant reductions in cardiac index (from 3.04 (SD 0.21) to 2.44 (0.26) litre min-1 m-2, P < 0.01) and stroke volume index (from 40 (5) to 31 (5) ml beat-1 m-2, P < 0.01). The systemic vascular resistance index increased significantly (P < 0.05). Cardiac output was probably reduced by a decrease in venous return and an increase in systemic vascular resistance.
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PMID:Haemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anaesthesia. 1089 51

An experience of construction and implementation of nursing care protocols and procedures for district nurses is described. A course was offered to all the district nurses, where the indications for the nursing care of some common patients' problems (pressure sores management, mobilization of the stroke patient, the management of patients in pain; the nursing care to stoma patients etc.) were presented. After having compared their work habits with the indications derived from the literature, the nurses were asked to produce protocols and procedures for the problems addressed during the course. The protocols were revised by experts and formally adopted by the responsible of the District, printed in a booklet and mailed with an official letter, to all the district nurses. After two years from the mailing, the knowledge of the nurses (44) on the areas covered by the guidelines was assessed with a multiple choice questionnaire. The level of knowledge varied from 100% of correct answers for the meatal care before catheterization, to the 23% of correct answers on how to remove the needle from a port-a-cath system. The level of knowledge was dishomogenous not only across nurses but also across subjects. In fact low level of correct answers were obtained also for frequently encountered problems, such as patients with pressure sores. The possible causes of the failure of the implementation of the guidelines are discussed.
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PMID:[Evaluation of the adherence to nursing care protocols in a district]. 1098 40

The aim of the present investigation was to identify the frequency and grading of pressure sores in a large series of unselected consecutive deceased subjects before cremation and to discuss aspects of the forensic argumentation concerning causality. A total of 10,222 corpses were examined prospectively over a 1-year-period (1998) for the occurrence, localization and grading of pressure sores. Epidemiological aspects (e.g. age, sex, underlying and contributing causes of death, place of death etc.) were taken from the death certificate. The mean prevalence of pressure sores was 11.2% (87.1% isolated sores; predominant localization of advanced grades on the sacrum in 69.6%). There was a positive correlation between the prevalence of sores and advanced age resulting in a clear female predominance in the age group of 80 years and over because of differences in life expectancy. A significant correlation was found between the prevalence of pressure sores and certain underlying diseases, e.g. trauma, senile dementia, neurological diseases, apoplexy and marasmus. Pressure sores of all grades were more frequently found in the deceased when a senior citizen's or nursing home was given on the death certificate as the domicile in the last period of life. The forensic argumentation for the causal relationship of a pressure sore as the focus of fatal infectious complications or septicemia has to be based on the results of clinical expertises and forensic investigations (evaluation of the institutional documentation of the patient's course, autopsy findings, histology, immunohistochemistry). The vast majority of physicians seem to pay only little attention to the potentially fatal outcome of pressure sores and fatalities associated with this condition are clearly underreported. From the point of view of social medicine, the prevalence of pressure sores in a defined population can be seen as a parameter for the quality of nursing and medical care. In bringing these fatalities to light, the field of legal medicine contributes to a general quality control of standards of nursing and medical care.
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PMID:Pressure sores: epidemiology, medico-legal implications and forensic argumentation concerning causality. 1100 64

Heterotopic ossification (HO) is an important cause of restriction in range of movements and secondary motor disability following neurotrauma, orthopaedic interventions and burns. It has not received focussed attention in non-traumatic neurological disorders. In a prospective study of 377 patients, on medical problems in neurological rehabilitation setting, 15 subjects (3.97%) had neurogenic heterotopic ossification. Their clinical diagnosis was: transverse myelitis (7), neurotuberculosis (4), traumatic myelopathy (2) and stroke (2). Hip (10), knee (4) and elbow joints (1) were involved. The risk factors included urinary tract infection (15), spasticity (6), pressure sores (13) and deep venous thrombosis (DVT) (6). The initial diagnosis was often other than HO and included DVT (3), haematoma (2) and arthritis (2). ESR and serum alkaline phosphatase levels were elevated in all but one subject. The diagnosis of HO was established using X-rays, CT Scan and three-phase bone scan. Following treatment with non-steroidal anti-inflammatory drugs, the range of motion improved in only four patients. HO resulted in significant loss of therapy time during rehabilitation. High index of suspicion about this complication is necessary for early diagnosis and prompt intervention.
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PMID:Neurogenic heterotopic ossification : a diagnostic and therapeutic challenge in neurorehabilitation. 1130 39

The objective of this study was to investigate the extent to which internal risk factors for the development of decubitus ulcers are related to the blood flow response following the relief of a pressure load. There were 122 nursing home patients (43 men, 69 women, mean age: 81 +/- 8 years; range: 60-97). The following potential, internal risk factors for the development of decubitus ulcers were assessed: chronic disorders (diabetes mellitus, cardiovascular disease [congestive heart failure, history of myocardial infarct or angina pectoris] and cerebrovascular accident), fever, blood pressure, nutritional status, serum hemoglobin concentration, and serum urea and serum creatinine concentrations. Skin temperature response (latency time and total response time) was measured following relief of a 100 kPa test pressure. The presence of cardiovascular disease, cerebrovascular accident, poor nutritional condition, high serum urea and male gender showed a significant relationship with an impaired blood flow response. The delayed latency found showed a similarity to the so-called "no-reflow phenomenon." The association of cardiovascular disease and a cerebrovascular accident with a delay in the blood flow response may result from endothelial damage. A poor nutritional condition may be associated with a deficit of scavengers of oxygen-derived free radicals. The presence of free radicals may damage endothelium during reperfusion, thus influencing the blood flow response. The association of high serum urea with delayed vasodilatation may theoretically be explained by the association of serum urea and impaired kidney functioning, since the kidney is an important organ in the production of vasoactive substances. Serum urea can also be considered a measure for nutritional condition. Gender may function as a substitute for other, unmeasured factors that are related to blood flow response.
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PMID:Relationship between internal risk factors for development of decubitus ulcers and the blood flow response following pressure load. 1143 31

The phenomenon of pressure sores in the elderly patient often requires an alternative management policy to that of the standard treatment. In general, the therapeutic approach to pressure sores in the elderly should be different to that in younger patients. This modification is due to the accompanying comorbidity so often associated with aging. Due to accompanying illnesses, the aging population is at high risk and more predisposed to the development of pressure sores. The importance of the establishment of a unit for pressure sores arises from the specific geriatric team approach to the patient and the need to focus carefully on the pressure sores. The management of this special Pressure Sores Unit with a permanent capable staff requires skilled treatment, both localized and systemic, since pressure sores are very often a result of systemic failure or an indication of a terminal condition in the elderly patient. Over six months we followed-up on the number and location of the pressure sores in 47 patients in addition to other functional and nutritional parameters, in order to investigate any connection between the pressure sores and nutritional parameters. The results of the study indicate that the nutritional state of the patients admitted for pressure sores was very poor. Two thirds of the patients suffered from either dementia or stroke, and 90 percent were bedridden, incontinent and enterally fed. Despite the poor general condition of the patient, the study shows improvement in the pressure sores with a reduction from an average of 2.8 to 1.8 pressure sores per patient. The improvement in the pressure sore located on the legs was three times greater than those located in the pelvic area. By the end of the study, 50% of the patients had died, 33% of the original patients who were still in the unit showed improvement in the pressure sores and 15% were discharged showing complete recovery from the sores. No significant correlation was found between changes in the pressure sores and the parameters relating to nutritional status (albumin, cholesterol, body weight and total lymphocyte count) except for the level of hemoglobin. Since there was no control group, the results of the study, naturally, did not show any advantage in treatment of pressure sores in a specific unit as opposed to such treatment in a general ward. Nevertheless, the need for a Pressure Sores Unit is justified and important. It is possible that the patients observed in this study arrived for treatment in the unit at very late, irreversible and terminal stages. The presence of a Pressure Sores Unit would heighten awareness and early referral of these patients.
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PMID:[Pressure sores unit--a one year study]. 1168 Nov 20

Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.
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PMID:Proximal femoral fractures. 1259 64

Hip fractures include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region that is exposed to large compressive stresses. Implants used to address these fractures must accommodate significant loads while the fractures consolidate. Complications secondary to hip fractures produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.
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PMID:Innovations in the management of hip fractures. 1293 39

Plastic surgeons are integral to the management team for patients with spinal cord injuries, with responsibilities including pressure sore management and upper extremity reconstruction. Injury to the spinal cord profoundly disrupts the body's ability to maintain homeostasis. In particular, the autonomic system can become unregulated, resulting in a massive sympathetic discharge called autonomic dysreflexia. Autonomic dysreflexia occurs in the majority of patients with injuries above the sixth thoracic vertebra and causes sudden, severe hypertension. If left untreated, autonomic dysreflexia can result in stroke or death. Because this syndrome causes morbidity and mortality, it is crucial for plastic surgeons to be able to recognize and treat autonomic dysreflexia. This article reviews the etiology, symptoms, and treatment of this syndrome.
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PMID:Autonomic dysreflexia: a plastic surgery primer. 1296 49

A non-experimental, retrospective analysis of pressure ulcer quality-assurance data was conducted from October 1997 to October 2002 to ascertain the relationship between the occurrence of nosocomial full-thickness pressure ulcers, healing, and mortality. The records of 74 patients (one woman, 73 men) who developed full-thickness pressure ulcers as inpatients at a regional Veterans Affairs medical center with acute, intensive, and long-term care units were assessed. Start day was the day that the ulcer was determined to have occurred and end day was the date the patient was pronounced dead. Major diagnoses for all patients, 70.7% for whom end-of-life planning was in effect, were cerebrovascular accident, diabetes, and cancer. The majority of ulcers were located in the sacral/coccygeal area (66.2%) and heel (16.2%). None of the ulcers healed in patients who died within 180 days of ulcer onset. A 180-day mortality rate of 68.9% was noted in people who developed nosocomial full-thickness pressure ulcers, with an average of 47.0 days from ulcer onset to death. No deaths were related to the presence of the pressure ulcer. In this data set of people with a heavy disease burden who were approaching the end of life, the development of full-thickness pressure ulcers appeared to be a comorbid pathologic process. Collecting and analyzing long-term pressure ulcer healing and mortality outcomes is a missing component of pressure ulcer quality-assurance data.
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PMID:Long-term outcomes of full-thickness pressure ulcers: healing and mortality. 1536 46


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