检索结果-南通市图书馆

Use of ketamine sedation for the management of displaced paediatric forearm fractures

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Orthopedics 2018年第3期9卷 50-57页

作者： Anatole Vilhelm Wiik Poonam Patel Joanna Bovis Adele Cowper Philip Socrates Pastides Alison Hulme Stuart Evans Charles Stewart Department of Surgery and Cancer Charing Cross Hospital Department of Paediatric Emergency Chelsea and Westminster Hospital Department of Trauma and Orthopaedics Chelsea Westminster Hospital

AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna(moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and postmanipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also *** During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate(3), fractures of both radius and ulna(6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthes

关键词： Paediatrics Forearm fractures Displaced fractures Ketamine Salter Harris Procedural sedation

Management of achilles tendon injury: A current concepts systematic review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Orthopedics 2015年第4期6卷 380-386页

作者： Vivek Gulati Matthew Jaggard Shafic Said Al-Nammari Chika Uzoigwe Pooja Gulati Nizar Ismail Charles Gibbons Chinmay Gupte Department of Orthopaedic Surgery Chelsea and Westminster Hospital Department of Orthopaedic Surgery Imperial College

Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmB ase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.

关键词： Orthopaedic surgery Achilles tendon injury Sports injury Tendon rupture Conservative management

Surgical chylothorax in neonates:management and outcomes

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Pediatrics 2018年第2期14卷 110-115页

作者： Karina Miura Costa Amulya Kumar Saxena Department of Pediatric Surgery Chelsea Children's HospitalChelsea and Westminster Hospital NHS Foundation TrustImperial College LondonLondonUK Ribeirao Preto Medical School University of Sao PauloRibeirao PretoBrazil

Background Postoperative chylothorax occurs due to trauma to lymphatic vessels and can occur after any thoracic *** study reviewed recent literature to evaluate the management and outcomes of surgical chylothorax in *** PubMed database was searched for articles in English,Portuguese and Spanish from 2000 to *** were collected for surgery,chylothorax management,complications,mortality and length of hospital stay(LOS).Results Twenty studies offered 107 neonates:congenital diaphragmatic hernia(CDH)(n=76,71%),cardiac malforma-tions(n=25,23.4%),esophageal atresia(n=5,4.7%)and CDH+extralobar sequestration(n=1,0.9%).Medium-chain tri-glycerides(MCT)was the initial treatment in 52 neonates(48.6%),prednisolone+MCT in one(0.9%),total parenteral nutri-tion in 51 patients(47.7%),and three patients(2.8%)did not require any *** and somatostatin were used as second or third line treatment in 25 neonates(23.4%),and 15 neonates(14%)underwent 17 surgeries,including thoracic duct ligation(TDL)(n=9);pleurodesis(n=3)(2 patients required TDL);TDL+pleurodesis(n=2),and TDL+placement of hemostat(n=1).Complications due to the chylothorax were reported in 27 neonates(25.2%):hypoalbuminemia+hypona-tremia(n=18),hypoalbuminemia(n=4),hypoalbuminemia with cutaneous flushing as colateral effect of somatostatin(n=1),loose stool after somatostatin use(n=1),pneumonia(n=1),congestive heart failure+hypernatremia(n=1),and hyponatremia(n=1).There were 21 deaths(19.6%)and median LOS was 53.4 days(30-93.1 days).Conclusions Conservative management is appropriate as initial treatment for neonatal postsurgical *** and somatostatin are safe in neonates and surgical approach should be considered in prolonged leaks.

关键词： Chylothorax Neonate Thoracic surgery Treatment outcome

Studies on the allostimulatory function of dendritic cells from HCV-HIV-1 co-infected patients

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Cell Research 2004年第3期14卷 251-256页

作者： Justin STEBBING,Steve PATTERSON,Simon PORTSMOUTH,Claire THOMAS,Robert GLASSMAN,Adrian WILDFIRE,Frances GOTCH,Mark BOWER,Mark NELSON,Brian GAZZARD The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Road London SW10 9NH UK The Department of Immunology Division of Investigative Science Faculty of Medicine Imperial College of Science Technology and Medicine the chelsea and westminster hospital 369 Fulham Ro

There is increasing recognition of the potential morbidity and mortality associated with HIV-1 and hepatitis C (HCV) co-infection. HIV appears to adversely affect HCV disease while the reciprocal effect of HCV on HIV remains controversial. We therefore studied the effect of co-infection on dendritic cell function versus HIV infection alone, as previous work has shown that HCV impairs dendritic cell (DC) function. HIV-1 positive individuals with HCV were matched for CD4 count, HIV-1 RNA viral load and therapy, to HIV-1 positive patients without HCV. Monocyte-derived DC were generated and mixed leukocyte reactions were performed. We assessed allostimulatory capacity with and without administration of exogenous Thl cytokines, using thymidine uptake and cell division analyses with the vital dye CFSE. We found that monocyte-derived DC from co-infected individuals showed no significant differences in allostimulatory capacity to ex vivo generated DC from HIV-1 infected individuals without HCV. Unlike the situat

关键词： hepatitis C HIV co-infection dendritic cells.

Ventilation strategies in burn intensive care:A retrospective observational study

同方期刊数据库评论

在线全文

同方期刊数据库

学校读者我要写书评

暂无评论

Burns & Trauma 2014年第1期2卷 29-35页

作者： Stefano Palazzo Emma James-Veldsman Caroline Wall Michelle Hayes Marcela Vizcaychipi Magill Department of Anaesthesia Intensive Care Medicine and Pain ManagementChelsea and Westminster HospitalLondonUK

Consensus regarding optimal burns intensive care(BICU)patient management is *** study aimed to assess whether ventilation strategies,cardiovascular support and sedation in BICU patients have changed over time,and whether this affects outcome.A retrospective observational study comparing two 12-patient BICU cohorts(2005/06 and 2010/11)was *** and admission characteristics,ventilation parameters,sedation,fluid resuscitation,cardiovascular support and outcome(length of stay,mortality)data were collected from patient *** was analysed using T-tests,Fisher’s exact and Mann-Whitney U *** our study cohort groups were equivalent in demographic and admission *** were equal ventilator-free days in the two cohorts 10±12.7 vs.13.3±12.2 ventilator free days;(P=0.447).The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort(568 ventilator days/1000 patient BICU days vs.206 ventilator days/1000 patient BICU days;P=0.001).The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous(17.8%vs.26%;P=0.001)and volumecontrolled modes(34.4%vs.40.8%;P=0.001).Patients in 2010/11 cohort were more heavily sedated(P=0.001)with more long-acting sedative drug use(P=0.001)than the 2005/06 cohort,fluid administration was *** outcome did not *** injury patients were ventilated in volume-controlled(44.5%vs.28.1%;P=0.001)and pressure-controlled modes(18.2%vs.9.5%;P=0.001)more frequently than those *** did not *** study showed there has been shift away from mechanical ventilation,with increased use of tracheostomy/tracheal tube airway spontaneous *** injury patients require more ventilatory support though patient outcomes do not *** trials are required to establish which strategies confer benefit.

关键词： Burns intensive care ventilation inhalation injury

Asynchronus bilateral ovarian torsions in girls-systematic review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Pediatrics 2017年第5期13卷 416-420页

作者： Maja Raicevic Amulya Kumar Saxena Clinic for Pediatric Surgery and Orthopedic Nis Clinical Center NisSerbia Department of Pediatric Surgery Chelsea Children's HospitalChelsea and Westminster NHS Fdn TrustImperial College LondonUnited Kingdom

Background:Bilateral ovarian torsions with complete loss of ovaries is *** study analyzed the literature on bilateral ovarian torsions in girls to evaluate surgical options and ***:Literature was searched on Pubmed(R)(1987-2014) using terms 'bilateral','adnexal','ovary','torsion' and 'children'.Data were collected on age,surgical preference,pathology and ***:Thirteen articles were identified,and 9 met the inclusion criteria (5 case reports,4 original articles);and analyzed 17 girls (mean age:8.75 years,range:1-16).Bilateral oophorectomies (n=4),ipsilateral oophorectomy of severely affected ovary and contralateral oophoropexy (n=10),and detorsion of bilateral ovaries and bilateral oophoropexy (n=3) were *** torsion recurrence occurred after two *** and open surgery was done in 2 and 15 girls,*** etiology,there were simple tubo-ovarian torsions (n=8),polycystic ovary (n=1),polycystic ovary associated with Down syndrome (n=1) and corpus luteum cyst (n=1).No tumors were *** ultrasound follow-ups of ipsilateral oophorectomy and contralateral oophoropexy (n=5) confirmed follicular function (n=4) and viability and position of the ovary (n=l).Conclusions:Though extremely rare,school age girls present bilateral ovarian torsion,Ipsilateral oophorectomy and contralateral detorsion with oophoropexy has been the preferred approach.

关键词： asynchronous bilateral outcomes ovarian torsion surgery

Magnesium: The Neglected Electrolyte? A Clinical Review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Pharmacology & Pharmacy 2014年第7期5卷 762-772页

作者： Pranev Sharma Christine Chung Marcela Vizcaychipi Imaging & Anaesthetics Chelsea & Westminster Hospital London UK Magill Department of Anaesthesia Chelsea & Westminster Hospital London UK

Magnesium, Mg2+, is the second most abundant intracellular cation after potassium and the fourth most abundant in the body. It was first isolated in 1808 by the English chemist, Sir Humphrey Davy. Magnesium is essential to numerous biochemical reactions. It modulates key physiological processes such as metabolic biochemistry, nucleic acid synthesis, receptor-binding and ion flux. The western diet falls short of the recommended daily allowance of 4.5 mg/Kg/day and important dietary sources are seeds, grains, nuts and green vegetables. It is used as a therapeutic agent in a broad range of pathologies: neurological, cardiovascular, respiratory, gastrointestinal and obstetric. The pharmacokinetics and pharmacodynamics of magnesium, as a drug, are not well understood. Despite its fundamental importance to human physiology, it remains an electrolyte that is not routinely measured as part of the “urea & electrolytes” test and is the most overlooked electrolyte deficiency in hospital inpatients. This review will summarise the importance of magnesium homeostasis, its pharmacological effects and clinical applications.

关键词： Magnesium Pharmacology Pharmacodynamics Pharmacokinetics Physiology Arrhythmias Eclampsia Pre-Eclampsia Phaeochromocytoma

Complications in children with percutaneous endoscopic gastrostomy (PEG) placement

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Pediatrics 2019年第1期15卷 12-16页

作者： Brigitta Balogh Tamás Kovács Amulya Kumar Saxena Division of Pediatric Surgery Department of PediatricsUniversity of SzegedKorányi fasor 14-15Szeged 6725Hungary Department of Pediatric Surgery Chelsea Children's HospitalChelsea and Westminster NHS Fdn TrustImperial College LondonLondonUK

Introduction The aim of this study was to analyze the complication rates and mortality in association with different operative techniques of percutaneous endoscopic gastrostomy (PEG),age,underlying diseases and other risk ***,analysis of the indications of PEG insertion and the underlying comorbidities was also *** This study performs a literature analysis of PEG-related complications in *** was searched on PubMed(R) (1994-2017) using terms 'percutaneous endoscopic gastrostomy','complications','mortality' and 'children'.Results Eighteen articles with 4631 patients were *** mean age was 3 years (0-26 years).Operative techniques were:pull technique in 3507 (75.7%),1 stage PEG insertion in 449 (9.7%),introducer technique in 435 (9.4%),image-guided technique in 195 (4.2%) and laparoscopic-assisted PEG in 45 (1.6%).Most frequent indications for PEG insertion were dysphagia (n =859,32.6%),failure to thrive (n =723,27.5%) and feeding difficulties (n =459,17.4%).Minor complications developed in n 1518 patients (33%),including granulation (n =478,10.3%),local infection (n =384,8.3%) and leakage (n =279,6%).In 464 (10%) patients,major complications occurred;the most common were systemic infection (n =163,3.5%)and cellulitis (n =47,1%).Severe complication like perforation occurred in less than 0.3%.Patients with lethal outcomes (n =7,0.15%) had severe comorbidities;and the cause of mortality was sepsis in all *** or young age did not affect complication *** with ventriculoperitoneal (VP) shunt had higher risk of major *** high-risk patients,laparoscopic-assisted PEG insertion had less major and severe complication than traditional pull *** PEG is a safe operative technique;although minor complications are relatively common and occur in up to 1/3 of patients,there is a fairly low rate of severe ***-thirds of PEG patients have at least one ***

关键词： Children Complications Percutaneous endoscopic gastrostomy

Classical seminoma in a 92-year-old patient

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Clinical Urology 2017年第1期6卷 27-29页

作者： Catharine Denning Li June Tay James Carton Kaka Hama Attar Department of Urology Chelsea and Westminster Hospital

Seminoma is a germ cell tumour which primarily affects the testes. Seminomas are treated by orchidectomy with usually excellent outcomes. We report the occurrence of a classical seminoma in a 92-year-old man,who is currently the oldest patient with this histology reported in literature. He presented with a painful,swollen testis. Scrotal ultrasound scan revealed a testicular mass. A left inguinal orchidectomy was carried out and histological examination confirmed the diagnosis of a classical seminoma. Further staging by computerised tomography revealed pulmonary lesions suspicious of metastases. The patient declined further treatment in view of his age and co-morbidities.

关键词： Urology Geriatrics Seminoma Medical oncology