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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  132. Kongress der Deutschen Gesellschaft für Chirurgie; 20150428-20150501; München; DOC15dgch420 /20150424/
    Publication Date: 2015-04-25
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    Keywords: CANCER ; IRRADIATION ; Germany ; imaging ; DISEASE ; HISTORY ; DRUG ; SURGERY ; PATIENT ; treatment ; COMPUTED-TOMOGRAPHY ; ABNORMALITIES ; ANGIOGRAPHY ; SMALL-INTESTINE ; COMPLICATIONS ; INFLAMMATORY-BOWEL-DISEASE ; STENOSIS ; technique ; PUSH-ENTEROSCOPY ; DRUGS ; ENDOSCOPY ; BOWEL ; Crohn disease ; gastrointestinal bleeding ; jejunal stenosis ; wireless capsule enteroscopy
    Abstract: Wireless capsule enteroscopy, being a novel, painless investigative technique, is reported to be significantly superior to push enteroscopy in its ability to find bleeding abnormalities in the small intestine. Here we report a case of acute jejunal obstruction following wireless capsule endoscopy. The patient had a 1-month history of gastrointestinal bleeding of unknown source. Further evaluation including gastroscopy and colonoscopy, angiography and computed tomography (angio-CT), and radio-labeled erythrocytes scan failed to reveal a source of bleeding. Therefore, wireless capsule enteroscopy was performed. Before capsule endoscopy, there was no clinical or imaging evidence of strictures or stenosis. At readmission it could be shown that there were two inflamed strictures of the small intestine. The capsule was detected at a stricture of the small intestine detected by abdominal ultrasonography and conventional computed tomography. The patient underwent a medical treatment with steroidal and other anti-inflammatory drugs for a total of 23 days and was discharged without complaints. Acute laparotomy after readmission with jejunal ileus proofed the capsule occluding two highly inflamed jejunal stenosis caused by Crohn disease. The present case demonstrates the potential for complications when wireless capsule enteroscopy is performed in the presence of intestinal strictures. Any history of inflammatory bowel disease, abdominal irradiation, cancer, obstruction, and abdominal surgery must be elicited in detail and may exclude the use of wireless capsule enteroscopy
    Type of Publication: Journal article published
    PubMed ID: 16411112
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  • 3
    ISSN: 1435-1285
    Keywords: Schlüsselwörter Troponin T – Schnelltest – Myokardinfarkt – präklinische Diagnostik – Notfallmedizin ; Key words Troponin T – rapid assay – myocardial infarction – preclinical diagnosis – EMS system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Objective: To evaluate the practical performance and the diagnostic power of a rapid, qualitative assay for the detection of cardiac Troponin T (indicated cut-off level: 0.3 ng/ml) in EMS patients presenting with acute myocardial ischemia. Patients: 145 consecutive patients with non-traumatic chest pain treated by the Mobile Intensive Care Unit team. During phase 1 (73 patients), blood drawn at the emergency site was used to perform a Troponin T rapid assay under defined conditions at the hospital. During phase 2 (72 patients), the rapid assay was already performed at the emergency site. Results: In phase 1 all tests were performed correctly, whereas 5.6% of the test results had to be declared unvalid in phase 2. 17 (11.7%) of the 145 patients showed a positive test result. Analytic sensitivity was 100%, specificity 96.3%. 37 of the 145 patients (median duration of symptoms: 150 minutes) showed a myocardial infarction (MI). Related to the diagnosis of MI diagnostic sensitivity, specificity, positive and negative predictive values were 35.1, 96.3, 76.5, and 81.3%. Mortality in patients with a positive rapid assay was 35.3%, compared to 6.3% in patients with a negative test result (p〈0.001). Conclusions: The rapid assay allows the detection of Troponin T in concentrations above the cut-off level. Meticulous observance of the manufacturer's rules is imperative. A single preclinical rapid assay does not allow to exclude a MI. However, the test enables EMS personnel to identify patients who are at increased risk of dying from an acute coronary syndrome in the immediate future.
    Notes: Zusammenfassung Einführung: Die präklinische Diagnostik von Patienten mit akutem Koronarsyndrom stützt sich primär auf die Anamnese und die klinische Symptomatik, Parameter mit unbefriedigender Sensitivität und Spezifität. 1994 wurde ein Schnelltest zum qualitativen Nachweis von kardialem Troponin T entwickelt. Mit der vorliegenden Arbeit sollte dessen Eignung zur präklinischen Diagnostik bei dem o.g. Krankheitsbild evaluiert werden. Methodik: In die Studie wurden 145 notärztlich versorgte Patienten mit akuten ischämieverdächtigen Thoraxschmerzen eingeschlossen. Während der ersten Studienphase (73 Patienten) wurde der Test anhand der präklinisch entnommenen Blutproben unter standardisierten Bedingungen in der Klinik durchgeführt, während der zweiten Phase (72 Patienten) dagegen noch am Notfallort. Ergebnisse: Während der Test in Phase 1 stets korrekt durchgeführt wurde, traf dies nur für 68 (94,4%) der Patienten in Phase 2 zu. Insgesamt wiesen 17 von 145 Patienten (11,7%) einen positiven Schnelltest auf. In allen Fällen wurde die vom Hersteller angegebene Nachweisgrenze von 0,3 ng/ml eingehalten. Bei 37 Patienten (mediane Beschwerdedauer: 150 min) bestand ein akuter Myokardinfarkt. Die Kenngrößen diagnostische Sensitivität, Spezifität, positiver und negativer prädiktiver Wert betrugen 35,1%, 69,3%, 76,5% und 81,3%. Patienten mit positivem Testresultat wiesen gegenüber negativ getesteten Patienten eine deutlich höhere Hospitalletalität auf (35,3% vs. 6,3%, p〈0,001). Schlußfolgerungen: Der Schnelltest weist Troponin T in Konzentrationen von ≥0,3 ng/ml zuverlässig nach. Die strikte Beachtung der Herstellervorgaben reduziert die Wahrscheinlichkeit von fehlerhaften Testinterpretationen, schließt diese jedoch nicht aus. Bei kurzer Anamnesedauer ist der Test nicht mit hinreichender Sicherheit zum Infarktausschluß geeignet. Patienten mit positivem Testergebnis weisen eine schlechte Prognose auf.
    Type of Medium: Electronic Resource
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