European journal of medical research
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Randomized Controlled Trial Multicenter Study
Oxygen generation by combined electrolysis and fuel-cell technology: clinical use in COPD patients requiring long time oxygen therapy.
Oxy-Gen lite, a recently developed combined electrolysis and fuel cell technology, de-novo generates oxygen with high purity for medical use from distilled water and room air. However, its use in patients with chronic respiratory failure has never been evaluated. ⋯ The use of Oxy-Gen lite in COPD patients with hypoxemia and LTOT
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Case Reports
Traumatic abdominal wall hernia diagnosed 14 years after a bad fall with lumbar spine fracture.
Traumatic abdominal wall hernias have significant implications for patients and insurance companies, especially when not been discovered at the time of trauma. We present the case of a gardener who sustained a bad fall during work in 1994 with immediate admission to the hospital for treatment. A fracture of the second lumbar spine body has been diagnosed and stabilized operatively. Postoperative computer tomography and magnetic resonance examinations demonstrated correct healing of the fracture. Neither the pain in the sacral spine, the left leg and left lower abdominal wall nor the sudden pain attacks in the groins with preference of the left groin stopped. Different neurologists considered as cause of the unchanged pain in the lower abdomen and left leg a radiculopathy in the lumbar spine. As a result of the neurological assessment the patient was operated in the lumbar spine (fixation of the fourth and fifth body) in a different hospital in 2007, unfortunately without elimination of the pain and no change of the neurological defects. The complaints increased to an extent that the patient was unable to drive a car, climb stairs or walk a longer distance. In 2008, when he was examined by the rheumatologist and internal medicine specialist, Prof. Dr. Ursula Gresser, in the Praxisklinik Sauerlach, the diagnosis of a traumatic abdominal wall hernia and isolated nerve compression syndrome was made. Prof. Gresser referred the patient to my hernia centre for surgical treatment. The intraoperative findings and histological examination of tissue were consistent with this diagnosis. The difficult meticulous repair of the 14 years old massive defects of the several layers of the abdominal wall and compression of nerves, when crossing these layers, has been made possible in a time demanding open approach with special care for the viable tissue and anatomy. Immediately after the operation the patient had no longer pain in the sacral spine, with a massive decline of pain level in the remaining areas. Without any further pain medication the patient is now able to climb stairs, walk longer distances and drive his car. ⋯ Patients suffering from pain and neurological alterations in the lower abdomen, groins and legs, with or without known trauma, may have a traumatic abdominal wall hernia and nerve compression syndrome. Before planning extensive orthopaedic operations in spine and hip, it is rewarding to exclude other causes, e.g., Sportsman hernia, traumatic hernia or occult hernia. A treatment of the hernia is absolutely necessary to avoid loss of quality of life for the patient and further detrimental development to the patient, e.g., destruction of the head of the femur, deterioration of the respiratory activity and lordosis of the spine. One should not get distracted by evident fractures in the spine to look for other causes of pain.
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Skin and soft tissue abscesses are common findings in injecting drug users (IDUs) who present to the surgical emergency department for evaluation and treatment. Although most cases can be managed by incision and drainage, they do require special considerations as compared to abscesses which are not caused by intravenous drug abuse. ⋯ IDUs presenting with skin and soft tissue abscesses can be managed safely if some special issues are taken in account. The presented algorithm may help facilitate the decision-making in this context.
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Total hip arthroplasty (THA) is an established and cost effective procedure in the treatment of severe arthritis of the hip. However, bearing recent demographic changes in mind, the increasing demand for total hip arthroplasty during the next decades catalyzes health economic re-consideration of the overall health care process of initial surgery and subsequent rehabilitation. One point for discussion is due to postoperative rehabilitation, since direct costs of the latter crucially depend on whether in-patient (indoor) or out-patient (outdoor) rehabilitation is recommended. Whereas out-patient rehabilitation is obviously more cost efficient from a health insurer's perspective than its indoor alternative, it is open for discussion, whether the alternatives' clinical benefit profiles from a patient's perspective are of comparable order. Therefore this pilot investigation was implemented to assess the clinical benefit and cost effectiveness of in-patient versus out-patient rehabilitation after THA. ⋯ In this matched pilot investigation the overall health care process involving in-patient rehabilitation after total hip arthroplasty did not demonstrate a significantly superior cost effectiveness when compared to its out-patient alternative from a health care insurer's perspective. This observation is complemented by a rather small difference in clinical benefit. However, prospective investigations, which should randomize the rehabilitation alternatives onto appropriate patients, are necessary to confirm the above pilot results.
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We describe a clinical case of ARDS in an HIV infected patient. ARDS was associated to a respiratory syncytial virus infection that triggered a suspected Pneumocystis infection that despite missing etiologic proofs was treated with antimycotics. As rather limited information on RSV associated ARDS in HIV patients is available in the current literature, this case is of significant interest.