Introduktion: Uppsatsen är en systematisk litteraturstudie där författaren kritiskt granskar adekvata artiklar och annan aktuell litteratur, vilka beskriver Dupuytren´s kontraktur. Dupuytrens kontraktur är en fibroproliferativ sjukdom i palmar fascia och kännetecknas av en överdriven kollageninlagring. Syfte: Syftet med studien var att undersöka situationen för det kliniska arbetet samt forskning, hur man med den samlade kunskapen kan behandla Dupuytren´s kontraktur, vilka behandlings-metoder som har evidens idag samt vilken praxis som tillämpas inom området. Metod: En litteratursökning genomfördes i PubMed med sökord och kombination med Booleska sökoperationer för framtagning av relevanta artiklar, vilka faller inom ramen för uppsatta inklusionskriterier samt matchar syftet för uppsatsen. Resultat: Ingen behandling är överlägsen någon annan behandling och det finns en betydande och delad uppfattning om respektive metoder. Mindre invasiva tekniker, såsom perkutan nålfasciotomi samt injektionsbehandling med enzymet Kollagenas, är många gånger ett alternativ till kirurgi Slutsats: Hanteringen av en handkontraktur hos patienter med Dupuytrens sjukdom innebär fortfarande många utmaningar för handkirurger, trots framsteg inom medicinsk vetenskap och kirurgiska tekniker.

Percutaneous endoscopic placement of feeding gastrostomies (PEG) was pioneered by Gauderer et. al, in 1980. Since then, it has become the preferred method of providing enteral nutritional support in children and adults because of advantages in morbidity and cost. Pneumonia is a known sequel of this procedure, occurring at different rates, depending on the length of follow-up. Some series have shown an incidence of 10% at 30 days and others 56% at 11 months. It does not appear that PEG feeding offers an advantage over the more traditional naso-enteric tube feeding methods in this respect. To study the prevalence of gastroesophageal reflux (GER) in PEG-fed patients, we quantitated GER by 24-hour intraesophageal pH monitoring in a group of patients who developed post-PEG pneumonia and compared it with a control group. Our study demonstrates an increased prevalence of GER in the pneumonia group compared with the control group. However, the exact contribution of this observed increased GER to the development of pneumonia needs to be determined.

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

Percutaneous dilatational tracheostomy (PDT) has become an appropriate alternative to conventional surgical tracheostomy. It is now performed worldwide by a diverse array of physician specialists. Although adverse events are relatively uncommon, serious complications can arise from this bedside procedure. We report a patient who suffered life-threatening hemorrhage from a common carotid artery laceration and pseudo-aneurysm formation in the innominate artery following an elective PDT procedure.

Purpose of Review: This article reviews the latest data on unprotected left main (ULM) percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery, with a focus on the NOBLE and EXCEL trials. Recent Findings: In EXCEL trial, the primary endpoint at 3 years was 15.4% in the PCI group and 14.7% in the CABG group (p = 0.02 for non-inferiority of PCI versus CABG). In NOBLE, the primary endpoint at 5 years was 28% and 18% for PCI and CABG, respectively (HR 1.51, CI 1.13–2.0, which did not meet the criteria for non-inferiority of PCI to CABG; p for superiority of CABG was 0.0044). Higher repeat revascularization and non-procedural myocardial infarction were noted in PCI group but there was no difference in all-cause or cardiac mortality between the two groups. Summary: A heart team approach with appropriate patient selection, careful assessment of LM lesions, and meticulous procedural technique makes PCI a valid alternative to CABG for ULM stenosis.

Purpose of Review: Patients with stable coronary artery disease (CAD) and a high risk of bleeding are not ideal candidates for a polymer-based drug-eluting stent (DES) because it requires 6–12 months of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). The purpose of this review is to assess the angiographic and clinical outcomes of polymer-free drug-coated stents (PF-DCS) in stable CAD patients with a high bleeding risk. Recent Findings: Several randomized controlled trials (RCTs) have compared angiographic and clinical outcomes of PF-DCS with bare-metal stents (BMS), permanent polymer (PP)-DES, or biodegradable polymer (BP)-DES. However, none of these studies particularly recruited patients with stable CAD and a high risk of bleeding. Furthermore, there are limited data available on duration of DAPT following PF-DCS placement. Summary: PF-DCS has a better efficacy and similar safety as compared with BMS. PF-DCS with dual drug is noninferior to currently available PP-DES. Further RCTs are needed to assess the safety and efficacy of PF-DCS to BP-DES and PP-DES comparing shorter to standard durations of DAPT.

Every year, hundreds of thousands of patients have coronary angiograms performed in the United States. The Impella is a percutaneous ventricular support device that provides hemodynamic support for patients if hemodynamic instability occurs during the procedure. The critical care nurse is responsible for the recovery and management of the patient with the Impella device in place. The purpose of this scholarly project is to provide registered nurses (RN) who have not previously managed the Impella device with the appropriate education in order to demonstrate competency. The program demonstrated improved RN knowledge about the Impella and increased confidence when managing the Impella device and controller. King's goal attainment theory was used as a framework to develop nurse-patient collaboration. Kirkpatrick's 4-level training evaluation model provided the framework for evaluation of the RN educational program. The sources of evidence included literature and an expert panel that was recruited to evaluate the material prior to implementation of the educational program. The data were analyzed by comparing the results of the preeducational and posteducational questionnaires. The paired t test demonstrated statistical significance based on the scores from the pre- and post-tests taken by the RNs before and after the Impella educational program as p < .001. Increased RN confidence was demonstrated by p < .001, while a change in RN attitude towards the Impella established improvement by p < .001. Providing professional development opportunities has been shown to benefit RNs to allow the delivery of safe care while allowing for positive social change by impacting patient lifestyle and outcomes.

Perkutan nefrostomi är en väl använd och utarbetat intervention som används som behandling av flera urologiska tillstånd. 10% av alla patienter med perkutan nefrostomi kommer att få en komplikation. Röntgensjuksköterskan ska ha kunskap om de komplikationer som uppkommer för att kunna arbeta förebyggande. Syfte: Syftet med denna litteraturöversikt var att undersöka vilka komplikationer som drabbar patienter med perkutan nefrostomi, hur allvarliga komplikationerna var och orsaken till att de uppkommer. Metod: En allmän litteraturöversikt baserad på 10 kvantitativa vetenskapliga artiklar funna genom artikelsökning i databaserna PubMed och Cinahl. Artiklarna kvalitetsgranskades och analyserades för att sedan presenteras i resultatet under tre huvudkategorier. Resultat: Patienterna drabbades av komplikationer som sepsis, urinvägsinfektion, retroperitonealt hematom, hematuri och komplikationer med nefrostomikatetern. Komplikationerna kunde leda till vidare sjukhusvistelse, utökad behandlingstid med perkutan nefrostomi och vidare ingrepp för korrigering av komplikationen. Sepsis var en bidragande faktor i de dödsfall som var noterade. Slutsats: Kunskapen om komplikationer är betydelsefull i det arbete som röntgensjuksköterskan utför för att kunna agera när de uppstår och arbeta förbyggande. / Percutaneous nephrostomy is a well used and completed intervention used as treatment for many urological conditions. 10% of all patients with percutaneous nephrostomy will get a complication. The radiographer must have knowledge of the complications that occur in order to work preventively. Aim: The aim of this literature review was to examine what kind of complications affect patients with percutaneous nephrostomy, how serious the complications were and causes to the complications. Method: A literature review based on 10 quantitative scientific articles that was found in databases Pubmed and Cinahl. The articles had been quality reviewed and analyzed and was presented under three main categories. Results: The patients suffered from complications as sepsis, urinary tract infection, retroperietal hematoma, hematuria and complications with the nephrostomy catheter. The complications could lead to hospitalization, extended time of treatment with the nephrostomy catheter and more invasive correction for the complication. Sepsis was a contributing factor to the cases with a deadly outcome.  Conclusion: The knowledge of the complications is an important part in the work as a radiographer in order to act when they occur and work preventively.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12999号 / 論医博第2107号 / 新制||医||1016(附属図書館) / 32927 / (主査)教授 川上 浩司, 教授 古川 壽亮, 教授 小池 薫 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19549号 / 医博第4056号 / 新制||医||1012(附属図書館) / 32585 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 吉村 長久, 教授 山下 潤 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM