Recognize cholesteatomas early

Cholesteatomas are benign tumors that develop in the middle ear, and their rapid growth patterns can impinge on local structures, resulting in adverse sequelae such as hearing loss, pain, or neuropathies. These late signs and symptoms can be avoided by early identification and prompt intervention. Primary care providers should be aware of the incidence, prevalence, identification, and associated symptoms of cholesteatomas to reduce the later untoward affects and promote prompt referral.     

艾灸在初产妇产后初期乳胀护理中的应用

[目的]探讨护理产后乳房肿胀的有效方法。[方法]将产后乳胀的初产妇50例随机分为实验组与对照组。实验组26例采用艾灸疏通乳腺管处理;对照组24例采用传统热敷按摩方法,观察两组乳房胀痛消失时间及24h乳汁排出量情况。[结果]实验组减轻乳房胀痛的效果明显优于对照组(P<0.01);实验组24h乳汁排出量明显多于对照组(P<0.01)。[结论]艾灸护理产后乳房胀痛效果明显优于热敷按摩疏通乳腺管传统方法。     

Acne: intervene early

"There is no single disease which causes more psychic trauma, more maladjustment between parents and children, more general insecurity and feelings of inferiority, and greater sums of psychic suffering than does acne vulgaris."     

Bleeding in early pregnancy

Bleeding in pregnancy is a distressing experience for any woman, particularly if she has had a previous miscarriage. Though often offered, hospital admission is thought to have no prognostic advantage over home management. A factor not always considered is the need for administration of anti-D immunoglobulin to rhesus-negative women.     

The early repolarization syndrome

The syndrome of the early repolarization variant is described. This benign ECG phenomenon is noted in 1% to 2% of the adult population and generally occurs in the absence of myocardial disease. The ECG manifestations may mimic acute myocardial injury or pericarditis. Exercise and isoproterenol tend to normalize the RST segment elevation. The presence of "early repolarization" does not preclude diagnosis of exercise-induced myocardial ischemia by treadmill testing, and coronary vaso-occlusive lesions may be demonstrated in some patients with the early repolarization pattern on ECG. The presence of S-T elevation in a patient with chest pain of possible cardiac origin mandates hospitalization and cardiac monitoring even if the ECG may confirm to a classic pattern of early repolarization; in this context, the diagnosis of benign early repolarization is one of exclusion. Recognition of this clinical entity and the use of previous ECGs for comparison would in most cases forestall the administration of thrombolytic agents to patients with S-T segment elevation due to benign early repolarization.     

Emergency department blood transfusion predicts early massive transfusion and early blood component requirement

BACKGROUND: The purpose of this study was to evaluate the ability of uncrossmatched transfusions in the emergency department (ED) to predict early (<6 hr) massive transfusion (MT) of red blood cells (RBCs) and blood components. STUDY DESIGN AND METHODS: All patients admitted to a Level 1 trauma center between July 2005 and June 2007 who received any transfusions and were transported directly from the scene of injury were included. Early MT was defined as the need for 10 U or more or RBCs in the first 6 hours. Early MT plasma was defined as 6 U or more of plasma in the first 6 hours. Early MT platelets (PLTs) were defined as two or more apheresis transfusions in the first 6 hours. Univariate and multivariate analyses were performed. RESULTS: A total of 485 patients (34%) received ED transfusions (ED RBC+) and 956 (66%) did not receive ED transfusions (ED RBC–). ED RBC+ patients were younger, were more likely to be male, and arrived with more severe injuries. Multivariate regression identified ED transfusion of uncrossmatched RBC as an independent predictor of requiring early MT of RBCs (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.36‐7.59; p = 0.001), plasma (OR, 2.7; 95% CI, 1.66‐4.39; p < 0.001), and PLTs (OR, 1.9; 95% CI, 1.08‐3.41; p = 0.025). CONCLUSION: Patients receiving uncrossmatched RBCs in the ED are more than three times more likely to receive early MT of RBCs. Additionally, patients transfused with ED RBCs are more likely to receive 6 units or more of plasma and two or more apheresis PLT transfusions. Given these findings, ED transfusion of uncrossmatched RBCs should be considered a potential trigger for activation of an institution's MT protocol.