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31.
The azygoesophageal recess is the interface of the subcarinal portion of the mediastinum and the right lower lobe. The configuration of the recess on CT can be used as a sensitive indicator of abnormality in the mediastinum. In normal adults the recess is concave. A convex contour is a normal variant, particularly in young adults. The normal appearance of the azygoesophageal recess in children has not been studied. Accordingly, we reviewed chest CT examinations performed in 253 children ranging from 1 month to 20 years old. Forty patients were excluded from further analysis either because the recess could not be evaluated properly or because underlying disease caused the mediastinum to have an abnormal configuration. An age-related spectrum of normal configurations was observed in the remaining 213 patients. A convex or straight contour was found in 96% of children less than 3 years old. Scans of children 3-12 years old revealed a spectrum of configurations. The typical adult concave configuration was seen in 78% of adolescents more than 12 years old. Overall, in only 90 (42%) of 213 children in this study was a concave recess observed on CT. Our experience shows a convex azygoesophageal recess on CT should be considered the normal configuration in infants and young children. Recognition of this age-related variation is useful in the CT evaluation of the mediastinum in children. 相似文献
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33.
A 10-year retrospective review of 73 children who had ingested a corrosive agent was performed. Presentation, management, and eventual outcome were assessed, and comparisons were made between those who received early medical treatment and those who did not. Results suggested that immediate proper assessment of the oesophagus and institution of appropriate therapy may reduce the incidence of complications associated with treatment of subsequent stricture formation. The importance of oesophagoscopy in the direct visualization of the oesophagus within 24-48 h of the burn is stressed. 相似文献
34.
P P Rieker E M Fitzgerald L A Kalish J P Richie G S Lederman S D Edbril M B Garnick 《Cancer》1989,64(11):2399-2407
In a retrospective study of 223 testis cancer survivors and 120 controls matched sociodemographically, we examined the relative impact of sociodemographic and clinical factors on long-term outcomes in the areas of sexual function, relationships, employment, and mental outlook. For most of the survivors, testis cancer did not lead to unemployment (4.5%), divorce (6.8%), or disabling psychological problems. Multivariate analysis results confirm that cancer survivors report significantly more infertility and sexual performance distress, but not more desire distress, than the control group. Survivors' sexual impairment varied according to treatment received (and therefore histologic factors) and sociodemographic variables. Parental status (not having children) and education (college or less) independently predict infertility distress, whereas education and lower occupational level independently predicted sexual performance distress. Adjusting for socioeconomic status (SES), the men with advanced testis cancer who received chemotherapy and standard retroperitoneal lymph node dissection (RPLND) had significantly more infertility and performance distress than those men who received other treatments. Neither the treatment or SES variables predicted disrupted relationships or a deteriorated mental outlook. However, men with sexual impairment distress were more likely to report strained relationships and a pessimistic mental outlook. These findings have implications for treatment decisions and can be used to identify subgroups of survivors who could benefit from counseling and sexual rehabilitation services. 相似文献
35.
M Schiffler F J Rescorla J Fitzgerald J L Grosfeld 《Archives of surgery (Chicago, Ill. : 1960)》1988,123(6):780-781
Most cases of congenital diaphragmatic hernia present as acute respiratory emergencies in the newborn period. Delayed presentation may be heralded by symptoms referred to the respiratory or gastrointestinal tract. An infant with unrecognized right-sided foramen of Bochdalek hernia presented with obstructive jaundice due to compression of the herniated common bile duct by the rim of the diaphragmatic defect. To our knowledge, this occurrence has not been previously observed in infancy or childhood. 相似文献
36.
Elaine Ziemba 《Journal of healthcare risk management》2004,24(4):32-32
37.
S J Levitz L S Whiteside T A Fitzgerald 《Clinics in Podiatric Medicine and Surgery》1988,5(3):721-736
The podiatrist specializing in biomechanical therapy must begin with a solid foundation of standardized definitions in order to discuss theories of mechanical foot treatment as they have been presented and developed over the past century. Equally important, is the building of a working knowledge and familiarity with the wide variety of available materials and their diverse properties. In addition, in order to arrive at an accurate biomechanical diagnosis, the clinician must evaluate the patient from static, dynamic, and radiographic perspectives. One must also keep current in regard to various technological advances in casting and fabrication of orthotic devices, as well as in new developments in biomechanical theory and associated therapy. It also must be kept in mind that functional foot orthoses are not 100 per cent efficient, therefore, their shape, fabrication, and composition should all be devised and prescribed with specific goals for total body mechanics. 相似文献
38.
39.
Guilherme Santoro-Lopes Erika Ferraz de Gouvêa Rodrigo Carreira M Monteiro Rodrigo Castelo Branco José Rodolfo Rocco Márcia Halpern Adriana Lúcia Pires Ferreira Elaine Gama Pessoa de Araújo Samanta T Basto Vinicius Gomes Silveira Joaquim Ribeiro-Filho 《Liver transplantation》2005,11(2):203-209
Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection after orthotopic liver transplantation (OLT). Colonization with MRSA is associated with a higher risk of infection. Previous studies have shown a high prevalence of MRSA colonization among OLT candidates. However, the risk of colonization with MRSA after OLT is still unclear. The objective of this study was to estimate the incidence and the factors associated with colonization with MRSA after OLT. This was a prospective cohort study including patients submitted to OLT between the years 2000 and 2002. Surveillance cultures of nasal swab specimens were performed within the 1st 72 hours of hospital admission and, subsequently, on weeks 2, 6, 13, and 26. Patients whose baseline cultures revealed nasal carriage of MRSA were excluded. A total of 60 patients were included in the study. The median follow-up was 72 days. A total of 9 patients (15%) became colonized. In multiple logistic regression analyses, the use of a urinary catheter for > or =5 days (P = .006), postoperative bleeding at the surgical site (P = .009), and preoperative use of fluoroquinolones (P = .08) were associated with a higher risk of colonization. Patients without any of these risk factors did not become colonized. In conclusion, nasal carriage of MRSA is frequently acquired after OLT. Periodic postoperative screening for MRSA carriage should be an integral component in programs designed to reduce nosocomial MRSA transmission in these patients. Further studies are needed to set up and validate a predictive model that could allow targeting postoperative screening to high-risk OLT recipients. 相似文献
40.
Prospective study of the evolution of Raynaud's phenomenon 总被引:2,自引:0,他引:2
O Fitzgerald E V Hess G T O'Connor G Spencer-Green 《The American journal of medicine》1988,84(4):718-726
Seventy-four patients with Raynaud's phenomenon and no associated illness were followed prospectively to determine whether a secondary disease would develop, and clinical and laboratory assessments were performed at study entry to determine their association with the subsequent development of disease. After an average of 2.7 years of follow-up (range 0.5 to 5.7 years), outcome information was available on 58 persons (78.4 percent). A connective tissue disease developed in 11 (19.0 percent): three systemic sclerosis and eight CREST syndrome. The two variables at entry most strongly associated with the subsequent development of a connective tissue disease were an abnormal nailfold capillary pattern (adjusted odds ratio = 26.82, 95 percent confidence interval = 4.69, 153.2) and an abnormal pulmonary function test result (odds ratio = 4.78, 95 percent confidence interval = 1.02, 22.41). The positive association of an abnormal barium esophagram, presence of antinuclear antibodies, and cutaneous abnormalities did not reach statistical significance. The development of connective tissue diseases in this group of patients is not rare. An abnormal nailfold capillary pattern is strongly associated with the subsequent development of systemic sclerosis or CREST syndrome in patients with Raynaud's phenomenon. 相似文献