Knowledge and attitudes about otitis media risk: implications for prevention

OBJECTIVES: To investigate maternal knowledge and attitudes about otitis media (OM) risk, to estimate the prevalence of risk factors in the first year of life, and to identify barriers to the reduction of risk factors (eg, formula feeding, day care attendance, and exposure to passive smoke). METHODS: Questionnaires mailed to a systematic sample of 504 Minnesota women >/=18 years old identified through 1994 birth certificates. RESULTS: Eighty percent returned a completed survey. According to maternal report, 29% of infants (age 8 to 13 months) had recurrent OM (>/=3 episodes) and 2% had tympanostomy tubes. Forty-six percent attended day care, 29% had >/=1 smoking parent, and 49% breastfed for 相似文献   

MR imaging of myocardial haematoma after blunt chest injury

Myocardial contusion after a chest trauma is a frequently under-diagnosed injury. We report two cases of myocardial contusion in which MR imaging, thanks to its contrast capability, was able to assess the presence of a haematoma and in one case to demonstrate the recovery of the lesion.     

Humoral and cellular immunity against Cryptosporidium infection

Protozoans of the genus Cryptosporidium are the etiological agents of opportunistic infections mainly of the gastrointestinal tract of animals and humans. Young and elderly persons, those with concomitant infections, with AIDS, under an immunosuppressive therapy, with congenital T-cell, B-cell or other effector cell deficiencies develop persistent progressive infections of different degree of severity related to the level of immunodepression. Both humoral and cellular immunity play a role in the control of this infection, but the latter plays the major role, mainly in the intestinal mucosa. However, a natural resistance to these coccidian parasites is also involved. IgG, IgM and IgA have been detected in serum and mucosa of humans and animals with the resolution of the infection; but also high levels of these immunoglobulins have been detected in persons with AIDS with chronic cryptosporidiosis. In HIV-positive persons, CD4+ T-cells are required to prevent the establishment of the infection and IFN-gamma and CD4+ T-cells can also limit the duration and the clinical manifestations of the infection. In persons exposed to cryptosporidial infections, it has been possible to show the important role of IFN-gamma in both the innate and acquired cell mediated immunity. The severity of cryptosporidiosis has been also associated with the inability to produce IFN-gamma. An antibody therapy using bovine colostrum from cows hyperimmunised with Cryptosporidium oocysts or monoclonal antibodies against sporozoite antigens has been developed at the experimental level mainly for persons with AIDS or with other immunodeficiencies; however, these preparations of antibodies have shown only a limited degree of efficacy both in animals and humans.     

Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis.

BACKGROUND: Several cases of obesity-associated focal segmental glomerulosclerosis (OB-FSG) have been reported but little is known about the clinico-pathological features of this entity and its long-term outcomes. METHODS: We studied 15 obese patients (BMI 35+/-5.2 kg/m(2)) with biopsy-proven FSG. They were compared with a control group of 15 non-obese patients with idiopathic FSG (I-FSG). RESULTS: Mean proteinuria at the time of renal biopsy was 3.1+/-2 g/24 h in OB-FSG; it reached the nephrotic range (> or =3.5 g/24 h) during follow-up in 12 patients (80%), but none of them had oedema, hypoproteinaemia, or hypoalbuminaemia. Proteinuria was more marked amongst I-FSG (6.5+/-4.2 g/24 h) and most of them developed oedema and biochemical nephrotic syndrome. Glomerulomegaly was observed in all renal biopsies from OB-FSG patients (mean glomerular diameter 256+/-24 microm in OB-FSG vs 199+/-26 microm in I-FSG, P<0.001). Twelve OB-FSG patients (80%) were treated with ACE inhibitors (ACEI) and proteinuria significantly decreased within the first 6 months of treatment but showed a later increase. None of the obese patients achieved a sustained weight loss. Seven (46%) patients with OB-FSG experienced a progressive renal insufficiency and five of them started intermittent dialysis. Kaplan-Meier estimated probabilities of renal survival after 5 and 10 years were 77 and 51%, respectively, in OB-FSG patients, and 52 and 30% in I-FSG (P<0.05). The risk of developing progressive renal failure among OB-FSG patients was statistically correlated with serum creatinine and creatinine clearance at presentation. CONCLUSIONS: OB-FSG indicates a poor prognosis with almost one-half of patients developing advanced renal failure. Knowledge of the clinico-pathological features of this entity (obesity, FSG lesions with glomerulomegaly, absence of nephrotic syndrome despite nephrotic-range proteinuria) should be helpful in establishing an accurate and early diagnosis.     

Hormonal erectile dysfunction. Evaluation and management

The clinical diagnosis of hypogonadism in the adult is difficult to establish on the basis of a history and physical examination and universally requires biochemical investigations. A serum testosterone determination is justified in men complaining of erectile dysfunction with or without alterations in sexual desire. Among the causes of erectile dysfunction, hypotestosteronemia rates are low. The prevalence of erectile dysfunction particularly is common at a period in life when alterations occur in male hormonal environment. The treatment of hypogonadal erectile dysfunction, regardless of age, is readily available, safe, and effective. The positive impact of treatment on the overall quality of life can be significant. The presence of erectile dysfunction in an aging man (> 55 years) does not imply the presence of hypogonadism, and, even if the two conditions are present, the indications for treatment require good clinical judgment. Persistent low testosterone levels may have significant detrimental effects in other organ systems; therefore, a timely diagnosis of androgen deficiency and appropriate treatment may have significant effects outside the narrow field of sexual performance.     

Left atrial aneurysm

Aneurysms of the left atrium are rare abnormalities. They can be congenital or acquired. Whereas a true congenital aneurysm presents as isolated pathology, inflammatory or degenerative processes involving the endocardium are associated with the acquired type. The clinical records of 2 patients with the diagnosis of left atrial aneurysm were reviewed, along with the surgical strategies, current literature, and patient outcomes. Because of the risk of life-threatening complications, surgery is recommended even in asymptomatic cases. Resection and mitral valvuloplasty should be the treatment of choice.     

Value of digital exploration for diagnosing injuries to the left side of the diaphragm caused by stab wounds

HYPOTHESIS: The digital exploration of stab wounds in the left thoracoabdominal region allows the early diagnosis of diaphragmatic lesions. DESIGN: Diagnostic test study. The digital exploration of the diaphragm was compared with laparotomy (the gold standard) and thoracoscopy. SETTING: The study setting was the Hospital Universitario San Vicente de Paúl (Medellín, Colombia). This is a referral trauma center for the general community. PATIENTS: The study included 82 consecutive patients who were admitted to our institution during a 12-month period with injuries caused by stab wounds to the left thoracoabdominal region and who did not have indications for immediate surgery. Digital exploration of the wound was performed by the attending surgeon in the emergency department. If a lesion of the diaphragm was identified, a laparotomy was performed; if no diaphragmatic lesion was found, a diagnostic left thoracoscopy and/or laparotomy was performed. Results of the laparotomy (n = 63) or thoracoscopy (n = 19) were used as the standard of reference for the determination of sensitivity, specificity, and predictive values of digital exploration. INTERVENTION: The integrity of the diaphragm was determined by digital exploration through the stab wound. MAIN OUTCOME MEASURES: Sensitivity, specificity, predictive value, and likelihood ratio were calculated. RESULTS: For the detection of diaphragmatic lesions, digital exploration demonstrated a sensitivity of 96%, a specificity of 83.3%, a positive predictive value of 91%, and a negative predictive value of 93.7%. CONCLUSION: Digital exploration is a reliable method for the detection of injuries to the left side of the diaphragm caused by stab wounds.