Chest
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We present a patient who had chronic, bilateral pleural effusions without evidence of parenchymal, retrocardiac or mediastinal masses. A CAT scan of the abdomen and chest revealed the extension of a large abdominal pseudocyst through the diaphragm into the posterior mediastinum. The pseudocyst resolved with conservative management.
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The validity and utility of physical examination maneuvers were determined in diagnosing congestive heart failure (CHF) in patients with acute dyspnea. Fifty one patients presented to the emergency room with the chief complaint of shortness of breath. ⋯ The hepatojugular reflux and Valsalva maneuvers were valid in the diagnosis of congestive heart failure in acutely dyspneic patients. Although these maneuvers rarely added to the routine assessment of patients in this study, they may provide a useful, noninvasive adjunct to clinical diagnosis in problematic cases.
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The objective of this study was to determine the prevalence of tuberculous infection and the incidence of active tuberculosis in homeless men attending a shelter-based clinic and to examine risk factors for acquisition of infection and development of active disease. The design was a prospective cross-sectional survey. Men were evaluated by standardized interviews using a questionnaire. ⋯ Increasing age, length of stay in the shelter system, black race, and intravenous drug use were found to be independently associated with tuberculous infection. Age, length of stay in the shelter system, and intravenous drug use were independently associated with active tuberculosis. We achieved a compliance rate of 36 percent completing treatment and 13 percent receiving treatment at the conclusion of the study.