Comprehensive therapy
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Comprehensive therapy · Jul 1995
ReviewPericardial effusion and tamponade: evaluation, imaging modalities, and management.
Pericardial effusions may be present in a variety of clinical situations, often presenting challenging clinical diagnostic and therapeutic problems. Although several imaging modalities are available, ECHO has become the diagnostic method of choice due to its portability and wide availability. CT and MRI may also be employed and may be more accurate. ⋯ However, this may need to be accompanied by catheter drainage or surgical pericardial window. A new catheter based technique--percutaneous balloon pericardiotomy-- appears useful in select patients with malignancy in order to avoid more invasive surgical procedures. Occasionally, in patients with recurrent effusions, instillation of sclerosing agents into the pericardial space or even total pericardiectomy may be necessary.
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Fulminant hepatic failure is defined as the development of hepatic encephalopathy within 8 weeks of the onset of illness. While there are many causes of FHF, viral hepatitis, particularly hepatitis B, remains the most common etiology. Several drugs and toxins can also lead to FHF, most notably acetaminophen. ⋯ Conservative management focuses on invasive monitoring and the prevention and treatment of complications like cerebral edema, infection, renal failure, and coagulopathy. Only orthotopic liver transplantation has reduced mortality from 80% to 30% to 50%. Therefore, the goals of management and treatment now include determining which patients are appropriate for liver transplant and finding a donor in a timely fashion.
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Patients with short stature may go unrecognized if routine, accurate growth measurements are not performed by primary care physicians: This cannot be overemphasized. An accurate assessment of growth requires reliable growth measurements and proper plotting of growth data on correct growth charts. This should be done by the primary care physician yearly and at every office visit. ⋯ In some children other specialized testing is required, such as chromosomal analysis or GH testing. The therapy, if any, of short stature will of course depend on the underlying etiology. Often reassurance is all that is necessary.
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A variety of benign and malignant bone tumors can affect the metabolically active pediatric skeleton. A thorough investigation with pertinent imaging studies can establish an appropriate differential diagnosis and frequently allows distinction between benign and malignant tumors. By using a multidisciplinary approach to the treatment of malignant tumors, a number of advances have been made. Further research is needed to gain more understanding and improve on the remarkable advances of the past 20 years.