1,720,965 research outputs found
An adolescent with acute abdominal pain and bowel wall thickening
No full textA 15-year-old girl was admitted with acute crampy abdominal pain and repeated vomiting over the preceding 2 hours; no fever, diarrhoea or abdominal trauma was reported. She had started oestrogen-progestin contraception 3 months ago. She had sought medical advice twice in the previous weeks for self-limiting episodes of right hand swelling, without urticaria. On examination, she was unwell and in pain, with severe tenderness in the right lower quadrant, without guarding or rebound tenderness. Bowel sounds were diminished. Blood tests were unremarkable. Two hours after admission, an abdominal ultrasound scanning showed an impressive wall thickening (>1 cm) of the terminal ileum, caecum and ascending colon (figure 1). Abundant free intraperitoneal fluids in the pelvis and in the hepatorenal recess were present. Figure 1Marked caecal wall thickening evidenced at the ultrasound scanning.
QUESTIONS:
Which of the following is the most likely diagnosis in this patient? Ileocolic intussusceptionGastrointestinal manifestation of Henoch-Schönlein purpuraAbdominal attack of hereditary angioedema (HAE)Acute pancreatitisWhich of the following blood tests may help to confirm the diagnosis? Erythrocyte sedimentation rateC4Serum amylase: 36 IU/LC1-inhibitorHow should this patient be evaluated and treated
Appendicitis in children less than five years old: A challenge for the general practitioner
Full text linkAcute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5 years old, followed by vomiting, fever, anorexia and diarrhea. The most common physical sign is focal tenderness (61% of the patients) followed by guarding (55%), diffuse tenderness (39%), rebound (32%), and mass (6%). Neonatal appendicitis is a very rare disease with high mortality; presenting symptoms are nonspecific with abdominal distension representing the main clinical presentation. The younger the patient, the earlier perforation occurs: 70% of patients less than 3 years develop a perforation within 48 h of onset of symptoms. A timely diagnosis reduces the risk of complications. We highlight the epidemiology, pathophysiology, clinical signs and laboratory clues of appendicitis in young children and suggest an algorithm for early diagnosis
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
La sindrome del QT lungo
No full textThe long QT syndrome (LQTS) is an arrhythmogenic syndrome due to cardiac ion channel disorders characterized by prolonged QT interval on ECG (QTc >440 ms for male, >460 ms for female) and the most common presentations are syncope, seizures, cardiac arrest and sudden death. Many different congenital forms have been identified but also an acquired form due to specific drugs, hypokalaemia, or hypomagnesemia is known. Familiarity is the leading risk factor. LQTS should be suspected in case of any syncope in order to perform ECG and start proper therapy. To identify and remove risk factors it is necessary to avoid potentially life-threatening arrhythmia in these patients
La gestione del bambino con gastroenterite acuta.
No full textAcute gastroenteritis (AG) is a very common disease in children. It causes significant mortality in developing countries and significant economic burden to developed countries. Viruses are responsible for approximately 70% of episodes of acute gastroenteritis in children and rotavirus is one of the best studied of these viruses. Although guidelines exist to assist clinicians, there is evidence that the treatment of paediatric AG varies considerably from place to place, that Oral Rehydration Solution (ORS) is still underused and that children frequently receive intravenous rehydration. In this paper the literature and international guidelines on the epidemiology, diagnosis, management and prevention of AG and its major complication, dehydration are reviewed; in particular a scale to evaluate the level of dehydration and a detailed protocol for oral and intravenous rehydration are provided.
The correct approach to diet and the role of antiemetic drugs are also discussed
Glucose Metabolism Evaluated By Glycated Hemoglobin And Insulin Sensitivity Indexes In Children Treated With Recombinant Human Growth Hormone
No full textOBJECTIVE:
To evaluate glucose metabolism and insulin sensitivity in children with idiopathic growth hormone (GH) deficiency treated with recombinant human GH (rhGH) and to identify possible risk factors for the development of glucose abnormalities in this population.
METHODS:
We retrospectively collected data from 101 patients (60 males, median age 10.4 years, 77 prepubertal), with confirmed GH deficiency, enrolled before starting rhGH and followed up for the first three years of treatment. Glucose metabolism was evaluated every year by oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c). OGTT was used to calculate insulin sensitivity (HOMA-S) and insulin resistance (HOMA-IR), defined as HOMA-IR>3.
RESULTS:
RhGH was effective in improving growth and its dosage was significantly reduced after the first year of therapy. No patient developed diabetes mellitus. After one year of therapy, a significant increase in HbA1c (p=0.0042) and insulin levels (fasting p<0.0001, 60 min p=0.0018, 120 min p=0.0003) was observed, with higher prevalence of insulin resistance (p<0.05 for HOMA-IR). These indexes did not alter further during the follow-up and were not related to GH doses or to familiarity for diabetes. A significant correlation was found only for insulin resistance indexes and pubertal status, weight and age (p<0.05).
CONCLUSIONS:
In this retrospective study on a large GH deficient pediatric population, conventional use of replacement therapy resulted in an increase in HbA1c and insulin resistance after one year of therapy, regardless of rhGH dosage. These alterations were transient and not associated with significant changes in glucose metabolism during the subsequent follow-up
L'ascesso retrofaringeo
No full textRetropharyngeal abscess in children is a rare suppurative complication of upper respiratory infections. Clinical manifestations can be variable but the most common features are fever, neck pain, neck lymphoadenopathy, neck mass, torticollis, neck stiffness, drooling, dysphagia, and sore throat. Less frequently, it might present with respiratory findings. Physical examination can show pharyngeal wall bulging which is pathognomonic but not always present. Retropharyngeal abscess can cause serious complications that might eventually lead to death. The potential seriousness of the pathology has decreased because of advances in imaging allowing an early detection. Indeed, over the years, there has been a remarkable reduction of the incidence of complications and mortality. However, several studies highlight a significant increase in incidence in the last ten years. CT seems to be the gold diagnostic standard because of its high sensitivity. This article provides a review of the recent literature about etiopathogenesis, epidemiology, clinical features, diagnosis and therapy. Finally, the experience of the authors’ Institution in the last 10 years is reported
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