The Mount Sinai journal of medicine, New York
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Patients with HIV-1 infection are at risk for developing renal diseases with diverse etiologies. Acute renal failure occurs in up to 20% of hospitalized patients with HIV infection, and chronic renal disease of diverse etiology has been reported. The single most common cause of chronic renal insufficiency in HIV-1+ patients is HIV-associated nephropathy (HIVAN). Typical morphologic features include enlarged kidneys, microcystic tubule dilatation, tubulointerstitial inflammation, and focal and segmental glomerulosclerosis. ⋯ In seropositive patients with renal disease, renal biopsies should be performed to confirm the diagnosis and determine the true incidence. Special attention should be directed toward understanding the underlying cause(s) of HIVAN. A multicenter trial to explore the potential for antiviral therapy in this disease should be initiated.
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Review Comparative Study
The evaluation of blunt abdominal trauma: the evolving role of ultrasound.
There is a growing body of literature pertaining to the use of ultrasound in the evaluation of patients with blunt abdominal trauma. Multiple studies have looked at the use of this modality as a screening examination for the detection of intra-abdominal fluid and as a means of diagnosing specific organ injuries. ⋯ In many centers, ultrasound is now being performed by emergency medicine physicians and trauma surgeons as part of the initial trauma evaluation. This paper summarizes the recent literature on the use of ultrasound in evaluating blunt abdominal trauma as an adjunct or an alternative to diagnostic peritoneal lavage and abdominal computed tomography.
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Trauma is the leading cause of death in infants and children. Caring for the pediatric trauma victim requires a systematic approach which utilizes an understanding of the anatomic and pathophysiologic characteristics that make children different from adults. Child abuse frequently presents as trauma, making a high index of suspicion for mechanism and severity of injury an important component of trauma assessment. A basic approach to managing pediatric trauma with emphasis on initial stabilization is presented, followed by discussion of specific areas including head and neck trauma, chest trauma, abdominal trauma, and extremity trauma.
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Maintenance of the airway is the most important and one of the most challenging functions that an emergency physician has to perform. This article is a review of the various techniques that can be used by both emergency and nonemergency physicians to secure the airway. It includes standard orotracheal intubation, nasotracheal intubation, fiberoptic intubation, and cricothyroidotomy. The medications used in these procedures and in rapid sequence intubation are discussed.