Israel journal of medical sciences
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Various radiological techniques are used for the evaluation of nasopharyngeal lesions--conventional lateral and base projections, computed tomography (CT), magnetic resonance imaging (MRI), and angiography. Owing to its multiplanar imaging capability, MRI is the optimal modality for investigation of the anatomy and demonstration of the pathology. Gadolinium-DTPA enhancement helps to delineate the lesions and their extension, especially into the intracranial cavity; however, since fat and bone marrow enhance prominently, MR fat suppression technique should be utilized in certain cases. A detailed description is given of the clinical and radiological (CT, MRI) features of the different benign (adenoid tissue hypertrophy, Thornwaldt cyst, juvenile angiofibroma) and malignant diseases, 80% of which are squamous cell carcinomas.
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Review Clinical Trial
Corticosteroids in sepsis and septic shock: has the jury reached a verdict?
Mortality from septic shock remains high, despite early diagnosis, comprehensive care and monitoring, and intensive therapy. The use of high-dose corticosteroids as adjunctive therapy in septic states has been extensively debated in the literature, but no clear consensus has been reached. ⋯ Recently, however, well-designed clinical studies have consistently failed to show a beneficial effect of corticosteroid use in septic states. After re-examining the theoretical basis for the use of steroids, possible side effects, experimental results and clinical trials, it is concluded that, based upon current knowledge, high-dose corticosteroids should not be used as adjunctive therapy in human sepsis and septic shock.
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In rescue operations for people trapped under fallen debris, i.v. replenishment of the massive internal fluid volume losses should be started as soon as physical contact has been established with the injured person. This should be followed by induced alkaline-mannitol diuresis. ⋯ Local treatment of the crushed limbs should be conservative. A closed injury should not be converted into an open one unless distal arterial perfusion has been compromised.