Articles: adult.
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The primary presentation of congenital megaureter in adults is rare. Development of urolithiasis may lead to this unusual underlying diagnosis. Urinary tract stones can form either within the dilated ureteral segment or in a part of the upper urinary tract proximal to the abnormal ureteral segment. ⋯ Typically, stones will develop within the dilated segment of ureter. Atypically, stones may develop away from the site of the underlying abnormality. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.
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This study aimed to review the literature addressing motor physical therapy for intensive care unit adult patients. A literature search was conducted in the databases, PubMed, MedLine (International Literature and Health), LILACS (Latin American and Caribbean Health Sciences) and Cochrane between 1995 and December 2008 using the keywords: physical therapy, mobilization and intensive care unit. For comparison purposes we selected randomized controlled trials and prospective studies, addressing the subject motor physical therapy for intensive care unit adult patients. ⋯ Early mobilization is a new area, with little evidence so far. However, recent studies have confirmed that mechanically ventilated patients mobilization is safe and feasible, reducing both the intensive care unit and hospital stay. However, more studies are warranted to identify the exercise type, duration, intensity and impact for of early motor therapy in specific groups of patients.
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Rev Bras Ter Intensiva · Dec 2009
Genetic susceptibility in acute lung injury and acute respiratory distress syndrome.
Acute lung injury and its most severe presentation, acute respiratory distress syndrome, are a common denominator for several diseases which can lead to exaggerated lung inflammation. In the last years this variability has been ascribed, at least partially, to genetic issues. This study aims to review the role of the main genes involved in acute lung injury and acute respiratory distress syndrome susceptibility, morbidity and mortality. ⋯ Genetic polymorphisms are gene variations in at least 1% population. These gene variations may influence the inflammatory response mediators' expression, directly affecting the susceptibility to acute lung injury, the intensity of lung parenchyma inflammation, the development clinical course and outcome. Association studies reproducible in large populations will definitely allow genomics to be included into the diagnostic and therapeutic armamentarium for acute lung injury/acute respiratory distress syndrome patients.
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Duchenne muscular dystrophy (DMD), Becker muscular dystrophy (BMD) and limb girdle muscular dystrophies (LGMD) represent a significant proportion of paediatric and adult neuromuscular neurology practice. The proactive symptom-based multidisciplinary team (MDT) management and access to non-invasive ventilation have enabled improved survival into adulthood. Nevertheless the severe disability imposed by conditions such as DMD poses a challenge for successful transition of care and management for paediatric and adult neurology teams. ⋯ LGMDs are much rarer than DMD and BMD, and in addition there is a significant genetic and clinical heterogeneity, which leads to diagnostic difficulties. The clinical and laboratory diagnostic features of seven LGMD subtypes are summarised, and their allelic "non-limb girdle" phenotypes are tabulated to illustrate the theme of one gene causing multiple clinical phenotypes, with the aim of refining the clinician's diagnostic approach. The lessons learnt from DMD MDT management to improve survival are broadly applicable to LGMDs with severe motor disability/multisystem complications.
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Hand (New York, N.Y.) · Sep 2009
The Buttazzoni classification of distal radial fractures in adults: interobserver and intraobserver reliability.
Despite the fact that distal radial fracture is the commonest fracture, there is a little evidence-based knowledge about the value of its classification to guide management and predict prognosis. The available classification systems are either complicated or weakly applicable in clinical practice. Older's classification is the most reliable, but does not cover all radial fracture types. ⋯ The reliability was better for younger patients and when evaluation was carried out by hand-surgery-interested orthopedic surgeons. The new classification system is simple, covers all radial fracture types, and has an acceptable reliability. Further studies are needed to judge its ability to direct management and predict prognosis.