PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed ...PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed external hemorrhoids a fter conservative or surgical management. METHODS: Two hundred and thirty-one c onsecutive patients with thrombosed external hemorrhoids treated from 1990 to 20 02 were identified. Recurrence was defined as complete resolution of the index l esion with subsequent return of a thrombosed external hemorrhoid and did not inc lude patients with chronic symptoms. Data were gathered retrospectively. Multipl e potential risk factors were reviewed. RESULTS: The index thrombosed external h emorrhoid was managed conservatively in 51.5 percent of cases and surgically in 48.5 percent. There were no differences between groups in gender, age, or race, and 44.5 percent of all patients had a prior history of thrombosed external hemo rrhoid. A prior history was less common in the conservative group than in the su rgical group (38.1 percent vs. 51.3 percent; P < 0.05). The frequency of pain or bleeding as the primary complaint was higher in the surgical group (P< 0.001 and P< 0.002) . In addition, the surgical group was more likely to report all three symptoms o f pain, bleeding, and a lump (P< 0.005). Mean follow-up was 7.6 months, with th e range extending to 7 years. Time to symptom resolution averaged 24 days in the conservative group vs. 3.9 days in the surgical group (P< 0.0001). The overall incidence to recurrence was 15.6 percent-80.6 percent in the conservative group vs. 19.4 percent in the surgical group. The rate of recurrence in the conservat ive group was 25.4 percent (4/29; 14 percent were excised) whereas only 6.3 perc ent of the surgical patients had recurrence (P < 0.0001). Mean time to recurrenc e was 7.1 months in the conservative group vs. 25 months in the surgical group ( P < 0.0001). Survival analysis for time to recurrence of thrombosed external hem orrhoid indicated that t展开更多
been described in japanese populations. These convulsions are not related to clinical signs of dehydration or electrolyte disorder. This entity was called CwG,benign Convulsions with mild Gastroenteritis. We report th...been described in japanese populations. These convulsions are not related to clinical signs of dehydration or electrolyte disorder. This entity was called CwG,benign Convulsions with mild Gastroenteritis. We report the case of a 19 month-old japanese boy who presented with a CwG. We described the characteristic clinical features of this entity and we reviewed the cases reported in literature. The evolution of the CwG is always simple without relapse or side effects. Better understanding will help pediatricians make more accurate diagnosis and avoid treatment even though initial signs might be severe.展开更多
Objectives: To determine incidence, outcomes, and risk factors for pediatric c erebral edema with diabetic ketoacidosis (CEDKA) in Canada. Study design: This w as a case-control study nested within a population-based ...Objectives: To determine incidence, outcomes, and risk factors for pediatric c erebral edema with diabetic ketoacidosis (CEDKA) in Canada. Study design: This w as a case-control study nested within a population-based active surveillance s tudy of CEDK A in Canada from July 1999 to June 2001. Cases are patients with DK A <16 years of age with cerebral edema. Two unmatched control subjects per case are patients with DKA without cerebral edema. Results: Thirteen cases of CEDKA w ere identified over the surveillance period for an incidence rate of 0.51%; 23 %died and 15%survived with neurologic sequelae. CEDKA was present at initial p resentation of DKA in 19%of cases. CEDKA was associated with lower initial bica rbonate (P =. 001), higher initial urea (P =. 001), and higher glucose at presen tation (P =. 014). Although there was a trend to association with higher fluid r ates and treatment with bicarbonate, these were not independent predictors. Conc lusions: CEDKA remains a significant problem with a high mortality rate. No asso ciation was found between the occurrence of CEDKA and treatment factors. The pre sence of cerebral edema before treatment of DKA and the association with severit y of illness suggest that prevention of DKA is the key to avoiding this devastat ing complication.展开更多
Objective: To determine the impact of age and condition at the time of diagnosis on survival of patients with cystic fi-brosis (CF). Study design: By mode of diagnosis, 27,692 patients documented in the 1986-2000 CF F...Objective: To determine the impact of age and condition at the time of diagnosis on survival of patients with cystic fi-brosis (CF). Study design: By mode of diagnosis, 27,692 patients documented in the 1986-2000 CF Foundation Registry were segregated into meconium ileus (MI), prenatal or neonatal screening (SCREEN), positive family history only (FH), and symptoms other than MI (SYMPTOM). Patients in the MI, SCREEN, and SYMPTOM groups were further categorized by initial presenting symptoms into combined respiratory symptoms and malnutrition (RESP + NUTR), RESP, NUTR, other less common symptoms (OTHER), and OTHER + RESP/NUTR. Results: Fifty-five percent of patients in the SCREEN group and 59% of patients in the MI group were diagnosed within age 1 month, as contrasted with 5% in patients in the SYMPTOM group (P < .001). Compared with patients in the SCREEN group, patients in the MI and SYMPTOM groups had significantly greater risks of shortened survival. Patients in the SYMPTOM group presenting with RESP + NUTR had significantly greater risk of shortened survival than the SCREEN group (P < .05). Survival of patients in the SYMPTOM group diagnosed “ early,” that is, within 1 month of age, did not differ from patients in the SCREEN group but was significantly better than patients in the SYMPTOM group diagnosed beyond age 1 month to 10 years. Conclusions: Early diagnosis through screening is associated with better survival compared with delayed diagnosis through non-MI symptoms beyond the age of 1 month.展开更多
文摘PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed external hemorrhoids a fter conservative or surgical management. METHODS: Two hundred and thirty-one c onsecutive patients with thrombosed external hemorrhoids treated from 1990 to 20 02 were identified. Recurrence was defined as complete resolution of the index l esion with subsequent return of a thrombosed external hemorrhoid and did not inc lude patients with chronic symptoms. Data were gathered retrospectively. Multipl e potential risk factors were reviewed. RESULTS: The index thrombosed external h emorrhoid was managed conservatively in 51.5 percent of cases and surgically in 48.5 percent. There were no differences between groups in gender, age, or race, and 44.5 percent of all patients had a prior history of thrombosed external hemo rrhoid. A prior history was less common in the conservative group than in the su rgical group (38.1 percent vs. 51.3 percent; P < 0.05). The frequency of pain or bleeding as the primary complaint was higher in the surgical group (P< 0.001 and P< 0.002) . In addition, the surgical group was more likely to report all three symptoms o f pain, bleeding, and a lump (P< 0.005). Mean follow-up was 7.6 months, with th e range extending to 7 years. Time to symptom resolution averaged 24 days in the conservative group vs. 3.9 days in the surgical group (P< 0.0001). The overall incidence to recurrence was 15.6 percent-80.6 percent in the conservative group vs. 19.4 percent in the surgical group. The rate of recurrence in the conservat ive group was 25.4 percent (4/29; 14 percent were excised) whereas only 6.3 perc ent of the surgical patients had recurrence (P < 0.0001). Mean time to recurrenc e was 7.1 months in the conservative group vs. 25 months in the surgical group ( P < 0.0001). Survival analysis for time to recurrence of thrombosed external hem orrhoid indicated that t
文摘been described in japanese populations. These convulsions are not related to clinical signs of dehydration or electrolyte disorder. This entity was called CwG,benign Convulsions with mild Gastroenteritis. We report the case of a 19 month-old japanese boy who presented with a CwG. We described the characteristic clinical features of this entity and we reviewed the cases reported in literature. The evolution of the CwG is always simple without relapse or side effects. Better understanding will help pediatricians make more accurate diagnosis and avoid treatment even though initial signs might be severe.
文摘Objectives: To determine incidence, outcomes, and risk factors for pediatric c erebral edema with diabetic ketoacidosis (CEDKA) in Canada. Study design: This w as a case-control study nested within a population-based active surveillance s tudy of CEDK A in Canada from July 1999 to June 2001. Cases are patients with DK A <16 years of age with cerebral edema. Two unmatched control subjects per case are patients with DKA without cerebral edema. Results: Thirteen cases of CEDKA w ere identified over the surveillance period for an incidence rate of 0.51%; 23 %died and 15%survived with neurologic sequelae. CEDKA was present at initial p resentation of DKA in 19%of cases. CEDKA was associated with lower initial bica rbonate (P =. 001), higher initial urea (P =. 001), and higher glucose at presen tation (P =. 014). Although there was a trend to association with higher fluid r ates and treatment with bicarbonate, these were not independent predictors. Conc lusions: CEDKA remains a significant problem with a high mortality rate. No asso ciation was found between the occurrence of CEDKA and treatment factors. The pre sence of cerebral edema before treatment of DKA and the association with severit y of illness suggest that prevention of DKA is the key to avoiding this devastat ing complication.
文摘Objective: To determine the impact of age and condition at the time of diagnosis on survival of patients with cystic fi-brosis (CF). Study design: By mode of diagnosis, 27,692 patients documented in the 1986-2000 CF Foundation Registry were segregated into meconium ileus (MI), prenatal or neonatal screening (SCREEN), positive family history only (FH), and symptoms other than MI (SYMPTOM). Patients in the MI, SCREEN, and SYMPTOM groups were further categorized by initial presenting symptoms into combined respiratory symptoms and malnutrition (RESP + NUTR), RESP, NUTR, other less common symptoms (OTHER), and OTHER + RESP/NUTR. Results: Fifty-five percent of patients in the SCREEN group and 59% of patients in the MI group were diagnosed within age 1 month, as contrasted with 5% in patients in the SYMPTOM group (P < .001). Compared with patients in the SCREEN group, patients in the MI and SYMPTOM groups had significantly greater risks of shortened survival. Patients in the SYMPTOM group presenting with RESP + NUTR had significantly greater risk of shortened survival than the SCREEN group (P < .05). Survival of patients in the SYMPTOM group diagnosed “ early,” that is, within 1 month of age, did not differ from patients in the SCREEN group but was significantly better than patients in the SYMPTOM group diagnosed beyond age 1 month to 10 years. Conclusions: Early diagnosis through screening is associated with better survival compared with delayed diagnosis through non-MI symptoms beyond the age of 1 month.
