RESUMEN
Patients newly diagnosed with end stage renal disease are faced with many treatment decisions. The decision-making process should follow some well-defined steps. These start with the decision to initiate dialysis and may end with a 'do not resuscitate' request or even a withdrawal from dialysis. The nephrology team can lead the patient and family through this process by providing timely, realistic information to help them make the best decisions. End-of-life decision making should be a part of the initial long-term care planning done with every patient and family.
Asunto(s)
Conducta Cooperativa , Toma de Decisiones , Familia/psicología , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Grupo de Atención al Paciente/organización & administración , Participación del Paciente , Cuidado Terminal/psicología , Humanos , Apoyo SocialRESUMEN
Otitis media is a common childhood disease with a spectrum of pathology ranging from acute, painful infection to persistent middle ear effusion to chronic negative middle ear pressure and development of cholesteatoma. Amoxicillin remains the initial empiric drug of choice with TMP-SMZ or erythromycin-sulfisoxazole used for penicillinallergic patients or for amoxicillin therapy failures. Amoxicillin-clavulante, cefuroxime axetil (no elixir form available) or cefixime may then be tried keeping in mind relative costs, side effects, dosing frequency and drug formulation. Prophylactic amoxicillin or sulfisoxazole at one-half the usual daily dose given once a day throughout the URI season is effective in reducing the number of episodes of AOME. Prolonged sulfonamide use should be carefully monitored. Tympanostomy tube insertion is indicated for frequently recurring otitis media and for persistent middle ear effusions. Adenoidectomy is an adjunctive procedure shown to be effective in children requiring a second set of tubes for recurrent infections or for children four years old or older with persistent middle ear fluid. Tympanoplasty may be necessary to prevent ossicular chain damage due to severe cases of MEVD or to repair non-healing perforations. Cholesteatomas must be surgically removed and may require elaborate reconstructive techniques.
Asunto(s)
Otitis Media/terapia , Adenoidectomía , Antiinfecciosos/uso terapéutico , Niño , Preescolar , Oído Medio/cirugía , Humanos , Ventilación del Oído Medio , Otitis Media/tratamiento farmacológico , Otitis Media/cirugía , RecurrenciaRESUMEN
We have evaluated Roche Diagnostics' RIA-CEA and Abbott Diagnostics' EIA-CEA methods for precision, normal reference interval, concordance, and correlation of malignant disease with increase in carcinoembryonic antigen (CEA) in plasma. In examining concordance, we used data on 138 patients with primary carcinomas of the breast, colon, lung, or pancreas, each further classified by extent of dissemination. We find the two methods to be comparably precise. The respective upper reference limits of normal for the Roche and Abbott methods were determined to be 5.0 micrograms/L and 4.6 micrograms/L. The regression equation for a log transformation of the 177 data points is y = 0.966x + 0.03, where x = Roche and y = Abbott, with a correlation coefficient of 0.948. According to the criteria we used, the concordance was 78.7%. The largest discordance was observed in widely disseminated disease states and in cancers of the colon and pancreas. Paired data analysis of discordance indicated greater increases in apparent CEA by the Abbott method in most colon cancers with liver involvement; six of the eight discordant pancreatic cancers had higher Roche-CEA values. CEA heterogeneity and the role of the liver in CEA metabolism appear to contribute to the observed differences. We show why the two methods should not be used interchangeably, and that baseline values for CEA must be established for each method.