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January 16, 2003 Vol. 348 No. 3
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Renal imaging is recommended for children after a first documented urinary tract infection. In this prospective study, 309 children between the ages of one month and two years underwent renal imaging studies (technetium-99m–labeled dimercaptosuccinic acid scanning and renal ultrasonography) within 72 hours after the diagnosis of urinary tract infection, voiding cystourethrography one month later, and repeated scanning six months later. Management was not changed by the finding of ultrasonographic abnormalities (in 12 percent of the children). Monitoring with urinalysis and culture appears to be as effective as imaging studies.
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The outcome of treatment in advanced ovarian cancer can vary considerably among patients with similar clinical and pathological findings. In this immunohistochemical study of tumors from 186 patients, the presence of T cells within the tumor was strongly associated with a good outcome, whereas the absence of T cells correlated with a poor outcome.
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Two reports in this issue describe outbreaks of Pseudomonas aeruginosa infections in hospitals. In both cases an increase in the frequency of pseudomonas infections was associated with bronchoscopy. In one study, isolates from the patients were genetically related to isolates from bronchoscopes that had loose caps on their biopsy ports.
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This study compared characteristics of patients with retained sponges or instruments after surgery, identified through a large malpractice insurer, and control patients who underwent the same types of surgery but did not have retained foreign objects. Independent predictors of the retention of a foreign body included emergency surgery, an unplanned change in procedure, and higher body-mass index. Counts of instruments and sponges were less likely to have been performed for patients with retained foreign bodies than for controls, although in the majority of cases, such counts were performed and were recorded as being correct.
An otherwise healthy 22-year-old woman comes to the emergency department with acute abdominal pain of 18 hours' duration in the right lower quadrant. On physical examination, she is afebrile, with tenderness on deep palpation in the right lower quadrant, and has no peritoneal signs. Pelvic examination reveals tenderness in the right adnexa without a mass. How should this patient be further evaluated?
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