Management of chylothorax

BACKGROUND: Chylothorax is a rare primary or secondary condition the optimum management of which remains uncertain. METHODS: Twenty cases of chylothorax, including ten of primary chylothorax and ten secondary to either malignancy, subclavian vein thrombosis or lymphangioma treated between 1956 and 1986 have been reviewed. RESULTS: Open pleurectomy was the most successful treatment in preventing reaccumulation of the effusion. Three patients had thoracic duct-azygous vein anastomoses, but all anastomoses were probably occluded within a year of surgery. Three patients have been lost to follow-up and five died within 2 years of their treatment, but 12 patients were alive and free from an effusion 3-22 years after treatment. CONCLUSION: Patients with chylothorax should undergo lymphangiography to identify the cause and site of the lymphatic abnormality. Conservative treatment is successful in some patients but should be abandoned if the fluid loss exceeds 1.5 l/day for more than 5-7 days in an adult or more than 100 ml/day in a child. Parietal pleurectomy is the most successful treatment when no distinct chylous leak can be identified. Less commonly, an isolated chylous leak either in the chest or in the abdomen may be identified and this should be treated by direct ligation.     

A8高速路公园

Koog aan de Zaan是阿姆斯特丹附近的个可爱的小村庄，坐落于Zaan河边。20世纪70年代早期，这里新建了条高速路。为了跨过河，A8高速下面由桥墩支撑。这条新路奇妙地穿过镇子，在城市肌理中形成了个粗暴的切口。具有讽刺意义的是，在这里形成了个教会和政府间的根本分离：高架路的一侧是一个小教堂，而另一侧则是原来的市政厅。桥墩大概有7米高。桥下的空间变得非常具有纪念性：成为一个延伸的教堂。     

Behavioral genetics and evolutionary psychology: unified perspective on personality research

Behavioral geneticists and evolutionary psychologists have generally pursued human behavioral analyses with little theoretical or methodological exchange. However, significant benefits might accrue from increased communication between these disciplines. The primary goals of this article are (1) to identify meaningful junctures between behavioral genetics and evolutionary psychology, (2) to describe behavioral genetic research designs and their applications to evolutionary analyses, and (3) to reassess current personality research in light of behavioral genetic and evolutionary concepts and techniques. The five-factor model of personality is conceptualized as subsuming variation in normative species-typical systems with adaptive functions in the human environment of evolutionary adaptation. Considered as universal evolved mechanisms, personality systems are often seen in dynamic conflict within individuals and as highly compartmentalized in their functioning between settings. However, genetically influenced individual differences in personality may also be understood within an evolutionary framework. Studies of the heritability of personality traits indicate broad-sense heritabilities in the 0.40-0.50 range with evidence of substantial nonadditive genetic variation and nonshared environmental influences. Evidence indicates that evolutionary theory (e.g., inclusive fitness theory) predicts patterns of social interaction (e.g., cooperation and bereavement) in relatives. Furthermore, variation in personality may constitute a range of viable strategies matching the opportunities available in the complex niche environment of human societies. Within this wide range of viable strategies, personality variation functions as a resource environment for individuals in the sense that personality variation is evaluated according to the interests of the evaluator (e.g., friendships, coalitions, or mate choice).     

Pulmonary complications after bone marrow transplantation: high-resolution CT and pathologic findings

The explosion of new knowledge about the complex mechanisms mediating high blood pressure is providing new targets for drug therapy of hypertension and other cardiovascular disorders. This article reviews the current status of several new approaches in the management of hypertension, including vasopressin antagonists, natriuretic peptide clearance inhibitors, endothelin antagonists, renin inhibitors, angiotensin receptor antagonists, and selective T-type calcium ion channel antagonists.     

Tailed. New options in therapy of bronchial asthma

A correct access opening is the key to endodontics. An adequate anatomical access preparation maximizes cleaning, shaping, and obturation. The major objectives of access preparation are straight line access to the apical area, conservation of tooth structure, and unroofing of the pulp chamber. The safe-ended diamond bur technique provides an efficient and rapid means to obtain the objective of access preparation in posterior teeth.