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McAuliffe S, Archer A, Carter A, Ray S. An evaluation of nasogastric (NG) tube removal practices and nutritional intake parameters in an acute neurosurgical population: The development of an NG Transition Feeding Protocol. J Hum Nutr Diet 2024; 37:246-255. [PMID: 37867393 DOI: 10.1111/jhn.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND As a result of the complex nature of neurosurgical patients, nasogastric (NG) tube feeding is often implemented for patients who are unable to consume adequate oral intake. During recovery, patients on enteral nutrition (EN) are progressed to oral nutrition, which can result in NGT removal and discontinuation of supportive feeding plans. This is often before patients become established on sufficient oral intake to meet their nutritional requirements. METHODS We conducted an exploration of current NG removal practices in patients (n = 23) across five neurosurgical wards over a 3-month period to assess practitioner review response times, NG feeding duration, decision making on NG removal, and the influence of dietary recommendations and differing EN protocols on patients' ability to meet their nutritional requirements. Our aim was to use this data to design and implement a protocol to improve consistency of these practices. RESULTS After oral intake was commenced, only those receiving supplementary EN achieved nutritional targets immediately. Conversely, no patient who had their NGT removed at this stage achieved these targets. Following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian led cessation of NG feeding. These findings led us to develop an "NG Transition Feeding Protocol" to serve as a simple, clear pathway which treating teams can utilise to guide NG feeding decisions. CONCLUSIONS NG feeding supports neurosurgical patients to meet nutritional requirements in the early stages following commencement of oral intake. The development of an "NG Transition Feeding Protocol" may help to improve consistency of transition feeding on neurosurgical wards, allowing time for nutrition assessment to support informed decisions around NG removal. The aim of this protocol is to improve the efficiency of transition feeding, improve dietetic workload efficiency, nursing staff confidence and avoid compromising nutritional status of patients as a result of the early cessation of EN.
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Affiliation(s)
- Shane McAuliffe
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- NNEdPro Global Institute for Food, Nutrition and Health, Cambridge, UK
| | - Alan Archer
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Amy Carter
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sumantra Ray
- NNEdPro Global Institute for Food, Nutrition and Health, Cambridge, UK
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Findlay-White F, Dornan T, Davies M, Archer A, Kilvert A, Fox C. From fixer to facilitator: an interpretative phenomenological study of diabetes person-centred counselling and empowerment-based education. F1000Res 2023; 11:78. [PMID: 38434003 PMCID: PMC10904953 DOI: 10.12688/f1000research.73596.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 03/05/2024] Open
Abstract
Background The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, 'being the way I want to be' in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants' experience of transformation may also guard against professional burnout.
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Affiliation(s)
- Florence Findlay-White
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Mark Davies
- Clinical Psychology Department, Belfast City Hospital, Belfast, Northern Ireland, BT9 7AE, UK
| | - Alan Archer
- Derbyshire Community Health Service, Walton Hospital, Chesterfield, England, S40 3HW, UK
| | - Anne Kilvert
- Northampton Community Diabetes Service, Danetre Hospital, Daventry, England, NN11 4DY, UK
| | - Charles Fox
- Diabetes Research Centre, University of Leicester, Leicester, England, LE5 4PW, UK
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Birnbaum S, Archer A, Stalens C, Lejeune J, Hogrel J. VP.40 Exploring barriers and facilitators to physical exercise in autoimmune myasthenia gravis : The MYaEX study. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Archer A, Foxhall HR, Allan NL, Shearer JRW, Gunn DSD, Harding JH, Todorov IT, Travis KP, Purton JA. Multiple cascade radiation damage simulations of pyrochlore. Molecular Simulation 2020. [DOI: 10.1080/08927022.2020.1805449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A. Archer
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK
| | - H. R. Foxhall
- Engineering Materials, University of Sheffield, Sheffield S7 3JD, UK
| | - N. L. Allan
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK
| | - J. R. W. Shearer
- School of Chemistry, University of Bristol, Bristol BS8 1TS, UK
- School of Chemistry, University of Southampton, Southampton SO17 1BG, UK
| | - D. S. D. Gunn
- STFC Daresbury Laboratory, SCD, Warrington WA4 4AD, UK
| | - J. H. Harding
- Engineering Materials, University of Sheffield, Sheffield S7 3JD, UK
| | - I. T. Todorov
- STFC Daresbury Laboratory, SCD, Warrington WA4 4AD, UK
| | - K. P. Travis
- Engineering Materials, University of Sheffield, Sheffield S7 3JD, UK
| | - J. A. Purton
- STFC Daresbury Laboratory, SCD, Warrington WA4 4AD, UK
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Hases L, Archer A, Indukuri R, Birgersson M, Savva C, Korach-André M, Williams C. High-fat diet and estrogen impacts the colon and its transcriptome in a sex-dependent manner. Sci Rep 2020; 10:16160. [PMID: 32999402 PMCID: PMC7527340 DOI: 10.1038/s41598-020-73166-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
There is a strong association between obesity and colorectal cancer (CRC), especially in men, whereas estrogen protects against both the metabolic syndrome and CRC. Colon is the first organ to respond to high-fat diet (HFD), and estrogen receptor beta (ERβ) can attenuate CRC development. How estrogen impacts the colon under HFD and related sex differences has, however, not been investigated. To dissect this, mice were fed control diet or HFD for 13 weeks and administered receptor-selective estrogenic ligands for the last three weeks. We recorded impact on metabolism, colon crypt proliferation, macrophage infiltration, and the colon transcriptome. We found clear sex differences in the colon transcriptome and in the impact by HFD and estrogens, including on clock genes. ERα-selective activation reduced body weight and generated systemic effects, whereas ERβ-selective activation had local effects in the colon, attenuating HFD-induced macrophage infiltration and epithelial cell proliferation. We here demonstrate how HFD and estrogens modulate the colon microenvironment in a sex- and ER-specific manner.
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Affiliation(s)
- L Hases
- Science for Life Laboratory, Department of Protein Science, KTH Royal Institute of Technology, Solna, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - A Archer
- Science for Life Laboratory, Department of Protein Science, KTH Royal Institute of Technology, Solna, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - R Indukuri
- Science for Life Laboratory, Department of Protein Science, KTH Royal Institute of Technology, Solna, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - M Birgersson
- Science for Life Laboratory, Department of Protein Science, KTH Royal Institute of Technology, Solna, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - C Savva
- Department of Medicine, Metabolism Unit and Integrated CardioMetabolic Center (ICMC), Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - M Korach-André
- Department of Medicine, Metabolism Unit and Integrated CardioMetabolic Center (ICMC), Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - C Williams
- Science for Life Laboratory, Department of Protein Science, KTH Royal Institute of Technology, Solna, Sweden. .,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
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Archer A, Benbow W, Bird R, Brose R, Buchovecky M, Buckley J, Bugaev V, Connolly M, Cui W, Daniel M, Feng Q, Finley J, Fortson L, Furniss A, Gillanders G, Hütten M, Hanna D, Hervet O, Holder J, Hughes G, Humensky T, Johnson C, Kaaret P, Kar P, Kelley-Hoskins N, Kertzman M, Kieda D, Krause M, Krennrich F, Kumar S, Lang M, Lin T, Maier G, McArthur S, Moriarty P, Mukherjee R, O’Brien S, Ong R, Otte A, Petrashyk A, Pohl M, Pueschel E, Quinn J, Ragan K, Reynolds P, Richards G, Roache E, Rulten C, Sadeh I, Santander M, Sembroski G, Staszak D, Sushch I, Wakely S, Wells R, Wilcox P, Wilhelm A, Williams D, Williamson T, Zitzer B. Measurement of cosmic-ray electrons at TeV energies by VERITAS. Int J Clin Exp Med 2018. [DOI: 10.1103/physrevd.98.062004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
A survey has been undertaken of the distribution of blood lead concentrations in pre-school children attending nursery schools or day centres in Birmingham. The majority of levels in excess of 1.65 μmol/l were found in children of Asian origin. It is thought likely that the high blood lead concentration seen in these children is related to nutritional rather than environmental factors.
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Archambault S, Archer A, Benbow W, Bird R, Bourbeau E, Brantseg T, Buchovecky M, Buckley J, Bugaev V, Byrum K, Cerruti M, Christiansen J, Connolly M, Cui W, Daniel M, Feng Q, Finley J, Fleischhack H, Fortson L, Furniss A, Geringer-Sameth A, Griffin S, Grube J, Hütten M, Håkansson N, Hanna D, Hervet O, Holder J, Hughes G, Hummensky B, Johnson C, Kaaret P, Kar P, Kelley-Hoskins N, Kertzman M, Kieda D, Koushiappas S, Krause M, Krennrich F, Lang M, Lin T, McArthur S, Moriarty P, Mukherjee R, Nieto D, O’Brien S, Ong R, Otte A, Park N, Pohl M, Popkow A, Pueschel E, Quinn J, Ragan K, Reynolds P, Richards G, Roache E, Rulten C, Sadeh I, Santander M, Sembroski G, Shahinyan K, Smith A, Staszak D, Telezhinsky I, Trepanier S, Tucci J, Tyler J, Wakely S, Weinstein A, Wilcox P, Williams D, Zitzer B. Dark matter constraints from a joint analysis of dwarf Spheroidal galaxy observations with VERITAS. Int J Clin Exp Med 2017. [DOI: 10.1103/physrevd.95.082001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abeysekara AU, Archambault S, Archer A, Aune T, Barnacka A, Benbow W, Bird R, Biteau J, Buckley JH, Bugaev V, Cardenzana JV, Cerruti M, Chen X, Christiansen JL, Ciupik L, Connolly MP, Coppi P, Cui W, Dickinson HJ, Dumm J, Eisch JD, Errando M, Falcone A, Feng Q, Finley JP, Fleischhack H, Flinders A, Fortin P, Fortson L, Furniss A, Gillanders GH, Griffin S, Grube J, Gyuk G, Hütten M, Håkansson N, Hanna D, Holder J, Humensky TB, Johnson CA, Kaaret P, Kar P, Kelley-Hoskins N, Khassen Y, Kieda D, Krause M, Krennrich F, Kumar S, Lang MJ, Maier G, McArthur S, McCann A, Meagher K, Moriarty P, Mukherjee R, Nieto D, Bhróithe AOD, Ong RA, Otte AN, Park N, Perkins JS, Petrashyk A, Pohl M, Popkow A, Pueschel E, Quinn J, Ragan K, Ratliff G, Reynolds PT, Richards GT, Roache E, Rousselle J, Santander M, Sembroski GH, Shahinyan K, Smith AW, Staszak D, Telezhinsky I, Todd NW, Tucci JV, Tyler J, Vassiliev VV, Vincent S, Wakely SP, Weiner OM, Weinstein A, Wilhelm A, Williams DA, Zitzer B, Smith PS, Holoien TWS, Prieto JL, Kochanek CS, Stanek KZ, Shappee B, Hovatta T, Max-Moerbeck W, Pearson TJ, Reeves RA, Richards JL, Readhead ACS, Madejski GM, Djorgovski SG, Drake AJ, Graham MJ, Mahabal A. GAMMA-RAYS FROM THE QUASAR PKS 1441+25: STORY OF AN ESCAPE. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/2041-8205/815/2/l22] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Schwieger J, Helderman T, Archer A, Chan S. 20: Knowledge of Heart Attack Symptoms in a Population Survey in Ecuador. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.01.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Poole C, Bass C, Sorrell J, Thompson M, Harrison J, Archer A. Reply. Occup Med (Lond) 2006. [DOI: 10.1093/occmed/kql144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thalacker C, Archer A, Dorfman M. Interpretation of Electrocardiograms by Emergency Medicine Residents in Comparison to Emergency Medicine Attendings. Ann Emerg Med 2005. [DOI: 10.1016/j.annemergmed.2005.06.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
A longitudinal sample survey testing for Cryptosporidium in livestock and small wild mammals conducted over 6 years (1992-1997) on a lowland farm in Warwickshire, England, has shown the parasite to be endemic and persistently present in all mammalian categories. Faecal samples were taken throughout the year and oocysts concentrated by a formal ether sedimentation method for detection by immunofluorescence staining using a commercially available genus specific monoclonal antibody. Cryptosporidium parvum was identified by morphology and measurement of modified Ziehl-Neelsen stained oocysts. C. muris was rarely found in wild mammals and C. andersoni oocysts were never detected in livestock. Faecal samples from 3721 individuals gave cumulative 6-year prevalences for C. parvum as follows: bull beef, 3.6%; dairy cows, 3.5%; ewes, 6.4%; horses, 8.9%; calves (home bred), 52%; calves (bought-in) 23.2%; lambs, 12.9%; small wild mammals (rodents) living in and around farm buildings, 32.8%; small wild mammals (mainly rodents) living in areas of pasture, 29.9%. Animal categories with the highest prevalences also shed the highest average oocyst numbers per gram of faeces (ranging from 1.4 x 10(3) for bull beef to 1.1 x 10(5) for calves). Analysis of annual and seasonal data for each animal category revealed that patterns of infection were variable and sporadic; this means that short-term sampling was never likely to provide a true or representative picture. Seasonally combined data for adult livestock, young livestock and small wild mammals showed all three categories tended to have the highest Cryptosporidium prevalences in the autumn. Calves were separated from their dams within 24h of birth and yet showed high prevalence of infection in most years despite the low prevalence for the dairy herd. It is possible the coincidence of high autumn prevalence in mice with the main period for the rearing of calves contributed to the infection of the latter. The farming estate was used to teach students of agriculture and took pride in good land management and husbandry practices that produced well fed and healthy livestock. The data from this estate may represent, therefore, the baseline, the lowest possible levels to be expected, for Cryptosporidium infection and oocyst production on a lowland farm in the United Kingdom.
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Affiliation(s)
- A P Sturdee
- Cell and Molecular Biosciences, School of Science and Environment, Coventry University, Priory Street, Coventry CV1 5FB, UK.
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Steadman J, Archer A, Churchouse V, Jackson H, Lord S, Pearson J, Coutts F, Scott O, Bithell C, Kalra L. Is there a Link Between Patients Perception of Their Walking and Objective Walking Performance Following Stroke? Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_1.p26-c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- A Archer
- Department of Radiology, Washington Hospital Center, Washington, DC 20010
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Feurestein IM, Archer A, Pluda JM, Francis PS, Falloon J, Masur H, Pass HI, Travis WD. Thin-walled cavities, cysts, and pneumothorax in Pneumocystis carinii pneumonia: further observations with histopathologic correlation. Radiology 1990; 174:697-702. [PMID: 2305052 DOI: 10.1148/radiology.174.3.2305052] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thin-walled pulmonary cystic lesions were found in five immunocompromised patients, four with acquired immunodeficiency syndrome (AIDS). Four patients had Pneumocystis carinii pneumonia (PCP), and one had pulmonary lesions and disseminated P carinii infection. Two patients demonstrated P carinii within necrotizing, thin-walled, smaller intraparenchymal cavities lined by organisms, exudate, and chronic inflammation. Larger, typically apical and subpleural cysts, lined by fibrosis and/or alveolar parenchyma with little inflammation, were also found during acute episodes. The larger subpleural cysts can arise via rupture of intraparenchymal necrotizing cavities into the subpleural area. Pneumothorax in the four patients with AIDS could not be cured by close thoracostomy drainage; all required pleurodesis. The cysts persisted in cases that were followed up. All cysts were more obvious and numerous with computed tomography (CT), especially with 1.5-mm collimation. CT may be indicated in immunocompromised patients with unexplained pneumothorax or when tube thoracostomy has failed and surgery is being considered, as it can positively influence the operative approach.
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Affiliation(s)
- I M Feurestein
- Diagnostic Radiology Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892
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Archer A, Choyke PL, O'Brien W, Maxted WC, Grant EG. Scrotal enlargement following inguinal herniorrhaphy: ultrasound evaluation. Urol Radiol 1988; 9:249-52. [PMID: 3293300 DOI: 10.1007/bf02932679] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although sonography has become an established modality in the evaluation of acute and chronic scrotal abnormalities, its role in the post-herniorrhaphy patient with scrotal swelling has not yet been defined. We present 5 patients with immediate and delayed complications of herniorrhaphy in which sonography provided useful clinical information. Immediate complications included scrotal hematomas, scrotal wall and septal thickening, epididymitis, and testicular displacement. Delayed complications included an infected hydrocele demonstrating a fluid-debris level. The etiology of scrotal swelling in postherniorrhaphy patients can be determined with sonography.
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Affiliation(s)
- A Archer
- Department of Radiology, Georgetown University Hospital, Washington, D.C
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Archer A. Panoramic zonography of the middle and inner ear. Radiography (Lond) 1984; 50:107-9. [PMID: 6739751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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