Lightcurve Results for Eleven Asteroids

NASA Astrophysics Data System (ADS)

Gartrelle, Gordon M.

2012-04-01

Differential photometry techniques were used to develop lightcurves, rotation periods and amplitudes for eleven main-belt asteroids: 833 Monica, 962 Aslog, 1020 Arcadia, 1082 Pirola, 1097 Vicia, 1122 Lugduna, 1145 Robelmonte, 1253 Frisia, 1256 Normannia, 1525 Savolinna, and 2324 Janice. Ground-based observations from Badlands Observatory (BLO) in Quinn, SD, as well as the University of North Dakota Observatory (UND) in Grand Forks, ND, provided the data for the project. A search of the asteroid lightcurve database (LCDB) did not reveal any previously reported results for seven of the eleven targets in this study.

Eleven patients with primary thyroid lymphoma: a single center experience

PubMed

Bostancı, Hasan; Dikmen, Kürşat; Akyürek, Nalan; Büyükkasap, Ahmet Çağrı; Yavuz, Aydın; Yalçın, Mehmet Muhittin; Akın, Murat

2017-11-13

Background/aim: Primary thyroid lymphoma (PTL) is a very rare thyroid malignancy. It should be diagnosed and treated immediately and accurately. Our aim was to evaluate the diagnostic methods and treatment results for patients with PTL.Materials and methods: We retrospectively evaluated the records of 11 patients with PTL from 2009 to 2015, diagnosed at our institute. Age, sex, stage, histopathologic type, presence of Hashimoto's thyroiditis, diagnostic methods, treatment types, and recurrence were examined.Results: Six patients were female, 5 were male, and the median age of the patients was 61 years (range: 15-76 years). All patients had a large palpable mass in the neck. Fine needle aspirate (FNA) biopsy was performed in all patients; however, it was useful only in the diagnosis of 7 patients. Excisional and surgical biopsy was performed in 4 patients. All patients had non-Hodgkin B-cell lymphoma, including 9 cases of diffuse large B-cell lymphoma (DLBCL), and 2 patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Recurrence was observed in one patient. Median survival was 34 months.Conclusions: The preferred option for the diagnosis of PTL should be FNA biopsy, and the treatment should be decided on according to whether the disease is limited to the thyroid gland or not, its histological type, and its stage.

N = 1 supercurrents of eleven-dimensional supergravity

NASA Astrophysics Data System (ADS)

Becker, Katrin; Becker, Melanie; Butter, Daniel; Linch, William D.

2018-05-01

Eleven-dimensional supergravity can be formulated in superspaces locally of the form X × Y where X is 4D N = 1 conformal superspace and Y is an arbitrary 7-manifold admitting a G 2-structure. The eleven-dimensional 3-form and the stable 3-form on Y define the lowest component of a gauge superfield on X × Y that is chiral as a superfield on X. This chiral field is part of a tensor hierarchy giving rise to a superspace Chern-Simons action and its real field strength defines a lifting of the Hitchin functional on Y to the G 2 superspace X × Y . These terms are those of lowest order in a superspace Noether expansion in seven N = 1 conformal gravitino superfields Ψ. In this paper, we compute the O(Ψ) action to all orders in the remaining fields. The eleven-dimensional origin of the resulting non-linear structures is parameterized by the choice of a complex spinor on Y encoding the off-shell 4D N = 1 subalgebra of the eleven-dimensional super-Poincaré algebra.

Impact of cone beam computed tomography on periapical assessment and treatment planning five to eleven years after surgical endodontic retreatment.

PubMed

Kruse, C; Spin-Neto, R; Wenzel, A; Vaeth, M; Kirkevang, L-L

2018-01-18

To evaluate how additional information from Cone Beam CT (CBCT) impacts on periapical assessment and treatment planning based on clinical examination and periapical radiographs (PR) in cases followed up five to eleven years after surgical endodontic retreatment (SER). Patients receiving SER during 2004-2010 were reinvited for follow-up examination including clinical examination, PR, and CBCT. In total, 108 patients (119 teeth) were reinvited, 74 patients (83 teeth) accepted to participate. Three observers initially assessed PR according to the four-scaled, increasing disease severity criteria by Rud et al. (International Journal of Oral Surgery, 1, 1972 and 195) and Molven et al. (International Journal of Oral and Maxillofacial Surgery, 16, and 432): 'Radiographic assessment A'. By including clinical information 'Treatment plan A' was made as follows: 1) no treatment, 2) further observation, 3) SER reoperation (SER-R), or 4) extraction. Hereafter, the CBCT volume was assessed and the information incorporated for 'Radiographic assessment B' followed by 'Treatment plan B'. Agreement between radiographic assessments and between treatment plans was recorded and assessed statistically by Stuart-Maxwell test for marginal homogeneity. Nine teeth had been extracted; thus, the final analysis included 74 teeth (66 patients). The radiographic assessment was changed as a result of the CBCT evaluation in 38 cases (51.4%), of which 35 (47.3%) were to a higher Rud & Molven score, P < 0.001. The treatment plan was changed for 18 teeth (24.3%). For 14 teeth (18.9%), the change was from no treatment or further observation to a more invasive treatment plan (SER-R or extraction), P = 0.005. The use of CBCT for long-term follow-up after SER led to more cases diagnosed with persisting or recurrent apical periodontitis and hence often to the recommendation of a more invasive treatment modality. © 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Eleven years' experience with Intrathecal Baclofen - Complications, risk factors.

PubMed

Pucks-Faes, Elke; Hitzenberger, Gabriel; Matzak, Heinrich; Fava, Elena; Verrienti, Giulio; Laimer, Ilse; Fritz, Josef; Saltuari, Leopold

2018-05-01

Treatment with intrathecal baclofen (ITB) is commonly used in patients with severe spasticity. However, complications may occur after implantation of the ITB-device, albeit mainly procedure- and device-related problems. The aim of the study was to assess surgical- as well as catheter- and pump-related complications and define their risk factors. We retrospectively evaluated all patients with an implanted ITB-device who were treated at the Department of Neurology, Hochzirl Hospital, Zirl, Austria, between 2006 and 2016. Twenty-nine of 116 (25%) patients experienced 32 complications: 5 procedure- and 27 device-related (4 pump- and 23 catheter-associated) problems occurred. Risk factors for sustaining any complication were a spinal localization of lesion (odds ratio [OR] OR 2.71, p  = .021), other catheter types than an Ascenda ® catheter (OR 3.87, p  = .041), a lower modified Rankin Scale (median 4 vs. 5; OR 2.86, p  = .015) and a higher Barthel Index (median 53 vs. 0; OR 2.84, p  = .006). The median time from the last ITB-related surgery to the first complication was 18 (IQR 1-57) months. Overall, 47% complications occurred within the first year after any surgical procedure regarding the ITB-device, thereof 25% within the first month. Procedure- and device-related complications are frequent after implantation of an ITB-device with catheter-associated complications as the most frequently encountered problems. Patients with a spinal origin of spasticity, a lower modified Rankin Scale and a higher Barthel Index have a higher risk to sustain a complication.

The NANOGrav Eleven-Year Data Set: High-precision timing of 48 Millisecond Pulsars

NASA Astrophysics Data System (ADS)

Nice, David J.; NANOGrav

2017-01-01

Gravitational waves from sources such as supermassive black hole binary systems perturb times-of-flight of signals traveling from pulsars to the Earth. The NANOGrav collaboration aims to measure these perturbations in high precision millisecond pulsar timing data and thus to directly detect gravitational waves and characterize the gravitational wave sources. By observing pulsars over time spans of many years, we are most sensitive to gravitational waves at nanohertz frequencies. This work is complimentary to ground based detectors such as LIGO, which are sensitive to gravitational waves with frequencies 10 orders of magnitude higher.In this presentation we describe the NANOGrav eleven-year data set. This includes pulsar time-of-arrival measurements from 48 millisecond pulsars made with the Arecibo Observatory (for pulsars with declinations between -1 and 39 degrees) and the Green Bank Telescope (for other pulsars, with two pulsars overlapping with Arecibo). The data set consists of more than 300,000 pulse time-of-arrival measurements made in nearly 7000 unique observations (a given pulsar observed with a given telescope receiver on a given day). In the best cases, measurement precision is better than 100 nanoseconds, and in nearly all cases it is better than 1 microsecond.All pulsars in our program are observed at intervals of 3 to 4 weeks. Observations use wideband data acquisition systems and are made at two receivers at widely separated frequencies at each epoch, allowing for characterization and mitigation of the effects of interstellar medium on the signal propagation. Observation of a large number of pulsars allows for searches for correlated perturbations among the pulsar signals, which is crucial for achieving high-significance detection of gravitational waves in the face of uncorrelated noise (from gravitational waves and rotation noise) in the individual pulsars. In addition, seven pulsars are observed at weekly intervals. This increases our sensitivity

Eleven-Year Retrospective Report of Super-Selective Venous Sampling for the Evaluation of Recurrent or Persistent Hyperparathyroidism in 32 Patients.

PubMed

Habibollahi, Peiman; Shin, Benjamin; Shamchi, Sara P; Wachtel, Heather; Fraker, Douglas L; Trerotola, Scott O

2018-01-01

Parathyroid venous sampling (PAVS) is usually reserved for patients with persistent or recurrent hyperparathyroidism after parathyroidectomy with inconclusive noninvasive imaging studies. A retrospective study was performed to evaluate the diagnostic efficacy of super-selective PAVS (SSVS) in patients needing revision neck surgery with inconclusive imaging. Patients undergoing PAVS between 2005 and 2016 due to persistent or recurrent hyperparathyroidism following surgery were reviewed. PAVS was performed in all patients using super-selective technique. Single-value measurements within central neck veins performed as part of super-selective PAVS were used to simulate selective venous sampling (SVS) and allow for comparison to data, which might be obtained in a non-super-selective approach. 32 patients (mean age 51 ± 15 years; 8 men and 24 women) met inclusion and exclusion criteria. The sensitivity and positive predictive value (PPV) of SSVS for localizing the source of elevated PTH to a limited area in the neck or chest was 96 and 84%, respectively. Simulated SVS, on the other hand, had a sensitivity of 28% and a PPV of 89% based on the predefined gold standard. SSVS had a significantly higher sensitivity compared to simulated SVS (p < 0.001). SSVS is highly effective in localizing the source of hyperparathyroidism in patients undergoing revision surgery for hyperparathyroidism in whom noninvasive imaging studies are inconclusive. SSVS data had also markedly higher sensitivity for localizing disease in these patients compared to simulated SVS.

Clinical Outcomes after Keraring Implantation for Keratoconus Management in Patients Older Than 40 Years: A Retrospective, Interventional, Cohort Study.

PubMed

Gatzioufas, Zisis; Khine, Aye; Elalfy, Mohamed; Guber, Ivo; McLintock, Cameron; Sabatino, Francesco; Hamada, Samer; Lake, Damian

2018-06-01

Intracorneal ring segment implantation is an effective and safe method of visual improvement in patients with keratoconus. The aim of our study was to evaluate the long-term clinical outcomes after Keraring implantation for keratoconus in patients older than 40 years. Eleven eyes from 11 patients with keratoconus who underwent femtosecond laser-assisted Keraring implantation for keratoconus were included in this retrospective study. The uncorrected visual acuity (UCVA), corrected visual acuity, keratometric readings, central corneal thickness and thinnest corneal pachymetry were evaluated preoperatively and 6 months after the Keraring implantation. UCVA, BCVA and keratometric readings improved at 6 months postoperatively. Our data showed significant keratometric amelioration and visual improvement after Keraring implantation for keratoconus in patients older than 40 years at 6 months postoperatively.

The Prevalence of Idiopathic Scoliosis in Eleven Year-Old Korean Adolescents: A 3 Year Epidemiological Study

PubMed Central

Lee, Jin-Young; Moon, Seong-Hwan; Kim, Han Jo; Suh, Bo-Kyung; Nam, Ji Hoon; Jung, Jae Kyun; Lee, Hwan-Mo

2014-01-01

Purpose School screening allows for early detection and early treatment of scoliosis, with the purpose of reducing the number of patients requiring surgical treatment. Children between 10 and 14 years old are considered as good candidates for school screening tests of scoliosis. The purpose of the present study was to assess the epidemiological findings of idiopathic scoliosis in 11-year-old Korean adolescents. Materials and Methods A total of 37856 11-year-old adolescents were screened for scoliosis. There were 17110 girls and 20746 boys. Adolescents who were abnormal by Moiré topography were subsequently assessed by standardized clinical and radiological examinations. A scoliotic curve was defined as 10° or more. Results The prevalence of scoliosis was 0.19% and most of the curves were small (10° to 19°). The ratio of boys to girls was 1:5.5 overall. Sixty adolescents (84.5%) exhibited single curvature. Thoracolumbar curves were the most common type of curve identified, followed by thoracic and lumbar curves. Conclusion The prevalence of idiopathic scoliosis among 11-year-old Korean adolescents was 0.19%. PMID:24719147

Choosing health care online: a 7-Eleven case study.

PubMed

Fuller, Margaret; Beauregard, Cindy

2003-01-01

This article describes 7-Eleven's success in offering Web-based health care enrollment to its diverse workforce, which made the introduction of such service delivery strategy unusually challenging. Through its efforts, 7-Eleven was able to meet several important objectives, including helping employees better appreciate the value of their benefits, providing employees with increased services and convenience, and encouraging employees to make more cost-effective choices in their health care coverage.

Differences in Faculty and Standardized Patient Scores on Professionalism for Second-Year Podiatric Medical Students During a Standardized Simulated Patient Encounter.

PubMed

Mahoney, James M; Vardaxis, Vassilios; Anwar, Noreen; Hagenbucher, Jacob

2018-03-01

This study examined the differences between faculty and trained standardized patient (SP) evaluations on student professionalism during a second-year podiatric medicine standardized simulated patient encounter. Forty-nine second-year podiatric medicine students were evaluated for their professionalism behavior. Eleven SPs performed an assessment in real-time, and one faculty member performed a secondary assessment after observing a videotape of the encounter. Five domains were chosen for evaluation from a validated professionalism assessment tool. Significant differences were identified in the professionalism domains of "build a relationship" ( P = .008), "gather information" ( P = .001), and share information ( P = .002), where the faculty scored the students higher than the SP for 24.5%, 18.9%, and 26.5% of the cases, respectively. In addition, the faculty scores were higher than the SP scores in all of the "gather information" subdomains; however, the difference in scores was significant only in the "question appropriately" ( P = .001) and "listen and clarify" ( P = .003) subdomains. This study showed that professionalism scores for second-year podiatric medical students during a simulated patient encounter varied significantly between faculty and SPs. Further consideration needs to be given to determine the source of these differences.

Long-term results of aortic valve replacement with Edwards Prima Plus stentless bioprosthesis: eleven years' follow up.

PubMed

Auriemma, Stefano; D'Onofrio, Augusto; Brunelli, Massimo; Magagna, Paolo; Paccanaro, Mariemma; Rulfo, Fanny; Fabbri, Alessandro

2006-09-01

The Edwards Lifesciences Prima Plus stentless valve (ELSV) is a bioprosthesis manufactured from a porcine aortic root. The study aim was to evaluate late clinical outcomes after aortic valve replacement (AVR) with ELSV implanted as a miniroot in patients with aortic valve disease. Between 1993 and 2004, 318 patients (232 males, 86 females; mean age 69 +/- 9 years; range: 37-83 years) underwent AVR with the ELSV. Preoperatively, 102 patients (32%), 162 (51%) and 54 (17%) were in NYHA classes I/II, III and IV, respectively. Aortic stenosis, aortic regurgitation and combined lesions were present in 124 patients (39%), 114 (36%) and 41 (13%), respectively. Twenty patients (6%) were referred for an acute aortic dissection, 20 (6%) for an aortic root aneurysm, and 139 (44%) had an associated aneurysmal dilatation of the ascending aorta. The ascending aorta was replaced in 159 patients (50%); aortic arch replacement was required in 10 (3%). Coronary artery bypass graft was performed in 86 patients (27%). The follow up was based on clinical data. Operative mortality was 5% (n = 17). There were 49 late deaths (5.2%/pt-yr). Valve-related mortality occurred in 10 patients (1%/pt-yr). Actuarial survival at five and 10 years was 78% and 33%, respectively. Actuarial freedom from valve reoperation and structural valve deterioration at 10 years were 100% and 64%. Actuarial freedom from embolic events and endocarditis at 10 years were 84% and 81%, respectively. The ELSV, when implanted as a miniroot, provided good early and long-term results in terms of survival and freedom from major complications.

Documentation of Eleven Programs for the Hewlett-Packard 97 Calculator.

DTIC Science & Technology

1979-01-01

A139 268 DOCUMENTATION OF ELEVEN PROGRAMS FOR THEi/ HNLETT-PACKARD 97 CALCULRTOR(U) NAVAL HEALTH RESEARCH CENTER SAN DIEGO CA N MPUGH JAN 79...MEDICAL RESEARCH AND DEVELOPMENT COMMAND This dam .mqt g]a s bos p prme BETHESDA, MARYLAND • ,:-, triluti is ttlImited.0......0 o o9 79 DISCLAIMER...DOCUMENTATION OF ELEVEN PROGRAMS FOR THE HEWLETT-PACKARD 97 CALCULATOR* William M. Pugh Naval Health Research Center P.O. Box 85122 San Diego, California

CEP's Eleven Principles of Effective Character Education

ERIC Educational Resources Information Center

Lickona, Tom; Schaps, Eric; Lewis, Catherine

2007-01-01

There is no single script for effective character education, but there are some important basic principles. This document presents eleven principles that schools and other groups can use to plan a character education effort and to evaluate available character education programs: (1) Promotes core ethical values and supportive performance values as…

Hysterical identification in an eleven-year-old girl.

PubMed

Sherick, Ivan

2014-10-01

The concept of hysterical identification was reviewed and illustrated in child analytic process material obtained in the treatment of a latencyage girl. It is the author's contention that "hysteria" and its dynamics, for example, hysterical identification, have fallen into disuse, to the disservice of our child patients. This contribution is aimed at getting child analysts to reconsider the merits of this outcome.

In New Survey Of Eleven Countries, US Adults Still Struggle With Access To And Affordability Of Health Care.

PubMed

Osborn, Robin; Squires, David; Doty, Michelle M; Sarnak, Dana O; Schneider, Eric C

2016-12-01

Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination. Project HOPE—The People-to-People Health Foundation, Inc.

Cockpit noise intensity : eleven twin-engine light aircraft.

DOT National Transportation Integrated Search

1968-10-01

Eleven of the most popular twin-engine general-aviation light aircraft were tested for the noise intensity present during normal cruising operations at 2000, 6000, and 10000 feet MSL (mean sea level). Although generally quieter than single-engine pla...

Eleven years of experience with bisphosphonate plus alfacalcidol treatment in a man with osteogenesis imperfecta type I

PubMed Central

Iwamoto, Jun; Sato, Yoshihiro; Uzawa, Mitsuyoshi; Matsumoto, Hideo

2013-01-01

We report the 11-year follow-up of a man with osteogenesis imperfecta type I who was treated with bisphosphonates and alfacalcidol. A 36-year-old Japanese man with osteogenesis imperfecta type I who had frequently experienced painful fragility fractures consulted our clinic because of chronic back pain. The patient had multiple morphometric vertebral fractures and a low bone mineral density (BMD) at the lumbar spine. The patient was treated with cyclical etidronate 200 mg, for 2 weeks every 3 months, plus alfacalcidol 1 μg daily, for 2 years; and alendronate 5 mg daily or 35 mg weekly, plus alfacalcidol 1 μg daily for 9 years. After 11 years of treatment, BMD at the lumbar spine increased by 6.4%, following a 20.3% reduction in serum alkaline phosphatase. Serum calcium, phosphorus, and intact parathyroid hormone levels remained within the normal ranges. Three clinical fractures occurred at two ribs and the metacarpus, and two morphometric vertebral fractures occurred at the thoracic spine during the 11-year treatment period, but the patient experienced no adverse effects. Thus, the present case report shows the long-term outcome and safety of bisphosphonate plus alfacalcidol treatment in a man with osteogenesis imperfecta type I. PMID:23293527

Platelet response to aspirin 50 and 100 mg in patients with coronary heart disease over a five-year period.

PubMed

Berent, Robert; Auer, Johann; Franklin, Barry; Schmid, Peter; von Duvillard, Serge P

2011-09-01

Aspirin has been shown to decrease cardiovascular (CV) events by ∼25%. Despite aspirin therapy 10% to 20% of patients with arterial vascular disease develop atherothrombotic events. A meta-analysis of antiplatelet therapy showed a progressive decrease in clinical efficacy of aspirin after 2 years. Whether this is due to a decreased sensitivity to aspirin during long-term therapy remains unclear. A prospective randomized clinical trial with serial monitoring over 5 years was conducted in 100 patients with documented coronary heart disease. We investigated whether long-term treatment with aspirin 50 and 100 mg affects platelet response similarly. Occurrence of CV events was documented. Platelet sensitivity to aspirin, prostacyclin, and adenosine diphosphate-, collagen-, and epinephrine-induced platelet aggregation were evaluated over time. In addition, β-thromboglobulin and inflammatory markers were measured. Four patients were lost to follow-up and 10 patients died. Eleven patients developed nonfatal CV events. In the 2 groups platelet response to aspirin and the referenced variables remained unchanged over 5 years. In patients who developed CV events, the last monitoring interval revealed no difference in platelet response to aspirin. However, patients with nonfatal and fatal CV events showed increased inflammatory markers versus patients without CV events independent of aspirin 50 or 100 mg intake. In conclusion, our study revealed no difference in antiplatelet response to aspirin 50 versus 100 mg or CV events over 5 years in patients with coronary heart disease. Copyright © 2011 Elsevier Inc. All rights reserved.

Association between Maternal Depression Symptoms across the First Eleven Years of Their Child’s Life and Subsequent Offspring Suicidal Ideation

PubMed Central

Hammerton, Gemma; Mahedy, Liam; Mars, Becky; Harold, Gordon T.; Thapar, Anita; Zammit, Stanley; Collishaw, Stephan

2015-01-01

Depression is common, especially in women of child-bearing age; prevalence estimates for this group range from 8% to 12%, and there is robust evidence that maternal depression is associated with mental health problems in offspring. Suicidal behaviour is a growing concern amongst young people and those exposed to maternal depression are likely to be especially at high risk. The aim of this study was to utilise a large, prospective population cohort to examine the relationship between depression symptom trajectories in mothers over the first eleven years of their child’s life and subsequent adolescent suicidal ideation. An additional aim was to test if associations were explained by maternal suicide attempt and offspring depressive disorder. Data were utilised from a population-based birth cohort: the Avon Longitudinal Study of Parents and Children. Maternal depression symptoms were assessed repeatedly from pregnancy to child age 11 years. Offspring suicidal ideation was assessed at age 16 years. Using multiple imputation, data for 10,559 families were analysed. Using latent class growth analysis, five distinct classes of maternal depression symptoms were identified (minimal, mild, increasing, sub-threshold, chronic-severe). The prevalence of past-year suicidal ideation at age 16 years was 15% (95% CI: 14-17%). Compared to offspring of mothers with minimal symptoms, the greatest risk of suicidal ideation was found for offspring of mothers with chronic-severe symptoms [OR 3.04 (95% CI 2.19, 4.21)], with evidence for smaller increases in risk of suicidal ideation in offspring of mothers with sub-threshold, increasing and mild symptoms. These associations were not fully accounted for by maternal suicide attempt or offspring depression diagnosis. Twenty-six percent of non-depressed offspring of mothers with chronic-severe depression symptoms reported suicidal ideation. Risk for suicidal ideation should be considered in young people whose mothers have a history of

Neoplasia in ferrets: eleven cases with a review.

PubMed

Dillberger, J E; Altman, N H

1989-02-01

Records from a veterinary diagnostic laboratory in south Florida, U.S.A. were reviewed for cases of neoplasia in pet ferrets. Twelve ferret tumours were received over a four-year period; one case, a ferret with lymphocytic leukaemia and multi-organ involvement, had been reported previously. The other eleven tumours were: two chordomas of the tail, two sebaceous adenomas of the skin, a sebaceous epithelioma of the skin, a cutaneous mastocytoma, a malignant fibrous histiocytoma from the eyelid, a malignant mesenchymoma and an undifferentiated sarcoma from the dorsal abdominal cavity, a leiomyosarcoma found unattached in the abdominal cavity and an interstitial cell tumour of the testicle. A review of the literature yielded reports of 83 other tumours in domestic ferrets, black-footed ferrets and European polecats. Of the 95 ferret tumours, 46 were considered malignant. Tumours occurred in all organ systems except the respiratory tract and central nervous system. Affected ferrets ranged in age from 209 days to 12 years. The most frequently occurring tumours were ovarian stromal tumours (24 of 95), haemangiomas/haemangio-sarcomas (15 of 95). This information indicates that, contrary to previous opinion, ferrets appear to be subject to a similar incidence and variety of tumours as other animals.

Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1000 conserve plus.

PubMed

Amstutz, Harlan C; Le Duff, Michel J

2008-09-01

Hip resurfacing is currently the fastest growing hip procedure worldwide. We reviewed 1000 hips in 838 patients who received a Conserve Plus (Wright Medical Technology, Inc., Arlington, Tenn) resurfacing at a single institution. The mean age of the patients was 50.0 years with 74.7% male. The hips were resurfaced irrespective of femoral defect size or etiology. The mean follow-up was 5.6 years (range, 1.1-11.0 years). All clinical scores improved significantly (P < .05). There was no acetabular component loosening. Ten were converted to total hip arthroplasty for femoral neck fracture, 20 for femoral loosening, 2 for sepsis, and 1 for recurrent subluxations. The 5-year survivorship was 95.2% with no failures in hips implanted since 2002. Short-term failures can be prevented. First-generation surgical technique and a low body mass index were the most important risk factors for the procedure. Improvements in bone preparation significantly increased prosthetic survival in hips with risk factors for failure.

Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals.

PubMed

Maggio, Marcello; Corsonello, Andrea; Ceda, Gian Paolo; Cattabiani, Chiara; Lauretani, Fulvio; Buttò, Valeria; Ferrucci, Luigi; Bandinelli, Stefania; Abbatecola, Angela Marie; Spazzafumo, Liana; Lattanzio, Fabrizia

2013-04-08

The use of proton pump inhibitors (PPIs) has rapidly increased during the past several years. However, concern remains about risks associated with their long-term use in older populations. To investigate the relationship between the use of PPIs and the risk of death or the combined end point of death or rehospitalization in older patients discharged from acute care hospitals. We investigated the relationship between PPI use and study outcomes using time-dependent Cox proportional hazards regression in patients 65 years or older discharged from acute care medical wards from April 1 to June 30, 2007. Eleven acute care medical wards. Four hundred ninety-one patients (mean [SD] age, 80.0 [5.9] years). Mortality and the combined end point of death or rehospitalization. RESULTS The use of PPIs was independently associated with mortality (hazard ratio, 1.51 [95% CI, 1.03-2.77]) but not with the combined end point (1.49 [0.98-2.17]). An increased risk of mortality was observed among patients exposed to high-dose PPIs vs none (hazard ratio, 2.59 [95% CI, 1.22-7.16]). In older patients discharged from acute care hospitals, the use of high-dose PPIs is associated with increased 1-year mortality. Randomized controlled studies including older frail patients are needed. In the meantime, physicians need to use caution and balance benefits and harms in long-term prescription of high-dose PPIs.

Eleven years of experience with low-bandwidth telemedicine in a nurse-led rural clinic in Scotland.

PubMed

Harvey, Sylvia; Peterkin, Gordon; Wootton, Richard

2010-01-01

A pilot trial of telemedicine in primary care began in the village of Letham in 1998. The service provided conventional consultations with the district nurse, plus teleconsultations with a general practitioner (GP) at the health centre in Forfar, a few km away. In the first year, the videoconferencing link was used by 14 patients, all aged over 65 years. The telemedicine service was judged to be successful and subsequently expanded to patients of any age. It was used for a wide range of health matters, including postnatal care, mental health problems, physical ailments, receiving test results and discussions with the doctor. During the 11-year study period, a total of 646 teleconsultations were conducted, a median rate of 65 per year. A qualitative evaluation of the service was conducted in 1999. Although the GPs involved expressed some reservations about the limited video quality, all three user groups were positive about the service. Nonetheless, the telemedicine service was not adopted as a routine method of health-care delivery by the NHS. To enable any telemedicine application to move from the pilot trial stage to routine service requires several things to happen at an organisational and contractual level. Ultimately an organizational decision about adoption is required, followed by appropriate mechanisms to enable diffusion.

Cell block eleven (left) and cell block fifteen, looking from ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Cell block eleven (left) and cell block fifteen, looking from cell block two into the "Death Row" exercise yard - Eastern State Penitentiary, 2125 Fairmount Avenue, Philadelphia, Philadelphia County, PA

Topic 101: Eleven Campuses, One University, Many Strikes

ERIC Educational Resources Information Center

Navarro-Rivera, Pablo

2010-01-01

Students from the University of Puerto Rico (UPR) went on strike in April, and, soon after, 10 of the 11 campuses of a public system with more than 60,000 students were closed. "Once recintos, una universidad" (eleven campuses, one university) was the maxim students used to emphasize the concept of the UPR as a system unified by similar…

An eleven-year retrospective hospital-based study of epidemiological data regarding human strongyloidiasis in northeast Thailand.

PubMed

Prasongdee, Thidarat K; Laoraksawong, Pokkamol; Kanarkard, Wanida; Kraiklang, Ratthaphol; Sathapornworachai, Kraisit; Naonongwai, Sureeporn; Laummaunwai, Porntip; Sanpool, Oranuch; Intapan, Pewpan M; Maleewong, Wanchai

2017-09-18

Human strongyloidiasis is a chronic and persistent gastrointestinal disease caused by infection with soil-transmitted helminths of the genus Strongyloides. The aim of this research was to obtain diagnostic prevalence regarding strongyloidiasis in northeast Thailand through a hospital-based study. Patients' demographic data and the results of stool examinations conducted using the formalin ethyl acetate concentration technique were collected from the parasitology laboratory records at Srinagarind Hospital in Khon Kaen, Thailand. The relevant information from years 2004 to 2014 was collected and descriptively analyzed. Of a total of 22,338 patients, 3889 (17.4%) had stool samples that tested positive for Strongyloides larvae. The highest prevalence was 22.8% (95% CI = 19.6-26.2%) in the year 2004. This percentage progressively decreased, reaching 11.2% (95% CI = 10.2-12.4%) in 2013 and remaining stable at 12.9% (95% CI = 11.8-14.1%) in 2014. Males (2741 cases) had double the positivity rate of females (1148 cases). The prevalence of infection was highest (25.9%; 95% CI = 24.5-27.3%) among patients that were 51-60 years of age. Areas endemic for strongyloidiasis should be emphasized under the national helminth control program and health education campaigns. Nationwide assessments should also be performed regarding Strongyloides infection, including risk factors, treatment, and prevention. The diagnostic laboratory data presented here identify the geographical focus of disease to be the northeastern region of the country. Further targeted surveillance using more sensitive methods will almost certainly reveal a higher individual disease burden than found in this report.

Changes in sick-leave diagnoses over eleven years in a cohort of young adults initially sick-listed due to low back, neck, or shoulder diagnoses.

PubMed

Festin, Karin; Alexanderson, Kristina

2009-05-01

To study future general and diagnoses-specific sickness absence and disability pension among young adults who were initially on long-term sick-leave due to back, neck, or shoulder diagnoses. Eleven-year prospective cohort study. All 213 adults in a Swedish municipality who, in 1985, were in the age range 25-34 years and had begun a spell of sick-leave lasting > or = 28 days with low back, neck, or shoulder diagnoses. For the time-period 1985-96, data regarding the dates and diagnoses for all periods of sick-leave, and the dates of disability pension, emigration, and death were obtained. Numbers of days of sick-leave and disability pension were analysed separately for each of the 11 years in relation to the number of days at risk for such benefits. The cohort members were on sick-leave or disability pension for 25% of all days at risk during the 11 years of follow-up. A large difference in the number of sick-leave days between the 22% of subjects who were later granted disability pension and the others was already apparent during the first 2 years. During the entire period, up to 21% of the sick-leave days for women and 24% for men entailed psychiatric diagnoses. This cohort of young adults, initially off sick for 4 weeks due to back, neck, or shoulder diagnoses, also had a high level of sickness absence in the subsequent 11 years with other diagnoses.

Incidence of paediatric fatal and non-fatal low speed vehicle run over events in Queensland, Australia: eleven year analysis

PubMed Central

2014-01-01

Background The purpose of this study was to estimate the incidence of fatal and non-fatal Low Speed Vehicle Run Over (LSVRO) events among children aged 0–15 years in Queensland, Australia, at a population level. Methods Fatal and non-fatal LSVRO events that occurred in children resident in Queensland over eleven calendar years (1999-2009) were identified using ICD codes, text description, word searches and medical notes clarification, obtained from five health related data bases across the continuum of care (pre-hospital to fatality). Data were manually linked. Population data provided by the Australian Bureau of Statistics were used to calculate crude incidence rates for fatal and non-fatal LSVRO events. Results There were 1611 LSVROs between 1999–2009 (IR = 16.87/100,000/annum). Incidence of non-fatal events (IR = 16.60/100,000/annum) was 61.5 times higher than fatal events (IR = 0.27/100,000/annum). LSVRO events were more common in boys (IR = 20.97/100,000/annum) than girls (IR = 12.55/100,000/annum), and among younger children aged 0–4 years (IR = 21.45/100000/annum; 39% or all events) than older children (5–9 years: IR = 16.47/100,000/annum; 10–15 years IR = 13.59/100,000/annum). A total of 896 (56.8%) children were admitted to hospital for 24 hours of more following an LSVRO event (IR = 9.38/100,000/annum). Total LSVROs increased from 1999 (IR = 14.79/100,000) to 2009 (IR = 18.56/100,000), but not significantly. Over the 11 year period, there was a slight (non –significant) increase in fatalities (IR = 0.37-0.42/100,000/annum); a significant decrease in admissions (IR = 12.39–5.36/100,000/annum), and significant increase in non-admissions (IR = 2.02-12.77/100,000/annum). Trends over time differed by age, gender and severity. Conclusion This is the most comprehensive, population-based epidemiological study on fatal and non-fatal LSVRO events to date. Results from this study indicate

Cell block eleven, looking from the "Death Row" exercise yard, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Cell block eleven, looking from the "Death Row" exercise yard, facing north (note cell block fifteen to the right and cell block fourteen in the distance_ - Eastern State Penitentiary, 2125 Fairmount Avenue, Philadelphia, Philadelphia County, PA

Eleven years of itching: a case report of crusted scabies.

PubMed

Kutlu, Nurdan S; Turan, Enver; Erdemir, Asli; Gürel, Mehmet S; Bozkurt, Erol

2014-08-01

Crusted scabies is a rare and highly contagious form of scabies that is characterized by uncontrolled proliferation of mites in the skin, extensive hyperkeratotic scaling, crusted lesions, and variable pruritus. We report the case of a 48-year-old man with an 11-year history of pruritic, hyperkeratotic, psoriasiform plaques and widespread erythematous papules that was diagnosed as crusted scabies.

[Epidemiological, clinical and progressive aspects of neurological manifestations associated with retroviral infections: eleven year retrospective study].

PubMed

Sene-Diouf, F; Ndiaye, M; Diop, A G; Thiam, A; Ndao, A K; Diagne, M; Ndiaye, M M; Ndiaye, I P

2000-01-01

Through a cohort of 93 neuroaids which has been diagnosed at Dakar in our Neurology Department, the authors evaluated the hospital prevalence of retrovirus, detected socio-demographic factors, related AIDS outline the mean neurological picture and try to correlate survival and neurological involvement of these patients. Among 1151 patients who got retroviral blood test, 93 were seropositive (8.1%). On these repartitions 36 were females (38.7%) and 57 males (61.3%). The age goes from 19 to 76 years old. 45 patients (48.4%) have been found positive for HIV-1 blood test, 21 patients (22.6%) for HIV-2 blood test, 11 patients (11.8%) for both HIV2, 11 patients (11.8%) for HTLV1, 3 patients (3.2%) for both HIV-1 and HTLV1, and 2 patients (2.2%) for both HIV-2 and HTLV1. In our study the transmission of AIDS occur mainly through heterosexual inter course and multiple parternship is a high risk group. The central nervous system deseases represented 68.8% of cases. The pathology were dominated by stroke, myelopathies, meningoencephalotis and spinal cord compression. The peripheral nervous system desease were found in 7.5% of cases. The peripheral facial paralysis occupied the first place in HIV infections of peripheral nervous system deseases (57.1% of cases). When neurological involvement set up the letality is higher for HIV-1 (57% of global letality) and for central system nervous involvement (76.2%).

Transcript levels of ten-eleven translocation type 1–3 in cervical cancer and non-cancerous cervical tissues

PubMed Central

Bronowicka-Kłys, Dorota Ewa; Roszak, Andrzej; Pawlik, Piotr; Sajdak, Stefan; Sowińska, Anna; Jagodziński, Paweł Piotr

2017-01-01

Decreased expression of ten-eleven translocation (TET1, TET2 and TET3) proteins has been reported in various types of cancer. However, the expression levels of TET proteins in cervical cancer (CC) remain to be elucidated. The present study determined the levels of TET1, TET2 and TET3 transcripts in cancerous (n=80) and non-cancerous cervical tissues (n=41). The results revealed a significant reduction in TET1 transcripts (P=0.0000001) in cervical tissue samples from patients with primary CC compared with samples from control patients. Significantly decreased TET1 transcript levels, as compared to non-cancerous cervical tissues, were also observed in tissue samples with the following characteristics: Stage I (P=0.016), II (P<0.0001), III (P=0.00007) and grade of differentiation G1 (P=0.026), G2 (P=0.00006), G3 (P=0.0007) and Gx (P=0.0004) and squamous histological type (P<0.00001). TET1 transcript levels were significantly lower in patients aged 45–60 years (P=0.0002) and patients age >60 years (P=0.003), as compared with non-cancerous cervical tissues. TET2 transcript levels were lower in cervical cancer tissues classified as stage II (P=0.043) and TET3 transcript levels were lower in stage III samples (P=0.010), tissue samples with a grade of differentiation of G3 (P=0.025) and tissue with squamous type histology (P=0.047), all compared with non-cancerous cervical tissues. The present study demonstrated a significantly reduced level of TET1 transcripts in cancerous cervical tissues, as compared with non-cancerous tissues. Furthermore, decreased TET1-3 transcript levels were identified when patients with CC were stratified by clinicopathological variables, as compared with non-cancerous cervical tissues. PMID:28521490

Age group athletes in inline skating: decrease in overall and increase in master athlete participation in the longest inline skating race in Europe - the Inline One-Eleven.

PubMed

Teutsch, Uwe; Knechtle, Beat; Rüst, Christoph Alexander; Rosemann, Thomas; Lepers, Romuald

2013-01-01

Participation and performance trends in age group athletes have been investigated in endurance and ultraendurance races in swimming, cycling, running, and triathlon, but not in long-distance inline skating. The aim of this study was to investigate trends in participation, age, and performance in the longest inline race in Europe, the Inline One-Eleven over 111 km, held between 1998 and 2009. The total number, age distribution, age at the time of the competition, and race times of male and female finishers at the Inline One-Eleven were analyzed. Overall participation increased until 2003 but decreased thereafter. During the 12-year period, the relative participation in skaters younger than 40 years old decreased while relative participation increased for skaters older than 40 years. The mean top ten skating time was 199 ± 9 minutes (range: 189-220 minutes) for men and 234 ± 17 minutes (range: 211-271 minutes) for women, respectively. The gender difference in performance remained stable at 17% ± 5% across years. To summarize, although the participation of master long-distance inline skaters increased, the overall participation decreased across years in the Inline One-Eleven. The race times of the best female and male skaters stabilized across years with a gender difference in performance of 17% ± 5%. Further studies should focus on the participation in the international World Inline Cup races.

[Aqueductal stenosis in the neurofibromatosis type 1. Presentation of 19 infantile patients].

PubMed

Pascual-Castroviejo, I; Pascual-Pascual, S I; Velázquez-Fragua, R; Viaño, J; Carceller-Benito, F

To present a series of infantile patients with aqueductal stenosis associated with neurofibromatosis type 1 (NF1). Nineteen patients with ages below 16 years, 11 girls and 8 boys, with NF1 presented hydrocephalus due to aqueductal stenosis. All patients, except one who died before the imaging study was performed and was diagnosed by autopsy, were studied by pneumoencephalography (since 1965 to 1974), computerized tomography (CT) (since 1975 to 1984), magnetic resonance (MR) or MR and CT (since 1985 to 2004) (two children had been studied by pneumoencephalography some years before) most times to discard optic pathway tumor and, in few patients, because of intracranial hypertension. All patients showed three ventricular hydrocephalus with aqueductal stenosis. Eleven patients showed optic pathway tumor. One patient had a benign aqueductal tumor that impaired the normal flow of cerebrospinal fluid. Neurological features of hydrocephalus occurred very rapidly in some patients and after several years of evolution in others. Two boys showed precocious puberty. All patients were treated with shunt. In our series, aqueductal stenosis occurred in about 5% of children with NF1. Aqueductal stenosis and hydrocephalus were identified at a short age because many patients were studied suspecting optic pathway tumor. Eleven patients (about 60%) associated optic pathway tumor and aqueductal stenosis.

Cognitive Experiences Reported by Borderline Patients and Axis II Comparison Subjects: A 16-year Prospective Follow-up Study

PubMed Central

Zanarini, Mary C.; Frankenburg, Frances R.; Wedig, Michelle M.; Fitzmaurice, Garrett M.

2013-01-01

Objective This study assesses three main types of cognition: nonpsychotic thought (odd thinking, unusual perceptual experiences, and non-delusional paranoia), quasi-psychotic thought, and true-psychotic thought in borderline patients followed prospectively for 16 years. It also compares the rates of these disturbed cognitions to those reported by axis II comparison subjects. Method The cognitive experiences of 362 inpatients—290 borderline patients and 72 axis II comparison subjects—were assessed at study entry using the cognitive section of the Revised Diagnostic Interview for Borderlines. Their cognitive experiences were reassessed every two years using the same interview. Results Each of the five main types of thought studied was reported by a significantly higher percentage of borderline patients than axis II comparison subjects over time. Each of these types of thought, except true-psychotic thought, declined significantly over time for those in both groups. Eleven of the 17 more specific forms of thought studied were also reported by a significantly higher percentage of borderline patients over the years of follow-up: magical thinking, overvalued ideas, recurrent illusions, depersonalization, derealization, undue suspiciousness, ideas of reference, other paranoid ideation, quasi-psychotic delusions, quasi-psychotic hallucinations, and true-psychotic hallucinations. Fourteen specific forms of thought were found to decline significantly over time for those in both groups: all forms of thought mentioned above except true-psychotic hallucinations plus marked superstitiousness, sixth sense, telepathy, and clairvoyance. Conclusions Disturbed cognitions are common among borderline patients and distinguishing for the disorder. They also decline substantially over time but remain a problem, particularly those of a nonpsychotic nature. PMID:23558452

Eleven Years of Parotid Gland Surgery in a Plastic and Reconstructive Department.

PubMed

Correia-Sá, Inês Bastos; Correia-Sá, Mário; Costa-Ferreira, Pedro; Silva, Álvaro; Marques, Marisa

2016-01-01

Salivary gland tumors are an uncommon entity, comprising 3% to 6% of all head and neck tumors. Approximately 75% to 80% occur in the parotid gland, and 80% are benign. It is difficult to establish epidemiologic characteristics of parotid gland tumors due to their low incidence. We performed a retrospective study to analyze clinical diagnostic and therapeutic features of patients submitted to parotid gland surgery. A retrospective study was performed, regarding all the patients (n = 96) submitted to surgery for treatment of parotid gland disease in the Department of Plastic and Reconstructive Surgery of Centro Hospitalar de S. João (Porto, Portugal) between 2002 and 2012. Medical records were analyzed and the following data were collected: patient age at diagnosis, sex, tumor location, symptom, tumor position, preoperative diagnosis techniques, type of operation performed, pathology, postoperative complications, adjuvant therapy (radiotherapy or chemotherapy), follow-up time, and tumor recurrence. SPSS was used for statistical analysis. Fifty-two percent of the patients were males and 48% females and mean age of 52.02. In 68.75% of the patients, superficial parotidectomy was performed. Benign pathology was found in 72% patients, and pleomorphic adenoma the most common tumor (39%). Facial paralysis (41.7%), Frey syndrome (9.4%), and great auricular nerve hyposthesia (10.4%) were major complications. Tumor recurrence was observed in 16 patients (16.7%), which forced 17 reoperations (17.7%). There were 5 deaths (5.2%). For most tumors, superficial parotidectomy is an effective treatment with acceptable morbidity. In patients of malignancy, treatment should be aggressive.

Rotational Spectroscopy Unveils Eleven Conformers of Adrenaline

NASA Astrophysics Data System (ADS)

Cabezas, C.; Cortijo, V.; Mata, S.; Lopez, J. C.; Alonso, J. L.

2013-06-01

Recent improvements in our LA-MB-FTMW instrumentation have allowed the characterization of eleven and eight conformers for the neurotransmitters adrenaline and noradrenaline respectively. The observation of this rich conformational behavior is in accordance with the recent observation of seven conformers for dopamine and in sharp contrast with the conformational reduction proposed for catecholamines. C. Cabezas, I. Peña, J. C. López, J. L. Alonso J. Phys. Chem. Lett. 2013, 4, 486. H. Mitsuda, M. Miyazaki, I. B. Nielsen, P. Carcabal,C. Dedonder, C. Jouvet, S. Ishiuchi, M. Fujii J. Phys. Chem. Lett. 2010, 1, 1130.

GAS eleven node thermal model (GEM)

NASA Technical Reports Server (NTRS)

Butler, Dan

1988-01-01

The Eleven Node Thermal Model (GEM) of the Get Away Special (GAS) container was originally developed based on the results of thermal tests of the GAS container. The model was then used in the thermal analysis and design of several NASA/GSFC GAS experiments, including the Flight Verification Payload, the Ultraviolet Experiment, and the Capillary Pumped Loop. The model description details the five cu ft container both with and without an insulated end cap. Mass specific heat values are also given so that transient analyses can be performed. A sample problem for each configuration is included as well so that GEM users can verify their computations. The model can be run on most personal computers with a thermal analyzer solution routine.

All symmetric space solutions of eleven-dimensional supergravity

NASA Astrophysics Data System (ADS)

Wulff, Linus

2017-06-01

We find all symmetric space solutions of eleven-dimensional supergravity completing an earlier classification by Figueroa-O’Farrill. They come in two types: AdS solutions and pp-wave solutions. We analyze the supersymmetry conditions and show that out of the 99 AdS geometries the only supersymmetric ones are the well known backgrounds arising as near-horizon limits of (intersecting) branes and preserving 32, 16 or 8 supersymmetries. The general form of the superisometry algebra for symmetric space backgrounds is also derived.

Age group athletes in inline skating: decrease in overall and increase in master athlete participation in the longest inline skating race in Europe – the Inline One-Eleven

PubMed Central

Teutsch, Uwe; Knechtle, Beat; Rüst, Christoph Alexander; Rosemann, Thomas; Lepers, Romuald

2013-01-01

Background Participation and performance trends in age group athletes have been investigated in endurance and ultraendurance races in swimming, cycling, running, and triathlon, but not in long-distance inline skating. The aim of this study was to investigate trends in participation, age, and performance in the longest inline race in Europe, the Inline One-Eleven over 111 km, held between 1998 and 2009. Methods The total number, age distribution, age at the time of the competition, and race times of male and female finishers at the Inline One-Eleven were analyzed. Results Overall participation increased until 2003 but decreased thereafter. During the 12-year period, the relative participation in skaters younger than 40 years old decreased while relative participation increased for skaters older than 40 years. The mean top ten skating time was 199 ± 9 minutes (range: 189–220 minutes) for men and 234 ± 17 minutes (range: 211–271 minutes) for women, respectively. The gender difference in performance remained stable at 17% ± 5% across years. Conclusion To summarize, although the participation of master long-distance inline skaters increased, the overall participation decreased across years in the Inline One-Eleven. The race times of the best female and male skaters stabilized across years with a gender difference in performance of 17% ± 5%. Further studies should focus on the participation in the international World Inline Cup races. PMID:23690697

Abdominal Wall Endometriosis Eleven Years After Cesarean Section: Case Report

PubMed

Djaković, Ivka; Vuković, Ante; Bolanča, Ivan; Soljačić Vraneš, Hrvojka; Kuna, Krunoslav

2017-03-01

Endometriosis is a common chronic disease characterized by growth of the endometrial gland and stroma outside the uterus. Symptoms affect physical, mental and social well-being. Extrapelvic location of endometriosis is very rare. Abdominal wall endometriosis occurs in 0.03%-2% of women with a previous cesarean section or other abdominopelvic operation. The leading symptoms are abdominal nodular mass, pain and cyclic symptomatology. The number of cesarean sections is increasing and so is the incidence of abdominal wall endometriosis as a potential complication of the procedure. There are cases of malignant transformation of abdominal wall endometriosis. Therefore, it is important to recognize this condition and treat it surgically. We report a case of a 37-year-old woman with abdominal wall endometriosis 11 years after cesarean section. She had low abdominal pain related to menstrual cycle, which intensified at the end of menstrual bleeding. A nodule painful to palpation was found in the medial part of previous Pfannenstiel incision. Ultrasound guided biopsy was performed and the diagnosis of endometriosis confirmed. Surgery is the treatment of choice for abdominal wall endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. A wide spectrum of mimicking conditions is the main reason for late diagnosis and treatment of abdominal wall endometriosis. In our case, the symptoms lasted for eight years and had intensified in the last six months prior to surgery.

Lightcurve Analysis for Eleven Main-belt Asteroids

NASA Astrophysics Data System (ADS)

Polakis, Tom

2018-04-01

Synodic rotation periods were determined for eleven main-belt asteroids: 300 Geraldina, 6.847 ± 0.012 h; 597 Bandusia, 7.6636 ± 0.0008 h; 868 Lova, 41.118 ± 0.011 h; 904 Rockefellia, 6.826 ± 0.004 h; 964 Subamara, 6.8695 ± 0.0012 h; 965 Angelica, 26.752 ± 0.035 h; 1105 Fragaria, 5.4312 ± 0.0008 h; 1181 Lilith, 15.033 ± 0.003 h; 1197 Rhodesia, 16.060 ± 0.006 h; 1255 Schilowa, 76.275 ± 0.041 h; and 1883 Rimito, 6.475 ± 0.008 h. All the data have submitted to the ALCDEF database.

[Simultaneous kidney and pancreas transplantation (SKPT) in patients with type 1 diabetes and chronic renal failure: experience in 12 patients in Chile].

PubMed

Alba, Andrea; Morales, Jorge; Ferrario, Mario; Zehnder, Carlos; Aguiló, Jorge; Zavala, Carlos; Herzog, Cristina; Calabran, Lorena; Contreras, Luis; Espinoza, Ricardo; Buckel, Erwin; Fierro, Juan Alberto

2011-01-01

Simultaneous kidney and pancreas transplantation (SKPT) is the best alternative for end stage renal disease among patients with insulin dependent diabetes mellitus. To report our experience with SKPT. Retrospective analysis of 12 recipients of SKPT transplanted in one center starting in 1994, with a mean follow-up period of 6.8 years (2-15). Eleven of 12 recipients were in chronic hemodialysis before SKPT. Mean A, B, DR and HLA mismatch was 4.3. Mean preformed anti HLA antibodies was 3.3 %. Mean cold ischemia times for pancreas and kidney were 6 and 10 hours, respectively. In the first eight cases, the pancreas was drained to the bladder, and in the last four, an enteric drainage was performed. Eleven recipients were induced with antibodies, and maintenance immunosuppression consisted of cyclosporin or tacrolimus plus an antiproliferative agent. Ten year patient survival was 70%. Pancreas and kidney survival, defined by insulin and dialysis independence, were 72 and 73% respectively. Fifty percent of recipients experienced acute graft rejection (cellular or humoral), with good response to treatment except in one case. This experience shows that SKPT is associated with an excellent patient survival associated to insulin and dialysis independence in 70% of patients at 10 years.

Photogrammetry research for FAST eleven-meter reflector panel surface shape measurement

NASA Astrophysics Data System (ADS)

Zhou, Rongwei; Zhu, Lichun; Li, Weimin; Hu, Jingwen; Zhai, Xuebing

2010-10-01

In order to design and manufacture the Five-hundred-meter Aperture Spherical Radio Telescope (FAST) active reflector measuring equipment, measurement on each reflector panel surface shape was presented, static measurement of the whole neutral spherical network of nodes was performed, real-time dynamic measurement at the cable network dynamic deformation was undertaken. In the implementation process of the FAST, reflector panel surface shape detection was completed before eleven-meter reflector panel installation. Binocular vision system was constructed based on the method of binocular stereo vision in machine vision, eleven-meter reflector panel surface shape was measured with photogrammetry method. Cameras were calibrated with the feature points. Under the linearity camera model, the lighting spot array was used as calibration standard pattern, and the intrinsic and extrinsic parameters were acquired. The images were collected for digital image processing and analyzing with two cameras, feature points were extracted with the detection algorithm of characteristic points, and those characteristic points were matched based on epipolar constraint method. Three-dimensional reconstruction coordinates of feature points were analyzed and reflective panel surface shape structure was established by curve and surface fitting method. The error of reflector panel surface shape was calculated to realize automatic measurement on reflector panel surface shape. The results show that unit reflector panel surface inspection accuracy was 2.30mm, within the standard deviation error of 5.00mm. Compared with the requirement of reflector panel machining precision, photogrammetry has fine precision and operation feasibility on eleven-meter reflector panel surface shape measurement for FAST.

A 20-year follow-up of the mesh wallstent in the treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury.

PubMed

Abdul-Rahman, Ahmad; Ismail, Soran; Hamid, Rizwan; Shah, Julian

2010-11-01

To assess the long-term (20 years) effectiveness of the UroLume wallstent(TM) (Pfizer Inc., UK) in the treatment of detrusor external sphincter dyssynergia (DESD) in patients with spinal cord injury (SCI). Twelve patients with quadriplegia secondary to SCI underwent external striated sphincter stenting with the UroLume wallstent in place of sphincterotomy for DESD ≈ 20 years ago. The mean (range) age was 41.8 (26-65) years. Eleven patients had cervical level injury whilst one had a thoracic injury. All the patients were shown to have high-pressure neurogenic detrusor overactivity and DESD with incomplete emptying on preoperative video-cystometrograms (VCMG). Six of the 12 patients have now been followed-up for a mean (range) of 20 (19-21) years. Of the remaining six, two were lost to follow-up at 1 and 3 years, but both remained free of complications during that time. Two patients developed encrustation causing obstruction, requiring stent removal within 1 year of insertion. Another patient with an adequately functioning stent died 7 years after stent insertion from a chest infection. The twelfth patient developed bladder cancer 14 years after stent insertion and underwent cystectomy with urinary diversion. VCMG follow-up of the six patients showed a significantly sustained reduction of maximum detrusor pressure and duration of detrusor contraction at the 20-year follow-up. Five of these six patients developed bladder neck dyssynergia of varying degrees as shown on VCMG within the first 9 years of follow-up. All were successfully treated with bladder neck incision (BNI) where the last BNI needed was at 12 years. We did not encounter any problem with stent migration, urethral erosion, erectile dysfunction or autonomic dysreflexia. Urethral stenting using the UroLume wallstent is effective in the management of DESD in patients with SCI and provides an acceptable long-term (20-year follow-up) alternative to sphincterotomy. The failures manifest within the first few

Characteristics of Cytomegalovirus Uveitis in Immunocompetent Patients.

PubMed

Woo, Jyh Haur; Lim, Wee K; Ho, Su L; Teoh, Stephen C

2015-01-01

To present the clinical characteristics of patients with anterior uveitis who had evidence of cytomegalovirus (CMV) infection on polymerase chain reaction PCR-based assays for viral DNA in aqueous samples. This was a retrospective observational case series of 16 patients with CMV infection on qualitative polymerase chain reaction PCR-based assays for viral DNA in aqueous samples. Case records of 16 patients were reviewed and relevant clinical information was collected using a standardized data sheet. There were 10 male and 6 female patients, with 16 eyes included. The median age at the first attack was 52 years (range 27-77 years). Thirteen patients (81.3%) presented with an initial BCVA of 20/40 or better. Eleven eyes (68.8%) had anterior chamber inflammation of 1+ cells or less. Eight eyes (50.0%) had concomitant sectoral iris atrophy, while 2 eyes were noted to have heterochromic irides. Eleven patients (68.8%) presented with an elevated intraocular pressure. Seven patients (43.8%) had clinical features that led to a presumptive diagnosis of Posner-Schlossman syndrome, while 3 patients (18.8%) were initially diagnosed with Fuchs heterochromic iridocyclitis. Six patients were initially treated for uveitic glaucoma or anterior uveitis of unknown cause. There is a spectrum of clinical manifestations of CMV anterior uveitis. A high index of suspicion of a possible viral etiology, especially CMV, and subsequent accurate identification of the virus involved are fundamental to the overall therapeutic approach.

Eleven-year trends in gender differences of treatments and mortality in ST-elevation acute myocardial infarction in northern Italy, 2000 to 2010.

PubMed

Corrada, Elena; Ferrante, Giuseppe; Mazzali, Cristina; Barbieri, Pietro; Merlino, Luca; Merlini, Piera; Presbitero, Patrizia

2014-08-01

The aim of this study was to assess recent trends in hospital mortality and in the treatment techniques for patients with ST-segment elevation myocardial infarction according to gender. Data on hospitalizations for ST-segment elevation myocardial infarction from 2000 to 2010 were extracted from hospital discharge record databases (International Classification of Diseases, Ninth Revision, Clinical Modification, codes) in the Lombardy Region of Italy. The impact of female gender on in-hospital mortality was assessed by multivariable regression after adjusting for invasive approach use (i.e., coronary angiography, angioplasty or coronary artery bypass graft), age, and co-morbidities. A total of 89,562 patients, men (66.5%) and women (33.5%), were enrolled. The use of an invasive approach increased over time in both sexes although it was higher in men (from 54.9% in 2000 to 91.9% in 2010 in men; from 36.8% in 2000 to 72.0% in 2010 in women). This pattern was driven by the subgroup of patients aged ≥75 years, whereas differences between sexes were not observed in patients <65 years and were small in patients aged 65 to 74 years. In-hospital mortality presented a small decrease from 7.6% in 2000 to 6.2% in 2010 in men (p for trend = 0.004), whereas it remained higher and substantially constant over time in women (16.6% in 2000, 15.5% in 2010, p for trend = 0.09). At multivariable regression, female gender did not emerge as an independent predictor of mortality (p = 0.13). However, a significant gender-age interaction was found, with female gender being a significant predictor of increased mortality in patients aged ≥75 years (odds ratio [OR] 1.33) while predicting a reduced mortality in patients aged <75 years (OR 0.93, p for interaction <0.0001). The use of an invasive approach was an independent predictor of mortality (OR 0.23, p <0.0001), the magnitude of mortality reduction being higher in men than in women and in patients aged <75 years than in those aged

Longevity of men capable of prolonged vigorous physical exercise: a 32 year follow up of 2259 participants in the Dutch eleven cities ice skating tour.

PubMed Central

van Saase, J L; Noteboom, W M; Vandenbroucke, J P

1990-01-01

OBJECTIVE--To compare the long term survival of a group of athletes taking prolonged vigorous physical exercise to that of the general population. DESIGN--Follow up of a cohort of participants in the Dutch eleven cities ice skating tour (a race and recreational tour) over a distance of 200 kilometers. SETTING--Data on participation from the organising committee and data on mortality from all municipalities in The Netherlands. SUBJECTS--2259 Male athletes. MAIN OUTCOME MEASURES--Comparison of all cause mortality in male participants in the tour with that in the general population of The Netherlands. RESULTS--The standardised mortality ratio for all participants during 32 years of follow up was 0.76 (95% confidence interval 0.68 to 0.85), and 0.90 (0.48 to 1.44) for participants in the race, and 0.72 (0.60 to 0.86) for participants in the recreational tour who finished within the time limit. CONCLUSIONS--The capacity for prolonged and vigorous physical exercise, particularly if the exercise is recreational, is a strong indicator of longevity. Images p1409-a p1411-a PMID:2279154

An eleven year old boy with pain abdomen and early morning neuroparalytic syndrome.

PubMed

Sharma, Milap; Kalia, Shaurya; Sharma, Seema

2016-08-01

An 11 year old boy presented with pain abdomen and tenderness all over body when he got up from sleep early in the morning and subsequently had one vomiting after 30 min. He had no other significant past medical history. The child was shifted to nearby health facility where he was managed as a case of acute abdomen on the basis of suggestive history and clinical findings. Within 2 h after the onset of clinical features suggestive of acute abdomen the patient went on to develop marked ptosis and flaccid quadriplegia. The young boy underwent a sequence of clinical tests which were noncontributory. Based on the clinical picture, a differential diagnosis of hypokalemic paralysis, botulism, Miller Fischer syndrome and EMNS were considered. Through exclusion, the most probable diagnosis for the symptoms was elapid envenomation hence he was started on anti-snake venom (ASV) with working diagnosis of EMNS. Within 2 h, he began to show improvement. This recovery with ASV suggests the possibility of elapid envenomation. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

An eleven gene molecular signature for extra-capsular spread in oral squamous cell carcinoma serves as a prognosticator of outcome in patients without nodal metastases.

PubMed

Wang, Weining; Lim, Weng Khong; Leong, Hui Sun; Chong, Fui Teen; Lim, Tony K H; Tan, Daniel S W; Teh, Bin Tean; Iyer, N Gopalakrishna

2015-04-01

Extracapsular spread (ECS) is an important prognostic factor for oral squamous cell carcinoma (OSCC) and is used to guide management. In this study, we aimed to identify an expression profile signature for ECS in node-positive OSCC using data derived from two different sources: a cohort of OSCC patients from our institution (National Cancer Centre Singapore) and The Cancer Genome Atlas (TCGA) head and neck squamous cell carcinoma (HNSCC) cohort. We also sought to determine if this signature could serve as a prognostic factor in node negative cancers. Patients with a histological diagnosis of OSCC were identified from an institutional database and fresh tumor samples were retrieved. RNA was extracted and gene expression profiling was performed using the Affymetrix GeneChip Human Genome U133 Plus 2.0 microarray platform. RNA sequence data and corresponding clinical data for the TCGA HNSCC cohort were downloaded from the TCGA Data Portal. All data analyses were conducted using R package and SPSS. We identified an 11 gene signature (GGH, MTFR1, CDKN3, PSRC1, SMIM3, CA9, IRX4, CPA3, ZSCAN16, CBX7 and ZFP3) which was robust in segregating tumors by ECS status. In node negative patients, patients harboring this ECS signature had a significantly worse overall survival (p=0.04). An eleven gene signature for ECS was derived. Our results also suggest that this signature is prognostic in a separate subset of patients with no nodal metastasis Further validation of this signature on other datasets and immunohistochemical studies are required to establish utility of this signature in stratifying early stage OSCC patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Brain MRI Characteristics of Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Their Associations with 2-Year Clinical Outcome.

PubMed

Zhang, T; Duan, Y; Ye, J; Xu, W; Shu, N; Wang, C; Li, K; Liu, Y

2018-05-01

Anti- N -methyl-D-aspertate receptor encephalitis is an autoimmune-mediated disease without specific brain MRI features. Our aim was to investigate the brain MR imaging characteristics of anti- N -methyl-D-aspartate receptor encephalitis and their associations with clinical outcome at a 2-year follow-up. We enrolled 53 patients with anti- N -methyl-D-aspartate receptor encephalitis and performed 2-year follow-up. Brain MRIs were acquired for all patients at the onset phase. The brain MR imaging manifestations were classified into 4 types: type 1: normal MR imaging findings; type 2: only hippocampal lesions; type 3: lesions not involving the hippocampus; and type 4: lesions in both the hippocampus and other brain areas. The modified Rankin Scale score at 2-year follow-up was assessed, and the association between the mRS and onset brain MR imaging characteristics was evaluated. Twenty-eight (28/53, 53%) patients had normal MR imaging findings (type 1), and the others (25/53, 47%) had abnormal MRI findings: type 2: 7 patients (13%); type 3: seven patients (13%); and type 4: eleven patients (21%). Normal brain MRI findings were more common in female patients ( P = .02). Psychiatric and behavioral abnormalities were more common in adults ( P = .015), and autonomic symptoms ( P = .025) were more common in pediatric patients. The presence of hippocampal lesions ( P = .008, OR = 9.584; 95% CI, 1.803-50.931) and relapse ( P = .043, OR = 0.111; 95% CI, 0.013-0.930) was associated with poor outcome. Normal brain MRI findings were observed in half of the patients. Lesions in the hippocampus were the most common MR imaging abnormal finding. The presence of hippocampal lesions is the main MR imaging predictor for poor prognosis in patients with anti- N -methyl-D-aspartate receptor encephalitis. © 2018 by American Journal of Neuroradiology.

Hydroquinone Increases 5-Hydroxymethylcytosine Formation through Ten Eleven Translocation 1 (TET1) 5-Methylcytosine Dioxygenase*

PubMed Central

Coulter, Jonathan B.; O'Driscoll, Cliona M.; Bressler, Joseph P.

2013-01-01

DNA methylation regulates gene expression throughout development and in a wide range of pathologies such as cancer and neurological disorders. Pathways controlling the dynamic levels and targets of methylation are known to be disrupted by chemicals and are therefore of great interest in both prevention and clinical contexts. Benzene and its metabolite hydroquinone have been shown to lead to decreased levels of DNA methylation, although the mechanism is not known. This study employs a cell culture model to investigate the mechanism of hydroquinone-mediated changes in DNA methylation. Exposures that do not affect HEK293 cell viability led to genomic and methylated reporter DNA demethylation. Hydroquinone caused reactivation of a methylated reporter plasmid that was prevented by the addition of N-acetylcysteine. Hydroquinone also caused an increase in Ten Eleven Translocation 1 activity and global levels of 5-hydroxymethylcytosine. 5-Hydroxymethylcytosine was found enriched at LINE-1 prior to a decrease in both 5-hydroxymethylcytosine and 5-methylcytosine. Ten Eleven Translocation-1 knockdown decreased 5-hydroxymethylcytosine formation following hydroquinone exposure as well as the induction of glutamate-cysteine ligase catalytic subunit and 14-3-3σ. Finally, Ten Eleven Translocation 1 knockdown decreased the percentage of cells accumulating in G2+M following hydroquinone exposure, indicating that it may have a role in cell cycle changes in response to toxicants. This work demonstrates that hydroquinone exposure leads to active and functional DNA demethylation in HEK293 cells in a mechanism involving reactive oxygen species and Ten Eleven Translocation 1 5-methylcytosine dioxygenase. PMID:23940045

Hydroquinone increases 5-hydroxymethylcytosine formation through ten eleven translocation 1 (TET1) 5-methylcytosine dioxygenase.

PubMed

Coulter, Jonathan B; O'Driscoll, Cliona M; Bressler, Joseph P

2013-10-04

DNA methylation regulates gene expression throughout development and in a wide range of pathologies such as cancer and neurological disorders. Pathways controlling the dynamic levels and targets of methylation are known to be disrupted by chemicals and are therefore of great interest in both prevention and clinical contexts. Benzene and its metabolite hydroquinone have been shown to lead to decreased levels of DNA methylation, although the mechanism is not known. This study employs a cell culture model to investigate the mechanism of hydroquinone-mediated changes in DNA methylation. Exposures that do not affect HEK293 cell viability led to genomic and methylated reporter DNA demethylation. Hydroquinone caused reactivation of a methylated reporter plasmid that was prevented by the addition of N-acetylcysteine. Hydroquinone also caused an increase in Ten Eleven Translocation 1 activity and global levels of 5-hydroxymethylcytosine. 5-Hydroxymethylcytosine was found enriched at LINE-1 prior to a decrease in both 5-hydroxymethylcytosine and 5-methylcytosine. Ten Eleven Translocation-1 knockdown decreased 5-hydroxymethylcytosine formation following hydroquinone exposure as well as the induction of glutamate-cysteine ligase catalytic subunit and 14-3-3σ. Finally, Ten Eleven Translocation 1 knockdown decreased the percentage of cells accumulating in G2+M following hydroquinone exposure, indicating that it may have a role in cell cycle changes in response to toxicants. This work demonstrates that hydroquinone exposure leads to active and functional DNA demethylation in HEK293 cells in a mechanism involving reactive oxygen species and Ten Eleven Translocation 1 5-methylcytosine dioxygenase.

Comparing perceptions of dental aesthetics in the USA with those in eleven ethnic groups.

PubMed

Cons, N C; Jenny, J

1994-12-01

The Standard DAI is an orthodontic index based on perceptions of dental aesthetics in the USA. The Standard DAI is a regression equation linking perceptions of the social acceptability of dental aesthetics with the objective intraoral measurements of ten occlusal traits. Since the Standard DAI is based on perceptions of dental aesthetics in the USA it can be used without modification only where perceptions of dental aesthetics are similar to those in the USA. This study was designed to determine whether perceptions of dental aesthetics of students in eleven diverse ethnic groups are similar to those of students in the USA. The same 25 stimuli (photographs of dental configurations, a subset of the 200 stimuli used in deriving the Standard DAI equation) were rated for dental aesthetics by Australian, Chinese, German, Japanese, Korean, Latvian, Native American, Singaporean Chinese, Singaporean Indian, Singaporean Malay, and Thai students. Their ratings were compared with the ratings of the same 25 stimuli by students in the USA. Spearman rank-order correlations ranged from 0.84 to 0.94. These correlations are sufficiently high to show that perceptions of dental aesthetics in all eleven ethnic groups are very similar to the perceptions of USA students. Therefore the Standard DAI can be used without modification in all eleven ethnic groups.

Comparing perceptions of dental aesthetics in the USA with those in eleven ethnic groups.

PubMed

Cons, N C; Jenny, J

1994-10-01

The Standard DAI is an orthodontic index based on perceptions of dental aesthetics in the USA. The Standard DAI is a regression equation linking perceptions of the social acceptability of dental aesthetics with the objective intraoral measurements of ten occlusal traits. Since the Standard DAI is based on perceptions of dental aesthetics in the USA it can be used without modification only where perceptions of dental aesthetics are similar to those in the USA. This study was designed to determine whether perceptions of dental aesthetics of students in eleven diverse ethnic groups are similar to those of students in the USA. The same 25 stimuli (photographs of dental configurations, a subset of the 200 stimuli used in deriving the Standard DAI equation) were rated for dental aesthetics by Australian, Chinese, German, Japanese, Korean, Latvian, Native American, Singaporean Chinese, Singaporean Indian, Singaporean Malay, and Thai students. Their ratings were compared with the ratings of the same 25 stimuli by students in the USA. Spearman rank-order correlations ranged from 0.84 to 0.94. These correlations are sufficiently high to show that perceptions of dental aesthetics in all eleven ethnic groups are very similar to the perceptions of USA students. Therefore the Standard DAI can be used without modification in all eleven ethnic groups.

[Effects of prophylactic chemotherapy on outcomes and prognosis of patients older than 40 years with invasive mole].

PubMed

Jiang, S Y; Li, L; Zhao, J; Xiang, Y; Wan, X R; Feng, F Z; Ren, T; Yang, J J

2017-06-25

Objective: To discuss the effects of prophylactic chemotherapy on the outcomes and prognosis of invasive mole patients. Methods: One hundred and fifteen invasive mole (IM) patients older than 40 years were registered in Peking Union Medical Collage Hospital.Eleven of them were treated with prophylactic chemotherapy before diagnosed as IM prophylactic chemotherapy group, while the other 104 cases received therapeutic chemotherapy after diagnosed as IM (non-prophylactic chemotherapy group). The general clinical data (including age, clinical stage, risk factor score), treatment, outcomes and relapse of patients were retrospectively compared between two groups. Results: (1) The age of prophylactic chemotherapy group and non-prophylactic chemotherapy group were (47±5) versus (46±4) years old. Ratio of clinical stageⅠ-Ⅱ were 3/11 versus 29.8% (31/104), clinical stage Ⅲ-Ⅳ were 8/11 versus 70.2% (73/104). Ratio of risk factor score 0-6 were 11/11 versus 84.6% (88/104), risk factor score >6 were 0 versus 15.4% (16/104). There were no significant statistical differences between two groups in age, clinical stage or risk factor score (all P> 0.05). (2) Treatment: the total chemotherapy courses between prophylactic chemotherapy group and non-prophylactic chemotherapy group (median 7 versus 5) were significantly different ( Z= 3.071, P= 0.002). There were no significant statistical differences between two groups in the chemotherapy courses until negative conversion of β-hCG, consolidation chemotherapy courses, total therapeutic chemotherapy courses or ratio of hysterectomy (all P> 0.05). (3) Outcomes and relapse: between the prophylactic chemotherapy group and the non-prophylactic chemotherapy group, the complete remission rate were 11/11 versus 98.1%(102/104), the relapse rate were 0 versus 1.0%(1/102). There were no significant difference between the two groups in outcomes or relapse rate ( P> 0.05). Conclusions: Prophylactic chemotherapy does not substantially

Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience

PubMed Central

Maliwan, N; Zvetina, J

2005-01-01

Aims: To analyse clinical features and treatment outcomes of patients with pulmonary Mycobacterium kansasii infection treated at Hines VA Hospital between 1952 and 1995, and followed up until 2003. Findings: 302 patients were confirmed to have M kansasii pulmonary infection; diagnosis was not made until death in 2%. The average age was 50 years old; 76% were white; all were men. Productive cough, dyspnoea, and chest pain were common; 16% were asymptomatic. Right sided, apical or subapical, thin walled cavitary infiltrate was the characteristic radiological feature. Heavy smoking, chronic obstructive pulmonary disease, alcoholism, peptic ulcer disease, coronary artery disease, prior tuberculosis, psychosis, prior pneumonia, and immunocompromising conditions were prevalent. Average follow up was 10 years and 2 months. PPD was positive in 58% of 179 tested. Two thirds of the patients required only first line drugs. Fourteen per cent required surgical intervention, none after 1977. Spontaneous resolution occurred in 1%. Aspergillosis developed in 4%. Bronchogenic carcinoma coexisted with M kansasii infection in 6% and followed it in 4%. Extrapulmonary malignancy coexisted with the infection in 4% and followed it in 6%; most involved head and neck. Eleven per cent of 224 deaths were attributed to M kansasii. Outcomes were affected by comorbidity, treatment compliance, rifampicin use, and extent of infection. Conclusions: Prognosis of M kansasii pulmonary infection is good if diagnosed and treated early, together with control of underlying conditions. Clinicians should be aware of atypical radiological manifestations of the disease when coexisting with other pulmonary or immunocompromising conditions. PMID:16085747

40 CFR 60.2040 - Do all eleven components of these new source performance standards apply at the same time?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Do all eleven components of these new... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY... or After June 1, 2001 Applicability § 60.2040 Do all eleven components of these new source...

Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years.

PubMed

Tan, K K; Chiu, M T; Vijayan, A

2010-12-01

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

Trans-obturator vaginal tape (TOT) for female stress incontinence: one year follow-up in 120 patients.

PubMed

Roumeguère, Thierry; Quackels, Th; Bollens, R; de Groote, A; Zlotta, A; Bossche, M Vanden; Schulman, C

2005-11-01

The aim of this study was to evaluate the effectiveness of a new minimally invasive surgical procedure, the Trans-obturator Vaginal Tape (TOT) in the treatment of female urodynamic stress incontinence (USI) and to analyse functional results and quality of life after one year of follow up. 120 consecutive women with stress urinary incontinence underwent the procedure since February 2002 under general or loco-regional anesthesia. Minimum follow up was one year (range 12-30 months). Mean age was 58 years (range 31-86). 70% of the patients had pure USI. 5 patients were previously operated for USI. In 10 cases, concomitant repair of pelvic floor defects was mandatory. Collection of the data included operative time, pre- and post-operative complications. Patients were post-operatively assessed at one week, one month and one year. A validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire (Contilife) was sent and completed 12 months after surgery. The mean operative time was 12 min (range 6-30) with a catheterisation time of 0,9 day (range 0-2). No severe bleeding was observed. There were 13 minor lateral tears of the vagina without any sequelae. Three perforations of the urethra and one of the bladder occurred during the learning phase. In two cases a re-intervention was necessary for tape removal when the injury was not recognised during the procedure. Two transient urinary retention needed a supra pubic catheter and tape release. Eleven women presented transient voiding outflow obstruction. After one month, 93% patients were cured with no pad and a negative cough test with a full bladder. Uroflowmetry did not show any significant changes between pre- and post-operative time in all the population. De novo urgency occurred only in 2.5% and persistent dysuria (Qmax <10 ml/s and/or post-void residual volume >120 cc) in 4%. 80% of patients were completely dry after one year and 12% were greatly improved. According to the pre-operative maximal

Consumption of fruits and vegetables among adolescents: a multi-national comparison of eleven countries in the Eastern Mediterranean Region.

PubMed

Al Ani, M F; Al Subhi, L K; Bose, S

2016-03-28

Regional cross-country profile of fruit and vegetable (F&V) consumption is lacking in the Eastern Mediterranean Region (EMR). This study examines the prevalence and differences of consuming F&V ≥5 times/d among adolescents in eleven EMR countries, and also describes differences in the proportions of taking F&V ≥5 times/d by sex, age and BMI. The study included 26 328 school adolescents (13-15 years) with complete data on consumption of F&V, age, sex, weight and height taken from the Global School-based Student Health Survey conducted in the EMR between 2005 and 2009. Overall, only 19·4 % of adolescents reported consuming F&V ≥5 times/d. The highest prevalence was reported in Djibouti (40·4 %) and the lowest was reported in Pakistan (10·0 %). Statistically significant differences in prevalence were observed across countries (P<0·05). With the exception of Oman, Libya and Djibouti, significantly more males than females ate F&V ≥5 times/d. Proportion of students consuming F&V ≥5 times/d also varied significantly in all counties based on BMI (P<0·0001), with students within normal BMI having the highest frequency. A negative trend was observed between age and the prevalence of taking F&V ≥5 times/d in most of the eleven EMR countries but Jordan, Djibouti and Morocco. The prevalence of adequate intake of F&V was low in the eleven EMR countries. There is a need for interventions to increase the prevalence of adolescents consuming F&V ≥5 times/d. Interventions should take into consideration psychosocial, environmental and socio-environmental factors influencing F&V intake within countries.

Eleven-year trend in acetanilide pesticide degradates in the Iowa River, Iowa

USGS Publications Warehouse

Kalkhoff, Stephen J.; Vecchia, Aldo V.; Capel, Paul D.; Meyer, Michael T.

2012-01-01

Trends in concentration and loads of acetochlor, alachlor, and metolachlor and their ethanasulfonic (ESA) and oxanilic (OXA) acid degradates were studied from 1996 through 2006 in the main stem of the Iowa River, Iowa and in the South Fork Iowa River, a small tributary near the headwaters of the Iowa River. Concentration trends were determined using the parametric regression model SEAWAVE-Q, which accounts for seasonal and flow-related variability. Daily estimated concentrations generated from the model were used with daily streamflow to calculate daily and yearly loads. Acetochlor, alachlor, metolachlor, and their ESA and OXA degradates were generally present in >50% of the samples collected from both sites throughout the study. Their concentrations generally decreased from 1996 through 2006, although the rate of decrease was slower after 2001. Concentrations of the ESA and OXA degradates decreased from 3 to about 23% yr-1. The concentration trend was related to the decreasing use of these compounds during the study period. Decreasing concentrations and constant runoff resulted in an average reduction of 10 to >3000 kg per year of alachlor and metolachlor ESA and OXA degradates being transported out of the Iowa River watershed. Transport of acetochlor and metolachlor parent compounds and their degradates from the Iowa River watershed ranged from <1% to about 6% of the annual application. These trends were related to the decreasing use of these compounds during the study period, but the year-to-year variability cannot explain changes in loads based on herbicide use alone. The trends were also affected by the timing and amount of precipitation. As expected, increased amounts of water moving through the watershed moved a greater percentage of the applied herbicides, especially the relatively soluble degradates, from the soils into the rivers through surface runoff, shallow groundwater inflow, and subsurface drainage.

Differential Outcomes in High-Stakes Eleven Plus Testing: The Role of Gender, Geography, and Assessment Design in Trinidad and Tobago

ERIC Educational Resources Information Center

De Lisle, Jerome; Smith, Peter; Keller, Carol; Jules, Vena

2012-01-01

High-stakes placement testing at eleven plus remains a central and constant feature of education systems in the Anglophone Caribbean. In the Republic of Trinidad and Tobago, the Eleven Plus has been retained well into the era of universal secondary education, with a perceived legitimacy founded on the belief that examinations provide the fairest…

Eleven years of tropospheric NO2 measured by GOME, SCIAMACHY and OMI

NASA Astrophysics Data System (ADS)

Eskes, H.; Boersma, F.; Dirksen, R.; van der A, R.; Veefkind, P.; Levelt, P.; Brinksma, E.; van Roozendael, M.; de Smedt, I.; Gleason, J.

2006-12-01

Based on measurements of GOME on ESA ERS-2, SCIAMACHY on ESA-ENVISAT, and Ozone Monitoring Instrument (OMI) on the NASA EOS-Aura satellite there is now a unique 11-year dataset of global tropospheric nitrogen dioxide measurements from space. The retrieval approach consists of two steps. The first step is an application of the DOAS (Differential Optical Absorption Spectroscopy) approach which delivers the total absorption optical thickness along the light path (the slant column). For GOME and SCIAMACHY this is based on the DOAS implementation developed by BIRA/IASB. For OMI the DOAS implementation was developed in a collaboration between KNMI and NASA. The second retrieval step, developed at KNMI, estimates the tropospheric vertical column of NO2 based on the slant column, cloud fraction and cloud top height retrieval, stratospheric column estimates derived from a data assimilation approach and vertical profile estimates from space-time collocated profiles from the TM chemistry-transport model. The second step was applied with only minor modifications to all three instruments to generate a uniform 11-year data set. In our talk we will address the following topics: - A short summary of the retrieval approach and results - Comparisons with other retrievals - Comparisons with global and regional-scale models - OMI-SCIAMACHY and SCIAMACHY-GOME comparisons - Validation with independent measurements - Trend studies of NO2 for the past 11 years

Eleven-year trend in acetanilide pesticide degradates in the Iowa River, Iowa.

PubMed

Kalkhoff, Stephen J; Vecchia, Aldo V; Capel, Paul D; Meyer, Michael T

2012-01-01

Trends in concentration and loads of acetochlor, alachlor, and metolachlor and their ethanasulfonic (ESA) and oxanilic (OXA) acid degradates were studied from 1996 through 2006 in the main stem of the Iowa River, Iowa and in the South Fork Iowa River, a small tributary near the headwaters of the Iowa River. Concentration trends were determined using the parametric regression model SEAWAVE-Q, which accounts for seasonal and flow-related variability. Daily estimated concentrations generated from the model were used with daily streamflow to calculate daily and yearly loads. Acetochlor, alachlor, metolachlor, and their ESA and OXA degradates were generally present in >50% of the samples collected from both sites throughout the study. Their concentrations generally decreased from 1996 through 2006, although the rate of decrease was slower after 2001. Concentrations of the ESA and OXA degradates decreased from 3 to about 23% yr. The concentration trend was related to the decreasing use of these compounds during the study period. Decreasing concentrations and constant runoff resulted in an average reduction of 10 to >3000 kg per year of alachlor and metolachlor ESA and OXA degradates being transported out of the Iowa River watershed. Transport of acetochlor and metolachlor parent compounds and their degradates from the Iowa River watershed ranged from <1% to about 6% of the annual application. These trends were related to the decreasing use of these compounds during the study period, but the year-to-year variability cannot explain changes in loads based on herbicide use alone. The trends were also affected by the timing and amount of precipitation. As expected, increased amounts of water moving through the watershed moved a greater percentage of the applied herbicides, especially the relatively soluble degradates, from the soils into the rivers through surface runoff, shallow groundwater inflow, and subsurface drainage. Copyright © by the American Society of Agronomy

Development of a Compact Eleven Feed Cryostat for the Patriot 12-m Antenna System

NASA Technical Reports Server (NTRS)

Beaudoin, Christopher; Kildal, Per-Simon; Yang, Jian; Pantaleev, Miroslav

2010-01-01

The Eleven antenna has constant beam width, constant phase center location, and low spillover over a decade bandwidth. Therefore, it can feed a reflector for high aperture efficiency (also called feed efficiency). It is equally important that the feed efficiency and its subefficiencies not be degraded significantly by installing the feed in a cryostat. The MIT Haystack Observatory, with guidance from Onsala Space Observatory and Chalmers University, has been working to integrate the Eleven antenna into a compact cryostat suitable for the Patriot 12-m antenna. Since the analysis of the feed efficiencies in this presentation is purely computational, we first demonstrate the validity of the computed results by comparing them to measurements. Subsequently, we analyze the dependence of the cryostat size on the feed efficiencies, and, lastly, the Patriot 12-m subreflector is incorporated into the computational model to assess the overall broadband efficiency of the antenna system.

Eleven Lessons in Drug Abuse Education for Use in Junior High School Science.

ERIC Educational Resources Information Center

Dade County Public Schools, Miami, FL.

Eleven lessons for use in junior high school science present two major themes: (1) the use of tobacco, alcohol, and narcotics represents a serious danger to the health of individuals and to national welfare in general; and (2) the best way to combat dangers involved in the use of tobacco, alcohol, and narcotics is through an educated public. Each…

Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases.

PubMed

Al-Koudmani, Ibrahim; Darwish, Bassam; Al-Kateb, Kamal; Taifour, Yahia

2012-04-19

Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.

Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases

PubMed Central

2012-01-01

Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). Conclusions New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis. PMID:22515842

Survival of Patients with Oral Cavity Cancer in Germany

PubMed Central

Listl, Stefan; Jansen, Lina; Stenzinger, Albrecht; Freier, Kolja; Emrich, Katharina; Holleczek, Bernd; Katalinic, Alexander; Gondos, Adam; Brenner, Hermann

2013-01-01

The purpose of the present study was to describe the survival of patients diagnosed with oral cavity cancer in Germany. The analyses relied on data from eleven population-based cancer registries in Germany covering a population of 33 million inhabitants. Patients with a diagnosis of oral cavity cancer (ICD-10: C00-06) between 1997 and 2006 are included. Period analysis for 2002–2006 was applied to estimate five-year age-standardized relative survival, taking into account patients' sex as well as grade and tumor stage. Overall five-year relative survival for oral cavity cancer patients was 54.6%. According to tumor localization, five-year survival was 86.5% for lip cancer, 48.1% for tongue cancer and 51.7% for other regions of the oral cavity. Differences in survival were identified with respect to age, sex, tumor grade and stage. The present study is the first to provide a comprehensive overview on survival of oral cavity cancer patients in Germany. PMID:23349710

Parallaxes and Distance Estimates for Eleven Cataclysmic Binary Stars

NASA Astrophysics Data System (ADS)

Thorstensen, John R.; Lepine, S.; Shara, M.; Peters, C. S.

2007-12-01

We will present new distance estimates for eleven cataclysmic binary stars, based on trigonometric parallaxes measured with the 2.4m Hiltner telescope at MDM Observatory. The MDM parallaxes have typical uncertainties of 1 mas. A Bayesian formalism is used to find the most likely distance given the parallax, proper motion, and prior information. Results will be reported for the eclipsing dwarf nova HT Cas, for which our parallax favors a relatively short distance; KT Per, which proves to have a K-dwarf physical companion; the 65-minute double-degenerate system V396 Hya (CE 315); and the low accretion rate-polar MQ Dra (SDSS 1553). We gratefully acknowledge funding from the NSF through grants AST-9987334, AST-0307413, and AST-0708810.

Tolerability and efficacy of deferasirox in patients with transfusional iron overload: results from a German 2-year non-interventional study.

PubMed

Nolte, Florian; Nückel, Holger; Schmidt, Burkhard; Geer, Thomas; Rubanov, Oleg; Hebart, Holger; Jarisch, Andrea; Albrecht, Stefan; Johr, Christiane; Schumann, Christiane; Hofmann, Wolf-Karsten

2018-05-14

Iron overload (IOL) due to repetitive transfusions of packed red blood cells (pRBC) has a major impact on morbidity and mortality in patients with inherited bone marrow failure syndromes and hemoglobinopathies such as thalassemia and sickle cell disease. However, whether IOL influences the outcome of elderly patients with myeloid malignancies is not yet clear. Moreover, clinical trials have reported high drop-out rates during treatment with the oral iron chelator deferasirox (DFX). Here we report the results of a 2-year prospective observational study that aimed at describing the routine use of DFX in patients with hematological malignancies with regard to safety, efficacy and handling of the drug in a routine setting. A total of 406 patients were included. 58% of the patients were male. Most of the patients had myelodysplastic syndromes (MDS) (68%) and myeloproliferative neoplasms (MPN) (14%). Median time from first transfusion to study enrollment was 1.1 years (0-25.5 years) and most patients were chelation naive (91%) at enrollment. With regard to transfusion burden, most of the patients were moderately or mildly transfusion-dependent with 53% receiving 2-4 and 27% receiving less than 2 units of pRBC per month. Serum ferritin decreased from a mean of 2305 μg/l (± 1449 μg/l) to a mean of 1910 μg/l (± 1529 μg/l) at 24 months. There was no substantial change in transfusion-dependence during the observation period. Dose adjustments were reported in 48% of the patients with dose-escalation strategies being the most frequent reason for dosage increases (49%). The median observation time was 355 days (5-1080 days). Median duration of exposure to DFX was 322 days (2-1078 days). Two-hundred and ninety (72%) patients discontinued the trial prematurely after a median time of 235 days (1-808 days). Death (29%) and adverse events (23%) were the main reasons for discontinuation. Eleven percent of the patients discontinued treatment due to sufficient decrease in

Impact of post-remission therapy in patients aged 65-70 years with de novo acute myeloid leukemia: a comparison of two concomitant randomized ALFA trials with overlapping age inclusion criteria.

PubMed

Itzykson, Raphael; Gardin, Claude; Pautas, Cécile; Thomas, Xavier; Turlure, Pascal; Raffoux, Emmanuel; Terré, Christine; Fenaux, Pierre; Castaigne, Sylvie; Dombret, Hervé; Boissel, Nicolas

2011-06-01

There is no standard post-remission therapy in older patients with acute myeloid leukemia. From 1999 to 2006, the Acute Leukemia French Association group ran two concurrent randomized trials with overlapping inclusion criteria for patients aged 65 to 70 with acute myeloid leukemia, with different post-remission strategies: two intensive courses in the 9801 trial, one intensive course or six outpatient courses in the 9803 trial. We analyzed the outcome of these patients per protocol and per post-remission therapy. Two hundred and eleven patients aged 65 to 70 years with de novo acute myeloid leukemia were enrolled in trial 9801 (n=76) or 9803 (n=135). The patients in the two trials had comparable white blood cell counts (P=0.3), cytogenetics (P=0.49), and complete remission rates (70% and 57%, respectively; P=0.17). Overall survival was identical in both trials (32% and 34% at 2 years, respectively; P=0.71). Overall survival after complete remission was identical in the 103 of 130 patients who received the planned post-remission courses (n=44 with two intensive courses, n=28 with one intensive course, n=31 with six outpatient courses; 41%, 55%, and 58% at 2 years, respectively; P=0.34). Even in patients with favorable or normal karyotype (n=97), overall survival from complete remission was not improved by more intensive post-remission therapy. In patients aged 65 to 70 years with de novo acute myeloid leukemia in complete remission after standard intensive induction chemotherapy, there is no apparent benefit from intensive post-remission therapy. (ClinicalTrials.gov Identifiers: NCT00931138 and NCT00363025).

Fractures and refractures in intercollegiate athletes. An eleven-year experience.

PubMed

Whiteside, J A; Fleagle, S B; Kalenak, A

1981-01-01

This report on fractures and refractures in intercollegiate athletes covers an 11-year period from the early Fall of 1968 through the Spring of 1979. Two hundred thirty-one fractures occurred in 219 athletes. Of these athletes, 185 were male and 34 were female. Fractures occurred in 18 sports. Of these 18, football, basketball, wrestling, and soccer led in number for Men's (M) teams, and gymnastics, lacrosse, and volleyball led for Ladies' (L) teams. (Because of this institution's early involvement with Title IX, and the strong position taken by our administration, our teams are designated Gentlemen (Men for short), which constitute the LIONS, and Ladies, which make up the LADY LIONS.) No fractures were noted in the other 11 intercollegiate teams of cheerleading (M and L), bowling (M and L), golf (M and L), fencing (L), rifle (coed), tennis (M and L), and volleyball (M). Boxing, ice hockey, rugby, soccer, and synchronized swimming are club sports at the Pennsylvania State University and are not included in this study. The most common of the 17 fracture sites were the finger, hand, face, foot, nose, and leg, regardless of sport or gender. Fourteen of fifteen refractures occurred in collision/contact sports, and essentially the same mechanical forces caused both fractures. In football most fractures occurred during highly successful seasons.

Mesenteric blood flow, glucose absorption and blood pressure responses to small intestinal glucose in critically ill patients older than 65 years.

PubMed

Sim, Jennifer A; Horowitz, M; Summers, M J; Trahair, L G; Goud, R S; Zaknic, A V; Hausken, T; Fraser, J D; Chapman, M J; Jones, K L; Deane, A M

2013-02-01

To compare nutrient-stimulated changes in superior mesenteric artery (SMA) blood flow, glucose absorption and glycaemia in individuals older than 65 years with, and without, critical illness. Following a 1-h 'observation' period (t (0)-t (60)), 0.9 % saline and glucose (1 kcal/ml) were infused directly into the small intestine at 2 ml/min between t (60)-t (120), and t (120)-t (180), respectively. SMA blood flow was measured using Doppler ultrasonography at t (60) (fasting), t (90) and t (150) and is presented as raw values and nutrient-stimulated increment from baseline (Δ). Glucose absorption was evaluated using serum 3-O-methylglucose (3-OMG) concentrations during, and for 1 h after, the glucose infusion (i.e. t (120)-t (180) and t (120)-t (240)). Mean arterial pressure was recorded between t (60)-t (240). Data are presented as median (25th, 75th percentile). Eleven mechanically ventilated critically ill patients [age 75 (69, 79) years] and nine healthy volunteers [70 (68, 77) years] were studied. The magnitude of the nutrient-stimulated increase in SMA flow was markedly less in the critically ill when compared with healthy subjects [Δt (150): patients 115 (-138, 367) versus health 836 (618, 1,054) ml/min; P = 0.001]. In patients, glucose absorption was reduced during, and for 1 h after, the glucose infusion when compared with health [AUC(120-180): 4.571 (2.591, 6.551) versus 11.307 (8.447, 14.167) mmol/l min; P < 0.001 and AUC(120-240): 26.5 (17.7, 35.3) versus 40.6 (31.7, 49.4) mmol/l min; P = 0.031]. A close relationship between the nutrient-stimulated increment in SMA flow and glucose absorption was evident (3-OMG AUC(120-180) and ∆SMA flow at t (150): r (2) = 0.29; P < 0.05). In critically ill patients aged >65 years, stimulation of SMA flow by small intestinal glucose infusion may be attenuated, which could account for the reduction in glucose absorption.

Impact of post-remission therapy in patients aged 65–70 years with de novo acute myeloid leukemia: a comparison of two concomitant randomized ALFA trials with overlapping age inclusion criteria

PubMed Central

Itzykson, Raphael; Gardin, Claude; Pautas, Cécile; Thomas, Xavier; Turlure, Pascal; Raffoux, Emmanuel; Terré, Christine; Fenaux, Pierre; Castaigne, Sylvie; Dombret, Hervé; Boissel, Nicolas

2011-01-01

Background There is no standard post-remission therapy in older patients with acute myeloid leukemia. Design and Methods From 1999 to 2006, the Acute Leukemia French Association group ran two concurrent randomized trials with overlapping inclusion criteria for patients aged 65 to 70 with acute myeloid leukemia, with different post-remission strategies: two intensive courses in the 9801 trial, one intensive course or six outpatient courses in the 9803 trial. We analyzed the outcome of these patients per protocol and per post-remission therapy. Results Two hundred and eleven patients aged 65 to 70 years with de novo acute myeloid leukemia were enrolled in trial 9801 (n=76) or 9803 (n=135). The patients in the two trials had comparable white blood cell counts (P=0.3), cytogenetics (P=0.49), and complete remission rates (70% and 57%, respectively; P=0.17). Overall survival was identical in both trials (32% and 34% at 2 years, respectively; P=0.71). Overall survival after complete remission was identical in the 103 of 130 patients who received the planned post-remission courses (n=44 with two intensive courses, n=28 with one intensive course, n=31 with six outpatient courses; 41%, 55%, and 58% at 2 years, respectively; P=0.34). Even in patients with favorable or normal karyotype (n=97), overall survival from complete remission was not improved by more intensive post-remission therapy. Conclusions In patients aged 65 to 70 years with de novo acute myeloid leukemia in complete remission after standard intensive induction chemotherapy, there is no apparent benefit from intensive post-remission therapy. (ClinicalTrials.gov Identifiers: NCT00931138 and NCT00363025) PMID:21459791

A review of 15 years of ovarian tissue bank activities.

PubMed

Dolmans, Marie-Madeleine; Jadoul, Pascale; Gilliaux, Sébastien; Amorim, Christiani A; Luyckx, Valérie; Squifflet, Jean; Donnez, Jacques; Van Langendonckt, Anne

2013-03-01

To review 15 years of activities in ovarian tissue cryobanking from medical database files, including patient indications, histological evaluation and clinical characteristics. Retrospective longitudinal analysis of data from an ovarian tissue bank in an academic hospital. Five hundred and eighty-two patients had their ovarian tissue cryobanked between April 1997 and January 2012. Analysis of cryobanking database: precryopreservation patient characteristics, indications and safety issues, laboratory files and postcryopreservation clinical data. Of the 582 patients who had their ovarian tissue cryopreserved, 106 patients donated for research purposes and 476 patients for fertility preservation and long-term cryopreservation. Clinical data analysis of the 476 patients revealed a mean age at the time of cryopreservation of 23 ± 8.5 years (range: 9 months - 39 years), with 96.2 % of subjects aged ≤35 years (n = 458). Among 391 cases of malignant disease, hematological malignancies (39.9 %, n = 156) and breast cancer (21.7 %, n = 85) were the two main indications. At histology, malignant cells were found in ovarian tissue from leukemia patients (n = 3) and non-Hodgkin's lymphoma patients (n = 2). Eleven patients underwent autotransplantation, resulting in 5 live births and 1 ongoing pregnancy. This is the largest and most comprehensive study to describe and analyze indications and clinical patient characteristics before and after ovarian tissue cryopreservation. The procedure is safe, easy and promising. The database concept is a useful tool in patient selection for autotransplantation.

[Determination of eleven fluorescent whitening agents in paper food packaging materials by UPLC-FLD/PDA with series double-detector].

PubMed

Wang, Tianjiao; Wu, Pinggu; Hu, Zhengyan; Wang, Liyuan; Tang, Jun; Jiang, Wei; Wang, Zhiyuan

2016-07-01

To establish a new qualitative and quantitative ultraperformance liquid chromatography-fluorescence detector / photodiode array detector with series double-detector method for the determination of eleven fluorescent whitening agents in paper food packaging materials. The sample was extracted with 40%acetonitrile water solution, separated by Waters ACQUITY UPLC BEH C_(18)column( 1. 7μm, 2. 1 mm × 100 mm) and eluted gradient. The excitation wavelength and emission wavelength of fluorescence detector( FLD) were 350 nm and 430 nm, and the wavelength of photodiode array detector( PDA) was 350 nm. The detectors were used in series to achieve qualitative and quantitative detection. In the substrates of paper cups, paper bowls, paper trays and paper boxes, those eleven fluorescent whitening agents were separated properly. For both detectors, in the linear range of 25- 1000 ng / m L, the correlation coefficient was greater than 0. 99, and the recoveries of spiked recoveries were between 82. 2%- 104. 1% with the RSD less than 10%( n = 6). The detection limits ofthose eleven fluorescent whitening agents were 0. 20- 0. 28 mg / kg for FLD and 1. 4- 2. 5mg / kg for PDA. The eleven fluorescent whitening agents could be separated properly with complete separation, good shapes and high recovery rate. This method is easy to operate also. Thus it's an effective method to detect the fluorescent whitening agents in paper food packaging materials.

Clinical outcomes of adenoid cystic carcinoma of the head and neck: a single institution 20-year experience.

PubMed

Ali, S; Yeo, J C-L; Magos, T; Dickson, M; Junor, E

2016-07-01

This study reports the clinical outcomes of head and neck adenoid cystic carcinoma treatment over a 20-year period. The treatment outcome of 51 head and neck adenoid cystic carcinoma patients treated between 1992 and 2013 were analysed. Patients were stratified into radical treatment and disease control groups. A total of 40 patients underwent surgery and post-operative radiotherapy. The 10-year disease-specific survival rate was 93 per cent. Eleven patients had tumour recurrence: of these, nine were pulmonary metastases. The 11 patients in the disease control group had a median follow up of 21 months (range, 2-172 months); 5 underwent radical radiotherapy with palliative intent. There was late tumour recurrence in over 25 per cent of patients. Adenoid cystic carcinoma has a high tendency to relapse even after radical excision and adjuvant therapy. However, definitive radiotherapy should still be considered on an individual basis because it may provide local control and prolong patient survival.

Adjuvant treatment in patients at high risk of recurrence of thymoma: efficacy and safety of a three-dimensional conformal radiation therapy regimen.

PubMed

Perri, Francesco; Pisconti, Salvatore; Conson, Manuel; Pacelli, Roberto; Della Vittoria Scarpati, Giuseppina; Gnoni, Antonio; D'Aniello, Carmine; Cavaliere, Carla; Licchetta, Antonella; Cella, Laura; Giuliano, Mario; Schiavone, Concetta; Falivene, Sara; Di Lorenzo, Giuseppe; Buonerba, Carlo; Ravo, Vincenzo; Muto, Paolo

2015-01-01

The clinical benefits of postoperative radiation therapy (PORT) for patients with thymoma are still controversial. In the absence of defined guidelines, prognostic factors such as stage, status of surgical margins, and histology are often considered to guide the choice of adjuvant treatment (radiotherapy and/or chemotherapy). In this study, we describe our single-institution experience of three-dimensional conformal PORT administered as adjuvant treatment to patients with thymoma. Twenty-two consecutive thymoma patients (eleven male and eleven female) with a median age of 52 years and treated at our institution by PORT were analyzed. The patients were considered at high risk of recurrence, having at least one of the following features: stage IIB or III, involved resection margins, or thymic carcinoma histology. Three-dimensional conformal PORT with a median total dose on clinical target volume of 50 (range 44-60) Gy was delivered to the tumor bed by 6-20 MV X-ray of the linear accelerator. Follow-up after radiotherapy was done by computed tomography scan every 6 months for 2 years and yearly thereafter. Two of the 22 patients developed local recurrence and four developed distant metastases. Median overall survival was 100 months, and the 3-year and 5-year survival rates were 83% and 74%, respectively. Median disease-free survival was 90 months, and the 5-year recurrence rate was 32%. On univariate analysis, pathologic stage III and presence of positive surgical margins had a significant impact on patient prognosis. Radiation toxicity was mild in most patients and no severe toxicity was registered. Adjuvant radiotherapy achieved good local control and showed an acceptable toxicity profile in patients with high-risk thymoma.

Malignant anal sac melanoma in dogs: eleven cases (2000 to 2015).

PubMed

Vinayak, A; Frank, C B; Gardiner, D W; Thieman-Mankin, K M; Worley, D R

2017-04-01

To report the signalment, clinical presentation, treatments pursued and outcomes of dogs with malignant anal sac melanoma. Medical records from five institutions from January 2000 through December 2015 were reviewed and dogs with cytologically- or histologically-confirmed malignant anal sac melanoma were identified. Signalment, clinical signs, staging, cytology, histopathologic analysis, surgical and non-surgical treatments were extracted from the medical records. The referring veterinarians and owners were contacted for follow-up data. Eleven dogs were included and survival data was available for all. The most common clinical signs were bloody anal sac discharge and perianal licking. Initial treatments pursued included surgery (n=8), chemotherapy (n=1), and palliative treatment with pain medications and stool softeners (n=2). In an adjuvant setting, melanoma vaccine was pursued following surgery in three dogs and chemotherapy in one dog. Regardless of treatment, progression-free survival (mean 92 · 5 days) and overall survival times (median 107 days) were short. Dogs in this case series had a guarded to poor prognosis regardless of treatment. Ten of 11 dogs were euthanased due to local or distant disease progression. Only 1 of 11 dogs was alive one year after diagnosis. An understanding of tumour behaviour in this location could lead to improved survival times with earlier diagnosis and treatment. © 2017 British Small Animal Veterinary Association.

An Experimental Evaluation of Advanced Rotorcraft Airfoils in the NASA Ames Eleven-foot Transonic Wind Tunnel

NASA Technical Reports Server (NTRS)

Flemming, Robert J.

1984-01-01

Five full scale rotorcraft airfoils were tested in the NASA Ames Eleven-Foot Transonic Wind Tunnel for full scale Reynolds numbers at Mach numbers from 0.3 to 1.07. The models, which spanned the tunnel from floor to ceiling, included two modern baseline airfoils, the SC1095 and SC1094 R8, which have been previously tested in other facilities. Three advanced transonic airfoils, designated the SSC-A09, SSC-A07, and SSC-B08, were tested to confirm predicted performance and provide confirmation of advanced airfoil design methods. The test showed that the eleven-foot tunnel is suited to two-dimensional airfoil testing. Maximum lift coefficients, drag coefficients, pitching moments, and pressure coefficient distributions are presented. The airfoil analysis codes agreed well with the data, with the Grumman GRUMFOIL code giving the best overall performance correlation.

Department of the Army Justification of Estimates for Fiscal Year 1983 Submitted to Congress February 1982. Part 2 (Missiles).

DTIC Science & Technology

1982-02-01

STINGER missiles and ground support equipment. The program for FY 1983 represents the sixth year of a planned eleven-year procurement effort designed ...planned eleven year procurement effort designed t., fill the Army’s inventory objective. The STINER, scheduled to replace the obsolete RED-YI, has greater...equipment. This is the fifth year of procurement designed to fill the Army inventory objective. MIRES is a self-propelled, fast- reacting, multiple rocket

Year to year change in FEV1 in patients with cystic fibrosis and different mutation classes.

PubMed

De Boeck, K; Zolin, A

2017-03-01

In patients with cystic fibrosis, most treatments addressing the underlying basic defect are mutation or mutation class specific. These treatments are disease modifying if they lower the year to year change in lung function. We therefore calculated the current loss of lung function, measured by year to year change in forced expired volume in 1s in 11,417 patients included in the European Cystic Fibrosis Society Patient Registry. Whereas patients with at least one mutation of class IV or V have on average a lower year to year change, we did not find a difference between patients with a stop codon mutation, homozygous for F508del or at least one class III mutation. These data are useful background information to discuss the impact of different disease modifying treatments. Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Cryogenic Integration of the 2-14 GHz Eleven Feed in a Wideband Receiver for VLBI2010

NASA Technical Reports Server (NTRS)

Pantaleev, Miroslaw; Jang, Jian; Karadikar, Yogesh; Helldner, Leif; Klein, Benjamin; Haas, Rudiger; Zaman, Ashraf; Zamani, Mojtaba; Kildal, Per-Simon

2010-01-01

The next generation VLBI systems require the design of a wideband receiver covering the 2-14 GHz range, necessitating a wideband feed. Presented here are the 2009 development of a cryogenic 2-14 GHz Eleven feed for reflector radio telescope antennas, including its integration into a cryogenic receiver. The Eleven feed is designed for dual linear polarization and consists of four log-periodic folded dipole arrays. Each pair of arrays is fed by a differential two-wire transmission line connected either to balun or a differential LNA. The present configuration has been measured in many configurations, at various independent labs - corresponding simulations have been done. The results show (across the band) a high polarization efficiency for the feed, with a nearly constant beam width, a reflection coefficient below -10dB, and a constant phase center. Electrical parameters under cryogenic conditions and measured receiver noise temperatures are presented.

Cytotoxicity potentials of eleven Bangladeshi medicinal plants.

PubMed

Khatun, Amina; Rahman, Mahmudur; Haque, Tania; Rahman, Md Mahfizur; Akter, Mahfuja; Akter, Subarna; Jhumur, Afrin

2014-01-01

Various forms of cancer are rising all over the world, requiring newer therapy. The quest of anticancer drugs both from natural and synthetic sources is the demand of time. In this study, fourteen extracts of different parts of eleven Bangladeshi medicinal plants which have been traditionally used for the treatment of different types of carcinoma, tumor, leprosy, and diseases associated with cancer were evaluated for their cytotoxicity for the first time. Extraction was conceded using methanol. Phytochemical groups like reducing sugars, tannins, saponins, steroids, gums, flavonoids, and alkaloids were tested using standard chromogenic reagents. Plants were evaluated for cytotoxicity by brine shrimp lethality bioassay using Artemia salina comparing with standard anticancer drug vincristine sulphate. All the extracts showed potent to moderate cytotoxicity ranging from LC50 2 to 115 µg/mL. The highest toxicity was shown by Hygrophila spinosa seeds (LC50 = 2.93 µg/mL) and the lowest by Litsea glutinosa leaves (LC50 = 114.71 µg/mL) in comparison with standard vincristine sulphate (LC50 = 2.04 µg/mL). Among the plants, the plants traditionally used in different cancer and microbial treatments showed highest cytotoxicity. The results support their ethnomedicinal uses and require advanced investigation to elucidate responsible compounds as well as their mode of action.

Aortic root remodeling: ten-year experience with 274 patients.

PubMed

Aicher, Diana; Langer, Frank; Lausberg, Henning; Bierbach, Benjamin; Schäfers, Hans-Joachim

2007-10-01

Dilatation of the aortic root with concomitant aortic regurgitation can be treated by valve-preserving surgery. We have consistently chosen root remodeling rather than reimplantation whenever the aortoventricular junction was not dilated. We have analyzed our 11-year experience with root remodeling. Between October 1995 and October 2006, 274 patients (201 male; 73 female, aged 59 +/- 15 years) were treated by root remodeling in the presence of a preserved aortoventricular diameter (<30 mm). Acute aortic dissection was present in 46 patients. The valve anatomy was tricuspid in 193 and bicuspid in 81 patients. Cusp disease was additionally corrected in 173 (63%) patients. Follow-up was complete in 99%. Cumulative follow-up was 1045 patient-years (mean of 4.0 +/- 2.7 years). Hospital mortality was 3.6% (elective 3.1%; emergency 6.5%). One patient had endocarditis 2 months postoperatively and subsequently underwent valve replacement. Freedom from aortic regurgitation of grade II or more was 91% and 87% at 10 years for bicuspid and tricuspid aortic valves. Nine patients required reoperation: in 6 patients the valve was replaced and in 3 patients rerepaired. Freedom from reoperation was 96% at 5 and 10 years, and freedom from valve replacement was 98% at 5 and 10 years. A comparison of 3 operative periods (1995-1998, 1999-2002, and 2003-2006) showed that with increasing experience cusp prolapse was diagnosed and corrected more frequently (8/49 = 17%; 62/105 = 59%; 103/108 = 82%; P < .0001), and repair stability significantly improved over time (P = .007). Root remodeling leads to durable restoration of aortic valve function in both tricuspid and bicuspid valve anatomy. Aggressive correction of cusp prolapse seems to have a beneficial effect on aortic valve competence.

Persistence of the effect of the Lung Health Study (LHS) smoking intervention over eleven years.

PubMed

Murray, Robert P; Connett, John E; Rand, Cynthia S; Pan, Wei; Anthonisen, Nicholas R

2002-10-01

Research on the long-term persistence of effects of interventions aimed at smoking cessation is limited. This paper examined the quitting behavior of individuals who were randomized to a smoking cessation intervention (SI) or to usual care (UC), at a point approximately 11 years later. The initial sample consisted of 5,887 adult smokers in 10 clinics who had evidence of airways obstruction. Two-thirds of the original participants were offered an intensive 12-week smoking cessation intervention. Of these, 4,517 were enrolled in the long-term follow-up study. Randomized group assignment was a strong predictor of smoking behavior after 11 years, in that 21.9% of SI participants and only 6.0% of UC participants maintained abstinence throughout the interval. Logistic regressions identified covariates associated with abstinence. A higher proportion of abstinence was observed in participants that had been assigned to SI (OR = 4.45), were older (OR = 1.11, increment 5 years), had more years of education (OR = 1.05), and fewer cigarettes/day at baseline (OR = 0.90, increment 10 cigarettes). Smokers exposed to an aggressive smoking intervention program and who sustain abstinence for a five-year period are very likely to still be abstinent after 11 years. Copyright 2002 American Health Foundation and Elsevier Science (USA)

Triple valve surgery: a 25-year experience.

PubMed

Yilmaz, Mustafa; Ozkan, Murat; Böke, Erkmen

2004-09-01

Surgical treatment of rheumatic valvular disease still constitutes a significant number of cardiac operations in developing countries. Despite improvements in myocardial protection and cardiopulmonary bypass techniques, triple valve operations (aortic, mitral and tricuspid valves) are still challenging because of longer duration of cardiopulmonary bypass and higher degree of myocardial decompensation. This study was instituted in order to assess results of triple valve surgery. Between 1977 and 2002, 34 patients underwent triple valve surgery in our clinic by the same surgeon (EB). Eleven patients underwent triple valve replacement (32.4%) and 23 underwent tricuspid valve annuloplasty with aortic and mitral valve replacements (67.6%). There was no significant difference between the two groups of patients who underwent triple valve replacement and aortic and mitral valve replacement with tricuspid valve annuloplasty. There were 4 hospital deaths (11.8%) occurring within 30 days. The duration of follow-up for 30 survivors ranged from 6 to 202 months (mean 97 months). The actuarial survival rates were 85%, 72%, and 48% at 5, 10, and 15 years respectively. Actuarial freedom from reoperation rates at 5, 10, and 15 years was 86.3%, 71.9%, and 51.2%, respectively. Freedom from cerebral thromboembolism and anticoagulation-related hemorrhage rates, expressed in actuarial terms was 75.9% and 62.9% at 5 and 10 years. Major cerebral complications occurred in 10 of the 30 patients. We prefer replacing, if repairing is not possible, the tricuspid valve, with a bileaflet mechanical prosthesis in a patient with valve replacement of the left heart who will be anticoagulated in order to avoid unfavorable properties of bioprosthesis like degeneration and of old generation mechanical prosthesis like thrombosis and poor hemodynamic function. In recent years, results of triple valve surgery either with tricuspid valve conservation or valve replacement in suitable cases have become

Comparison of gender-specific mortality in patients < 70 years versus ≥ 70 years old with acute myocardial infarction.

PubMed

Ishihara, Masaharu; Inoue, Ichiro; Kawagoe, Takuji; Shimatani, Yuji; Miura, Fumiharu; Nakama, Yasuharu; Dai, Kazuoki; Ootani, Takayuki; Ooi, Kuniomi; Ikenaga, Hiroki; Miki, Takashi; Nakamura, Masayuki; Kishimoto, Shinji; Sumimoto, Youji

2011-09-15

The aim of the present study was to investigate the gender-specific mortality after acute myocardial infarction in those aged < 70 years versus ≥ 70 years. The present study consisted of 2,677 consecutive patients with acute myocardial infarction who had undergone coronary angiography within 24 hours after the onset of symptoms. The patients were divided into 2 groups: 1,810 patients < 70 years old and 867 patients ≥ 70 years old. Women were older and had a greater incidence of hypertension and diabetes mellitus and a lower incidence of current smoking and previous myocardial infarction in both groups. The in-hospital mortality rate was significantly greater in women ≥ 70 years old age than in men ≥ 70 years old (16.2% vs 9.3%, respectively; p = 0.003) but was comparable between women and men in patients < 70 years old (5.7% vs 4.9%, respectively; p = 0.59). On multivariate analysis, the association between female gender and in-hospital mortality in patients ≥ 70 years old remained significant (odds ratio 1.78, 95% confidential interval 1.05 to 3.00), but the gender difference was not observed in patients < 70 years old (odds ratio 1.09, 95% confidence interval 0.53 to 2.24). In conclusion, female gender was associated with in-hospital mortality after acute myocardial infarction in patients ≥ 70 years old but not in patients < 70 years old. Copyright © 2011 Elsevier Inc. All rights reserved.

Length-weight relationship of eleven species of marine catfishes from the northern Arabian Sea coast of Pakistan

NASA Astrophysics Data System (ADS)

Farooq, Noureen; Qamar, Nazia; Rashid, Shahnaz; Panhwar, Sher Khan

2017-09-01

This study records length-weight relationships (LWRs) for eleven commercially important marine catfish species of the family Ariidae (sea catfishes) and Plotosidae (eel catfishes) from the northern Arabian Sea coast of Pakistan. The specimens were sampled from December 2014 to November 2015, using bottom trawls with various mesh sizes by commercial vessels. The species were Nemapteryx caelatus, Sciades sona, Arius gagora, Batrachocephalus mino, Netuma thalassina, N. bilineata, Osteogeneiosus militaris, Plicofollis dussumieri, P. tenuispinis, Plotosus limbatus, and P. lineatus. Of the eleven species, two species A. gagora and N. bilineata were recorded for the first time and LWRs for four species A. gagora, N. bilineata, S. sona, and B. mino still have no data in the FishBase database. In addition, new maximum length for each of the three species N. bilineata, O. militaris and B. mino was also found.

Decreased expression of ten-eleven translocation 1 protein is associated with some clinicopathological features in gastric cancer.

PubMed

Frycz, Bartosz Adam; Murawa, Dawid; Borejsza-Wysocki, Maciej; Marciniak, Ryszard; Murawa, Paweł; Drews, Michał; Kołodziejczak, Anna; Tomela, Katarzyna; Jagodziński, Paweł Piotr

2014-03-01

A decrease in ten-eleven translocation 1 (TET1) transcript and 5-Hydroxymethylcytosine (5hmC) levels has recently been demonstrated in primary gastric cancer (GC). However, little is known about TET1 protein levels in gastric tumoral and nontumoral tissue. Therefore, using reverse transcription, real-time quantitative polymerase chain reaction and western blotting analysis, we determined the TET1 transcript and protein levels in tumoral and nontumoral tissue from 38 patients with GC. We also assessed the association between the decrease in TET1 transcript and protein levels and some clinicopathological features in primary GC. We found significantly decreased levels of TET1 transcript (P=0.0023) and protein (P=0.00024) in primary tumoral tissues as compared to nontumoral tissues in patients with GC. Moreover, we also observed significantly lower amounts of TET1 transcript (P=0.03) and protein (P=0.00018) in tumoral tissues in patients aged>60. We also found significant lowered TET1 protein levels in male patients (P=0.0014), stomach (P=0.044) and cardia (P=0.013) tumor localization, T3 depth of invasion (P=0.019), N1 (P=0.012) and N3 lymph node metastasis (P=0.013) and G3 histological grade (P=0.0012). There were also significant decreases in TET1 transcript levels in female patients (P=0.042), intestinal histological types (P=0.0079) and T4 depth of invasion (P=0.037). Our results demonstrated that a decrease in TET1 transcript and protein levels is associated with some clinicopathological features in GC. Copyright © 2014. Published by Elsevier Masson SAS.

Outcomes of hip arthroscopy in patients aged 50 years or older compared with a matched-pair control of patients aged 30 years or younger.

PubMed

Domb, Benjamin G; Linder, Dror; Finley, Zachary; Botser, Itamar B; Chen, Austin; Williamson, Joseph; Gupta, Asheesh

2015-02-01

Age has been suggested as a negative prognostic factor for hip arthroscopy. The purpose of this study was to compare patient characteristics and outcomes after hip arthroscopy in patients aged 50 years or older with a matched control group of patients aged 30 years or younger at a minimum postoperative follow-up of 2 years. Between September 2008 and March 2010, data were prospectively collected on all patients aged 50 years or older undergoing primary hip arthroscopy. Fifty-two patients met our inclusion and matching criteria, of whom all 52 (100%) were available for follow-up at a minimum of 2 years. This cohort was compared with a matched-pair control group of patients aged 30 years or younger who underwent similar procedures. The mean age of the study group was 54.8 years (range, 50 to 69 years), and that of the control group was 20.3 years (range, 13 to 30 years). The groups were matched at a 1:1 ratio, including 18 male patients (34.6%) and 34 female patients (65.4%) in each group, with a mean follow-up period of 32 months (range, 24 to 54 months). In the younger control group, the score improvement from preoperatively to 2 years' follow-up was 62.9 to 84.2 for the modified Harris Hip Score, 60.5 to 84.2 for the Non-Arthritic Hip Score, 63.1 to 86.5 for the Hip Outcome Score-Activities of Daily Living, and 42.2 to 72.7 for the Hip Outcome Score-Sport-Specific Subscale. In the older study group, the score improvement from preoperatively to 2 years' follow-up was 61.2 to 82.2 for the modified Harris Hip Score, 59.9 to 80.4 for the Non-Arthritic Hip Score, 63.9 to 83 for the Hip Outcome Score-Activities of Daily Living, and 41.2 to 64.6 for the Hip Outcome Score-Sport-Specific Subscale. All improvements in both groups were statistically significant at the 2-year postoperative follow-up (P < .001). There was no significant difference for all patient-reported outcome (PRO) scores at final follow-up between both groups. When we compared the change in PRO scores (�

Aldolase B inhibits metastasis through Ten-Eleven Translocation 1 and serves as a prognostic biomarker in hepatocellular carcinoma.

PubMed

Tao, Qi-Fei; Yuan, Sheng-Xian; Yang, Fu; Yang, Sen; Yang, Yuan; Yuan, Ji-Hang; Wang, Zhen-Guang; Xu, Qing-Guo; Lin, Kong-Ying; Cai, Jie; Yu, Jian; Huang, Wei-Long; Teng, Xiao-Lei; Zhou, Chuan-Chuan; Wang, Fang; Sun, Shu-Han; Zhou, Wei-Ping

2015-09-17

Downregulation of Aldolase B (ALDOB) has been reported in hepatocellular carcinoma. However, its clinical significance and its role in pathogenesis of HCC remain largely unknown. We analyzed the expression of ALDOB and its clinical features in a large cohort of 313 HCC patients using tissue microarray and immunohistochemistry. Moreover, the function of stably overexpressed ALDOB in HCC cells was explored in vitro and in vivo. Gene expression microarray analysis was performed on ALDOB-overexpressing SMMC7721 cells to elucidate its mechanism of action. ALDOB downregulation in HCC was significantly correlated with aggressive characteristics including absence of encapsulation, increased tumor size (>5 cm) and early recurrence. ALDOB downregulation was indicative of a shorter recurrence-free survival (RFS) and overall survival (OS) for all HCC patients and early-stage HCC patients (BCLC 0-A and TNM I stage patients). Multiple analyses revealed that ALDOB downregulation was an independent risk factor of RFS and OS. Stable expression of ALDOB in HCC cell lines reduced cell migration in vitro and inhibited lung metastasis, intrahepatic metastasis, and reduced circulating tumor cells in vivo. Mechanistically, we found that cells stably expressing ALDOB show elevated Ten-Eleven Translocation 1 (TET1) expression. Moreover, ALDOB expressing cells have higher levels of methylglyoxal than do control cells, which can upregulate TET1 expression. The downregulation of ALDOB could indicate a poor prognosis for HCC patients, and therefore, ALDOB might be considered a prognostic biomarker for HCC, especially at the early stage. In addition, ALDOB inhibits the invasive features of cell lines partly through TET1 expression.

Submucosal reconstructive hemorrhoidectomy (Parks' operation): a 20-year experience.

PubMed

Rosa, G; Lolli, P; Piccinelli, D; Vicenzi, L; Ballarin, A; Bonomo, S; Mazzola, F

2005-12-01

Submucosal reconstructive hemorrhoidectomy has never been a popular operation due to its difficulty and duration, the amount of blood loss, and the risk of incontinence. The main indication for hemorrhoidectomy according to Parks is fourth-degree hemorrhoids with prolapse of the dentate line outside the anus and with simultaneous presence of external hemorrhoids. We report our experience in the treatment of hemorrhoids using submucosal reconstructive hemorrhoidectomy according to Parks. A total of 640 patients (381 men and 259 women) of median age 42 years (range, 18-81) were treated between 1983 and 2002; 80% of patients had fourth-degree, 19% third-degree and 1% second- degree hemorrhoids. All patients underwent rectosigmoidoscopic examination before surgery; patients over 35 years of age or with a suspected inflammatory or neoplastic disease underwent colonoscopy or barium enema. All patients underwent anorectal manometry before operation, to measure anal resting pressure, maximal squeeze and sphincter length, with the purpose of determining if an internal sphincterotomy was also necessary (in case of high anal resting tone). One-third of the patients also had an internal sphincterotomy to correct anal hypertonia. Postoperative bleeding occurred in 19 patients (2.9%), 0.9% requiring a reintervention. Severe pain was reported by 9 patients (1.4%); fecal impaction occurred in 3 cases (0.5%) and suture disruption in 2 patients (0.3%). In 74 patients (11.6%), bladder catheterization was needed due to urinary retention. Of 550 patients who had a minimum follow-up of 3 years and were sent a postal questionnaire, 374 patients responded, with a median 7.3-year follow- up; 176 patients (32%) were lost to follow-up. Eleven patients (2.9% of 374 cases) reported pain during defecation, 6 (1.6%) developed skin tags or recurrence, 3 (0.8%) reported gas incontinence, 2 (0.5%) developed anal fistula and 1 (0.3%) had anal stricture. Submucosal reconstructive hemorrhoidectomy

[Occupational exposure risk to body fluids in the Felix Bulnes Hospital during eleven years].

PubMed

Villarroel, Julia; Bustamante, M Cecilia; Manríquez, Iván; Bertoglia, M Paz; Mora, María; Galarce, Natalie

2012-06-01

Accidents with risk of occupational exposure to body fluids constitute more of a third of labor accidents. To describe the annual incidence of accidents with exposure to body fluids in the Felix Bulnes Hospital from 1998 to 2008. A retrospective analysis of reports from the Infection Control Committee. During 11 years, there were 415 accidents with exposure to body fluids, with the cumulative incidence of 3,4% (range 1.3% to 6%). Sharp instrument accidents accounted for 92,5% of cases. The main health care providers affected were the paramedical technicians and the students. The highest frequency of accidents occurred in the obstetrical operating rooms (20%) and in the central operating rooms (17%). There were no cases of seroconversion and no exposure to HCV or HBV. The estimated costs were USD $35638,6 or USD $271 per 1000 staff per year. The incidence increased during the first years of the study and then remained stable since 2001, despite efforts in training personnel. Many factors contribute to the development of these accidents, such as lack of experience, type of clinical benefit and even daytime working hours.

A video depicting resuscitation did not impact upon patients' decision-making.

PubMed

Richardson-Royer, Caitlin; Naqvi, Imran; Riffel, Christopher; Harvey, Lawrence; Smith, Domonique; Ayalew, Dagmawe; Motayar, Nasim; Amoateng-Adjepong, Yaw; Manthous, Constantine A

2018-01-01

Previous studies have demonstrated that video of and scripted information about cardiopulmonary resuscitation (CPR) can be deployed during clinician-patient end-of-life discussions. Few studies, however, examine whether video adds to verbal information-sharing. We hypothesized that video augments script-only decision-making. Patients aged >65 years admitted to hospital wards were randomized to receive evidence-based information ("script") vs. script plus video of simulated CPR and intubation. Patients' decisions registered in the hospital record, by hospital discharge were compared for the two groups. Fifty script-only intervention patients averaging 77.7 years were compared to 50 script+video patients with a mean age of 74.7 years. Eleven of 50 (22%) in each group declined CPR; and an additional three (script) vs. four (script+video) refused intubation for respiratory failure. There were no differences in sex, self-reported health trajectory, functional limitations, length of stay, or mortality associated with decisions. The rate at which verbally informed hospitalized elders opted out of resuscitation was not impacted by adding a video depiction of CPR.

Hip arthroplasty with the thrust plate prosthesis in patients of 65 years of age or older: 67 patients followed 2-7 years.

PubMed

Karatosun, Vasfi; Unver, Bayram; Gunal, Izge

2008-04-01

Thrust plate prosthesis (TPP) is a relatively new concept in total hip arthroplasty and advocated to be used in young patients. We retrospectively evaluated the results of 67 patients (71 hips) who were older than 65 years of age and underwent hip arthroplasty using the TPP. There were 50 female and 17 male patients with a mean age 71 (range 65-89) years. All patients received accelerated rehabilitation program either with full weight bearing in the second postoperative day or at 6 weeks. All patients were followed-up for at least 2 years (range 28-87 months). The average Harris hip score improved from 43 (range 8-72) to 93 (range 64-100) at the latest follow-up (p < 0.001). The overall revision rate was 8.4%. However, when the patients with definitive history of trauma were excluded the rate for loosening and technical errors decreased to 4.2%. There was no significant difference between the Harris hip score of patients with full weight bearing in the second postoperative day or 6 weeks (p = 0.57). We conclude that the TPP could be indicated for older patients without age limit and that an accelerated rehabilitation program with early weight bearing can be applied to these patients.

Actual 5-Year Nutritional Outcomes of Patients with Gastric Cancer.

PubMed

Kim, Ki Hyun; Park, Dong Jin; Park, Young Suk; Ahn, Sang Hoon; Park, Do Joong; Kim, Hyung Ho

2017-06-01

In this study, we aimed to evaluate the rarely reported long-term nutritional results of patients with gastric cancer after curative gastrectomy. We retrospectively reviewed the prospectively collected medical records of 658 patients who underwent radical gastrectomy with curative intent for gastric cancer from January 2008 to December 2009 and had no recurrences. All patients were followed for 5 years. Nutritional statuses were assessed using measurements of body weight, serum hemoglobin, total lymphocyte count (TLC), protein, albumin, cholesterol, and nutritional risk index (NRI). Patients who underwent total gastrectomy had lower body weights, hemoglobin, protein, albumin, and cholesterol levels. TLC and NRI valued after the first postoperative year (P<0.05), and lower hemoglobin and NRI valued during the fifth postoperative year than patients who underwent distal gastrectomy (P<0.05). Patients who received adjuvant chemotherapy after gastrectomy had lower hemoglobin, protein, albumin, and cholesterol levels. TLC and NRI valued during the first postoperative year, than those who underwent gastrectomy only (P<0.05). Regarding post-distal gastrectomy reconstruction, those who underwent Roux-en-Y had lower cholesterol levels than did those who underwent Billroth-I and Billroth-II reconstruction at the first and fifth years after gastrectomy, respectively (P<0.05). Patients undergoing total or distal gastrectomy with Roux-en-Y anastomosis or adjuvant chemotherapy after surgery should be monitored carefully for malnutrition during the first postoperative year, and patients undergoing total gastrectomy should be monitored for malnutrition and anemia for 5 years.

Fifth-year surveillance computed tomography scanning after potentially curative resections for colorectal cancer.

PubMed

Walter, Catherine J; Al-Allak, Asmaa; Borley, Neil; Goodman, Anthony; Wheeler, James M D

2013-02-01

Optimal follow-up after colorectal resection for adenocarcinoma is yet to be determined. The aim of this study was to examine the role of a fifth-year surveillance Computed Tomography (CT) scan in detecting recurrence in our population. A retrospective analysis of all patients who had undergone potentially curative resections of colorectal adenocarcinomas between 2003 and 2004 was performed using electronic and casenote records. Data analysis was performed using Microsoft Office Excel 2007 and GnuPSPP statistical software. Two hundred and seven patients (111 male and 96 female) with a median age of 74 years (IQR 66-80) undergoing colorectal resections were studied. One hundred and twenty-one patients (58%) were alive and disease free at 5 years of whom 81 (67%) had received a fifth-year surveillance CT scan. Fifth-year scanning did not demonstrate any new colorectal metastases. However 6 (7%) scans revealed new, undiagnosed, non-colorectal malignancies. Thirty-four patients developed metastatic disease. All metastasis were diagnosed by 3½ years of follow-up. Eleven of these 34 cases presented after their second-year surveillance CT scan. Those patients with asymptomatic metastasis at the time of their discovery demonstrated improved likelihood of five year survival. This study showed no role for a fifth-year surveillance CT scan in the detection of resectable metastases, however there was a 7% pick up rate for detecting new malignancies. CT scanning beyond 2 years was needed to identify about one-third of the recurrences reported in this study. Copyright © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Laryngeal assessment by videolaryngostroboscopy in patients with rheumatoid arthritis.

PubMed

Gómez-Puerta, José A; Cisternas, Ariel; Hernández, M Victoria; Ruiz-Esquide, Virginia; Vilaseca, Isabel; Sanmartí, Raimon

2014-01-01

To evaluate the larynx involvement in patients with rheumatoid arthritis (RA) in a clinical setting and correlate with the different clinical features related to more aggressive disease. Cross-sectional study including 36 consecutive patients with RA. Reflux symptoms were evaluated by the Reflux Symptom Index (RSI) and vocal cord impairment by the Voice Handicap Index-10 (VHI-10). Laryngeal involvement was done by videolaryngostroboscopy (VLS). The mean age was 56,3 ± 14 years with a mean disease duration of 2,6 ± 3,1 years (range 0-16 years). Voice use was considered as professional users in 33%. Twenty-four (67%) out of 36 patients had abnormal findings of VLS. One patient had larynx nodules (bamboo nodules). Eleven patients (31%) were diagnosed with muscle tension dysphonia, and there were symptoms and signs of pharyngeal-laryngeal reflux in 23 (64%) patients. No signs of cricoarytenoid joint impairment was found. Organic larynx involvement was uncommon in patients with RA. However symptoms and signs of pharyngeal-laryngeal reflux were seen in around 60% of patients. There was no correlation between the clinical phenotype, severity of disease, immunological profile or treatment with VLS findings. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Radiotherapy for stage I Hodgkin's disease: 20 years experience at St Bartholomew's Hospital.

PubMed Central

Ganesan, T. S.; Wrigley, P. F.; Murray, P. A.; Stansfeld, A. G.; d'Ardenne, A. J.; Arnott, S.; Jones, A.; Shand, W. S.; Malpas, J. S.; Lister, T. A.

1990-01-01

One hundred and one consecutive patients with newly diagnosed stage I Hodgkin's disease (HD) received treatment at St Bartholomew's Hospital, between 1968 and 1987, with a median follow-up of 12 years. Eleven patients have been excluded from detailed analysis because they either received involved field radiotherapy (RT) or radiotherapy with chemotherapy or were lost to follow-up. Actuarial analysis predicts 78% to be alive and without relapse of Hodgkin's disease at 15 years. Ninety evaluable patients (clinical stage (CS) 24; pathological stage (PS) 66) received either mantle or inverted 'Y' RT and form the basis of this analysis. The median age was 33 years (63 men, 27 women). Histology at presentation was nodular sclerosing (39), lymphocytic predominant (27) or mixed cellularity (24). The presenting site was neck (78), axilla (6) groin (4) and mediastinum (2). Complete remission was achieved in all evaluable patients, the actuarial proportion in remission being 75% at 15 years. Factors predictive of a prolonged remission were pathological staging versus clinical staging (P = 0.02) and lymph node size less than 3 cm (P = 0.04). Actuarial overall survival in these 90 patients was 75% at 15 years and none of the above factors correlated with survival. Relapse of HD has occurred in 18 patients (5 within RT field, 10 without and 3 in both). Second remission was achieved in 15/18. The actuarial rate of second remission and survival was 40% at 10 years. Sixteen patients have died, 7 of Hodgkin's disease, 7 of unrelated causes and 2 of second malignancy. A further 3 patients who developed second malignancy are still alive. At 15 years the actuarial mortality related to HD was 12%. These results confirm the importance of long follow up to assess the efficacy of primary therapy. PMID:2386750

Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

PubMed Central

Chammas, N. K.; Hill, R. L. R.; Edmonds, M. E.

2016-01-01

Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk. PMID:27213157

Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger.

PubMed

Morgan, Matthew D; Salmon, Lucy J; Waller, Alison; Roe, Justin P; Pinczewski, Leo A

2016-02-01

The current body of literature surrounding anterior cruciate ligament (ACL) survival and the variables contributing to further ACL injuries after primary ACL reconstruction in children and adolescents is limited, with no long-term evidence examining the incidence and contributing factors of further ACL injuries in this younger patient population. To determine the long-term survival of the ACL graft and the contralateral ACL (CACL) after primary reconstruction in patients aged ≤18 years and to identify the factors that increase the odds of subsequent ACL injuries. Case series; Level of evidence, 4. Patients having undergone primary ACL reconstruction at age ≤18 years between 1993 and 1998 who were included in a prospective database by a single surgeon were considered for this study. Single-incision endoscopic ACL reconstruction was performed with either an autologous bone-patellar tendon-bone graft or a hamstring tendon graft. At a minimum of 15 years after ACL reconstruction, patients completed a subjective survey involving the International Knee Documentation Committee (IKDC) questionnaire in addition to questions regarding current symptoms, further ACL injuries, family history of ACL injury, and current level of activity. A total of 288 adolescents (age range, 13-18 years) met the inclusion criteria, of whom 242 (84%) were reviewed at a mean of 16 years and 6 months after ACL reconstruction. Of these patients, 75 (31%) sustained a further ACL injury: 27 (11.2%) suffered an ACL graft rupture, 33 suffered a CACL injury (13.6%), and 15 sustained both an ACL graft rupture and a CACL injury (6.2%) over 15 years. Survival of the ACL graft was 95%, 92%, 88%, 85%, and 83% at 1, 2, 5, 10, and 15 years, respectively, and survival of the CACL was 99%, 98%, 90%, 83%, and 81%, respectively. Survival of the ACL graft was less favorable in those with a family history of ACL injury than in those without a family history (69% vs 90%, respectively; hazard ratio [HR], 3.6; P

Pituitary size in patients with Laron syndrome (primary GH insensitivity).

PubMed

Kornreich, Liora; Horev, Gadi; Schwarz, Michael; Karmazyn, Boaz; Laron, Zvi

2003-03-01

The purpose of the present study was to investigate whether lifelong secretion of high levels of GH, characteristic of Laron syndrome, leads to an increase in the size of the pituitary gland. Eleven patients (six females, five males) with Laron syndrome underwent magnetic resonance imaging of the pituitary region with a system operating at 0.5 T. There were nine adults aged 36-68 Years and two children, a 4-Year-old boy and a 9-Year-old girl. The latter patient had been treated with IGF-I (150-180 mg/kg per day) since the age of 3 Years; all the other patients were untreated. The height of the adenohypophysis was measured on the sagittal images and compared with reference values for age and sex. The height of the adenohypophysis was within the normal range for age and gender in all patients, except for one male, who had a small gland. No congenital anomalies of the pituitary-hypothalamic region were detected. Despite the lifelong high levels of GH, no pituitary hypertrophy was detected. The anatomy of the pituitary-hypothalamic region in Laron syndrome is normal.

Three-year outcome of shunted idiopathic NPH patients.

PubMed

Aygok, G; Marmarou, A; Young, H F

2005-01-01

The incidence of idiopathic normal pressure hydrocephalus (iNPH) has increased as a result of improved longevity. This report describes the 3-year outcome of shunted iNPH patients compared to three-month outcome after shunting. Patients (n = 50) (Age 70.4 +/- 8.9) admitted to our service were diagnosed and treated according to a fixed protocol for management of iNPH and after shunting were followed at least three times per year in clinic. The outcome of 50 patients was graded according to the level of improvement in symptoms as Excellent/Good, Partial or None in each category of Gait, Incontinence and Dementia. If we lump favorable (excellent, good, partial recovery) vs poor recovery (none), we found from 3 months to 3 years, a moderate decline in gait performance (91% to 75%), a retention of memory improvement (80%-80%) and an improvement in incontinence occurred over time (70%-82.5%). With proper diagnosis and management of iNPH, shunting of patients is associated with a favorable risk/benefit ratio that is reasonably long lasting.

Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE

PubMed Central

Guillén, Montserrat; Crimmins, Eileen M.

2013-01-01

Differences in health care utilization of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners, and hospital stays using the 2004 Survey of Health, Ageing, and Retirement in Europe database. In the pooled European sample and in some individual countries, older immigrants use from 13 to 20% more health services than native-borns after demographic characteristics are controlled. After controlling for the need for health care, differences between immigrants and native-borns in the use of physicians, but not hospitals, are reduced by about half. These are not changed much with the incorporation of indicators of socioeconomic status and extra insurance coverage. Higher country-level relative expenditures on health, paying physicians a fee-for-service, and physician density are associated with higher usage of physician services among immigrants. PMID:21660564

Living with Volcanoes: Year Eleven Teaching Resource Unit.

ERIC Educational Resources Information Center

Le Heron, Kiri; Andrews, Jill; Hooks, Stacey; Larnder, Michele; Le Heron, Richard

2000-01-01

Presents a unit on volcanoes and experiences with volcanoes that helps students develop geography skills. Focuses on four volcanoes: (1) Rangitoto Island; (2) Lake Pupuke; (3) Mount Smart; and (4) One Tree Hill. Includes an answer sheet and resources to use with the unit. (CMK)

SERT II thrusters - Still ticking after eleven years

NASA Technical Reports Server (NTRS)

Kerslake, W. R.

1981-01-01

The Space Electric Rocket Test II (SERT II) spacecraft was launched in 1970 with a primary objective of demonstrating long-term operation of a space electric thruster system. An overview is presented of all the SERT II testing conducted during the time from 1970 to 1981. Thruster testing and interaction results are considered, taking into account ion beam thrusting, distant neutralization, and the plasma beam thrust. In a discussion of durability testing, attention is given to the main cathodes, the neutralizer cathodes, the main keeper insulator, the H.V. grid insulators, the neutralizer propellant tanks, and the main propellant tanks. The most important result of the study is related to the confidence gained that mercury bombardment ion thruster systems can be built and operated in space on a routine basis with the same lifetime and performance as measured in ground testing.

Infective endocarditis: outcome in surviving patients with intracardiac complications.

PubMed

Mocchegiani, Roberto; Pergolini, Martina; Nataloni, Maura

2007-03-01

The purpose of this study was to assess the outcome of 15 patients who survived infective endocarditis with abscesses and other intracardiac complications. Abscesses were associated with native valve endocarditis in seven patients and prosthetic valve endocarditis in eight patients; fistulas were observed in three patients, and subaortic perforation in three patients. Sensitivity for the detection of abscesses was 42.8% and 92.8% using transthoracic and transoesophageal echocardiography, respectively. Eleven patients underwent surgical treatment with no operative mortality, whereas four patients were only medically treated. During follow-up (mean 8.26 years), two patients died (13%) and six recurrences (five early and one late prosthetic valve endocarditis) required re-intervention for prosthesis dysfunction (40%); an improvement in New York Heart Association class in survivors and no changes in echocardiographic lesions were observed. Infective intracardiac complications do not seem to significantly reduce the overall survival (87%) of patients at long-term follow-up.

Arthroscopic treatment of femoroacetabular impingement in patients older than 60 years.

PubMed

Mardones, Rodrigo; Via, Alessio Giai; Rivera, Alvaro; Tomic, Alexander; Somarriva, Marcelo; Wainer, Mauricio; Camacho, Daniel

2016-01-01

The indications of hip arthroscopy increased over the past decade. Although mostly recommended for treatment of femoroacetabular impingement (FAI) in young patients, well-selected older patients (> 60 years old) may benefit from this surgery. However, the role of hip arthroscopy for the management of older patients is controversial. The aim of the study is to evaluate the clinical outcomes of a series of patients aged 60 years and older who underwent hip arthroscopy for FAI at mid-term follow-up. Sixty-year-old patients and older, with a joint space greater than 2 mm, and a grade I and II hip osteoarthrosis (OA) according Tönnis scale were included into the study. Twenty-three patients (28 hips) met the inclusion criteria. The T-Student test was used to detect for differences between variables (p<0.05). The mean age of the patients was 63.4 years, and the mean follow-up was 4.4 years (2-9 years). We found an improvement in mHHS and VAS score from the baseline to the final follow-up in 87% of patients (p<0.05). Three patients (13%) were submitted to a THA at a mean of 12 months, while the survivorship rate at the final follow-up was 75%. No major complications have been reported. Arthroscopic treatment of FAI in patients over 60 years old, with no signs of advanced osteoarthrosis, showed a significant improvement of functional score and pain in most of cases, and it can be consider a reasonable option in well selected patients. Level of evidence: IV case series.

Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years

PubMed Central

Wolosker, Nelson; Krutman, Mariana; Teivelis, Marcelo Passos; de Paula, Rafael Pessanha; Kauffman, Paulo; de Campos, Jose Ribas Milanez; Puech-Leão, Pedro

2014-01-01

ABSTRACT Objective: Our aim was to analyze the effectiveness of oxybutynin for hyperhidrosis treatment in patients over 40 years. Methods: Eighty-seven patients aged over 40 years were divided into two groups. One group consisted of 48 (55.2%) patients aged between 40 and 49 years, and another was composed of 39 (44.8%) patients aged over 50 years (50 to 74 years). A comparative analysis of Quality of Life and level of hyperhidrosis between the groups was carried out 6 weeks after a protocol treatment with oxybutynin. A validated clinical questionnaire was used for evaluation. Results: In the younger age group, 75% of patients referred a “partial” or “great” improvement in level of hyperhidrosis after treatment. This number was particularly impressive in patients over 50 years, in which 87.2% of the cases demonstrated similar levels of improvement. Over 77% of patients in both groups demonstrated improvement in Quality of Life. Excellent outcomes were observed in older patients, in which 87.1% of patients presented “slightly better” (41%) or “much better” (46.1%) improvement. Conclusion: Patients aged over 40 years with hyperhidrosis presented excellent results after oxybutynin treatment. These outcomes were particularly impressive in the age group over 50 years, in which most patients had significant improvement in Quality of Life and in level of hyperhidrosis. PMID:24728245

Infliximab therapy in pediatric patients 7 years of age and younger.

PubMed

Kelsen, Judith R; Grossman, Andrew B; Pauly-Hubbard, Helen; Gupta, Kernika; Baldassano, Robert N; Mamula, Petar

2014-12-01

Infliximab (IFX) is efficacious for induction and maintenance of remission in pediatric patients with moderate-to-severe inflammatory bowel disease (IBD). It has, however, not been studied in patients 7 years old and younger. Our aim was to characterize efficacy and safety of IFX therapy in this cohort. This was a retrospective study of patients with IBD ages 7 years and younger, treated with IFX between 1999 and 2011. Medical records were reviewed for age of diagnosis, disease phenotype, therapy, surgery, IFX infusion dates, dose, and intervals. Outcome measures included physician global assessment, corticosteroid requirement, and adverse events. Thirty-three children (ages 2.4-7 years) were included. Twenty patients had Crohn disease, 4 had ulcerative colitis, and 9 had indeterminate colitis. Maintenance of IFX therapy at 1, 2, and 3 years was 36%, 18%, and 12%, respectively. Patients of age 5 years and younger had the lowest rates of maintenance of therapy at 25% at year 1, and 10% at years 2 and 3 combined. Nine percent of all of the patients demonstrated response measured by the physician global assessment and were steroid free at 1 year. There were 8 infusion reactions. There were no malignancies, serious infections, or deaths. IFX demonstrated a modest response rate and a low steroid-sparing effect in patients with IBD 7 years old and younger. Although this is a limited study, there appears to be a trend for decreased sustained efficacy with IFX in this age group, particularly in children 5 years old and younger, when compared with the previously published literature in older children.

Does endoscopy diagnose early gastrointestinal cancer in patients with uncomplicated dyspepsia?

PubMed Central

Sundar, N; Muraleedharan, V; Pandit, J; Green, J T; Crimmins, R; Swift, G L

2006-01-01

Background Recent guidelines from NICE have proposed that open access gastroscopy is largely limited to patients with “alarm” symptoms. Aims and methods This study reviewed the outcome of all our patients with verified oesophageal or gastric carcinoma who presented with uncomplicated dyspepsia to see if endoscopic investigation is warranted in this group. All patients with histologically verified upper gastrointestinal (GI) cancers who presented over a period from 1998 to 2002 were identified. Their presenting symptoms, treatment, and outcome were analysed. Results 228 upper GI cancers (119 oesophageal, 109 gastric; mean age 72 years (29–99 years); 130 male, 82 female) were identified in 11 145 endoscopies performed. Only 14 patients (6.2%) presented without alarm symptoms; three patients were under 55 years of age and all had gastric carcinoma—one of these had chronic diarrhoea only. Eleven had dyspepsia or reflux symptoms only, and two were under surveillance for Barrett's oesophagus. Only five patients had a curative surgical resection and are still alive two—six years from diagnosis. A sixth patient had a curative operation but died of a cerebrovascular accident one year later. The remaining eight patients unfortunately had either metastatic disease or comorbidity, which precluded surgery. All of these died within two years of diagnosis, mean survival 10 months. Conclusion Only five patients with dyspepsia and no alarm symptoms had resectable upper GI malignancies over a four year period. Limiting open access gastroscopy to those with alarm features only would “miss” a small number of patients who have curable upper GI malignancy. PMID:16397081

Cementless Total Knee Arthroplasty in Patients Older Than 75 Years.

PubMed

Newman, Jared M; Khlopas, Anton; Chughtai, Morad; Gwam, Chukwuweike U; Mistry, Jaydev B; Yakubek, George A; Harwin, Steven F; Mont, Michael A

2017-11-01

Some surgeons have been hesitant to use cementless fixation for total knee arthroplasty (TKA) in elderly patients due to concerns regarding successful bone biological fixation. Therefore, this study evaluated: (1) implant survivorship, (2) functional outcomes, (3) radiographic outcomes, and (4) complications in patients over 75 years of age who underwent cementless total knee arthroplasty. A total of 134 patients (142 TKAs) older than 75 years at a single institution between June 2008 and June 2014 were retrospectively reviewed. Their mean follow-up was 4 years (range: 2-8 years). The cohort consisted of 91 women and 43 men who had a mean age of 80 years (range: 76 to 88 years). The preoperative diagnoses were osteoarthritis ( n  = 107 patients), rheumatoid arthritis ( n  = 21 patients), and osteonecrosis ( n  = 6 patients). Descriptive statistics were used to calculate the means and ranges and a Kaplan-Meier analysis was performed to determine the aseptic and all cause implant survivorship. Radiographic evaluation was performed using the new Knee Society Radiographic Evaluation and Scoring System. Functional outcomes at the final follow-up as well as all medical and surgical complications were recorded for each patient. The aseptic implant survivorship was 99.3% (95% CI: 7.9-8.1), and the all cause implant survivorship was 98.6% (95% CI: 7.9-8.1). There was one aseptic revision and one septic revision. At the latest follow-up the mean Knee Society pain score was 93 points (range, 80-100 points), and the mean Knee Society function score was 84 points (range, 70-90 points). On radiographic evaluation, there were no progressive radiolucencies, subsidence, and loosening of prostheses at the latest follow-up. The use of cementless TKA demonstrated excellent survivorship, mid-term clinical and functional outcomes, as well as no progressive radiolucencies or subsidence in patients older than 75 years. In addition, there was a low rate of surgical and medical

[Five-year survival analysis in patients with penile cancer].

PubMed

Montiel-Jarquín, Álvaro José; Contreras-Díaz, Antonio Jesús; Vázquez-Cruz, Eduardo; Chopin-Gazga, Marco Antonio; Romero-Figueroa, María Socorro; Etchegaray-Morales, Ivet; Alvarado-Ortega, Ivan

2017-01-01

Short-term survival of penile cancer is poor. The objective was to describe the 5-years penile cancer survival. Retrospective cohort study. We included patients with penile cancer managed surgically from 2010 to 2014. Descriptive statistics were used for socio-demographic variables and the Kaplan-Meier estimator for survival function. We studied 22 patients with a mean age of 64.95 years and a time of evolution of 25 months after the diagnosis. 68.2% of patients smoked or had human papillomavirus (HPV); they all presented phimosis; 72.7% had pain in the penis and the groin area; 81.8% had palpable lymph nodes and 45.5% lesions ≥ 3 cm; 86.3% were diagnosed in clinical stage IIIa. 59.1% underwent partial penectomy and 86.4% had squamous cell variety. 40.9% of patients died six months after the surgery. 66% of the smokers presented metastasis; all of the patients that smoked and had HPV infection had neurovascular invasion and died; 83.3% of the patients (n = 6) who underwent partial penectomy and positive lymph node dissection due to metastases died. The 5-years mortality of patients with penile cancer was 40.9%. Tobacco use and HPV increase morbidity and mortality in patients with penile cancer; lesions greater than 5 cm are more common in smokers. The size of the lesion increases with the delay in treatment.

Pyometra in captive large felids: a review of eleven cases.

PubMed

McCain, Stephanie; Ramsay, Ed; Allender, Matthew C; Souza, Carlos; Schumacher, Juergen

2009-03-01

Eleven cases of pyometra were diagnosed in a captive exotic felid collection over 3 yr in seven African lions (Panthera leo), two tigers (P. tigris), one liger (lion-tiger crossbreed), and one leopard (P. pardus). Clinical signs included anorexia, lethargy, vulvar discharge, and vomiting. Diagnosis was based on clinical signs, complete blood cell counts, plasma biochemistry and electrolyte values, radiographs, and abdominal ultrasonography. The most common findings on complete blood count and biochemistry profiles were leukocytosis (>15,000/microL) and hyperproteinemia (>8.2 g/dL) due to increased globulins. Abdominal radiographic findings were largely nonspecific, but ultrasonography routinely showed a distended, fluid-filled uterus. Each case was treated with ovariohysterectomy and systemic antibiotic therapy. Lions were shown to be at an increased risk for developing pyometra compared with other species. Pyometra should be considered as a differential diagnosis in anorexic or lethargic intact female large felids, and ovariohysterectomy may be warranted in nonbreeding female lions.

One Year Follow-Up of Children and Adolescents With Chronic Immune Thrombocytopenic Purpura (ITP) Treated With Rituximab

PubMed Central

Mueller, Brigitta U.; Bennett, Carolyn M.; Feldman, Henry A.; Bussel, James B.; Abshire, Thomas C.; Moore, Theodore B.; Sawaf, Hadi; Loh, Mignon L.; Rogers, Zora R.; Glader, Bertil E.; McCarthy, Maggie C.; Mahoney, Donald H.; Olson, Thomas A.; Feig, Stephen A.; Lorenzana, Adonis N.; Mentzer, William C.; Buchanan, George R.; Neufeld, Ellis J.

2017-01-01

Background We previously showed in a prospective study that rituximab appears to be effective in some children and adolescents with severe chronic immune thrombocytopenia. Eleven of 36 patients achieved and maintained platelet counts over 50,000/mm3 within the first 12 weeks. These patients were followed for the next year. Methods Platelet counts were monitored monthly and all subsequent bleeding manifestations and need for further treatment was noted. Results Eight of the 11 initial responders maintained a platelet count over 150,000/mm3 without further treatment intervention. Three patients had a late relapse. One initial non-responder achieved a remission after 16 weeks, and two additional patients maintained platelet counts around 50,000/mm3 without the need for further intervention. Conclusions Rituximab resulted in sustained efficacy with platelet counts of 50,000/mm3 or higher in 11 of 36 patients (31%). PMID:18937333

The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery - A prospective cohort study within an ERAS protocol.

PubMed

Asklid, D; Segelman, J; Gedda, C; Hjern, F; Pekkari, K; Gustafsson, U O

2017-08-01

Restricted perioperative fluid therapy is one of several interventions in the enhanced recovery after surgery (ERAS) protocol, designed to reduce morbidity and hospital stay after surgery. The impact of this single intervention on short and long term outcome after colorectal surgery is unknown. This cohort study includes all consecutive patients operated with abdominal resection of colorectal cancer 2002-2007 at Ersta Hospital, Stockholm, Sweden. All patients were treated within an ERAS protocol and registered in the ERAS-database. Compliance to interventions in the ERAS protocol was analysed. The impact of a restrictive perioperative fluid therapy (≤3000 ml on the day of surgery) protocol on short-term outcomes as well as 5-year survival was assessed with multivariable analysis adjusted for confounding factors. Nine hundred and eleven patients were included. Patients receiving ≤3000 ml of intravenous fluids on the day of surgery had a lower risk of complications OR 0.44 (95% C I 0.28-0.71), symptoms delaying discharge OR 0.47(95% C I 0.32-0.70) and shorter length of stay compared with patients receiving >3000 ml. In cox regression analysis, the risk of cancer specific death was reduced with 55% HR 0.45(95% C I 0.25-0.81) for patients receiving ≤ 3000 ml compared with patients receiving >3000 ml. A restrictive compared with a non-restrictive perioperative fluid therapy on the day of surgery may be associated with lower short-term complication rates, faster recovery, shorter length of stay and improved 5-year survival. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Comparison of functional gains after arthroscopic rotator cuff repair in patients over 70 years of age versus patients under 50 years of age: a prospective multicenter study.

PubMed

Moraiti, Constantina; Valle, Pablo; Maqdes, Ali; Boughebri, Omar; Dib, Chourky; Giakas, Giannis; Kany, Jean; Elkholti, Kamil; Garret, Jérôme; Katz, Denis; Leclère, Franck Marie; Valenti, Philippe

2015-02-01

To assess rotator cuff rupture characteristics and evaluate healing and the functional outcome after arthroscopic repair in patients older than 70 years versus patients younger than 50 years. We conducted a multicenter, prospective, comparative study of 40 patients younger than 50 years (group A) and 40 patients older than 70 years (group B) treated with arthroscopic rotator cuff repair. Patients older than 70 years were operated on only if symptoms persisted after 6 months of conservative treatment, whereas patients younger than 50 years were operated on regardless of any persistent symptoms. Imaging consisted of preoperative magnetic resonance imaging and postoperative ultrasound. Preoperative and postoperative function was evaluated with Constant and modified Constant scores. Patient satisfaction was also assessed. The evaluations were performed at least 1 year postoperatively. No patient was lost to follow-up. The incidence of both supraspinatus and infraspinatus tears was greater in group B. Greater retraction in the frontal plane and greater fatty infiltration were observed in group B. The Constant score was significantly improved in both groups (51 ± 12.32 preoperatively v 77.18 ± 11.02 postoperatively in group A and 48.8 ± 10.97 preoperatively v 74.6 ± 12.02 postoperatively in group B, P < .05). The improvement was similar in both groups. The modified Constant score was also significantly improved in both groups (57.48 ± 18.23 preoperatively v 81.35 ± 19.75 postoperatively in group A and 63.09 ± 14.96 preoperatively v 95.62 ± 17.61 postoperatively in group B, P < .05). The improvement was greater for group B (P < .05). Partial rerupture of the rotator cuff occurred in 2 cases in group A and 5 cases in group B. Complete rerupture was observed in 2 patients in group B. In group A, 29 patients (72.5%) were very satisfied, 8 (20%) were satisfied, and 3 (7.5%) were less satisfied. In group B, 33 patients (82.5%) were very satisfied, 6 (15%) were

Eleven novel mutations of the BCKDHA, BCKDHB and DBT genes associated with maple syrup urine disease in the Chinese population: Report on eight cases.

PubMed

Li, Xiyuan; Ding, Yuan; Liu, Yupeng; Ma, Yanyan; Song, Jinqing; Wang, Qiao; Li, Mengqiu; Qin, Yaping; Yang, Yanling

2015-11-01

Maple syrup urine disease (MSUD) is a rare autosomal recessive disorder that affects the degradation of branched chain amino acids (BCAAs). Only a few cases of MSUD have been documented in Mainland China, and prenatal diagnosis has not been performed so far. In this report, 8 patients (4 girls and 4 boys) with MSUD from 8 unrelated Chinese families were diagnosed at the age of 9 days to 1 year and 8 months. The diagnosis was confirmed by serum BCAAs and genetic analyses. Among the 8 patients, only one was detected by newborn screening. The remaining 7 patients were admitted because of neurological disorders and underwent selective screening. Significantly elevated BCAAs were observed in 7 patients. One patient was diagnosed by post-mortem study. 12 mutations were found in the BCKDHA, BCKDHB and DBT genes. 11 of these mutations were novel: c.178G > T, c.491T > C, c.740A > G, c.1214_1219dupCCAACC and IVS6+1delG in BCKDHA; c.482T > G, c.508C > T, c.767A > G, c.768C > G and IVS4,-2A > C in BCKDHB; and c.1A > G in DBT. Only one mutation, c.659C > T in the BCKDHA gene, had been previously reported. 7 patients were treated by dietary intervention and symptomatic therapy. 6 of them showed clinical improvement. The mother of one patient who died from MSUD underwent amniocentesis during her second pregnancy. The BCAAs level in her amniotic fluid was normal. Only one heterozygous mutation, IVS4,-2A > C in the BCKDHB gene, was detected in the cultured amniocytes. The results revealed that the fetus was not affected by MSUD. Normal development and the blood BCAAs profile confirmed the prenatal diagnosis after birth. Thus, we identified eleven novel mutations associated with MSUD in the Chinese population. Prenatal diagnosis of MSUD was successfully performed on one fetus by genetic analysis of the cultured amniocytes. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Comparison of Outcomes of Acute Coronary Syndrome in Patients ≥80 Years Versus Those <80 Years in Israel from 2000 to 2013.

PubMed

Shechter, Michael; Rubinstein, Roy; Goldenberg, Ilan; Matetzki, Shlomi

2017-10-15

Although patients ≥80 years old constitute the fastest-growing segment of the population and have a high prevalence of coronary artery disease, few data exist regarding the outcome of octogenarians with acute coronary syndrome (ACS). In a retrospective study based on data of 13,432 ACS patients who were enrolled in the ACS Israel Survey, we first evaluated the clinical outcome of 1,731 ACS patients ≥80 years (13%) compared with 11,701 ACS patients <80 years (87%) hospitalized during 2000 to 2013. Second, we evaluated the clinical outcome of patients ≥80 years hospitalized during the 2000 to 2006 ("early") period (n = 1,037) compared with those of the same age group of patients hospitalized during the 2008 to 2013 ("late") period (n = 694). Implementation of the ACS AHA/ACC/ESC therapeutic guidelines was lower in ACS patients ≥80 years compared with patients <80 years. Multivariate Cox regression analysis demonstrated a worse 1-year survival rate in the ACS patients ≥80 years compared with those <80 years. During the late period, patients ≥80 years were more frequently treated with guideline-recommended therapies compared with patients from the same age group who were hospitalized in the early period. Multivariate Cox regression analysis demonstrated a better 1-year survival rate of patients ≥80 years during the late period compared with the early period (hazard ratio 1.17, 95% confidence interval 1.15 to 1.61; p = 0.01). In addition, adverse outcome rates of ACS patients ≥80 years were significantly higher compared with those of patients <80 years. However, survival rates of ACS patients ≥80 years were improved over the 200 to 2013 period. Copyright © 2017 Elsevier Inc. All rights reserved.

Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment.

PubMed

Upasani, Vidyadhar V; Caltoum, Christine; Petcharaporn, Maty; Bastrom, Tracey P; Pawelek, Jeff B; Betz, Randal R; Clements, David H; Lenke, Lawrence G; Lowe, Thomas G; Newton, Peter O

2008-05-01

A multicenter study of changes in Scoliosis Research Society (SRS) outcome measures after surgical treatment of adolescent idiopathic scoliosis (AIS). To evaluate changes in patient determined outcome measures between 2 and 5 years after AIS surgery. Current surgical procedures have been shown to improve subjective measures in patients with AIS. At 2-year follow-up, AIS patients reported significant improvement in all 4 preoperative domains of the SRS questionnaire. In addition, the major Cobb angle was shown to be negatively correlated with preoperative scores in the pain, general self-image, and general function domains. Five-year SRS scores have not been evaluated previously. A multicenter, prospectively generated database was used to obtain perioperative, radiographic, and SRS-24 outcomes data. The inclusion criteria were: a diagnosis of AIS, surgical treatment (anterior, posterior, or combined), a comprehensive set of radiographic measures, and completed preoperative, 2-year, and 5-year SRS questionnaires. Repeated measures analysis of variance was used to compare changes in patient responses for each of the 7 outcome domains. Univariate analysis of variance was used to compare the change in pain score at 5 years to the level of the lowest instrumented vertebrae and surgical approach. A correlation analysis was used to determine the association between changes in any of the radiographic variables and changes in SRS scores. The data were checked for normality and equal variances, and the level of significance was set at P < 0.01. Forty-nine patients (42 women, 7 men; 14.2 +/- 2.1 year old; 5.4 +/- 0.6 years follow-up) met the inclusion criteria for this study. Thirty-seven of 49 (76%) of these patients underwent an open or thoracoscopic anterior procedure. SRS-24 scores improved significantly in 3 of the 4 preoperative domains at the 2-year visit. At 5 years postop, a statistically significant decrease in the pain score (4.2 +/- 0.6 to 3.9 +/- 0.9, P = 0

Antioxidant and anticholinesterase activities of eleven edible plants.

PubMed

Boğa, Mehmet; Hacıbekiroğlu, Işıl; Kolak, Ufuk

2011-03-01

Consumers have become more interested in beneficial effects of vegetables, fruits, and tea to protect their health. The antioxidant potential and anticholinesterase activity of eleven edible plants were investigated. The dichloromethane, ethanol and water extracts prepared from celery [Apium graveolens L. (Umbelliferae)], Jerusalem artichoke [Helianthus tuberosus L. (Compositae)], spinach [Spinacia oleracea L. (Chenopodiaceae)], chard [Beta vulgaris L. var. cicla (Chenopodiaceae)], purslane [Portulaca oleracea L. (Portulacaceae)], ispit, or borage [Trachystemon orientale (L.) G. Don (Boraginaceae)], garden rocket [Eruca sativa Mill. (Brassicaceae)], red cabbage [Brassica oleracea L. var. capitata f. rubra DC. (Cruciferae)], lime flower [Tilia tomentosa Moench (Tiliaceae)], cinnamon [Cinnamomum cassia Presl. (Lauraceae)], and rosehip [Rosa canina L. (Rosaceae)], were tested to determine their antioxidant and anticholinesterase activities by using CUPRAC (cupric reducing antioxidant capacity) and Ellman methods, respectively, for the first time. As a result, the dichloromethane, ethanol and water extracts of cinnamon showed the best antioxidant effect among the extracts of the tested plants. The ethanol extract of cinnamon exhibited 63.02% inhibition against acetylcholinesterase and 85.11% inhibition against butyrylcholinesterase (BChE) at 200 µg/mL concentration while the dichloromethane extract of garden rocket possessed the highest inhibition (91.27%) against BChE among all the tested extracts. This study indicated that the ethanol extract of cinnamon may be a new potential resource of natural antioxidant and anticholinesterase compounds.

Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years).

PubMed

Vilallonga, Ramon; Himpens, Jacques; van de Vrande, Simon

2016-01-01

Few data are available about obesity surgery in adolescent patients. To assess long-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients <18 years. University Hospital, Europe. A retrospective study of prospectively collected data of patients <18 years (childhood group; ChG) (n = 28) treated by LRYGB of which 19 were available for follow-up between 2.4 and 10.2 years (mean 7.2 years). This group of patients was matched with an adult control group (AdG) of randomly chosen patients with similar characteristics who underwent LRYGB during the same period. The extensive survey included a telephonic questionnaire. 19 (12 females) of the 28 patients (67.9%) were available for follow-up. Preoperatively, 3 had type 2 diabetes mellitus (T2DM), 1 arterial hypertension, 5 dyslipidemia and 1 sleep apnea. In the ChG, average BMI after 7 years dropped from 38.9 kg/m2 preoperatively to 27.5 kg/m2. In the AdG, average BMI decreased from 39.4 to 27.1 kg/m2 in the same time period (nonsignificant between groups). One patient in the ChG needed a reoperation (internal hernia) versus 3 patients in the AdG (1 leak, 2 obstructions). All patients resolved their initial comorbidities. Two of 12 female patients in the ChG became pregnant 6 and 8 years after surgery, respectively, despite seemingly adequate oral contraception. Compliance with postoperative guidelines was good in 16/19 patients in ChG and in 14/18 patients in the AdG. Overall degree of satisfaction was high: 8.2/10 (SD 1.2, range 6-10) in the ChG and 8.9/10 (SD 1.7, range 5-10) in the AdG. LRYGB seems to be safe, provide good weight loss, and cure comorbidities in an adolescent population. Satisfaction degree is high. Inadvertent pregnancy despite conventional contraception is a possible issue. © 2016 S. Karger GmbH, Freiburg.

Simultaneous separation and determination of eleven nucleosides and bases in beer, herring sperm DNA and RNA soft capsule by high-performance liquid chromatography.

PubMed

Hou, Shengjie; Ding, Mingyu

2010-01-01

A simple and rapid high-performance liquid chromatography method was developed for the determination of eleven nucleosides and bases in beer, herring sperm DNA and RNA soft capsules. The separation was carried out on an Agilent extend-C(18) column with a simple gradient elution of acetonitrile and water as the mobile phase. Good linear relationships between the peak areas and the concentrations of the analytes were obtained. The detection limits for eleven analytes were in the range of 0.007-0.037 mg/L by UV detection at 260 nm. The relative standard deviations (RSDs) of the retention times were in the range of 0.78-1.85% for intra-day and 0.87-1.94% for inter-day, respectively. The RSDs of the peak areas were in the range of 2.71-3.22% for intra-day and 3.03-3.39% for inter-day, respectively. This method has been successfully applied to simultaneous determination of eleven nucleosides and bases in beer, herring sperm DNA and RNA soft capsules with the recoveries in the range of 93.7-108.3%.

Eighteen-year follow-up of hyperopic photorefractive keratectomy.

PubMed

Wagh, Vijay K; Dave, Reena; O'Brart, David P S; Lim, Wei S; Patel, Parul; Tam, Connan; Lee, Jennifer; Marshall, John

2016-02-01

To investigate the long-term efficacy of hyperopic photorefractive keratectomy (PRK). University Hospital, London, United Kingdom. Prospective case series. Patients with a follow-up of 18 years ± 0.7 (SD) attended for examination. All had spherical corrections with a 6.5 mm optical zone and 1.5 mm blend zone. Twenty-five patients (45 eyes) were included. The mean preoperative spherical equivalent (SE) refractive error was +4.11 ± 1.8 diopters (D) (range +1.125 to +7.25 D). Between 1 year and 18 years, in eyes that had no cataract surgery (n = 34), there was a +1.14 ± 1.48 D increase in the mean SE (P < .0002). The increase between 7.5 years and 18.0 years did not reach clinical significance (P = .1). Uncorrected distance visual acuity improved at 18 years (P < .02). Corrected distance visual acuity (CDVA) was reduced (P < .001). The efficacy index was 0.47, and the safety index was 0.83. Six eyes (18%) lost 2 lines of CDVA, of which 4 eyes had preexisting cataract. Keratometry remained stable between 1 year and 18 years (P = .2). Forty percent still had traces of peripheral haze, and 4 (9%) had Salzmann-like changes. Eleven eyes (24%) had cataract surgery and 4 (9%) had laser iridotomy. There was no evidence of ectasia. Hyperopic PRK showed an increase in hyperopic SE between 1.0 year and 7.5 years but was generally stable thereafter. The efficacy was limited. Peripheral haze was evident in 40% of cases with Salzmann-like changes in some. Ocular comorbidity in relationship to cataract was common and reduced CDVA. Dr. Marshall was a consultant to Summit Technology, Inc. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pitfalls in diagnosis and management of distal vaginal agenesis: 10-year experience at a single centre.

PubMed

Ugur, M G; Balat, O; Ozturk, E; Bekerecioglu, M; Dikensoy, E

2012-07-01

To discuss common pitfalls in diagnosis and management of distal vaginal agenesis, and summarize 10 years of experience among 11 patients using an interposition full-thickness graft and fibrin glue. Eleven patients with distal vaginal agenesis were evaluated and managed with an interposition full-thickness graft to bridge the gap between the upper vagina and the introitus. Associated renal abnormalities and complications including infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, vaginal stricture and graft uptake were all investigated. The mean age of the patients was 12.91 (standard deviation 1.22) years. All patients had primary amenorrhoea, cryptomenorrhea, and cyclical or constant pelvic pain. None of the patients had associated urological abnormalities, and there were no cases of infection, total lack of skin graft take, stress urinary incontinence, partial graft loss or vaginal stricture. Graft uptake was 100% in 10 of the 11 patients. Four patients have subsequently married and report a satisfactory sex life. Accurate diagnosis of distal vaginal agenesis and careful pre-operative set-up, including evaluation of associated anomalies, bowel preparation, available vaginal stents and a multidisciplinary approach for the potential need for grafts, may be key to success. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sofocleous, Constantinos T., E-mail: constant@pol.net; Hinrichs, Clay R.; Hubbi, Basil

Purpose. The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods. All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results. In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men)more » suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions. In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.« less

[Eleven thesis on the archive of scientific research, for a new patrimonial and scientific policy].

PubMed

Müller, Bertrand

2015-12-01

Abstracting the main content of a recent report on the bad state of the archives of scientific research, this paper puts forward eleven thesis likely to feed, in this time of numeric transition to a new documentary regime and to a new patrimonial policy. The recent numeric conditions impose to set new archival pratices, more proactive, anticipative and prospective. Archives of scientific research must be thought in a double memorial and scientific dimension, and not only as a patrimonial or historical one.

A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT.

PubMed

James, Iyore Ao; Moukalled, Ahmad; Yu, Elizabeth; Tulman, David B; Bergese, Sergio D; Jones, Christian D; Stawicki, Stanislaw Pa; Evans, David C

2014-10-01

Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%). The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%). Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

Connecting Worlds/Mundos Unidos Project: End-of-Year Report, 2007-2008

ERIC Educational Resources Information Center

Ciriza, Frank

2008-01-01

This report presents information on the Connecting Worlds/Mundos Unidos Project and provides a general comparison overview of accomplishments during its five years of operation. The Connecting Worlds/Mundos Unidos Project has been operating in the El Paso Independent School District (EPISD) for eleven years, but in the present format as a Jacob K.…

Six-year clinical outcome of single implant-retained mandibular overdentures--a pilot study.

PubMed

Passia, Nicole; Wolfart, Stefan; Kern, Matthias

2015-10-01

The aim of this prospective pilot study was to evaluate the prosthodontic maintenance as well as the implant outcome of single implant-retained mandibular overdentures over an observation period of 6 years. Eleven edentulous patients received one single implant in the midline of the mandible. Denture bases were temporarily relined and 2 months later provided with a ball attachment for implant retention. Implant related parameters and prosthodontic maintenance interventions were assessed 4 weeks after implant loading and then once a year. Over a mean observation period of 75.9 months, no implant was lost. The most frequent prosthetic maintenance intervention was activation of the matrix due to loss of retention, followed by exchange of the female part. Eight denture bases had to be repaired after a fracture in the midline area. Within the limitations of this preliminary clinical study, the concept of a single midline implant to retain a mandibular complete denture was a successful treatment option for elderly edentulous patients. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Analysis of surgical and oncological outcome in internal and external hemipelvectomy in 34 patients above the age of 65 years at a mean follow-up of 56 months.

PubMed

Guder, Wiebke K; Hardes, Jendrik; Gosheger, Georg; Henrichs, Marcel-Philipp; Nottrott, Markus; Streitbürger, Arne

2015-02-18

With an increasing life expectancy and improved treatment regimens for primary or secondary malignant diseases of soft tissue or bone, hemipelvectomy will have to be considered more often in elderly patients in the future. Scientific reviews concerned with the surgical and oncological outcome of elderly patients undergoing hemipelvectomy are scarce. Therefore, it is the purpose of this study to review the outcome of patients treated with that procedure at our hospital and investigate the feasibility of such extensive procedures at an increased age. A retrospective analysis of thirty-four patients who underwent hemipelvectomy at an age of 65 years or older was performed to determine their surgical and oncological outcome. The Kaplan-Meier method was used to calculate the cumulative probability of survival using the day of tumor resection as a starting point. Univariate analysis was carried out to investigate the influence of a particular single parameter. The mean age at operation was 70.2 years. Thirty patients were treated for intermediate- to high-grade sarcoma and 81.8% of tumors were larger than or equal to 10 cm in the longest diameter. Thirteen patients underwent internal hemipelvectomy and nine patients external hemipelvectomy as a primary procedure. Twelve patients were treated with external hemipelvectomy after failed local tumor control at primary operation. Wound infection occurred in 61.7% of cases. Three patients underwent amputation for non-manageable infection after internal hemipelvectomy. Hospital mortality was 8.8%. Clear resection margins were obtained in 88% of patients; in another 6% of patients planned intralesional resections were performed. Local recurrence occurred in 8.8% of patients at a mean time of 26 months after operation. Eleven patients are alive with no evidence of disease and 23 patients died of disease or other causes. Patients with pulmonary metastases had a mean survival period after operation to DOD of 22 months compared to 37

[Ocular findings in patients older than 99 years].

PubMed

Cypel, Marcela Colussi; Palácio, Guilherme; Dantas, Paulo Elias Correa; Lottenberg, Cláudio Luis; Belfort, Rubens

2006-01-01

To determine vision conditions and ocular findings in patients older than 99 years. Patients were recruited by media advertisement and examined at the Vision Institute of UNIFESP. The following examinations were performed: visual acuity, ectoscopy, refraction, biomicroscopy, tear film break-up time, Schirmer basal test, tonometry, direct and indirect ophthalmoscopy. Complementary examinations such as optical coherence tomography were performed when indicated. Thirty patients older than 99 years were identified. Mean age of 101.5+/-1.8, 25 females and 5 males. Most common systemic disease, according to history, was arterial hypertension. In 11 patients (55%), the best corrected far visual acuity was 20/100 or better. The best corrected near visual acuity was J4 or better also in 55% (11 patients) and 63.0% (7 patients) of these were the ones that had not been submitted to cataract surgery. The most frequent visual complaint was low vision for reading (55%) and other 8 patients (40%) reported no disturbance (satisfied with their vision). Lens opacity was present in 9 patients (60%) and 8 patients (40%) had previous cataract surgery (5 aphakic eyes, 9 pseudophakic eyes). Cataract was identified as important for impairment of vision in 5 patients but only 2 of them wanted to be submitted to surgery. The main cause of visual impairment was age-related macular degeneration, present in all patients, 95% with no exudative form. Vision improved with new refractive prescription in 4 patients. Once we understand the needs we can plan specific diagnostic and treatment strategies. This sample showed that most were female (83.3%), with good general health (35%), most with systemic arterial hypertension (40%), complaining of low vision for reading (55%) because of age-related macular degeneration (100%, 95% dry form). Only 40% had been previously submitted to cataract surgery. Most of the patients with cataract said to be satisfied with their vision; of the 5 patients that could

Neurological outcome of patients with cryopyrin-associated periodic syndrome (CAPS).

PubMed

Mamoudjy, Nafissa; Maurey, Hélène; Marie, Isabelle; Koné-Paut, Isabelle; Deiva, Kumaran

2017-02-14

To assess the neurological involvement and outcome, including school and professional performances, of adults and children with cryopyrin-associated periodic syndrome (CAPS). In this observational study, patients with genetically proven CAPS and followed in the national referral centre for autoinflammatory diseases at Bicêtre hospital were assessed. Neurological manifestations, CSF data and MRI results at diagnosis and during follow-up were analyzed. Twenty-four patients (15 adults and 9 children at diagnosis) with CAPS were included. The median age at disease onset was 0 year (birth) [range 0-14], the median age at diagnosis was 20 years [range 0-53] and the mean duration of follow-up was 10.4 ± 2 years. Neurological involvement at diagnosis, mostly headaches and hearing loss, was noted in 17 patients (71%). Two patients of the same family had abnormal brain MRI. A439V mutation is frequently associated with a non-neurological phenotype while R260W mutation tends to be associated with neurological involvement. Eleven adult patients (61%) and 3 children (50%) underwent school difficulties. Neurological involvement is frequent in patients with CAPS and the majority of patients presented difficulties in school performances with consequences in the professional outcome during adulthood. Further studies in larger cohorts of children with CAPS focusing in intellectual efficiency and school performances are necessary.

Patient-reported outcomes 5 years after laser in situ keratomileusis.

PubMed

Schallhorn, Steven C; Venter, Jan A; Teenan, David; Hannan, Stephen J; Hettinger, Keith A; Pelouskova, Martina; Schallhorn, Julie M

2016-06-01

To assess vision-related, quality-of-life outcomes 5 years after laser in situ keratomileusis (LASIK) and determine factors predictive of patient satisfaction. Optical Express, Glasgow, Scotland. Retrospective case series. Data from patients who had attended a clinical examination 5 years after LASIK were analyzed. All treatments were performed using the Visx Star S4 IR excimer laser. Patient-reported satisfaction, the effect of eyesight on various activities, visual phenomena, and ocular discomfort were evaluated 5 years postoperatively. Multivariate regression analysis was performed to determine factors affecting patient satisfaction. The study comprised 2530 patients (4937 eyes) who had LASIK. The mean age at the time of surgery was 42.4 years ± 12.5 (SD), and the preoperative manifest spherical equivalent ranged from -11.0 diopters (D) to +4.88 D. Five years postoperatively, 79.3% of eyes were within ±0.50 D of emmetropia and 77.7% of eyes achieved monocular uncorrected distance visual acuity (UDVA) and 90.6% of eyes achieved binocular UDVA of 20/20 or better. Of the patients, 91.0% said they were satisfied with their vision and 94.9% did not wear distance correction. Less than 2.0% of patients noticed visual phenomena, even with spectacle correction. Major predictors of patient satisfaction 5 years postoperatively were postoperative binocular UDVA (37.6% variance explained by regression model), visual phenomena (relative contribution of 15.0%), preoperative and postoperative sphere and their interactions (11.6%), and eyesight-related difficulties with various activities such as night driving, outdoor activities, and reading (10.2%). Patient-reported quality-of-life and satisfaction rates remained high 5 years after LASIK. Uncorrected vision was the strongest predictor of satisfaction. Dr. S.C. Schallhorn is a consultant to Abbott Medical Optics, Inc., Zeiss Meditec AG, and Autofocus Inc. and a global medical director for Optical Express. No other

Minimum and start of the eleven-year solar cycle, Earth's ionosphere and radioamateurs

NASA Astrophysics Data System (ADS)

Janda, F. K.

2010-12-01

During the last long and deep minimum of solar activity, particularly in the years 2008 and 2009, we could read a whole bunch of unfulfilled predictions, and inaccurate and confusing messages whose authors were apparently surprised , or at least showed up a surprised face. Usually, their common feature was focusing on only a small number of solar activity parameters, often neglecting results of historical observations. Recall "It has all been here already, and yet it will all happen again" (Wieslaw Brudzinski). At the same time, we have, so to say, "at our hands" a medium which simultaneously responds in a flexible and accurate way to most manifestations of the solar activity and which can be traced with just a radio receiver - and, of course, somewhat trained ear, for example of an amateur radio operator. Ionospheric probes are, however, much better for our purposes, and things that can be done with their current generation only very recently belonged to the world of dreams.

Stereotactic radiosurgery for brain metastases: a case-matched study comparing treatment results for patients 80 years of age or older versus patients 65-79 years of age.

PubMed

Watanabe, Shinya; Yamamoto, Masaaki; Sato, Yasunori; Kawabe, Takuya; Higuchi, Yoshinori; Kasuya, Hidetoshi; Yamamoto, Tetsuya; Matsumura, Akira; Barfod, Bierta E

2014-11-01

Recently, an increasing number of patients with brain metastases, even patients over 80 years of age, have been treated with stereotactic radiosurgery (SRS). However, there is little information on SRS treatment results for patients with brain metastases 80 years of age and older. The authors undertook this study to reappraise whether SRS treatment results for patients 80 years of age or older differ from those of patients who are 65-79 years old. This was an institutional review board-approved, retrospective cohort study. Among 2552 consecutive brain metastasis patients who underwent SRS during the 1998-2011 period, we studied 165 who were 80 years of age or older (Group A) and 1181 who were age 65-79 years old (Group B). Because of the remarkable disproportion in patient numbers between the 2 groups and considerable differences in pre-SRS clinical factors, the authors conducted a case-matched study using the propensity score matching method. Ultimately, 330 patients (165 from each group, A and B) were selected. For time-to-event outcomes, the Kaplan-Meier method was used to estimate overall survival and competing risk analysis was used to estimate other study end points, as appropriate. Although the case-matched study showed that post-SRS median survival time (MST, months) was shorter in Group A patients (5.3 months, 95% CI 3.9-7.0 months) than in Group B patients (6.9 months, 95% CI 5.0-8.1 months), this difference was not statistically significant (HR 1.147, 95% CI 0.921-1.429, p = 0.22). Incidences of neurological death and deterioration were slightly lower in Group A than in Group B patients (6.3% vs 11.8% and 8.5% vs 13.9%), but these differences did not reach statistical significance (p = 0.11 and p = 0.16). Furthermore, competing risk analyses showed that the 2 groups did not differ significantly in cumulative incidence of local recurrence (HR 0.830, 95% CI 0.268-2.573, p = 0.75), rates of repeat SRS (HR 0.738, 95% CI 0.438-1.242, p = 0.25), or incidence

Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand.

PubMed

Weeks, Dexter; Kasdan, Morton L; Wilhelmi, Bradon J

2016-01-01

The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function. We report a case in which surgical reconstruction of a volar hand burn was performed with full-thickness skin grafting. The patient had a 40-year follow-up to assess the function and cosmesis of the repaired hand. We report a case in which a 15-month-old boy presented after receiving third-degree burns to the left volar hand, including the flexural aspects of the index, long, and ring fingers by placing it on a hot kitchen stove burner. The patient subsequently underwent scar contracture release and full-thickness skin grafting. Eleven years after reconstruction, further contractures developed associated with the patient's growth, which were reconstructed with repeat full-thickness skin graft from the inguinal region. No recurrence was witnessed afterward and 40 years after initial injury, the patient maintains full activities of daily living and use of his hand in his occupation. There is debate regarding the superiority of split-thickness versus full-thickness grafts during reconstruction. Our case strengthens the argument for durability of a full-thickness skin graft following thermal burn injury.

Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review

PubMed Central

Damiani, Gianfranco; Salvatori, Eleonora; Silvestrini, Giulia; Ivanova, Ivana; Bojovic, Luka; Iodice, Lanfranco; Ricciardi, Walter

2015-01-01

Purpose Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. Methods The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen’s Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. Results A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. Conclusion Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people

Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review.

PubMed

Damiani, Gianfranco; Salvatori, Eleonora; Silvestrini, Giulia; Ivanova, Ivana; Bojovic, Luka; Iodice, Lanfranco; Ricciardi, Walter

2015-01-01

Cardiovascular diseases are the leading cause of death and disability worldwide. Among these diseases, heart failure (HF) and acute myocardial infarction (AMI) are the most common causes of hospitalization. Therefore, readmission for HF and AMI is receiving increasing attention. Several socioeconomic factors could affect readmissions in this target group, and thus, a systematic review was conducted to identify the effect of socioeconomic factors on the risk for readmission in people aged 65 years and older with HF or AMI. The search was carried out by querying an electronic database and hand searching. Studies with an association between the risk for readmission and at least one socioeconomic factor in patients aged 65 years or older who are affected by HF or AMI were included. A quality assessment was conducted independently by two reviewers. The agreement was quantified by Cohen's Kappa statistic. The outcomes of studies were categorized in the short-term and the long-term, according to the follow-up period of readmission. A positive association was reported if an increase in the risk for readmission among disadvantaged patients was found. A cumulative effect of socioeconomic factors was computed by considering the association for each study and the number of available studies. A total of eleven articles were included in the review. They were mainly published in the United States. All the articles analyzed patients who were hospitalized for HF, and four of them also analyzed patients with AMI. Seven studies (63.6%) were found for the short-term outcome, and four studies (36.4%) were found for the long-term outcome. For the short-term outcome, race/ethnicity and marital status showed a positive cumulative effect on the risk for readmission. Regarding the educational level of a patient, no effect was found. Among the socioeconomic factors, mainly race/ethnicity and marital status affect the risk for readmission in elderly people with HF or AMI. Multidisciplinary

Recharge and Groundwater Use in the North China Plain for Six Irrigated Crops for an Eleven Year Period

PubMed Central

Yang, Xiaolin; Chen, Yuanquan; Pacenka, Steven; Gao, Wangsheng; Zhang, Min; Sui, Peng; Steenhuis, Tammo S.

2015-01-01

Water tables are dropping by approximately one meter annually throughout the North China Plain mainly due to water withdrawals for irrigating winter wheat year after year. In order to examine whether the drawdown can be reduced we calculate the net water use for an 11 year field experiment from 2003 to 2013 where six irrigated crops (winter wheat, summer maize, cotton, peanuts, sweet potato, ryegrass) were grown in different crop rotations in the North China Plain. As part of this experiment moisture contents were measured each at 20 cm intervals in the top 1.8 m. Recharge and net water use were calculated based on these moisture measurement. Results showed that winter wheat and ryegrass had the least recharge with an average of 27 mm/year and 39 mm/year, respectively; cotton had the most recharge with an average of 211 mm/year) followed by peanuts with 118 mm/year, sweet potato with 76 mm/year, and summer maize with 44 mm/year. Recharge depended on the amount of irrigation water pumped from the aquifer and was therefore a poor indicator of future groundwater decline. Instead net water use (recharge minus irrigation) was found to be a good indicator for the decline of the water table. The smallest amount of net (ground water) used was cotton with an average of 14 mm/year, followed by peanut with 32 mm/year, summer maize with 71 mm/year, sweet potato with 74 mm/year. Winter wheat and ryegrass had the greatest net water use with the average of 198 mm/year and 111 mm/year, respectively. Our calculations showed that any single crop would use less water than the prevalent winter wheat summer maize rotation. This growing one crop instead of two will reduce the decline of groundwater and in some rain rich years increase the ground water level, but will result in less income for the farmers. PMID:25625765

Hepneriana Dworakowska (Hemiptera: Cicadellidae: Typhlocybinae: Erythroneurini), first record from China, with descriptions of eleven new species.

PubMed

Yang, Meixia; Cao, Yanghui; Zhang, Yalin

2016-11-15

A redescription of the erythroneurine leafhopper genus Hepneriana Dworakowska and a key to Chinese species of the genus are provided. Eleven new species, Hepneriana applanata, H. bicruris, H. concava, H. euryaedeaga, H. longa, H. menglunensis, H. paragamma, H. prostrata, H. robusta, H. taibaoensis and H. undulata spp. nov. are described and H. joannae (Dworakowska) is newly recorded from China.

Long-term durability of the distal urethral polypropylene sling for the treatment of stress urinary incontinence: minimum 11-year followup.

PubMed

Rogo-Gupta, Lisa; Baxter, Z Chad; Le, Ngoc-Bich; Raz, Shlomo; Rodríguez, Larissa V

2012-11-01

We report on the long-term outcomes of the distal urethral polypropylene sling for stress urinary incontinence in a patient cohort that was closely followed and whose outcomes were reported at 1 and 5 years after surgery. We performed a prospective study of all consecutive patients who underwent a distal urethral polypropylene sling procedure between November 1999 and April 2000. The 1 and 5-year outcomes for this particular patient cohort were previously reported. At the minimum 11-year followup, outcome was determined by patient self-assessment including validated questionnaires. A total of 69 patients were followed prospectively and followup was obtained for 30. Of those lost to followup 10 were deceased and 5 were cognitively impaired. Mean patient age at followup was 73 years (range 40 to 97). More than 11 years after surgery 48% of patients reported no stress urinary incontinence symptoms and 63% were never bothered by stress urinary incontinence. Patients reported a mean overall symptom improvement of 64% compared to 81% at 5 years. Overall 82% of patients met the criteria for treatment success by symptom scores and 80% met the criteria by bother scores. The distal urethral polypropylene sling procedure has excellent long-term durability in the treatment of stress urinary incontinence, in addition to low morbidity and low cost as previously described. Eleven years after the procedure the majority of patients report symptom improvement. Nevertheless, many older patients are unable to participate in followup. When choosing an anti-incontinence procedure, durability should be considered in light of patient age given that the theoretical advantages of long-term durability are limited by cognitive decline and mortality. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Management of Cerebral Radiation Necrosis: A Retrospective Study of 12 Patients.

PubMed

Liao, Chenlong; Visocchi, Massimiliano; Zhang, Wenchuan; Yang, Min; Zhong, Wenxiang; Liu, Pengfei

2017-01-01

Cerebral radiation necrosis (RN) is a severe complication of radiotherapy for cerebral pathologies. This study discusses the radiographic and pathological features of 12 patients with RN and investigates the management strategy. Eleven patients with brain tumors, and one with cerebral cavernous angioma, treated by surgical resection or Gamma Knife alone before radiotherapy developed RN during follow-up. Surgical resection for the cerebral RN was performed in nine patients, and the other three patients received medical treatment. The clinical features, magnetic resonance imaging (MRI), surgical findings, and pathological sections are reviewed. The diagnosis of RN was confirmed by histological study in all the patients; those with surgical and medical treatment recovered. As a major complication of radiotherapy, from the clinical and neuroradiological points of view, RN may simulate tumor recurrence. Due to the increasing number of patients with RN who will need to be treated in future years, the definite diagnosis and appropriate treatment of RN remain critical.

Comprehensive care program for elderly patients over 65 years with hip fracture.

PubMed

Fernández-Moyano, A; Fernández-Ojeda, R; Ruiz-Romero, V; García-Benítez, B; Palmero-Palmero, C; Aparicio-Santos, R

2014-01-01

To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Ten year survival of bridges placed in the General Dental Services in England and Wales.

PubMed

Burke, F J T; Lucarotti, P S K

2012-11-01

It is the aim of this paper to consider the factors associated with the need for re-intervention on a conventional or resin-retained bridge, excluding recementation. A data set was established consisting of patients, 18 years or older, whose birthdays were included within a set of randomly selected dates, one of which was chosen in each possible year of birth and whose restoration records contained the placement of one or more indirect restorations on courses of treatment with last date on the claim form after 31st December 1990, and with date of acceptance after September 1990 and before January 2002. For each patient treated with a bridge, the subsequent history of intervention on each tooth used as a bridge abutment was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. Thus a data set was created of bridge abutments which have been placed, with their dates of placement and their dates, if any, of re-intervention. Data for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 7874 abutments (6800 conventional and 1074 resin-retained) were obtained from the data over a period of eleven years. Factors which were found to reduce outcome of bridges included type of bridge, patient payment exemption status, patient attendance pattern and position of the bridge in the patient's mouth. Survival of conventional bridge abutments has been shown to be 72% at 10 years, this being similar survival time to crowns. Various patient factors and bridge type were also found to influence survival. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effective and sensitive determination of eleven disinfection byproducts in drinking water by DLLME and GC-MS.

PubMed

On, Jiwon; Pyo, Heesoo; Myung, Seung-Woon

2018-10-15

The aim of this study was to optimize the dispersive liquid-liquid microextraction (DLLME) parameters for simultaneous analysis through DLLME-gas chromatography-mass spectrometry (GC-MS) of six iodo-trihalomethanes, four haloacetonitriles, and one halonitromethane, which are residual disinfection products found in drinking water. Eleven disinfection by-product (DBPs) remaining in aqueous samples were extracted and concentrated using a simple, rapid, and environmentally friendly DLLME method, and then analyzed simultaneously by GC-MS. The optimized DLLME parameters were a sample volume of 5 mL, 100 μL of dichloromethane as the extraction solvent, 1 mL of methanol as the dispersion solvent, an extraction time of 60 s, and 1.5 g of sodium chloride for the salting out effect. The enrichment factor values obtained using the established DLLME-GC-MS method were 19.8-141.5, and the limit of detection and limit of quantification were 0.22-1.19 μg/L and 0.75-3.98 μg/L, respectively. The calibration curves had correlation coefficients (r 2 ) of 0.9958-0.9992 in the concentration range of 0.5-40 μg/L, and they exhibited good linearity in quantitative analysis. This new method could be useful for analyzing eleven DBPs that remain in drinking water. Copyright © 2018 Elsevier B.V. All rights reserved.

Efficacy of L-asparaginase with methotrexate and dexamethasone (AspaMetDex regimen) in patients with refractory or relapsing extranodal NK/T-cell lymphoma, a phase 2 study.

PubMed

Jaccard, Arnaud; Gachard, Nathalie; Marin, Benoit; Rogez, Sylvie; Audrain, Marie; Suarez, Felipe; Tilly, Hervé; Morschhauser, Franck; Thieblemont, Catherine; Ysebaert, Loic; Devidas, Alain; Petit, Barbara; de Leval, Laurence; Gaulard, Philippe; Feuillard, Jean; Bordessoule, Dominique; Hermine, Olivier

2011-02-10

Extranodal NK/T-cell lymphoma, nasal type, is a rare and highly aggressive disease with a grim prognosis. No therapeutic strategy is currently identified in relapsing patients. We report the results of a French prospective phase II trial of an L-asparaginase-containing regimen in 19 patients with relapsed or refractory disease treated in 13 centers. Eleven patients were in relapse and 8 patients were refractory to their first line of treatment. L-Asparaginase-based treatment yielded objective responses in 14 of the 18 evaluable patients after 3 cycles. Eleven patients entered complete remission (61%), and only 4 of them relapsed. The median overall survival time was 1 year, with a median response duration of 12 months. The main adverse events were hepatitis, cytopenia, and allergy. The absence of antiasparaginase antibodies and the disappearance of Epstein-Barr virus serum DNA were significantly associated with a better outcome. These data confirm the excellent activity of L-asparaginase-containing regimens in extranodal NK/T-cell lymphoma. L-Asparaginase-based treatment should thus be considered for salvage therapy, especially in patients with disseminated disease. First-line L-asparaginase combination therapy for extranodal NK/T-cell lymphoma warrants evaluation in prospective trials. This trial is registered at www.clinicaltrials.gov as #NCT00283985.

The use of fiber tractography for identifying patients with Alzheimer's disease

NASA Astrophysics Data System (ADS)

Dong, Kyung-Rae; Goo, Eun-Hoe; Lee, Jae-Seung; Chung, Woon-Kwan

2013-01-01

This study examined the usefulness of fiber tractography (FT) for identifying patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) through diffusion tensor imaging (DTI). DTI was performed on twelve patients with AD (four males and eight females, mean age: 78.1 ± 7.5 years) and an eleven patients with MCI (five males and six females, mean age: 69.3 ± 8.0 years) from January to December 2011 by using a 3.0T scanner. Two regions of interest were drawn on the pyramidal tract of Pons and the posterior limb of the internal capsule, which passed through both cortico spinal tracts on the color-cored fractional anisotropy (FA) map. The numbers of white matter fibers on the DTIs in the patients with AD and MCI were determined. The numbers of white matter fibers in the AD patients were 1055.67 ± 333.12 and 860.75 ± 355.50 on the left and the right, respectively. In the patients with MCI, the numbers of white matter fibers and were 1329.82 ± 238.99 and 1316.55 ± 215.25 on the left and the right, respectively. The difference between the right and the left sides in the AD patients was slightly higher than that in the MCI patients.

Metal-on-metal hip resurfacing in patients younger than 50 years: a retrospective analysis : 1285 cases, 12-year survivorship.

PubMed

Gaillard, Melissa D; Gross, Thomas P

2017-06-02

The Nordic registry reports patients under 50 years old with total hip replacements realize only 83% 10-year implant survivorship. These results do not meet the 95% 10-year survivorship guideline posed by the UK's National Institute for Health and Care Excellence (NICE) in 2014. The purpose of this study is threefold: First, we evaluate if metal-on-metal hip resurfacing arthroplasty meets these high standards in younger patients. Next, we compare outcomes between age groups to determine if younger patients are at higher risk for revision or complication. Lastly, we assess how outcomes between sexes changed over time. From January 2001 to August 2013, a single surgeon performed 1285 metal-on-metal hip resurfacings in patients younger than 50 years old. We compared these to an older cohort matched by sex and BMI. Kaplan-Meier implant survivorship was 96.5% at 10 years and 96.3% at 12 years; this did not differ from implant survivorship for older patients. Implant survivorship at 12 years was 98 and 93% for younger men and women, respectively; survivorship for women improved from 93 to 97% by using exclusively Biomet implants. There were four (0.3%) adverse wear-related failures, with no instances of wear or problematic ion levels since 2009. Activity scores improved from 5.4 ± 2.3 preoperatively to 7.6 ± 1.9 postoperatively (p < 0.0001), with 43% of patients reporting a UCLA activity score of 9 or 10. Hip resurfacing exceeds the stricter 2014 NICE survivorship criteria independently in men and women even when performed on patients under 50 years old.

Healthy life expectancy of oral squamous cell carcinoma patients aged 75years and older.

PubMed

Yamada, Shin-Ichi; Kurita, Hiroshi; Tomioka, Takahiro; Ohta, Ryousuke; Yoshimura, Nobuhiko; Nishimaki, Fumihiro; Koyama, Yoshihito; Kondo, Eiji; Kamata, Takahiro

2017-01-01

Healthy life expectancy, an extension of the concept of life expectancy, is a summary measure of population health that takes into account the mortality and morbidity of a population. The aim of the present study was to retrospectively analyze the self-reliance survival times of oral squamous cell carcinoma (OSCC) patients. One hundred and twelve patients aged 75years or older with primary OSCC were included and examined at Shinshu University Hospital. To investigate healthy life expectancy, OSCC patients older than 75years were divided into 3 groups: 75-79, 80-84, and older than 85years. The Kaplan-Meier method was used to estimate the median times of healthy life expectancy. The Log-rank test was used to test significant differences between actual curves. The median self-reliance survival times of patients aged 75-79, 80-84, and older than 85years were 5.7, 1.6, and 1.4years, respectively. Most patients with early stage cancers underwent curative treatments and showed a health expectancy of more than 5years. In patients with advanced cancers, health expectancy was poor (less than one year), except among patients aged 75-79years who underwent standard treatments. It seems that in patients with advanced cancers, health expectancy was poor (less than 1year), except among patients aged 75-79years who underwent standard treatments. In elderly patients, healthy life expectancy (self-reliance survival time) may be one of the measures of patient prognosis as well as overall survival times. Copyright © 2016 Elsevier Ltd. All rights reserved.

The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients.

PubMed

Zhang, Xin-Liang; Huang, Da-Geng; Wang, Xiao-Dong; Zhu, Jin-Wen; Li, Yi-Bing; He, Bao-Rong; Hao, Ding-Jun

2017-04-01

Ponticulus posticus is a common anatomic variation that can be mistaken for a broad posterior arch during C1 pedicle screw placement. When the atlas lateral mass screws are placed via the posterior arch, injury to the vertebral artery may result. To our knowledge, there are few clinical studies that have analyzed the feasibility of C1 pedicle screw fixation in patients with ponticulus posticus, in clinical practice. To evaluate the feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus. Between January 2008 and January 2012, 11 consecutive patients with atlantoaxial instability, and with a ponticulus posticus at C1, underwent posterior fusion surgery in our institution. According to preoperative computed tomography (CT) reconstruction, a complete ponticulus posticus was found unilaterally in nine patients and bilaterally in two. Postoperative CT reconstructive imaging was performed to assess whether C1 pedicle screw placement was successful. Patients were followed up at regular intervals and evaluated for symptoms of ponticulus posticus syndrome. Thirteen C1 pedicles (atlas vertebral artery groove), each with a complete ponticulus posticus, were successfully inserted with thirteen 3.5- or 4.0-mm diameter pedicle screws, without resection of the bony anomaly. No intraoperative complications (venous plexus, vertebral artery, or spinal cord injury) occurred. The mean follow-up period was 21 (range 14-30) months. Postoperative CT reconstructive images showed that all 13 pedicle screws were inserted in the C1 pedicles without destruction of the atlas pedicle cortical bone. In the follow-up period, none of the patients demonstrated clinical symptoms of ponticulus posticus syndrome or developed bone fusion. Three-dimensional CT imaging should be considered prior to C1 pedicle screw fixation in patients with ponticulus posticus, to avoid mistaking the ponticulus posticus for a widened dorsal arch of the atlas. If there is no ponticulus posticus

Patient injuries in operative rhinology during a ten-year period: Review of national patient insurance charts.

PubMed

Blomgren, K; Aaltonen, L-M; Lehtonen, L; Helmiö, P

2018-02-01

To assess factors contributing to patient injuries in operative rhinology. Data of the accepted patient injury claims involving operative rhinology, between the years 2001 and 2011, were obtained from the Finnish Patient Insurance Centre registry. Two senior otolaryngologists analysed and evaluated the injury mechanisms. Analysis and classification of factors contributing to patient injuries. During the ten-year study period, there were 67 patient injuries in operative rhinology, comprising 36% of all patient injuries in otorhinolaryngologic surgery. The majority (78%) of patients were treated in university or central hospitals and almost all (90%) by fully trained otolaryngology specialists. The factors contributing to the injuries were errors in surgical technique, like lesions to the orbit, skull base and meninges, and adjacent nerves, as well as mistakes with removable packings left in situ. Nearly half of the patients had undergone endoscopic sinus surgery. One patient died because of bleeding from the intracranial artery. Fourteen patients (21%) needed a re-operation due to the injury. Patient injuries in rhinology were caused by typical complications of common operations performed by otorhinolaryngology specialists. The increased volume of endoscopic sinus surgery was evident also in patient injuries. © 2017 John Wiley & Sons Ltd.

A 5-year comparison of ED visits by homeless and nonhomeless patients.

PubMed

Tadros, Allison; Layman, Shelley M; Brewer, Marissa Pantaleone; Davis, Stephen M

2016-05-01

A 2005 study examined emergency department (ED) utilization by homeless patients in the United States. Within the following 5 years, unemployment increased by 5%. The objective was to analyze changes in ED utilization between 2005 and 2010 by homeless patients and compare with nonhomeless visits. Data from the 2010 National Hospital Ambulatory Medical Care Survey were evaluated. Approximately 679854 visits were made by homeless patients, the majority of which were made by men (72.3%) and patients between the ages of 45 and 64 (50.5%). Homeless patients were twice as likely to be uninsured. ED visits by homeless patients had increased by 44% during the 5-year period. Arrival to the ED by ambulance increased by 14% between the study years, and homeless patients were less likely to be admitted. The number of visits by homeless patients in the ED increased proportionally to an overall increase in ED visits between 2005 and 2010. Copyright © 2016 Elsevier Inc. All rights reserved.

Awake Craniotomy: First-Year Experiences and Patient Perception.

PubMed

Joswig, Holger; Bratelj, Denis; Brunner, Thomas; Jacomet, Alfred; Hildebrandt, Gerhard; Surbeck, Werner

2016-06-01

Awake craniotomy for brain lesions in or near eloquent brain regions enables neurosurgeons to assess neurologic functions of patients intraoperatively, reducing the risk of permanent neurologic deficits and increasing the extent of resection. A retrospective review was performed of a consecutive series of patients with awake craniotomies in the first year of their introduction to our tertiary non-university-affiliated neurosurgery department. Operation time, complications, and neurologic outcome were assessed, and patient perception of awake craniotomy was surveyed using a mailed questionnaire. There were 24 awake craniotomies performed in 22 patients for low-grade/high-grade gliomas, cavernomas, and metastases (average 2 cases per month). Mean operation time was 205 minutes. Failure of awake craniotomy because of intraoperative seizures with subsequent postictal impaired testing or limited cooperation occurred in 2 patients. Transient neurologic deficits occurred in 29% of patients; 1 patient sustained a permanent neurologic deficit. Of the 18 patients (82%) who returned the questionnaire, only 2 patients recalled significant fear during surgery. Introducing awake craniotomy to a tertiary non-university-affiliated neurosurgery department is feasible and resulted in reasonable operation times and complication rates and high patient satisfaction. Copyright © 2016 Elsevier Inc. All rights reserved.

Sports activity following total knee arthroplasty in patients older than 60 years.

PubMed

Mayr, Hermann O; Reinhold, Maik; Bernstein, Anke; Suedkamp, Norbert P; Stoehr, Amelie

2015-01-01

In a retrospective study with a population over 65 years, sports activity was conducted 6 years after cruciate retaining (CR) total condylar knee arthroplasty (TKA) with rotating platform (RP). Eighty-one Patients (71.8±5.4years) were examined at follow-up 6.4±0.9 years postoperative. Sport was practiced 5.3 hours every week in mean. Patients were active in sports 3.5times per week. Twenty-five percent performed high impact sports, 47% medium impact sports and 52% low impact sports at follow-up. In KOOS sports 60±28 was reached, in WOMAC 12.1±15.1. It can be concluded that in this population 50% of patients were active in medium and low impact sport 6 years after surgery. However, a quarter of patients were also active in high impact sports. Copyright © 2014 Elsevier Inc. All rights reserved.

Emerging and Disruptive Technologies for Education: An Analysis of Planning, Implementation, and Diffusion in Florida's Eleven State University System Institutions

ERIC Educational Resources Information Center

Bradford, Deborah J.

2010-01-01

The purpose of the study was to understand and appreciate the methodologies and procedures used in determining the extent to which an information technology (IT) organization within the eleven member State University Systems (SUS) of Florida planned, implemented, and diffused emerging educational technologies. Key findings found how critical it…

Reversible sympathetic vasomotor dysfunction in POTS patients.

PubMed

Freitas, J; Santos, R; Azevedo, E; Costa, O; Carvalho, M; de Freitas, A F

2000-11-01

Orthostatic intolerance refers to the development upon assuming an upright posture of disabling symptoms, which are partly relieved by resuming the supine position. Postural tachycardia syndrome (POTS) is an orthostatic intolerance syndrome characterized by palpitations due to excessive orthostatic sinus tachycardia, lightheadedness, tremor, and near-syncope. Patients usually undergo extensive medical, cardiac, endocrine, neurological and psychiatric evaluation, which usually fails to identify a specific abnormality. We investigated the autonomic and hemodynamic profile of POTS patients and the efficacy of bisoprolol and or fludrocortisone. We evaluated eleven female patients with POTS before and after medical treatment with a cardio-selective beta blocker (bisoprolol) and/or fludrocortisone, and eleven age-matched controls. Variability of heart rate and systolic blood pressure was assessed by Fast Fourier Transform, and spontaneous baroreceptor gain by temporal sequences slope and alpha index. Modelflow was used to quantify hemodynamics. All patients improved greatly after medication. The autonomic and hemodynamic impairment observed in patients with POTS, particularly after orthostatic stress, is treated effectively with bisoprolol and/or fludrocortisone. These results need further confirmation in a controlled double-blind study. Proper medical treatment dramatically improves the clinical and autonomic/hemodynamic disturbances observed in patients with POTS. The data support the hypothesis that POTS is due to a hyperadrenergic activation and/or hypovolemia during orthostasis.

Ten-Year Survival of a Patient Treated with Stereotactic Gamma Knife Radiosurgery for Brain Metastases from Colon Cancer with Ovarian and Lymph Node Metastases: A Case Report.

PubMed

Morinaga, Nobuhiro; Tanaka, Naritaka; Shitara, Yoshinori; Ishizaki, Masatoshi; Yoshida, Takatomo; Kouga, Hideaki; Wakabayashi, Kazuki; Fukuchi, Minoru; Tsunoda, Yoshiyuki; Kuwano, Hiroyuki

2016-01-01

Brain metastasis from colorectal cancer is infrequent and carries a poor prognosis. Herein, we present a patient alive 10 years after the identification of a first brain metastasis from sigmoid colon cancer. A 39-year-old woman underwent sigmoidectomy for sigmoid colon cancer during an emergency operation for pelvic peritonitis. The pathological finding was moderately differentiated adenocarcinoma. Eleven months after the sigmoidectomy, a metastatic lesion was identified in the left ovary. Despite local radiotherapy followed by chemotherapy, the left ovarian lesion grew, so resection of the uterus and bilateral ovaries was performed. Adjuvant chemotherapy with tegafur-uracil (UFT)/calcium folinate (leucovorin, LV) was initiated. Seven months after resection of the ovarian lesion, brain metastases appeared in the bilateral frontal lobes and were treated with stereotactic Gamma Knife radiosurgery. Cervical and mediastinal lymph node metastases were also diagnosed, and irradiation of these lesions was performed. After radiotherapy, 10 courses of oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX) were administered. During FOLFOX administration, recurrent left frontal lobe brain metastasis was diagnosed and treated with stereotactic Gamma Knife radiosurgery. In this case, the brain metastases were well treated with stereotactic Gamma Knife radiosurgery, and the systemic disease arising from sigmoid colon cancer has been kept under control with chemotherapies, surgical resection, and radiotherapy.

General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital.

PubMed

Kwok, C-S; Gordon, A C

2016-09-01

Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.

Patients with n-hexane induced polyneuropathy: a clinical follow up.

PubMed Central

Chang, Y C

1990-01-01

The prognosis of hexacarbon induced polyneuropathy is usually good, though its clinical course after the cessation of exposure has not been described in detail. Eleven patients with moderate to severe n-hexane induced polyneuropathy due to occupational exposure were regularly followed up for a period of four years at the neurological department of the National Taiwan University Hospital. Sensorimotor neuropathy was diagnosed in nine patients and motor neuropathy in two. All were removed from further exposure to n-hexane after aetiological confirmation, but motor disturbance continued to worsen in five cases. Sensory functions were regained earlier than motor functions. All the patients, including one who was tetraplegic and confined to a wheelchair in the early stages, regained their full motor capabilities within one to four years. Three patients with severe neuropathy had residual muscle atrophy in the intrinsic foot and hand muscles. Signs of damage to the central nervous system, including increased tendon reflexes in two patients and leg tightness in six patients, emerged as muscle power was nearing complete recovery. The tightness of the legs gradually disappeared, but muscle cramps of the calves developed and these were still present at the end of follow up. Two patients had mild abnormal colour vision, and the abnormality was still detectable four years later. It is concluded that n-hexane induced neuropathy has a good prognosis, and that spasticity due to damage to the central nervous system is functionally reversible; muscle cramps and dyschromatopsia persist much longer. PMID:2166555

Inhibitory Activity of Eleven Artemisia Species from Iran against Leishmania Major Parasites

PubMed Central

Emami, Seyed Ahmad; Zamanai Taghizadeh Rabe, Shahrzad; Ahi, Ali; Mahmoudi, Mahmoud

2012-01-01

Objective(s) Annual incidence of cutaneous leishmaniasis is increasingly growing and development of the alternative drugs against it is a major concern. Artemisia genus is a traditional medicinal plant in Iran. The aim of this study was to examine the leishmanicidal activity of various Iranian Artemisia species extracts. Materials and Methods Different extracts were gathered from eleven Iranian Artemisia species. Their leishmanicidal activities against the growth of Leishmania major (L. major) promastigotes were examined as the half maximal inhibitory concentration (IC50) using MTT assay. Results Obtained results showed that ethanol extracts especially those taken from A. ciniformis, A. santolina and A. kulbadica have the strongest effects. Conclusion Looking for the effective leishmanicidal agents from natural resources in Iran, we found that the ethanol extract of collected Artemisia species had significant effect on in vitro leishmanicidal activity and may be suitable candidates in the treatment of leishmaniasis. PMID:23493354

Synchronous and metachronous neoplasms in gastric cancer patients: A 23-year study

PubMed Central

Ławniczak, Małgorzata; Gawin, Alicja; Jaroszewicz-Heigelmann, Halina; Rogoza-Mateja, Wiesława; Raszeja-Wyszomirska, Joanna; Białek, Andrzej; Karpińska-Kaczmarczyk, Katarzyna; Starzyńska, Teresa

2014-01-01

AIM: To determine the prevalence and characteristics of additional primary malignancies in gastric cancer (GC) patients. METHODS: GC patients (862 total; 570 men, 292 women; mean age 59.8 ± 12.8 years) diagnosed at the Department of Gastroenterology at Pomeranian Medical University over a period of 23 years were included in this retrospective analysis of a prospectively maintained database. Mean follow-up time was 31.3 ± 38.6 mo (range 1-241 mo). The following clinicopathological features of patients with synchronous tumors were compared to those with metachronous tumors: age, sex, symptom duration, family history of cancer, tumor site, stage (early vs advanced), histology, and blood group. GC patients with and without a second tumor were compared in terms of the same clinicopathological features. RESULTS: Of 862 GC patients, 58 (6.7%) developed a total of 62 multiple primary tumors, of which 39 (63%) were metachronous and 23 (37%) synchronous. Four (6.9%) of the 58 multiple GC patients developed two or more neoplasms. The predominant tumor type of the secondary neoplasms was colorectal (n = 17), followed by lung (n = 9), breast (n = 8), and prostate (n = 7). Age was the only clinicopathological feature that differed between GC patients with synchronous vs metachronous malignancies; GC patients with synchronous neoplasms were older than those with metachronous neoplasms (68.0 ± 10.3 years vs 59.9 ± 11.1 years, respectively, P = 0.008). Comparisons between patients with and without a second primary cancer revealed that the only statistically significant differences were in age and blood group. The mean age of the patients with multiple GC was higher than that of those without a second primary tumor (63.4 ± 11.4 years vs 59.5 ± 13.0 years, respectively, P = 0.026). GC patients with a second primary tumor were more commonly blood group O than those without (56.2% vs 31.6%, respectively, P = 0.002). CONCLUSION: GC patients may develop other primary cancers

Shoulder and Elbow Recovery at 2 and 11 Years Following Brachial Plexus Reconstruction.

PubMed

Wang, Jung-Pan; Rancy, Schneider K; Lee, Steve K; Feinberg, Joseph H; Wolfe, Scott W

2016-02-01

To report short-term and long-term outcomes on a single patient cohort observed longitudinally after nerve reconstruction for adult brachial plexus injury. Eleven male patients who underwent plexus reconstruction by the same surgeon at 2 institutions presented for clinical examination 7.5 or more years after surgery (average, 11.4 years; range, 7.5-22 years). Average age at the time of operation was 35 years (range, 17-73 years). Mean delay until surgery was 5 months (range, 2-11 months). Two patients had C5 paralysis, 2 had C5-C6 paralysis, 2 had C5-C7 paralysis, and 5 had complete 5-level injuries. Outcome parameters included active range of motion (ROM) in degrees, a modified British Medical Research Council (mBMRC) scale for muscle strength, and electromyographic motor unit configuration and recruitment pattern. Differences in ROM and mBMRC between 2-year and long-term follow-up were assessed with paired-sample t tests using an alpha value of .05. Average shoulder abduction and mBMRC at final follow-up were both significantly improved compared with the 2-year follow-up results (P < .05). Average elbow flexion and mBMRC increased significantly between 2 years and final follow-up (P < .05). Electromyographic results for 6 patients at final follow-up showed improved motor unit configuration in 10 of 15 muscles and improved recruitment in 3 of 15 muscles compared with 2-year electromyographic results. Patients continued to gain ROM and strength in the shoulder and elbow well after 2 to 3 years after surgery, contrary to previous reports. Although the precise mechanism is unknown, we speculate that a number of factors may be involved, including terminal collateral sprouting, maturation of motor units, improvements in motor unit recruitment, additional muscle fiber hypertrophy, or an as-yet undescribed mechanism. We recommend that patients be encouraged to continue strengthening exercises well after the initial recovery period and that more comparative long-term data

Patients' evaluations of European general practice--revisited after 11 years.

PubMed

Petek, Davorina; Künzi, Beat; Kersnik, Janko; Szecsenyi, Joachim; Wensing, Michel

2011-12-01

In the last decade many things have changed in healthcare systems, primary care practices and populations. To describe evaluations of general practice care by patients with a chronic illness in 2009 and compare these with a previous study done in 1998. A descriptive analysis of patients' evaluations, using data from the European practice assessment Cardio study on cardiovascular patients in eight European countries in 2009. We compared these evaluations with a subgroup of patients with self-defined chronic illness from the study in 1998, using a linear regression model. Patients' evaluation of general practice using the EUROPEP questionnaire. The EUROPEP is a 23-item validated measure of patient evaluations of general practice care. In 2009, 7472 patients from 251 practices participated in the study with an overall response rate of 49.6%. The percentage of patients with positive evaluations (good/excellent) was 80% or higher for all items, except for the waiting time. More positive evaluations were found in older patients, patients with a longer attachment to the practice, patients with a higher self-evaluation of their health, patients with fewer mental health problems and less pain/discomfort. The comparison between 1998 and 2009 showed no overall trends for all countries combined. Whereas English patients became fairly more positive about general practice in 2009, German patients became slightly less positive, although still more positive than English patients. Overall, the patients' evaluations of general practice were very positive in family practice care in the years 1998 and 2009. The trends over the years need to be carefully interpreted over time.

Repair of symptomatic paraesophageal hernias in elderly (>70 years) patients results in sustained quality of life at 5 years and beyond.

PubMed

Merzlikin, Oleg V; Louie, Brian E; Farivar, Alexander S; Shultz, Dale; Aye, Ralph W

2017-10-01

Paraesophageal hernias (PEHs) involve herniation of stomach and/or other viscera into the mediastinum. These commonly occur in the elderly and can severely limit quality of life. Short term outcomes of repaired PEH demonstrated low morbidity and significant improvement in quality of life, but long-term data for all patients, especially the elderly, are lacking. Retrospective chart review of a prospectively collected database of patients aged 70 or greater with a symptomatic PEH repaired 5+ years ago. Quality of life data were assessed preoperatively, at 12-24 months, and at 5+ years using QOLRAD, GERD-HRQL, and DSS. We identified 137 patients who met the age criteria, with 69 patients undergoing surgery 5+ years ago. With ten patients were lost to follow-up, 59 patients were analyzed, including 24 males and 35 females. Median age at repair was 77 years. There were two 90-day mortalities, with one occurring within 30 days of surgery. Patients alive at evaluation had a median age of 74 years and were followed a median 7.4 years. From baseline, QOLRAD improved from 4 to 6.5, GERD-HRQL improved from 11 to 5, and swallowing improved from 11 to 38. During follow-up, 21 patients died. Deceased patients lived a median of 4 years after repair, with a median age at repair of 80 years. At a median time follow-up of 2 years, this group's QOLRAD improved from 5.1 to 7, GERD-HRQL improved from 16 to 4, and swallowing improved from 14.5 to 35. In elderly patients with symptomatic PEH undergoing surgical repair more than 5 years ago, there was sustained improvement in quality of life. This justifies surgical repair of symptomatic PEH in elderly patients.

Two-year outcome of team-based intensive case management for patients with schizophrenia.

PubMed

Aberg-Wistedt, A; Cressell, T; Lidberg, Y; Liljenberg, B; Osby, U

1995-12-01

Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.

Intravitreal aflibercept for neovascular age-related macular degeneration in patients aged 90 years or older: 2-year visual acuity outcomes.

PubMed

Chatziralli, Irini; Regan, Shane O; Mohamed, Ryian; Talks, James; Sivaprasad, Sobha

2018-06-04

The purpose of this study was to investigate the efficacy of intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) in very elderly patients aged 90 years or older at 2 years after treatment initiation. In this multicentre retrospective data analysis from electronic medical record, consecutive treatment-naive patients with nAMD treated with aflibercept with at least 2 years follow-up were stratified into those aged < 90 years (Group I) and an older cohort aged 90 and over (Group II). We compared the visual acuity (EDTRS letters) outcomes at 4 weekly intervals between the two groups over a 2-year period. The mean visual acuity of Group I at presentation was 56.3 ETDRS letters versus 52.8 letters in Group II. Maximal visual acuity was achieved in both the groups by 6 months after initiating treatment (4.7 vs. 4.0 letters gain). By 2 years, the mean visual acuity of the older cohort fell marginally below their baseline visual acuity (0.8 letter loss), while Group I presented +2.1 letters gain. The number of injections given and the retention rate of the older cohort were no different to the rest of the patients. Very old patients with nAMD benefited from aflibercept, but not to the same degree as the younger patients. The study showed that, on an average, the very elderly patients were able to adhere to the intensive anti-VEGF treatment regimens.

Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year.

PubMed

Houben, Carmen H M; Spruit, Martijn A; Schols, Jos M G A; Wouters, Emiel F M; Janssen, Daisy J A

2015-06-01

Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care. Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative. One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak. End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The American Citizen: 11 Years after High School. Volume II.

ERIC Educational Resources Information Center

Wise,.Lauress L.; And Others

A third follow-up survey of ninth and tenth grade Project Talent participants (1962 and 1963 high school classes) was done approximately eleven years after their expected graduation from high school to gather additional data on the educational, career, personal, and family experiences of these individuals and their reflections on the value of…

Outcome and complications in peritoneal dialysis patients: a five-year single center experience.

PubMed

Alwakeel, Jamal S; Alsuwaida, Abdulkareem; Askar, Akram; Memon, Nawaz; Usama, Saira; Alghonaim, Mohammed; Feraz, Niaz A; Shah, Iqbal Hamid; Wilson, Hamsaveni

2011-03-01

Peritoneal dialysis (PD) is one of the modes of renal replacement therapy being utilized for the management of end-stage renal failure in King Khalid University Hospital, King Saud University, Riyadh, for more than two decades. The aim of this study was to evaluate the complications related to PD as well as its outcome in patients on this mode of therapy during the period between January 2004 and December 2008. There were 72 patients included in the study, of whom 43 were females. The average age was 50.7 ± 30.1 years (14-88 years). Diabetes was the leading cause of end-stage renal disease (ESRD) seen in 40.2% of the study patients. Twenty-eight patients (38.9%) were on continuous ambulatory peritoneal dialysis (CAPD) and 44 (61.1%) were on automated PD (nocturnal intermittent peritoneal dialysis, NIPD or continuous cycler peritoneal dialysis, CCPD). The mean duration on PD of the study patients was 25.5 ± 16.58 months (1-60 months). The peritonitis rate was one episode per 24.51 patient-months or one episode per 2.04 patient-years. The incidence of peritonitis per person-year was calculated as 0.42. The leading causative agent for peritonitis was Staphylococcus (32%). Exit-site infection (ESI) rate was one episode per 56.21 patient-months. The incidence of ESI was 0.214 per person-years. The most common infective organism for ESI was Pseudomonas aeru-ginosa (58.8%). At the end of 5 years, 35 patients were continuing on PD, 13 patients were shifted to hemodialysis (HD), nine patients underwent renal transplantation, and six patients were transferred to other centers. Among the 13 patients who were shifted to HD, four patients had refractory peritonitis, four others had catheter malfunction, three patients had inadequate clearance on PD and two patients had lack of compliance. A total of 11 patients died during the study period, giving an overall mortality rate of 15.27% for the five-year period. Our study suggests that there has been considerable improvement in

Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study.

PubMed

Weber, Andreas; Schneider, Jochen; Neu, Bruno; Meining, Alexander; Born, Peter; von Delius, Stefan; Bajbouj, Monther; Schmid, Roland M; Algül, Hana; Prinz, Christian

2013-02-07

This study analyzed clinical long-term outcomes after endoscopic therapy, including the incidence and treatment of relapse. This study included 19 consecutive patients (12 male, 7 female, median age 54 years) with obstructive chronic pancreatitis who were admitted to the 2(nd) Medical Department of the Technical University of Munich. All patients presented severe chronic pancreatitis (stage III°) according to the Cambridge classification. The majority of the patients suffered intermittent pain attacks. 6 of 19 patients had strictures of the pancreatic duct; 13 of 19 patients had strictures and stones. The first endoscopic retrograde pancreatography (ERP) included an endoscopic sphincterotomy, dilatation of the pancreatic duct, and stent placement. The first control ERP was performed 4 wk after the initial intervention, and the subsequent control ERP was performed after 3 mo to re-evaluate the clinical and morphological conditions. Clinical follow-up was performed annually to document the course of pain and the management of relapse. The course of pain was assessed by a pain scale from 0 to 10. The date and choice of the therapeutic procedure were documented in case of relapse. Initial endoscopic intervention was successfully completed in 17 of 19 patients. All 17 patients reported partial or complete pain relief after endoscopic intervention. Endoscopic therapy failed in 2 patients. Both patients were excluded from further analysis. One failed patient underwent surgery, and the other patient was treated conservatively with pain medication. Seventeen of 19 patients were followed after the successful completion of endoscopic stent therapy. Three of 17 patients were lost to follow-up. One patient was not available for interviews after the 1(st) year of follow-up. Two patients died during the 3(rd) year of follow-up. In both patients chronic pancreatitis was excluded as the cause of death. One patient died of myocardial infarction, and one patient succumbed to

Global patterns of domestic cannabis cultivation: sample characteristics and patterns of growing across eleven countries.

PubMed

Potter, Gary R; Barratt, Monica J; Malm, Aili; Bouchard, Martin; Blok, Thomas; Christensen, Anne-Sofie; Decorte, Tom; Frank, Vibeke Asmussen; Hakkarainen, Pekka; Klein, Axel; Lenton, Simon; Perälä, Jussi; Werse, Bernd; Wouters, Marije

2015-03-01

This article aims to provide an overview of: demographic characteristics; experiences with growing cannabis; methods and scale of growing operations; reasons for growing; personal use of cannabis and other drugs; participation in cannabis and other drug markets; contacts with the criminal justice system for respondents to an online survey about cannabis cultivation drawn from eleven countries (N=6530). Important similarities and differences between the national samples recruited will be discussed. This paper utilizes data from the online web survey of predominantly 'small-scale' cannabis cultivators in eleven countries conducted by the Global Cannabis Cultivation Research Consortium (GCCRC). Here we focus primarily on descriptive statistics to highlight key similarities and differences across the different national samples. Overall there was a great deal of similarity across countries in terms of: demographic characteristics; experiences with growing cannabis; methods and scale of growing operations; reasons for growing; use of cannabis and other drugs; participation in cannabis and other drug markets, and; contacts with the criminal justice system. In particular, we can recognise that a clear majority of those small-scale cannabis cultivators who responded to our survey are primarily motivated for reasons other than making money from cannabis supply and have minimal involvement in drug dealing or other criminal activities. These growers generally come from 'normal' rather than 'deviant' backgrounds. Some differences do exist between the samples drawn from different countries suggesting that local factors (political, geographical, cultural, etc.) may have some influence on how small-scale cultivators operate, although differences in recruitment strategies in different countries may also account for some differences observed. Copyright © 2014 Elsevier B.V. All rights reserved.

Teaching Process Simulation in Eleven Easy Lessons Using Excel and Its Tools

NASA Astrophysics Data System (ADS)

Morris, Arthur E.

The primary market driver for improving process technology is innovation, which requires a skilled and educated workforce. However, many Materials Science and Engineering departments have eliminated extractive metallurgy and chemical thermodynamics from their curricula, yet these topics contain the necessary fundamentals for process innovation. As a result, most MS&E students are ill-prepared for careers in processing. The dearth of process-oriented MS&E curricula has prompted some Universities to develop a "shared" effort to offer distance education between multiple institutions [1]. A target audience for a shared process simulation course would not only benefit students, but also be a basis for an on-line course for practicing engineers faced with new or changing career choices. To fill the gap, the basics of a process simulation course was developed in an abbreviated form as series of eleven articles and Excel workbooks published in Industrial Heating magazine between July 2012 and July 2013.

Fatigue in prostate cancer patients treated with external beam radiotherapy: a prospective 5-year long-term patient-reported evaluation.

PubMed

Fransson, Per

2010-01-01

Limited information is available regarding the long-term effect of external beam radiotherapy (EBRT) on fatigue in individuals with prostate cancer (PC). Men with PC treated with EBRT from January 1992 to June 2003 were enrolled in a prospective study. The QLQ-C30 questionnaire was used to evaluate pre-treatment fatigue and up to 5 years post-treatment. 407 men with 5-year assessments were analyzed. Fatigue increased between pre-treatment (mean: 15.5; CI: 13.6-17.4) and 5-years post-treatment (mean: 22.8; CI: 20.5-25.1; P<0.001). Pre-treatment fatigue was absent in 206/407 (59%) patients and 5-year post-treatment was reported by 264/407 (66%). Sixteen of 407 patients (4%) reported severe fatigue after 5 years. Physical-, emotional-, cognitive function, and dyspnea were the factors that correlated most to higher level of fatigue 5-year post-treatment. Fatigue is a common symptom among patients with PC. A large percentage of patients reported pre-treatment fatigue. Fatigue increased over time, with the highest level seen at the end of EBRT. Severe fatigue was reported by 4% 5-year post-treatment. More work is needed in order to identify which patients are most susceptible to developing fatigue especially during radiotherapy.

Community-acquired bacterial meningitis in elderly patients: experience over 30 years.

PubMed

Cabellos, Carmen; Verdaguer, Ricard; Olmo, Montse; Fernández-Sabé, Nuria; Cisnal, Maria; Ariza, Javier; Gudiol, Francesc; Viladrich, Pedro F

2009-03-01

Clinical characteristics, etiologies, evolution, and prognostic factors of community-acquired bacterial meningitis in elderly patients are not well known. To improve this knowledge, all episodes of community-acquired bacterial meningitis were prospectively recorded and cases occurring in patients >or=65 years old were selected. During the period 1977-2006, 675 episodes in adults (aged >or=18 yr) were recorded, with 185 (27%) in patients aged >or=65 years old; 76 were male and 109 were female, with a mean age of 73 +/- 6 years (range, 65-93 yr). Causative microorganisms were Streptococcus pneumoniae 74, Neisseria meningitidis 49, Listeria monocytogenes 17, other streptococcal 9, Escherichia coli 6, Haemophilus influenzae 4, Klebsiella pneumoniae and Staphylococcus aureus 2 each, Capnocytophaga canimorsus and Enterococcus faecalis 1 each, and unknown in 20. On admission 91% had had fever, 32% were in a coma (Glasgow Coma Scale patients (16%) presented with seizures during therapy. Mortality was 58/185 (31%). Compared with patients aged 18-65 years, there were significant differences among older patients (aged >or=65 yr), who showed a higher frequency of diabetes and malignancy as underlying disease; pneumonia, otitis, and pericranial fistula as predisposing factors; and S. pneumoniae and L. monocytogenes as etiology. There were also differences in clinical presentation, complications, sequelae, and mortality. Factors independently related with mortality were age, pneumonia as a predisposing factor, coma on admission, and heart failure and seizures after therapy. Dexamethasone therapy was a protective factor. In conclusion, bacterial meningitis in elderly patients is associated with greater diagnostic difficulties and neurologic severity and more complications, as well as with increased mortality. Antiseizure prophylaxis might be useful in these patients.

Laparoscopic gastropexy relieves symptoms of obstructed gastric volvulus in highoperative risk patients.

PubMed

Yates, Robert B; Hinojosa, Marcelo W; Wright, Andrew S; Pellegrini, Carlos A; Oelschlager, Brant K

2015-05-01

Operative repair of obstructive gastric volvulus is challenging. In high-operative risk patients with obstructive gastric volvulus, we perform laparoscopic reduction of gastric volvulus and anterior abdominal wall sutured gastropexy. This case series reports our experience with this operation. We reviewed the charts of all patients who presented with obstructive gastric volvulus and underwent laparoscopic gastropexy between 2007 and 2013. Eleven patients underwent laparoscopic gastropexy. Median age was 83 years (50 to 92). Six patients presented with chronic obstruction; 5 presented with acute obstruction. Median postoperative hospitalization was 2 days (1 to 39). Two patients required reoperation for displaced gastrostomy tubes. At median follow-up of 3 months (2 weeks to 57 months), all patients remained free of gastric obstructive symptoms and recurrent episodes of volvulus. Only 1 patient received nutrition via gastrostomy tube. Laparoscopic gastropexy can treat obstructed gastric volvulus in highoperative risk patients. Because of associated morbidity, gastrostomy tubes should be placed selectively. Copyright © 2015 Elsevier Inc. All rights reserved.

Complications and 1-year benefit of cardiac resynchronization therapy in patients over 75 years of age - Insights from the German Device Registry.

PubMed

Köbe, Julia; Andresen, Dietrich; Maier, Sebastian; Stellbrink, Christoph; Kleemann, Thomas; Gonska, Bernd-Dieter; Reif, Sebastian; Hochadel, Matthias; Senges, Jochen; Eckardt, Lars

2017-02-01

Evidence on cardiac resynchronization therapy (CRT) in older patients is scarce and conflicting. Nevertheless, CRT in the elderly is of major practical relevance as heart failure prevalence increases with age. The German Device Registry (DEVICE) is a nationwide, prospective registry with a longitudinal follow-up design investigating device implantations in 60 German centres. The present analysis of DEVICE focussed on perioperative complication rates and 1-year outcome of patients ≥75years (n=320) compared to younger patients (n=879) receiving a CRT device. Comorbidities were more common in older patients (chronic kidney disease (CKD): 27.5% vs. 21.5%, p=0.029; atrial fibrillation (AF): 26.9% vs. 15.6%, p<0.001). Despite higher NYHA classes in the older age group, ejection fractions were comparable (27.2±7.1% ≥75years, 26.2±7.1% <75years, p=0.06). Perioperative complications and mortality rates did not show significant difference between groups. After new device implantation, absolute 1-year mortality was higher in older patients (11.0% ≥75years, 6.4% <75years, p=0.014), with a significantly lower proportion of cardiac deaths in the older group (p=0.05). Patients ≥75years being alive after 1year had lower response rates, with chronic kidney disease (OR 0.46, p<0.05) and smaller QRS complexes (OR 0.31, p<0.01) being particular risk factors for missing improvement of heart failure symptoms. As expected severe heart failure (NYHA IV) was a strong independent predictor of death (HR 1.95, p=0.01), whereas AF as underlying rhythm could be worked out as predictor for mortality especially in the younger patients (HR 2.31, p=0.002). Patients ≥75years of age receiving a CRT device do not have a higher perioperative mortality and complication rate although comorbidities (CKD and AF) occur more frequently. The absolute 1-year mortality is higher; nevertheless, the proportion of cardiac deaths is even lower in the older patients reflecting a benefit of CRT in this

[Acute poisoning in patients over 65 years of age].

PubMed

Miranda Arto, P; Ferrer Dufol, A; Ruiz Ruiz, F J; Menao Guillén, S; Civeira Murillo, E

2014-01-01

There are few Spanish studies on acute poisoning in the elderly despite the associated risk factors of this group of patients. Retrospective descriptive study of acute poisonings treated in the Emergency Service of the University Hospital of Zaragoza from 1995 to 2009 on patients 65 years old or older. A total of 762 patients were selected in the study (4.74% of all acute poisonings) with a mean age of 74.16 (SD ± 6) years. Ingestion was the major route of exposure (85%) and alcohol overdose (28,7%) was the most frequent type of poisoning. A trend was also observed showing a lower emetic treatment and gastric lavage and an increase in activated charcoal. Benzodiazepines (14.3%) and toxic household products (11%) with caustic properties were also the main toxics found in the study. Acute poisonings in the elderly required more hospitalizations, have a higher mortality and more autolytic attempts which result in death.

An eleven-year record of mass balance of Brewster Glacier, New Zealand, determined using a geostatistical approach

NASA Astrophysics Data System (ADS)

Cullen, N. J.; Anderson, B.; Sirguey, P. J.; Stumm, D.; Mackintosh, A.; Conway, J. P.; Horgan, H. J.; Dadic, R.; Fitzsimons, S.; Lorrey, A.

2016-12-01

Recognizing the scarcity of glacier mass balance data in the Southern Hemisphere, a mass balance measurement program was started at Brewster Glacier in 2004. Evolution of the measurement regime over the 11 years of data recorded means there are differences in the spatial density of data obtained. To ensure the temporal integrity of the dataset a new, geostatistical approach has been developed to calculate mass balance. Spatial co-variance between elevation and snow depth has enabled a digital elevation model to be used in a co-kriging approach to develop a snow depth index (SDI). By capturing the observed spatial variability in snow depth, the SDI is a more reliable predictor than elevation and is used to adjust each year of measurements consistently despite variability in sampling spatial density. The SDI also resolves the spatial structure of summer balance better than elevation. Co-kriging is used again to spatially interpolate a derived mean summer balance index using SDI as a co-variate, which yields a spatial predictor for summer balance. A similar approach is also used to create a predictor for annual balance, which allows us to revisit years where summer balance was not obtained. The average glacier-wide surface winter, summer and annual mass balances over the period 2005-2015 are 2484, -2586, and -102 mm w.e., respectively, with changes in summer balance explaining most of the variability in annual balance. On the whole, there is good agreement between our ELA and AAR values and those derived from the end-of-summer snowline (EOSS) program, though discrepancies in some years cannot be fully accounted for. A mass balance map of Brewster Glacier in an equilibrium state, which by definition has a glacier-wide mass balance equal to zero (a balanced-budget), is used to calculate values of ELA (1923 ±25 m) and AAR (0.40) representative of the observational period. The relationships between mass balance and ELA/AAR are explored, demonstrating they are mostly

Improving vaccine-related pain, distress or fear in healthy children and adolescents - a systematic search of patient-focused interventions.

PubMed

Lee, Vivian Y; Caillaud, Corinne; Fong, Jacqueline; Edwards, Kate M

2018-05-24

The WHO recently highlighted the need for research into potential interventions that can be used to mitigate pain during mass vaccinations, in addition to interventions specific for adolescents. The current review examines the literature on potential interventions that can be used during mass vaccination settings in healthy individuals between the ages of 4 and 15 years old. Criteria for inclusion were: 1)participants between the ages of 4-15 years, 2)interventions that were patient-focused, 3)vaccinations in healthy individuals, 4)outcome measures to include self-reported pain, fear or distress. Twenty-seven articles were identified with a total of 31 interventions. Eleven interventions used injection-site specific interventions, 17 used patient-led interventions and three used a combination of both site-specific and patient-led interventions. Interventions using coolant and vibration together, as well as a combination of site-specific and patient-led interventions, showed the most consistent effects in reducing self-reported pain, fear or distress.

Interpretation of Contrastive Pitch Accent in Six- to Eleven-Year-Old English-Speaking Children (and Adults)

ERIC Educational Resources Information Center

Ito, Kiwako; Bibyk, Sarah A.; Wagner, Laura; Speer, Shari R.

2014-01-01

Both off-line and on-line comprehension studies suggest not only toddlers and preschoolers, but also older school-age children have trouble interpreting contrast-marking pitch prominence. To test whether children achieve adult-like proficiency in processing contrast-marking prosody during school years, an eye-tracking experiment examined the…

[DOPPS estimate of patient life years attributable to modifiable hemodialysis practices in France].

PubMed

Canaud, Bernard; Combe, Christian; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Friedrich K

2008-07-01

In this study, we used a prevalent cross-sectional sample of French hemodialysis patients from Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 (2002-2004) to determine the percentage of patients whose values failed to meet targets in six different areas of hemodialysis practice (dialysis dose, anemia, serum phosphorus (PO(4)), serum calcium (Ca), serum albumin and catheter use for vascular access). Cox survival models, with adjustments for patient characteristics, were used for these analyses to estimate mortality hazard ratios (HR). Based on the mortality HR, the fraction of patients outside each target and the total HD population in France, we estimated the number of patient life years that could potentially be gained if every chronic, in-center hemodialysis patient in France who is currently outside of the specified target was able to achieve it. The proportion of patients failing to meet one of the six practice targets in France varied from 15% (dialysis dose) to 75% (albumin) while the percentage of patients complying with all six targets was restricted to 1.2%. The relative risk of mortality (RR) associated with being outside these targets varied from 1.12 to 1.46. Based on these two measures the life-years survival was estimated. The projected number of patients and life years potentially gained from adherence to the six targets was estimated close to 10,600 years-patient. In conclusion, this study suggests large opportunities to improve hemodialysis patient care in France still exist. Compliance with two major practice targets, such as albumin and restriction of catheter use will save highly significant life years of hemodialysis patient. Implementing and strict adherence to national and international guidelines should serve as a basic inspiration for continual improvement of hemodialysis patient care.

Teriflunomide for the treatment of relapsing-remitting multiple sclerosis: patient preference and adherence.

PubMed

Bayas, Antonios; Mäurer, Mathias

2015-01-01

Multiple sclerosis (MS), a chronic demyelinating neuroinflammatory disease of the central nervous system, is the most common neurological disorder leading to disability in young adulthood. In the last 2 decades, numerous treatments for relapsing-remitting MS have been approved with eleven treatment options available worldwide. One of the determinants in treatment selection is disease activity in the individual patient. However, patient preferences play an increasingly major role in treatment decision making. With teriflunomide, a reversible inhibitor of the enzyme dihydroorotate dehydrogenase, a new oral therapeutic option, given once daily, has been approved within the last 2 years by the regulatory agencies. The current review focuses on characteristics of the drug relevant for patients' preferences in the treatment decision process in the light of the available medications. Perceiving and considering patients' preferences will have an effect on treatment adherence, which is known to be often low in MS patients. Teriflunomide-related adherence issues will also be discussed regarding mode of application, dosing, and potential side effects.

Cognitive impairments in former patients with work-related stress complaints - one year later.

PubMed

Eskildsen, Anita; Andersen, Lars Peter; Pedersen, Anders Degn; Andersen, Johan Hviid

2016-11-01

Patients on sick leave due to work-related stress often present with cognitive impairments. The aim of this prospective cohort study was to examine the long-term consequences of prolonged work-related stress in terms of cognitive functioning one year after initial professional care seeking. We tested a group of patients with work-related stress with a comprehensive neuropsychological test battery at two occasions, one year apart. At both time points, we compared the performance of patients with healthy controls matched pairwise on sex, age and length of education. This paper presents the results from the one-year follow-up. When adjusting for practice effects, patients improved on measures of prospective memory and processing speed. However, patients continued to perform worse than controls on all tests, though only half of the comparisons reached statistical significance. The effect sizes of the differences between the two groups at one-year follow-up were small to medium. In conclusion, former patients with prolonged work-related stress improved, but they continued to perform worse than controls after one year. In the acute phase, the largest impairments were related to executive function and mental speed but at follow-up memory impairments also became apparent.

How are the ancient cystic fibrosis patients? Cystic fibrosis diagnosed over 60 years-old.

PubMed

Prados, C; Lerín, M; Cabanillas, J J; Gómez-Carrera, L; Álvarez-Sala, R

2017-01-01

To specify the prevalence of patients diagnosed with CF at age of ≥60 year-old and to analyze their characteristics. Observational study of CF patients which were diagnosed at age ≥60 year-old. The analyzed variables were: age, sex, nationality, lung function parameters, conditions present at diagnosis, microbiological characteristics and genetic findings. eight patients were included. 7 patients were female (87.5%) with a mean age of 70.6 years (median 71.5 years, range 60-78 years). The most important findings were: sweat test >60 mEq/l; heterozygotes F508del; bronchiectasis in CT; methicillin-sensitive Staphylococcus aureus (50%) in sputum. The most patients presented a normal or mild obstructive lung function. CF must also be considered a disease diagnosed in adulthood, incorporating the sweat test within the usual techniques of differential diagnosis in patients with different diseases associated with CF, because genetic counselling is esencial.

Health literacy and the clozapine patient.

PubMed

Brosnan, Susan; Barron, Elizabeth; Sahm, L J

2012-01-01

To estimate the prevalence of limited health literacy in patients receiving clozapine for schizophrenia. To develop and produce a pharmacist-designed clozapine patient information leaflet (PIL) which has a higher readability score than the company-produced PIL. This was a cross sectional prevalence study. Ethical approval for the study was granted by the local ethics committee. Patients, over 18 years, attending the Clozapine Clinic of a Cork urban teaching hospital, were asked to participate in the study. Demographics such as gender, age, employment and smoking status, were gathered from all participants. The total daily clozapine dose, duration of clozapine treatment, and information regarding the clozapine DVD was also noted. The Rapid Estimate of Adult Literacy in Medicine (REALM) health literacy (HL) screening tool was then administered to each patient. A user-friendly PIL on clozapine was designed by the pharmacist, which was assessed for readability and compared to the company-produced PIL using the FRES and FKGL. Data were analysed using SPSS Version 15. Forty patients (65% male, 95% unemployed and 70% smokers) of average age 38.0 years (+/- 11.2) completed the REALM. The average score was 60.6 (+/- 8.7). Twenty-nine patients (72.5%) were found to have "adequate" health literacy. The remaining eleven patients were found to have either "marginal" or "low" health literacy. The pharmacist-designed PIL would have been readable by 95% of the study population, in contrast to 72.5% with the company-designed PIL. More than a quarter of the population were found to have marginal or low health literacy. Patient information should be matched to the health literacy level of the target population.

Progression of cognitive impairment in stroke/TIA patients over 3 years.

PubMed

Sachdev, Perminder S; Lipnicki, Darren M; Crawford, John D; Wen, Wei; Brodaty, Henry

2014-12-01

To examine how cognitive deficits progress in the years following a stroke or transient ischaemic attack (TIA). A follow-up study, with neuropsychological and MRI assessments undertaken 3 years after baseline assessments made 3-6 months poststroke in 183 stroke/TIA patients and 97 healthy controls participating in the Sydney Stroke Study. Additional measures included cardiovascular risk factors and apolipoprotein E (APOE) genotype. Stroke/TIA patients had poorer cognitive function and more vascular risk factors than controls at baseline, but did not show greater decline in cognitive function over 3 years except for verbal memory. Patients with a subsequent stroke/TIA showed greater decline in global cognitive function and a number of domains. Rates of incident dementia were 5.9% per year in patients and 0.4% in controls. Both groups showed increased atrophy of the hippocampus, amygdala and whole brain, and an increase in white matter hyperintensities over 3 years; whole brain atrophy was greater in patients. Cognitive decline was greater in women and in those with smaller hippocampi at baseline. For patients without a subsequent stroke/TIA, those with smaller hippocampi or the APOE ε4 allele had greater global cognitive and verbal memory decline. In poststroke patients, cognitive decline was not greater than in comparison subjects, except for verbal memory, unless they had another stroke/TIA. However, dementia incidence was higher in patients, as might be expected from their poorer baseline cognitive functioning. Smaller hippocampi were associated with an increased risk of decline in memory, and APOE ε4 was a risk factor in those without a subsequent stroke/TIA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Schizophrenia with Onset before the Age of Eleven: Clinical Characteristics of Onset and Course.

ERIC Educational Resources Information Center

Eggers, Christian; Bunk, Detlef; Krause, Dieter

2000-01-01

This study reports on the long-term course of 11 patients with childhood onset schizophrenia (COS). Patients were examined twice (mean follow-up period 38 years after onset). Various temporary premorbid behavioral peculiarities were precursors of COS. The nature of the diagnostic subtypes varied markedly across the course of the illness with…

Eleven-year loblolly pine growth in respononse to site preparation and seedling type in North Louisiana

Treesearch

Michael A. Blazier; Terry R. Clason

2006-01-01

On a well-drained site in northwest Louisiana, effects of seedling type (container, bareroot) and herbicide site preparation (hexazinone, hexazinone + sulfometuron, imazapyr + metsulfuron) on loblolly pine growth and survival have been tested for 11 years. All possible combinations of these treatments were applied to loblolly pine planted at 302 trees acre-1, and these...

Spinning-induced Rhabdomyolysis: Eleven Case Reports and Review of the Literature

PubMed Central

Kim, Daejin; Ko, Eun-Jung; Cho, HyeJeong; Park, Su Hyung; Lee, Sang Hwan; Cho, Nam-gil; Lee, So-Young; Jeong, Hye Yun

2015-01-01

Non-traumatic exertional rhabdomyolysis (exRML) occurs in individuals with normal muscles when the energy supplied to the muscle is insufficient. Here, we report 11 cases of spinning-induced rhabdomyolysis and review related literature. Spinning is a kind of indoor bicycle sport. The 11 patients who were diagnosed with exRML and admitted to CHA Bundang Medical Center were female and their ages ranged from 15 to 46 years. Two to three days prior to the presentation, the patients had attended a spinning class for the first time. All the patients had been otherwise healthy without any known medical illnesses. They were successfully treated without any complications, except mild non-symptomatic hypocalcemia. However, in the literature, severe complications such as compartment syndrome or acute kidney injury had been reported in relation to exRML including spinning-induced rhabdomyolysis. This spinning exercise needs prior guidelines and specific warnings to prevent exertional rhabdomyolysis. PMID:26848305

Major bleeding caused by warfarin in a genetically susceptible patient.

PubMed

Bloch, Aharon; Ben-Chetrit, Eldad; Muszkat, Mordechai; Caraco, Yoseph

2002-01-01

A 90-year-old woman was hospitalized for gastrointestinal bleeding. Although she had been receiving only warfarin 5 mg/day, her international normalized ratio (INR) was 66. Warfarin was discontinued, and her INR fell to 3.7 after transfusion of fresh-frozen plasma. However, it rose again spontaneously to 7.5. Eleven days after the last dose of warfarin had been administered, it was still detectable in the patient's plasma, indicating that impaired warfarin clearance may have caused an enhanced anticoagulation effect. Genetic analysis of the cytochrome P450 (CYP) isoenzyme 2C9, which mediates the major deactivating pathway of S-warfarin, revealed that the patient was a compound heterozygote carrying two variant alleles: CYP2C9*2 and CYP2C9*3. The patient's enhanced sensitivity to warfarin 5 mg/day can be ascribed to decreased clearance of S-warfarin secondary to genetic alteration of the gene encoding CYP2C9, resulting in a life-threatening complication.

Improving awareness, accountability, and access through health coaching: qualitative study of patients' perspectives.

PubMed

Liddy, Clare; Johnston, Sharon; Irving, Hannah; Nash, Kate; Ward, Natalie

2015-03-01

To assess patients' experiences with and perceptions of health coaching as part of their ongoing care. A qualitative research design using semistructured interviews that were recorded and transcribed verbatim.Setting Ottawa, Ont. Eleven patients (> 18 years of age) enrolled in a health coaching pilot program who were at risk of or diagnosed with type 2 diabetes. Patients' perspectives were assessed with semistructured interviews. Interviews were conducted with 11 patients at the end of the pilot program, using a stratified sampling approach to ensure maximum variation. All patients found the overall experience with the health coaching program to be positive. Patients believed the health coaching program was effective in increasing awareness of how diabetes affected their bodies and health, in building accountability for their health-related actions, and in improving access to care and other health resources. Patients perceive one-on-one health coaching as an acceptable intervention in their ongoing care. Patients enrolled in the health coaching pilot program believed that there was an improvement in access to care, health literacy, and accountability,all factors considered to be precursors to behavioural change.

Peroral endoscopic myotomy for achalasia in patients aged ≥ 65 years

PubMed Central

Li, Chen-Jie; Tan, Yu-Yong; Wang, Xue-Hong; Liu, De-Liang

2015-01-01

AIM: To investigate the safety and efficacy of peroral endoscopic myotomy (POEM) for achalasia in patients aged ≥ 65 years. METHODS: From November 2011 to August 2014, 15 consecutive patients (aged ≥ 65 years) diagnosed with achalasia were prospectively recruited and all underwent POEM at our institution. Eckardt score, lower esophageal sphincter (LES) pressure, esophageal diameter, SF-36 questionnaire, and procedure-related complications were used to evaluate the outcomes. RESULTS: All 15 patients were treated successfully by POEM, with a median operation time of 55 min. Median myotomy length was 10 cm. Three patients underwent circular myotomy and 12 full-thickness myotomies. Symptoms remitted in all cases during post-POEM follow-up of 6-39 mo. Eckardt score reduced significantly (pre-operation vs post-operation: 8.0 vs 1.0, P < 0.05). Median LES pressure decreased from 27.4 to 9.6 mmHg (P < 0.05). Median diameter of the esophagus was significantly decreased (pre-operation vs post-operation: 51.0 mm vs 30.0 mm, P < 0.05). Only one patient had reflux, which was resolved with oral proton pump inhibitors. No serious complications related to POEM were found. The quality of life of the 15 patients improved significantly after POEM. CONCLUSION: POEM is a safe and effective technique for treatment of achalasia in patients aged ≥ 65 years, with improvement in symptoms and quality of life. PMID:26290645

Gentamicin ototoxicity: a 23-year selected case series of 103 patients.

PubMed

Ahmed, Rebekah M; Hannigan, Imelda P; MacDougall, Hamish G; Chan, Raymond C; Halmagyi, G Michael

2012-06-18

To review patients with severe bilateral vestibular loss associated with gentamicin treatment in hospital. A retrospective case series of presentations to a balance disorders clinic between 1988 and 2010. Relationship between vestibulotoxicity and gentamicin dose or dosing profile; indications for prescribing gentamicin. 103 patients (age, 18-84 years; mean, 64 years) presented with imbalance, oscillopsia or both, but none had vertigo. Only three noted some hearing impairment after having gentamicin, but audiometric thresholds for all patients were consistent with their age. In all patients, the following tests gave positive results: a bilateral clinical head-impulse test, a vertical head-shaking test for vertical oscillopsia, and a foam Romberg test. In 21 patients, imbalance occurred during gentamicin treatment (ignored or dismissed by prescribers in 20) and in 66 after treatment; the remaining 16 could not recall when symptoms were first noticed, except that it was after gentamicin treatment in hospital. Total gentamicin dose range was 2-318 mg/kg (mean, 52 mg/kg), daily dose range was 1.5-5.6 mg/kg (mean, 3.5mg/kg), and duration was 1-80 days (mean, 17 days). Six patients had only a single dose; 26 had five or fewer doses. Serum gentamicin levels, measured in 82 patients, were in the recommended range in 59. Time to diagnosis ranged from 4 days to 15 years. Nephrotoxicity developed in 43 patients. Gentamicin dosage complied with contemporary or current Australian antibiotic guidelines in under half the patients. Gentamicin ototoxicity is vestibular, not cochlear, producing permanent loss of balance, but not of hearing. Gentamicin can be vestibulotoxic in any dose, in any regimen, at any serum level.

The Mosaic bioprosthesis in the aortic position: 17 years' results.

PubMed

Gansera, Brigitte; Hapfelmeier, Alexander; Brandl, Kristina; Spiliopoulos, Kyriakos; Gundling, Felix; Eichinger, Walter

2014-02-01

The Mosaic bioprosthesis (Medtronic Inc., Minneapolis, Minnesota, United States), a stented porcine aortic valve, combines glutaraldehyde fixation with zero-pressure, root-pressure techniques and antimineralization treatment with amino-oleic acid for improved hemodynamics and tissue durability. The first device has been implanted worldwide at the authors' institution in September 1993. The aim of the present study was to collect mid- to long-term data of the prosthesis. A total of 272 patients (124 males and 148 females) underwent isolated aortic valve replacement with the Mosaic bioprosthesis between September 1993 and August 2007. Median age at implant was 76.8 years (range, 31.3 to 90.7). Median follow-up was 12.0 years (range, 0 to 17.2 years); follow-up was complete for 223 (82%) patients. Early mortality (30 days) was 4% (12 patients). Overall survival at 5, 10, 15, and 17 years was 68.6% ± 3.1%, 36.4% ± 3.3%, 17.1% ± 3.6%, and 10.7% ± 4.3%, respectively. Eleven late deaths (5%) were cardiac related. There were 24 thromboembolic events, 1 hemorrhagic, and 6 reoperations/explants. At a median follow-up of 12 years, freedom from any cause of death was 27.0% ± 3.2% acting as a competing risk for the incidence of thromboembolic events (16.4% ± 3.5%), hemorrhage (0.5% ± 0.5%), and reoperation/explant (4.1% ± 1.8%). Two redos were due to structural valve deterioration (SVD), two for nonstructural dysfunction (paravalvular leakage), one for thrombosed prosthesis, and one for endocarditis. Performance and late outcome of the Mosaic bioprosthesis was satisfactory during 17 years after clinical introduction. The Mosaic bioprosthesis showed low incidence of SVD or need for reoperation in the long term. Georg Thieme Verlag KG Stuttgart · New York.

Three-Year Follow-Up Study in Patients with Guillain-Barré Syndrome.

PubMed

Martic, Vesna; Bozovic, Ivo; Berisavac, Ivana; Basta, Ivana; Peric, Stojan; Babic, Milica; Rajic, Sonja Lukic; Bjelica, Bogdan; Stojiljkovic Tamas, Olivera; Stojanov, Aleksandar; Grunauer, Marija; Cobeljic, Mina; Komatina, Nenad; Djuric, Vanja; Petrovic, Milutin; Vujovic, Balsa; Dominovic Kovacevic, Aleksandra; Djordjevic, Gordana; Jovanovic, Dejana; Stevic, Zorica

2018-05-01

A majority of patients with Guillain-Barré syndrome (GBS) have tendency of a good recovery. Our aim was to evaluate the outcome of the disease 1 and 3 years after GBS symptom onset. During 2014, GBS was diagnosed in 82 patients in seven tertiary healthcare centers. Neurological follow-up was conducted in 57 (70%) patients after 1 year, and in 54 (66%) after 3 years. Functional disability was estimated according to the GBS disability scale (GDS), with a score of 0-3 indicating mild disability and a score of 4-6 indicating severe disability during acute phase, whereas a score >1 indicated poor recovery on follow-ups. Visual analog scale was used to assess sensory symptoms and musculoskelatal pain, and Krupp's Fatigue Severity Scale was used to asses fatigue. Poor functional outcome was found in 39% of GBS patients at year 1 and 30% at year 3. Paresthesias/dysesthesias were detected in 60% of patients after 1 year and 43% after 3 years. Musculoskeletal pain was present in 40% of patients at year 1 and 33% at year 3. Significant fatigue after 1 year was found in 21% of subjects and after 3 years in 7%. Parameters associated with poor functional outcome after 1 year were age >55 years (p=0.05), severe disability at admission (p1 indique une récupération difficile au moment des suivis. L'échelle visuelle analogue (EVA) a aussi été utilisée pour évaluer leurs symptômes sensoriels et leurs douleurs musculo-squelettiques. Enfin, l'échelle de gravité de la fatigue de Krupp a été utilisée pour évaluer leur degré de fatigue. Résultats: La première année, on a observé une piètre amélioration des capacités fonctionnelles chez 39% des patients atteints du SGB; pour la troisième année, cette proportion était de 30%. Au bout d'un an, on a aussi détecté la présence de paresthésie/dysesthésie chez 60% des patients; pour la troisième année, cette proportion était de 43%. Des douleurs musculo-squelettiques ont été rapportées chez 40% des patients

Respirable Crystalline Silica Exposures During Asphalt Pavement Milling at Eleven Highway Construction Sites

PubMed Central

Hammond, Duane R.; Shulman, Stanley A.; Echt, Alan S.

2016-01-01

Asphalt pavement milling machines use a rotating cutter drum to remove the deteriorated road surface for recycling. The removal of the road surface has the potential to release respirable crystalline silica, to which workers can be exposed. This paper describes an evaluation of respirable crystalline silica exposures to the operator and ground worker from two different half-lane and larger asphalt pavement milling machines that had ventilation dust controls and water-sprays designed and installed by the manufacturers. Manufacturer A completed milling for eleven days at four highway construction sites in Wisconsin, while Manufacturer B completed milling for ten days at seven highway construction sites in Indiana. To evaluate the dust controls, full-shift personal breathing zone air samples were collected from an operator and ground worker during the course of normal employee work activities of asphalt pavement milling at eleven different sites. Forty-two personal breathing zone air samples were collected over 21 days (sampling on an operator and ground worker each day). All samples were below 50 µg/m3 for respirable crystalline silica, the National Institute for Occupational Safety and Health recommended exposure limit. The geometric mean personal breathing zone air sample was 6.2 µg/m3 for the operator and 6.1 µg/m3 for the ground worker for the Manufacturer A milling machine. The geometric mean personal breathing zone air sample was 4.2 µg/m3 for the operator and 9.0 µg/m3 for the ground worker for the Manufacturer B milling machine. In addition, upper 95% confidence limits for the mean exposure for each occupation were well below 50 µg/m3 for both studies. The silica content in the bulk asphalt material being milled ranged from 7% to 23% silica for roads milled by Manufacturer A and from 5% to 12% silica for roads milled by Manufacturer B. The results indicate that engineering controls consisting of ventilation controls in combination with water-sprays are

Optimal installation locations for automated external defibrillators in Taipei 7-Eleven stores: using GIS and a genetic algorithm with a new stirring operator.

PubMed

Huang, Chung-Yuan; Wen, Tzai-Hung

2014-01-01

Immediate treatment with an automated external defibrillator (AED) increases out-of-hospital cardiac arrest (OHCA) patient survival potential. While considerable attention has been given to determining optimal public AED locations, spatial and temporal factors such as time of day and distance from emergency medical services (EMSs) are understudied. Here we describe a geocomputational genetic algorithm with a new stirring operator (GANSO) that considers spatial and temporal cardiac arrest occurrence factors when assessing the feasibility of using Taipei 7-Eleven stores as installation locations for AEDs. Our model is based on two AED conveyance modes, walking/running and driving, involving service distances of 100 and 300 meters, respectively. Our results suggest different AED allocation strategies involving convenience stores in urban settings. In commercial areas, such installations can compensate for temporal gaps in EMS locations when responding to nighttime OHCA incidents. In residential areas, store installations can compensate for long distances from fire stations, where AEDs are currently held in Taipei.

Optimal Installation Locations for Automated External Defibrillators in Taipei 7-Eleven Stores: Using GIS and a Genetic Algorithm with a New Stirring Operator

PubMed Central

Wen, Tzai-Hung

2014-01-01

Immediate treatment with an automated external defibrillator (AED) increases out-of-hospital cardiac arrest (OHCA) patient survival potential. While considerable attention has been given to determining optimal public AED locations, spatial and temporal factors such as time of day and distance from emergency medical services (EMSs) are understudied. Here we describe a geocomputational genetic algorithm with a new stirring operator (GANSO) that considers spatial and temporal cardiac arrest occurrence factors when assessing the feasibility of using Taipei 7-Eleven stores as installation locations for AEDs. Our model is based on two AED conveyance modes, walking/running and driving, involving service distances of 100 and 300 meters, respectively. Our results suggest different AED allocation strategies involving convenience stores in urban settings. In commercial areas, such installations can compensate for temporal gaps in EMS locations when responding to nighttime OHCA incidents. In residential areas, store installations can compensate for long distances from fire stations, where AEDs are currently held in Taipei. PMID:25045396

Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur?

PubMed

Sevelda, Florian; Waldstein, Wenzel; Panotopoulos, Joannis; Kaider, Alexandra; Funovics, Philipp Theodor; Windhager, Reinhard

2018-05-01

The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup. The most common primary disease was breast cancer. In general, during this period, our indications for this procedure were extensive metastatic disease precluding internal fixation or isolated proximal or distal femur replacement, and an anticipated lifespan exceeding 6 months. Our contraindication for this procedure during this time was expected lifespan less than 6 months. Patient survival was assessed by Kaplan-Meier analysis; implant survival free from revision surgery and amputation were assessed by competing risk analysis. Function was determined preoperatively and 6 to 12 weeks postoperatively with the Musculoskeletal Tumor Society (MSTS) score normalized to a 100-point scale, with higher scores representing better function from a longitudinally maintained institutional database. Eleven patients died at a median of 5 months (range, 1-31 months) after surgery. One-year revision-free and limb survival were 82% (95% CI, 51%-98%) and 91% (95% CI, 61%-99%), respectively. Reasons for reoperation were hip dislocation, infection and local recurrence in one patient each. The

IDENTIFYING ELEVEN FACTORS OF SERVICE MARKETING MIX (4PS) EFFECTIVE ON TENDENCY OF PATIENTS TOWARD PRIVATE HOSPITAL

PubMed Central

Hosseini, Seyed Mojtaba; Etesaminia, Samira; Jafari, Mehrnoosh

2016-01-01

Introduction: One of the important factors of correct management is to identify the reasons for patient tendency toward private hospitals. This study measures these factors based on service marketing mixes. Patients and methods: This study used a cross sectional descriptive methodology. The study was conducted during 6 months in 2015. The studied population included patients of private hospitals in Tehran. Random sampling was used (n = 200). Data was collected by an author-made questionnaire for service marketing factors. Reliability and validity of the questionnaire were confirmed. Data analysis was done using factor analysis test in SPSS 20. Results: The results showed that constant attendance of physicians and nurses has the highest effect (0.707%) on patient tendency toward private hospitals. PMID:27999486

Thromboembolism in patients with pericardial valves in the absence of chronic anticoagulation: 12 years' experience.

PubMed

García-Bengoechea, J B; González-Juanatey, J R; Rubio, J; Durán, D; Sierra, J

1991-01-01

Between January 1977 and January 1989, 465 pericardial bioprostheses were implanted in 424 patients. The mean age of patients was 59.1 years (range 16-81 y.) At the time of surgery, 68% of the patients suffered from chronic atrial fibrillation. Mitral valve replacement was performed in 167 patients, aortic valve replacement in 216, multiple replacement in 40 (36 mitral and aortic, 3 mitral and tricuspid, and 1 mitral, aortic and tricuspid), and 1 pulmonary valve replacement. The different types of pericardial valve used were: Ionescu-Shiley 408, Mitral Medical 23, Bioflo 30, and Hancock 4. Hospital mortality was 10.1% with an attrition rate of 1.8 episodes per 100 patients/year. The 12-year actuarial survival rate was 65.1%. No patient underwent long-term anticoagulant treatment. The first 144 patients undergoing mitral and multiple valve replacements received temporary anticoagulation for the first 8 weeks after surgery. There was no valve thrombosis observed. Altogether 19 thromboembolic events (6 early and 13 late) were clinically documented. One patient died after an embolic event. The linearized rates of thromboembolism were 1.64 episodes per 100 patients/year for mitral and multiple valve replacements and 0.33 episodes per 100 patients/year for aortic valve replacement, with an overall rate of 1.0 episodes per 100 patients/year. Excluding early thromboembolism, the linearized rate was 1.02 episodes per 100 patients/year overall. The actuarial freedom from embolism was 92.4% overall, 88.2% for the mitral and multiple valve replacement group, and 97.6% for the aortic valve replacement group at a maximum follow-up of 12 years.(ABSTRACT TRUNCATED AT 250 WORDS)

The eleven observations of comets between 687 AD and 1114 AD recorded in the Anglo Saxon Chronicle

NASA Technical Reports Server (NTRS)

Mardon, E. G.; Williams, J.; Mardon, A. A.

1992-01-01

This research paper is an examination of the eleven cometary references (679AD, 729AD, 892AD, 950AD, 975AD, 995AD, 1066AD, 1097AD, 1106AD, 1110AD and 1114AD) found in the various manuscripts of The Anglo Saxon Chronicle between 678 AD and 1114 AD. The manuscripts contain more than 35 celestial observations. This is an examination of astronomical phenomena and other climatic or natural events, that are described in The Anglo Saxon Chronicle, which is also referred to as The Old English Annals.

The eleven observations of comets between 687 AD and 1114 AD recorded in the Anglo Saxon Chronicle

NASA Astrophysics Data System (ADS)

Mardon, E. G.; Mardon, A. A.; Williams, J.

1992-12-01

This research paper is an examination of the eleven cometary references (679AD, 729AD, 892AD, 950AD, 975AD, 995AD, 1066AD, 1097AD, 1106AD, 1110AD and 1114AD) found in the various manuscripts of The Anglo Saxon Chronicle between 678 AD and 1114 AD. The manuscripts contain more than 35 celestial observations. This is an examination of astronomical phenomena and other climatic or natural events, that are described in The Anglo Saxon Chronicle, which is also referred to as The Old English Annals.

Acute acalculous cholecystitis in patients with systemic lupus erythematosus: A unique form of disease flare.

PubMed

Yang, H; Bian, S; Xu, D; Zhang, F; Zhang, X

2017-09-01

Objective We aimed to investigate the clinical features of acute acalculous cholecystitis (AAC) in patients with systemic lupus erythematosus (SLE). Methods SLE patients with AAC hospitalized in the Peking Union Medical College Hospital (PUMCH) from January 2001 to September 2015 were retrospectively analyzed. Their medical records were systematically reviewed. The diagnosis of AAC was based on clinical manifestations and confirmed by radiologic findings including a distended gallbladder with thickened wall, pericholecystic fluid and absence of gallstones. Results Among the 8411 hospitalized SLE patients in PUMCH, 13 (0.15%) were identified to have SLE-AAC. Eleven (84.6%) of them were female, with a mean age of 30.1 ± 8.6 years. AAC was the initial manifestation of SLE in four (30.8%) cases. Eleven (84.6%) patients complained of fever and abdominal pain, four (30.8%) had positive Murphy's sign and six (46.2%) had elevated liver enzymes. The median SLE Disease Activity Index was 8.0 (range 0-20.0) at the time of AAC. Other affected organs in SLE-AAC included kidney (11, 84.6%) and hematologic system (11, 84.6%), followed by mucocutaneous (seven, 53.8%), musculoskeletal (seven, 53.8%) and neuropsychiatric (two, 15.4%) systems. All patients received treatment of glucocorticoids and immunosuppressants but none underwent surgical intervention. During a median follow-up of 28 months (range, 2-320 months), 12 cases (92.4%) responded to treatment with no relapse and one patient (7.6%) died of septic shock. Conclusion Our study suggests that AAC is a relatively uncommon and underestimated gastrointestinal involvement of SLE that is often associated with active disease. For patients with AAC in SLE, treatment with aggressive glucocorticoids could result in a good prognosis.

A register-based 13-year to 43-year follow-up of 70 patients with obsessive-compulsive disorder treated with capsulotomy.

PubMed

Rück, Christian; Larsson, Johan K; Mataix-Cols, David; Ljung, Rickard

2017-06-06

Little is known about the long-term medical status of patients with severe obsessive-compulsive disorder (OCD) undergoing capsulotomy, a neurosurgical last-resort treatment. The present study used national registers to identify all operated patients with OCD in Sweden and evaluated their long-term medical status, including mortality, hospital admissions and psychotropic medication after capsulotomy for OCD. Register-based long-term follow-up cohort study. We used the procedural and diagnostic codes in the Swedish National Patient Register to define the study population between 1970 and March 2013. Verification by manual review of medical records of the indication for surgery in those identified by the register yielded the final study cohort of 70 patients, followed 13-43 years after surgery. The sensitivity of the case selection method was 86%. We studied hospitalisation 5 years before and after surgery. Mortality data were derived from the Causes of Death Register. The Prescribed Drug Register was used to study psychotropic drug utilisation. By March 2013, 29 of the 70 patients were deceased. Their mean age at the time of death was 68 years (SD=14). Two patients had committed suicide and one had died of suspected suicide. Seventy per cent had been admitted to a psychiatric ward in the 5 years preceding surgery, and 84% in the first five postoperative years. Seventy-five per cent of those alive in 2012 were prescribed at least two psychotropic medications, often at high doses, the most common being antidepressants. Malignant OCD has a poor long-term prognosis. Patients who are candidates for surgery should be informed that, while OCD symptoms may be ameliorated with surgery, they should not expect long-term freedom from medication and psychiatric care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Liver resections in over-75-year-old patients: surgical hazard or current practice?

PubMed

Aldrighetti, Luca; Arru, Marcella; Catena, Marco; Finazzi, Renato; Ferla, Gianfranco

2006-03-01

To assess the safety of hepatic resections in the very old patient by comparing the outcome in patients younger and older than 75 years. Thirty-two resections in 31 patients > or =75 years (Over-75 Group) were compared with 164 resections in 162 patients <75 years (Control Group). Indications for resection, concomitant diseases, previous abdominal surgery, type of resection, associated surgical procedures, use/length of portal clamping, intra-operative blood losses and transfusions, and length of operation were preliminarily compared. The outcome was evaluated in terms of post-operative mortality, morbidity, transfusions, and postoperative hospitalization. Mean age was 76.0 +/- 2.3 years (range 75-83) in the Over-75 Group and 58.4 +/- 10.7 years (range 23-74) in the Control Group. The over-75 group included more hepatomas (43.8% vs. 26.8%, P = 0.09), chronic liver disease (31.3% vs. 28.7%, P = 0.03) and concomitant diseases (62.5% vs. 32.9%, P = 0.002). The two groups were comparable (P = n.s.) when evaluated for all other variables. The 30-day mortality rate was 3.6% in the Control Group and none in the Over-75 Group. Postoperative surgical complications occurred in 37 patients (22.6%) in the Control Group and 1 patient (3.1%) in the Over-75 Group, with statistically significant differences (P = 0.01), and incidence of medical complications was 13.4% in the Control Group and 3.1% in the Over-75 Group. Median postoperative hospitalization and transfusions were not statistically different. Hepatic resections in over-75-year-old patients are not a surgical hazard and may be carried out relatively safely as long as an accurate selection of the patient is performed.

Ten-Year Survival in Patients with Idiopathic Pulmonary Fibrosis After Lung Transplantation.

PubMed

ten Klooster, Liesbeth; Nossent, George D; Kwakkel-van Erp, Johanna M; van Kessel, Diana A; Oudijk, Erik J; van de Graaf, Ed A; Luijk, Bart; Hoek, Rogier A; van den Blink, Bernt; van Hal, Peter Th; Verschuuren, Erik A; van der Bij, Wim; van Moorsel, Coline H; Grutters, Jan C

2015-12-01

Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal fibrosing lung disease with a median survival of approximately 3 years after diagnosis. The only medical option to improve survival in IPF is lung transplantation (LTX). The purpose of this study was to evaluate trajectory data of IPF patients listed for LTX and to investigate the survival after LTX. Data were retrospectively collected from September 1989 until July 2011 of all IPF patients registered for LTX in the Netherlands. Patients were included after revision of the diagnosis based on the criteria set by the ATS/ERS/JRS/ALAT. Trajectory data, clinical data at time of screening, and donor data were collected. In total, 98 IPF patients were listed for LTX. During the waiting list period, 30 % of the patients died. Mean pulmonary artery pressure, 6-min walking distance, and the use of supplemental oxygen were significant predictors of mortality on the waiting list. Fifty-two patients received LTX with a median overall survival after transplantation of 10 years. This study demonstrated a 10-year survival time after LTX in IPF. Furthermore, our study demonstrated a significantly better survival after bilateral LTX in IPF compared to single LTX although bilateral LTX patients were significantly younger.

Implementation of a non-lethal biopsy punch monitoring program for mercury in smallmouth bass, Micropterus dolomieu Lacepede, from the Eleven Point River, Missouri

USGS Publications Warehouse

Ackerson, R.J.; McKee, J.M.; Schmitt, C.J.; Brumbaugh, William G.

2014-01-01

A non-lethal biopsy method for monitoring mercury (Hg) concentrations in smallmouth bass (Micropterus dolomieu; smallmouth) from the Eleven Point River in southern Missouri USA was evaluated. A biopsy punch was used to remove a muscle tissue plug from the area immediately below the anterior dorsal fin of 31 smallmouth. An additional 35 smallmouth (controls) were held identically except that no tissue plug was removed. After sampling, all fish were held in a concrete hatchery raceway for 6 weeks. Mean survival at the end of the holding period was 97 % for both groups. Smallmouth length, weight and Fulton’s condition factor at the end of the holding period were also similar between plugged and non-plugged controls, indicating that the biopsy procedure had minimal impact on growth under these conditions. Tissue plug Hg concentrations were similar to smallmouth Hg data obtained in previous years by removing the entire fillet for analysis.

Pancreaticoduodenectomy: a 20-year experience in 516 patients.

PubMed

Schmidt, C Max; Powell, Emilie S; Yiannoutsos, Constantin T; Howard, Thomas J; Wiebke, Eric A; Wiesenauer, Chad A; Baumgardner, Joel A; Cummings, Oscar W; Jacobson, Lewis E; Broadie, Thomas A; Canal, David F; Goulet, Robert J; Curie, Eardie A; Cardenes, Higinia; Watkins, John M; Loehrer, Patrick J; Lillemoe, Keith D; Madura, James A

2004-07-01

Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions. Retrospective review of a prospectively collected database. Academic tertiary care hospital. A total of 516 consecutive patients who underwent PD. Patient outcomes and survival factors. Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fifty-one percent of patients underwent pylorus preservation. Median operating time was 5 hours; blood loss, 1300 mL; and transfusion requirement, 1.5 U. Postoperative complications occurred in 43% of patients, including cardiopulmonary events (15%), fistula (9%), delayed gastric emptying (7%), and sepsis (6%). Additional surgery was required in 3% of patients, most commonly because of bleeding. Perioperative mortality was 3.9% overall but only 1.8% in patients with chronic pancreatitis; 25% of patients who died had preoperative complications associated with their periampullary condition. Three-year survival was 15% after resection for pancreatic cancer, 42% for duodenal cancer, 53% for ampullary cancer, and 62% for bile duct cancer. Univariate predictors of long-term survival in patients with periampullary adenocarcinoma included elevated glucose levels, liver function test results, abnormal tumor markers, blood loss, transfusion requirement, type of operation, and pathologic findings (periampullary adenocarcinoma type, differentiation, and margin and node status). Multivariate predictors were serum total bilirubin level, blood loss, operation type, diagnosis, and lymph node status. Pancreaticoduodenectomy continues to be associated with considerable morbidity. With careful patient selection, PD can be performed safely. Long-term survival in patients with periampullary adenocarcinoma can be predicted by preoperative laboratory values, intraoperative factors, and pathologic findings.

Laparoscopic Heller myotomy and fundoplication in patients with Chagas' disease achalasia and massively dilated esophagus.

PubMed

Pantanali, Carlos A R; Herbella, Fernando A M; Henry, Maria A; Mattos Farah, Jose Francisco; Patti, Marco G

2013-01-01

Laparoscopic Heller myotomy and fundoplication is considered today the treatment of choice for achalasia. The optimal treatment for end-stage achalasia with esophageal dilation is still controversial. This multicenter and retrospective study aims to evaluate the outcome of laparoscopic Heller myotomy in patients with a massively dilated esophagus. Eleven patients (mean age, 56 years; 6 men) with massively dilated esophagus (esophageal diameter greater than 10 cm) underwent a laparoscopic Heller myotomy and anterior fundoplication between 2000 and 2009 at three different institutions. Preoperative workup included upper endoscopy, esophagram, and esophageal manometry in all patients. Average follow-up was 31.5 months (range, 3 to 60 months). Two patients (18%) had severe dysphagia, four patients (36%) had mild and occasional dysphagia to solid food, and five patients (45%) were asymptomatic. All patients gained or kept body weight, except for the two patients with severe dysphagia. Of the two patients with severe dysphagia, one underwent esophageal dilatation and the other a laparoscopic esophagectomy. They are both doing well. Heller myotomy relieves dysphagia in the majority of patients even when the esophagus is massively dilated.

Cholecystectomy in patients with sickle cell disease: experience at a regional hospital in southeast Georgia.

PubMed Central

Rudolph, R.; Williams, J. S.

1992-01-01

The treatment of patients with sickle cell disease and cholelithiasis is controversial. This retrospective study assesses the outcome of preoperative transfusion and timely cholecystectomy in symptomatic sickle cell disease patients. Fourteen patients who had undergone cholecystectomy were determined to have sickle cell disease. The patients' mean age was 17.9 years. Eleven patients were female. Thirteen patients had complained of abdominal pain. Ultrasound confirmed the diagnosis of cholelithiasis in 12 of 13 patients tested. Hemoglobin before treatment averaged 7.7 g/dL. Transfusion or exchange transfusion was given to 12 patients, raising the average hemoglobin to 10.3 g/dL. Postoperative morbidity was 14%: one patient had a urinary tract infection and another a left-lower-lobe pneumonia. No sickle cell crises or deaths occurred. Postoperative hospital stay averaged 4.4 days. With judicious use of preoperative transfusion, early cholecystectomy for symptomatic gallstones was well tolerated by sickle cell disease patients and is advisable to avoid the morbid sequelae of acute cholecystitis and peroperative sickle cell crisis. PMID:1507260

Permanent epicardial pacing in pediatric patients: 12-year experience at a single center.

PubMed

Kwak, Jae Gun; Kim, Soo-Jin; Song, Jin Young; Choi, Eun Young; Lee, Sang Yoon; Shim, Woo Sup; Lee, Chang-Ha; Lee, Cheul; Park, Chun Soo

2012-02-01

Permanent cardiac pacing is not often done in children, and when done is usually accomplished through epicardial pacing. We reviewed a 12-year experience with the implantation of epicardial pacemakers by our clinical group. Fifty-three patients who underwent their first implantation of an epicardial pacemaker before the age of 18 years and between 1997 and 2009 were included in our study. The mean age of the patients at the time of first pacemaker implantation was 5.7±4.8 years. Indications for pacemaker implantation included postoperative or congenital atrioventricular block and sinus node dysfunction. The patients underwent 105 operations for the replacement of pacemaker pulse generators and 75 operations for the replacement of pacemaker leads. The most commonly used generator mode was the rate-responsive accelerometer-based (DDDR) mode, which was used in 40.9% of the patients. We used more non-steroid-eluting leads (70.1%) than steroid-eluting leads (29.1%). The overall duration of follow-up in the study was 8.0±4.5 years (range, 2.1 months to approximately 17.0 years). Freedom from the need for generator replacement was 98.0%, 60.7%, and 11.1% at 1, 5, and 8 years, respectively. A tendency toward early generator exhaustion was observed among younger patients (p=0.058). The generator mode used for pacing did not significantly affect generator longevity. Freedom from the need for lead replacement was 98.3%, 83.8%, and 63.6% at 1, 5, and 10 years, respectively. The mean longevity of the leads used in the study was 10.8±0.8 years. Neither patient age at the time of lead implantation nor type of lead significantly affected lead longevity. Lead longevity was sufficiently long and did not vary significantly according to type of lead. Generator longevity was not affected by lead type, generator mode, or patient age at the time of pacemaker implantation. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A case series of anal melanoma including the results of treatment with imatinib in selected patients.

PubMed

Knowles, J; Lynch, A C; Warrier, S K; Henderson, M; Heriot, A G

2016-09-01

Anal melanoma is a rare malignancy with a poor prognosis. All patients with a diagnosis of anal melanoma treated at a single institution between 2000 and 2012 were identified and their treatment and outcome were evaluated. Sixteen patients had a median survival of 2.9 years. Fourteen had Stage I or II disease with a median survival of 4.0 years and progression-free survival of 1.5 years. When used for disease staging, whole body positron emission tomography/CT identified an additional three sites of metastasis in five patients compared with CT of the chest, abdomen and pelvis. Surgery involved wide local excision or abdominoperineal excision with respective local recurrence rates of 50% and 66%. Eleven patients underwent testing for c-Kit mutations, of whom five were positive. Four of these were treated with the tyrosine kinase inhibitor imatinib, and showed rapid response of metastases outside the central nervous system. The outcome of this malignancy remains poor. PET is the modality of choice for disease staging. Testing tumours for c-Kit mutations may allow selected patients to participate in trials of tyrosine kinase inhibitors. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

Research on the Present Status of the Five-Year Medical Training Program in Chinese Medical Colleges

ERIC Educational Resources Information Center

Xu, Yan; Dong, Zhe; Miao, Le; Ke, Yang

2014-01-01

The five-year program is the main path for undergraduate medical training in China. Studies have shown that during the past eleven years, the scale of medical student enrollment increased annually with a relatively simple entrance exam. The ideas, teaching contents and methods, assessment and evaluation should be updated and improved. In general,…

Primary Helicobacter pylori resistance in elderly patients over 20 years: A Bulgarian study.

PubMed

Boyanova, Lyudmila; Gergova, Galina; Markovska, Rumyana; Kandilarov, Nayden; Davidkov, Lyubomir; Spassova, Zoya; Mitov, Ivan

2017-07-01

We evaluated the antibiotic susceptibility of 233 Helicobacter pylori strains isolated in the period 2011-2016, involving 62 strains from elderly patients aged 66-93years and 171 strains from younger adults. To assess resistance evolution, primary resistance rates in 92 strains from as many patients aged ≥60years in 1996-2003 were compared with those in 85 strains from infected patients in the same age group in 2011-2016. In the patients aged >65years evaluated during the last 6 years, amoxicillin resistance according to EUCAST and prior breakpoints was 1.6 and 0%, respectively. Resistance rates were the same by both breakpoint systems to metronidazole (35.5%), clarithromycin (22.6%), tetracycline (1.6%) and levofloxacin (32.3%). In 2011-2016, there were no significant differences between resistance rates in the subjects aged >65years and the younger adults. Notably, during the last 6 years, double/triple resistance was found in 21.0% of the subjects aged >65years. Moreover, the prevalence of quinolone primary resistance (30.0%) was significantly (3.4-fold) higher than that (8.9%) observed in 1996-2003. Briefly, the presence of both combined resistance and a strikingly high primary levofloxacin resistance in the elderly implies a cautious antibiotic choice for H. pylori eradication. In vitro susceptibility testing of the strains is highly important in this age group. The results can be linked to more frequent comorbidities and co-infection treatment in older compared with younger patients and, additionally, to the national antibiotic consumption. The high prevalence of quinolone resistance in the elderly patients is an alarming finding. Copyright © 2017 Elsevier Inc. All rights reserved.

Sarcopenia Is Predictive of 1-Year Mortality After Acetabular Fractures in Elderly Patients.

PubMed

Mitchell, Phillip M; Collinge, Cory A; OʼNeill, David E; Bible, Jesse E; Mir, Hassan R

2018-06-01

To determine whether sarcopenia is an independent predictor of mortality in geriatric acetabular fractures. Retrospective cohort. American College of Surgeons Level I trauma center. One hundred and forty-six patients over the age 60 with acetabular fractures treated at our institution over a 12-year period. The primary outcome was 1-year mortality, collected using the Social Security Death Index. We used the psoas:lumbar vertebral index (PLVI), calculated using the cross-sectional area of the L4 vertebral body and the left and right psoas muscles, to assess for sarcopenia. Using a multivariate logistic regression model, we found that low PLVI was associated with increased 1-year mortality (P = 0.046) when controlling for age, gender, Charlson Comorbidity Index, Injury Severity Score (ISS), smoking status, and associated pelvic ring injury. Increasing age and ISS also showed a relationship with 1-year mortality in this cohort (P < 0.001, P < 0.001, respectively). We defined sarcopenia as those patients in the lowest quartile of PLVI. The mortality rate of this cohort was 32.4%, compared with 11.0% in patients without sarcopenia (odds ratio 4.04; 95% confidence interval 1.62-10.1). Age >75 years, ISS >14, and sarcopenia had 1-year mortality rates of 37.1%, 30.9%, and 32.4%, respectively. In patients with all 3 factors, the mortality rate was 90%. Sarcopenia is an independent risk factor for 1-year mortality in elderly patients with acetabular fractures. This study highlights the importance of objective measures to assess frailty in elderly patients who have sustained fractures about the hip and pelvis. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Delayed pressure urticaria: response to treatment with sulfasalazine in a case series of seventeen patients.

PubMed

Swerlick, Robert A; Puar, Neha

2015-01-01

We retrospectively identified 17 patients with delayed pressure urticaria (DPU), diagnosed by history and confirmed with provocative pressure testing. The average age in the cohort was 42.6 years with 10 women and seven men. The mean duration of disease before diagnosis was 19.7 months (range, 1-60 months). The diagnosis of DPU was not included in the differential diagnosis of referring physicians and was not a diagnostic consideration in any of seven biopsies obtained. None of the patients responded adequately to treatment with antihistamines, but all 17 responded transiently when treated with either oral or intramuscular steroids. Eleven patients experienced complete or near complete resolution of DPU with treatment with sulfasalazine (SZ). Four patients had a partial response while two were unable to continue therapy because of drug intolerance. SZ appears to be a low cost and effective treatment for DPU. © 2015 Wiley Periodicals, Inc.

Red Cell Alloimmunization In Multitransfused Thalassaemia Major Patients.

PubMed

Moeen, Shazia; Farooq, Nazish; Irshad, Romana; Ashfaq, Muhammad; Farooq, Umer; Idris, Muhammad

2018-01-01

Lifelong transfusions are life savers for thalassaemia patients but are associated with many complications. Alloimmunization is a major problem for blood banks. Antigens of foreign red blood cells induce the formation of antibodies in patients suffering from thalassaemia. The purpose of this study was to examine the frequency of red cell alloantibodies and to express the type of these antibodies in thalassaemia patients. Patients that have received multiple transfusions were included in this study. Those with the positive Coombs test (DAT) results were excluded from the study and remaining patients were screened for antibodies. A panel of known blood group antigens was used for the patients who had a positive antibody screening test because they had alloantibodies in their serum. First, three cell panel was applied. If the screen was positive then eleven cell panels was used to identify the specific antibody. Both the cell panels were applied at room-temperature, liss (low ionic strength saline) and coombs phase. Three hundred & two patients were selected out of which 65.6% (n=198) were males and 34.4% (n=104) females. Patient's age ranged from 1.5 years to 26 years ±5.40 years. All of the patients were given regular red cell transfusion at 2-4 weeks interval. They were given non leukodepleted transfusions. It is not the practice in any thalassaemia Centre in Pakistan to give phenotypically matched blood for Kell, Kidd, Duffy or any other minor group antigens to patients on regular blood transfusion. Alloimmunization was positive in 12 (4.0%) of the 302 patients studied. Male were 66.67% (n=8) and female were 33.33% (n=4). Samples of these positive patients were further tested to determine specificity of alloantibodies. Anti Cw was most common, detected in 4 out of 12 (1.3%) patients. Anti K, k, S and Lua were detected in 2 out of 12 (0.7%) each. Thalassemia major patients on regular blood transfusions can develop red cell alloantibodies. Detailed pretransfusion

Is Bilateral Internal Mammary Arterial Grafting Beneficial for Patients Aged 75 Years or Older?

PubMed

Itoh, Satoshi; Kimura, Naoyuki; Adachi, Hideo; Yamaguchi, Atsushi

2016-07-25

Although bilateral internal mammary artery (BIMA) grafting is performed with increasing regularity in elderly patients, whether it is truly beneficial, and therefore indicated, in these patients remains uncertain. We retrospectively investigated early and late outcomes of BIMA grafting in patients aged ≥75 years. We identified 460 patients aged ≥75 years from among 2,618 patients who underwent either single internal mammary artery (SIMA) grafting (n=293) or BIMA grafting (n=107). Early outcomes did not differ between the SIMA and BIMA patients (30-day mortality: 1.7% vs. 0%, P=0.39; sternal wound infection: 1.0% vs. 4.7%; P=0.057). Late outcomes, 10-year survival in particular, were improved in the BIMA group (36.6% vs. 48.1%, P=0.033). In the analysis of the results in propensity score-matched groups (196 patients in the SIMA group, 98 patients in the BIMA group), improved 10-year survival was documented in the BIMA group (34.8% vs. 47.6%, P=0.030). Cox proportional regression analysis showed SIMA usage (non-use of BIMA) to be a predictor for late mortality (hazard ratio: 0.65, 95% confidence interval: 0.43-0.98, P=0.042). We further compared outcomes between the total non-elderly patients (n=2,158) and total elderly patients (n=460). BIMA usage was similar, as was 30-day mortality (1.0% vs. 1.3%, respectively). A survival advantage, with no increase in early mortality, can be expected from BIMA grafting in patients aged ≥75 years. (Circ J 2016; 80: 1756-1763).

A 5-year study of patients with pulmonary tuberculosis in a concurrent comparison of home and sanatorium treatment for one year with isoniazid plus PAS*

PubMed Central

Dawson, J. J. Y.; Devadatta, S.; Fox, Wallace; Radhakrishna, S.; Ramakrishnan, C. V.; Somasundaram, P. R.; Stott, H.; Tripathy, S. P.; Velu, S.

1966-01-01

This report from the Tuberculosis Chemotherapy Centre, Madras, summarizes the progress over a 5-year period of 193 patients with newly diagnosed, sputum-positive pulmonary tuberculosis who were admitted to a concurrent comparison of home and sanatorium treatment for one year with isoniazid plus PAS. Previous reports have shown that, despite the traditional advantages of sanatorium treatment—rest, adequate diet, nursing and supervised drug-administration—the home patients responded nearly as well as the sanatorium patients in the first year; further, the relapse rates over a 2-year period of follow-up were similar. The findings in the present report are based on a 4-year period of follow-up and extend these conclusions, the relapse rates over the period being 7% for the home patients and 10% for the sanatorium patients. Patients who failed to respond to treatment in the first year and those who had a bacteriological relapse in the second or subsequent years were usually re-treated with reserve regimens, first with streptomycin plus pyrazinamide and, if this was ineffective, with cycloserine plus ethionamide. Considering the findings over the entire 5-year period, five home patients and three sanatorium patients died from non-tuberculous causes. Of the remainder, 5% of the home patients and 6% of the sanatorium patients died of tuberculosis, 4% in each series had bacteriologically active disease at five years and 90% and 89%, respectively, had bacteriologically quiescent disease at that time. These findings are very encouraging, particularly for developing countries such as India, where tuberculosis is a major problem and sanatorium beds are very few. PMID:5296380

Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome.

PubMed

Viana, Celiana Figueiredo; Pradella-Hallinan, Márcia; Quadros, Abrahão Augusto Juviniano; Marin, Luis Fabiano; Oliveira, Acary Souza Bulle

2013-07-01

It was to evaluate the degree of fatigue in patients with paralytic poliomyelitis (PP) and with post-polio syndrome (PPS), and correlate it with parameters of sleep and the circadian cycle. Thirty patients, 17 female (56.7%), participated in the study: they answered the Revised Piper Fatigue Scale and performed a nocturnal polysomnographic study. Eleven had PP (mean age±standard deviation of 47.9±6.4 years), and 19 had PPS (mean age±standard deviation of 46.4±5.6 years). Our study showed that fatigue was worse in the afternoon in the PP Group and had a progressive increase throughout the day in the PPS Group. We also observed compromised quality of sleep in both groups, but no statically significant difference was found in the sleep parameters measured by polysomnography. Fatigue has a well-defined circadian variation, especially in PPS Group. Poor sleep quality is associated with fatigue and, therefore, sleep disturbances should be evaluated and treated in this group of PPS.

[Myocardial infarction in a 26-year-old patient with diabetes type 1].

PubMed

Rogowicz, Anita; Zozulińska, Dorota; Wierusz-Wysocka, Bogna

2007-11-01

A case of a 26-year-old patient with acute myocardial infarction and hypertension, hyperlipidaemia as well as type 1 diabetes from 18 years complicated by background retinopathy and nephropathy in the state of proteinuria is described. State of metabolic compensation of the diabetes was poor. The patient did not perform regular self-monitoring of glycaemia, smoked, and used oral contraception. Early diagnosis of vascular lesions in young persons with long-lasting of type 1 diabetes as well as the introduction of proper preventive and treatment methods may improve prognosis in these high-risk patients.

Olfactory neuroblastoma: 14-year experience at an Australian tertiary centre and the role for longer-term surveillance.

PubMed

Schmidt, C; Potter, N; Porceddu, S; Panizza, B

2017-07-01

Olfactory neuroblastoma is a rare sinonasal malignancy, with poorly defined treatment protocols. Management at a tertiary centre was retrospectively evaluated to inform future treatment and follow up. Cases treated with curative intent (2000-2014) were included. Data were collected, and overall and disease-free survival rates were calculated. Eleven cases were identified, with a median follow up of 87 months. One patient was Kadish stage A, one was stage B, eight were stage C and one was stage D. The latter patient underwent chemoradiotherapy alone. The remaining patients proceeded to: endoscopic-assisted wide local excision (n = 2), anterior craniofacial resection (n = 4) or endoscopic craniofacial resection (n = 4). No patients had primary nodal disease or elective neck treatment. One patient had neoadjuvant chemoradiation. Six patients had post-operative radiotherapy; three received adjuvant chemotherapy. Two patients had late cervical node failure, and proceeded to neck dissection and post-operative radiotherapy. Two patients had late local recurrence. Ten-year overall and disease-free survival rates were 68.2 and 46.7 per cent, respectively. Longer-term follow up is supported given the incidence of late regional and local recurrence. Prophylactic treatment of cervical nodes in locally advanced disease is an area for further investigation.

Ten Years of Abstinence in Former Opiate Addicts: Medication-Free Non-Patients Compared to Methadone Maintenance Patients.

PubMed

Peles, Einat; Sason, Anat; Tene, Oren; Domany, Yoav; Schreiber, Shaul; Adelson, Miriam

2015-01-01

Fifty-five former opioid addicts who have been methadone maintained patients for 10 or more years and whose urine has tested negative for drugs for 2 or more years were compared to 99 former opioid addicts who have been medication-free for 10 or more years. Groups were comparable in age and education, but the medication-free subjects were younger when having started opioids with more severe addiction scores. Methadone maintained patients presented with a higher proportion of psychiatric comorbidity and chronic pain. Their scores of perceived sleep quality and cognitive state were poorer than the medication-free individuals. Possible explanations of the differences are discussed in this article.

[Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications].

PubMed

López-Hualda, A; Marín-Aguado, M A; Valencia-García, H; López-González, D; Gavín-González, C

2014-01-01

Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. To compare injuries and complications after surgery between one group older than forty years of age and another younger group. A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group. There was no significant difference between the complications after surgery and the age according to the design (P>.05). Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Revision of anterior cruciate ligament reconstruction with allografts in patients younger than 40 years old: a 2 to 4 year results.

PubMed

Pascual-Garrido, Cecilia; Carbo, L; Makino, A

2014-05-01

The purpose of this study is first to report the outcomes, at 4 years follow-up, in revision ACL surgery using allografts in patients younger than 40 years old, and then compared soft tissue allografts to bone tendon allografts. This retrospective study included 47 patients who underwent ACL revision surgery with fresh-frozen allografts. Patellar tendon allograft or tibialis anterior allograft was used. Twenty-seven patients undergoing ACL revision with patellar tendon allograft were compared retrospectively with twenty-two patients undergoing the same procedure with soft tissue tibialis anterior allograft. Lysholm, IKDC, and KT-1000 values were obtained preoperatively and postoperatively. The average patient follow-up was 4.6 years (±2.5). The mean age at time of the revision was 34 years old (±6.3). Overall, patients reported the overall condition of their knee as excellent or good in 85% of the patients (10 excellent, 33 good). Based on their experience, 85% would have the surgery again if they had the same problem in the other knee. Both subgroups experienced significant improvement in Lysholm, IKDC, and KT-1000 values, with no difference found between groups at final follow-up. Revision ACL with allografts has excellent and good results in 85% of patients younger than 40 years old. No statistical difference was seen between soft tissue (tibialis anterior) and patellar tendon allograft. IV.

[Reliability of the PROFUND index to predict 4-year mortality in polypathological patients].

PubMed

Díez-Manglano, Jesús; Del Corral Beamonte, Esther; Ramos Ibáñez, Rosa; Lambán Aranda, María Pilar; Toyas Miazza, Carla; Rodero Roldán, María Del Mar; Ortiz Domingo, Concepción; Munilla López, Eulalia; de Escalante Yangüela, Begoña

2016-09-16

To determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. Multicenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. We included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60, delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. The PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

The 2013 ACC/AHA 10-year atherosclerotic cardiovascular disease risk index is better than SCORE and QRisk II in rheumatoid arthritis: is it enough?

PubMed

Ozen, Gulsen; Sunbul, Murat; Atagunduz, Pamir; Direskeneli, Haner; Tigen, Kursat; Inanc, Nevsun

2016-03-01

To determine the ability of the new American College of Cardiology and American Heart Association (ACC/AHA) 10-year atherosclerotic cardiovascular disease (ASCVD) risk algorithm in detecting high cardiovascular (CV) risk, RA patients identified by carotid ultrasonography (US) were compared with Systematic Coronary Risk Evaluation (SCORE) and QRisk II algorithms. SCORE, QRisk II, 2013 ACC/AHA 10-year ASCVD risk and EULAR recommended modified versions were calculated in 216 RA patients. In sonographic evaluation, carotid intima-media thickness >0.90 mm and/or carotid plaques were used as the gold standard test for subclinical atherosclerosis and high CV risk (US+). Eleven (5.1%), 15 (6.9%) and 44 (20.4%) patients were defined as having high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. Fifty-two (24.1%) patients were US + and of those, 8 (15.4%), 7 (13.5%) and 23 (44.2%) patients were classified as high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. The ACC/AHA 10-year ASCVD risk index better identified US + patients than SCORE and QRisk II (P < 0.0001). With EULAR modification, reclassification from moderate to high risk occurred only in two, five and seven patients according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. The 2013 ACC/AHA 10-year ASCVD risk estimator was better than the SCORE and QRisk II indices in RA, but still failed to identify 55% of high risk patients. Furthermore adjustment of threshold and EULAR modification did not work well. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Four years Follow-up of Patients with Irritable Bowel Syndrome.

PubMed

Rusu, F; Dumitraşcu, D L

2015-01-01

There is little data on the long term evolution of patients with irritable bowel syndrome (IBS) and of associated conditions. We therefore studied the evolution of IBS patients in a single tertiary center during a long interval of time. We carried out a retrospective study based on the survey of patients records. We analyzed the records of symptoms, therapy, associated diseases, as consigned at follow-up visits for an interval of 4 years in average (2008-2011). A cohort of 114 patients with IBS diagnosed based on Rome III criteria were included (29 men and 85 women), age 19-85 years (mean age: 43.45 years). Urban patients were predominant. The main three symptoms were: abdominal pain, bowel disorders (constipation, diarrhea) and bloating. IBS--constipation (IBS--C) is associated with a favorable course of symptoms (increasing the number of stools, decrease intensity of abdominal pain and bloating) after treatment and IBS--diarrhea (IBS--D) is associated with variable symptoms after treatment (p = 0.031). Using trimebutin or mebeverin in association with other drugs for one month correlates with a favorable evolution of symptoms after treatment and monotherapy is associated with fluctuating symptoms ( p< 0.001). Favorable symptoms are associated with the use of probiotics in combination, but not in monotherapy (p< 0.001). Favorable evolution of symptoms is also associated with the use of anxiolytics in combination. Persistence of symptoms after treatment was correlated with the presence or absence of depression. The absence of depression was correlated with a favorable evolution of symptoms (p = 0.005). IBS-C is associated at limit (marginal significance) with hemorrhoidal disease (p = 0.56). 33 patients (29%)--received monotherapy (trimebutin or mebeverin or probiotics); 81 patients (71%)--received combined therapy: (trimebutin or mebeverin or probiotics) + anxiolytics or proton pump inhibitors (PPI) or nonsteroidal anti-inflammatory (NSAI) or spasmolytics. The

Lung transplantation for patients older than 65 years: is it a feasible option?

PubMed

Machuca, T N; Camargo, S M; Schio, S M; Lobato, V; Sanchez, L B; Perin, F; Felicetti, J C; Camargo, J J

2011-01-01

Advanced age has been a relative contraindication to lung transplantation. However, the exact age limit for this procedure has not yet been established. The aim of this work is to present our experience with this particular group. This retrospective review included medical charts of patients who underwent lung transplantation at our institution from January 2004 to February 2009: namely, 112 cadaveric lung transplants with 12 patients (10.7%) >65 years old. There were 9 male patients and the overall mean age was 68 years (range 66-72). The indications were pulmonary fibrosis in 8 and emphysema in 4 cases. Four patients had mild coronary artery disease and 4 systemic hypertension. All of the procedures were unilateral and only 2 required extracorporeal circulation. Only 5 patients received blood product transfusions intraoperatively; the mean ischemic time was 222 minutes. Four patients developed primary graft dysfunction, the mean requirement for mechanical ventilation was 30 hours, and the mean intensive care unit stay, 11 days. Postoperative complications were respiratory infections (n = 8), catheter-related infection (n = 1), atrial fibrillation (n = 2). The mean hospital stay was 28 days and the 1-year survival was 75%. Lung transplantation is a feasible option for well-selected patients with end-stage pulmonary disease who are >65 years old. Our study reinforces the modern trend for unilateral procedures in this situation. Copyright © 2011 Elsevier Inc. All rights reserved.

Predictors of low haematocrit among repeat donors in São Paulo, Brazil: eleven year longitudinal analysis.

PubMed

Almeida, Fernanda N; Sabino, Ester C; Tunes, Gisela; Schreiber, George B; da Silva, Pedro Paulo S B; Carneiro-Proietti, Anna Barbara F; Ferreira, João Eduardo; Mendrone, Alfredo

2013-12-01

Few longitudinal studies have examined the long-term effect on deferral for low haematocrit (Hct) or haemoglobin, indicators of presence of anaemia. This study retrospectively analysed 11 years of donation history to examine predictors related to such deferrals among repeat blood donors. We included 385,357 donors with at least two visits to the blood centre between January 1996 and December 2006 who were not deferred due to haematocrit at their first visit. We evaluated variables related to the development of low Hct (LHct-below 38% for females and 39% for males) after whole blood donations. Over the 11-year period, 3,850 (1.5%) of the 252,301 males and 18,104 (13.6%) of the 133,056 females were deferred due to LHct at some point after their first donation. Genders, age, baseline Hct, Hct at the visit immediately before deferral due to LHct, and interval between donations, were associated with higher rates of development of LHct in repeat donors. Our analysis showed that deferral due to low Hct levels in repeat blood donors is highly prevalent in Brazil. Assigning longer donations intervals based on the Hct levels at the qualifying donation or supplementing iron to donors at risk may decrease deferral rate of donors with low Hct. Copyright © 2013 Elsevier Ltd. All rights reserved.

Overlapping features of polymyositis and inclusion body myositis in HIV-infected patients

PubMed Central

Lloyd, Thomas E.; Pinal-Fernandez, Iago; Michelle, E. Harlan; Christopher-Stine, Lisa; Pak, Katherine; Sacktor, Ned

2017-01-01

Objective: To characterize patients with myositis with HIV infection. Methods: All HIV-positive patients with myositis seen at the Johns Hopkins Myositis Center from 2003 to 2013 were included in this case series. Muscle biopsy features, weakness pattern, serum creatine kinase (CK) level, and anti–nucleotidase 1A (NT5C1A) status of HIV-positive patients with myositis were assessed. Results: Eleven of 1,562 (0.7%) patients with myositis were HIV-positive. Myositis was the presenting feature of HIV infection in 3 patients. Eight of 11 patients had weakness onset at age 45 years or less. The mean time from the onset of weakness to the diagnosis of myositis was 3.6 years (SD 3.2 years). The mean of the highest measured CK levels was 2,796 IU/L (SD 1,592 IU/L). On muscle biopsy, 9 of 10 (90%) had endomysial inflammation, 7 of 10 (70%) had rimmed vacuoles, and none had perifascicular atrophy. Seven of 11 (64%) patients were anti-NT5C1A-positive. Upon presentation, all had proximal and distal weakness. Five of 6 (83%) patients followed 1 year or longer on immunosuppressive therapy had improved proximal muscle strength. However, each eventually developed weakness primarily affecting wrist flexors, finger flexors, knee extensors, or ankle dorsiflexors. Conclusions: HIV-positive patients with myositis may present with some characteristic polymyositis features including young age at onset, very high CK levels, or proximal weakness that improves with treatment. However, all HIV-positive patients with myositis eventually develop features most consistent with inclusion body myositis, including finger and wrist flexor weakness, rimmed vacuoles on biopsy, or anti-NT5C1A autoantibodies. PMID:28283597

Cryptococcal meningitis in HIV-infected patients at Chiang Mai University Hospital: a retrospective study.

PubMed

Chaiwarith, Romanee; Vongsanim, Surachet; Supparatpinyo, Khuanchai

2014-05-01

Cryptococcal meningitis (CM) is a common central nervous system infection in HIV-infected patients. This study aimed to determine treatment outcomes among HIV-infected patients who had cryptococcal meningitis and to determine predictors of death. We conducted a retrospective cohort study among HIV-infected patients receiving care at Chiang Mai University Hospital from January 1, 2005 to December 31, 2010. We studied 79 patients; 45 (57.0%) were male and the mean age was 35.1 +/- 7.2 years. Eleven patients (13.9%) had previous opportunistic infection. The most common presenting symptoms were headache (63 patients, 79.8%), fever (49 patients, 62.0%), and altered consciousness (21 patients, 26.6%). The median CD4+ cell count was 20 cells/mm3 [Interquartile range (IQR) 10, 53]. The in-hospital, 90-day, and 1-year mortality rates were 24.1%, 32.4%, and 52.2%, respectively. The CM attributable in-hospital, 90-day and 1-year mortality rates were 13.9%, 20.3%, and 23.2%, respectively. Predictors associated with a 1-year mortality were a high cerebrospinal (CSF) cryptococcal antigen titer (> 1:10,000) [Odds Ratio (OR) =7.08, 95% confidence interval (CI): 1.62-31.00, p = 0.009], and altered consciousness at presentation (OR = 5.27; 95% CI: 1.16-24.05; p = 0.032). Cryptococcal meningitis is an important cause of death in HIV-infected patients. HIV-infected patients with a low CD4+ cell count, a headache, fever and altered consciousness should be investigated for CM and those with a high CSF cryptococcal antigen titer are at high risk for mortality.

Ten-year outcome of enzyme replacement therapy with agalsidase beta in patients with Fabry disease.

PubMed

Germain, Dominique P; Charrow, Joel; Desnick, Robert J; Guffon, Nathalie; Kempf, Judy; Lachmann, Robin H; Lemay, Roberta; Linthorst, Gabor E; Packman, Seymour; Scott, C Ronald; Waldek, Stephen; Warnock, David G; Weinreb, Neal J; Wilcox, William R

2015-05-01

Fabry disease results from deficient α-galactosidase A activity and globotriaosylceramide accumulation causing renal insufficiency, strokes, hypertrophic cardiomyopathy and early demise. We assessed the 10-year outcome of recombinant α-galactosidase A therapy. The outcomes (severe clinical events, renal function, cardiac structure) of 52/58 patients with classic Fabry disease from the phase 3 clinical trial and extension study, and the Fabry Registry were evaluated. Disease progression rates for patients with low renal involvement (LRI, n=32) or high renal involvement (HRI, n=20) at baseline were assessed. 81% of patients (42/52) did not experience any severe clinical event during the treatment interval and 94% (49/52) were alive at the end of the study period. Ten patients reported a total of 16 events. Patients classified as LRI started therapy 13 years younger than HRI (mean 25 years vs 38 years). Mean slopes for estimated glomerular filtration rate for LRI and HRI were -1.89 mL/min/1.73 m(2)/year and -6.82 mL/min/1.73 m(2)/year, respectively. Overall, the mean left ventricular posterior wall thickness and interventricular septum thickness remained unchanged and normal. Patients who initiated treatment at age ≥ 40 years exhibited significant increase in left ventricular posterior wall thickness and interventricular septum thickness. Mean plasma globotriaosylceramide normalised within 6 months. This 10-year study documents the effectiveness of agalsidase beta (1 mg/kg/2 weeks) in patients with Fabry disease. Most patients remained alive and event-free. Patients who initiated treatment at a younger age and with less kidney involvement benefited the most from therapy. Patients who initiated treatment at older ages and/or had advanced renal disease experienced disease progression. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Ten-year outcome of enzyme replacement therapy with agalsidase beta in patients with Fabry disease

PubMed Central

Germain, Dominique P; Charrow, Joel; Desnick, Robert J; Guffon, Nathalie; Kempf, Judy; Lachmann, Robin H; Lemay, Roberta; Linthorst, Gabor E; Packman, Seymour; Scott, C Ronald; Waldek, Stephen; Warnock, David G; Weinreb, Neal J; Wilcox, William R

2015-01-01

Background Fabry disease results from deficient α-galactosidase A activity and globotriaosylceramide accumulation causing renal insufficiency, strokes, hypertrophic cardiomyopathy and early demise. We assessed the 10-year outcome of recombinant α-galactosidase A therapy. Methods The outcomes (severe clinical events, renal function, cardiac structure) of 52/58 patients with classic Fabry disease from the phase 3 clinical trial and extension study, and the Fabry Registry were evaluated. Disease progression rates for patients with low renal involvement (LRI, n=32) or high renal involvement (HRI, n=20) at baseline were assessed. Results 81% of patients (42/52) did not experience any severe clinical event during the treatment interval and 94% (49/52) were alive at the end of the study period. Ten patients reported a total of 16 events. Patients classified as LRI started therapy 13 years younger than HRI (mean 25 years vs 38 years). Mean slopes for estimated glomerular filtration rate for LRI and HRI were −1.89 mL/min/1.73 m2/year and −6.82 mL/min/1.73 m2/year, respectively. Overall, the mean left ventricular posterior wall thickness and interventricular septum thickness remained unchanged and normal. Patients who initiated treatment at age ≥40 years exhibited significant increase in left ventricular posterior wall thickness and interventricular septum thickness. Mean plasma globotriaosylceramide normalised within 6 months. Conclusions This 10-year study documents the effectiveness of agalsidase beta (1 mg/kg/2 weeks) in patients with Fabry disease. Most patients remained alive and event-free. Patients who initiated treatment at a younger age and with less kidney involvement benefited the most from therapy. Patients who initiated treatment at older ages and/or had advanced renal disease experienced disease progression. PMID:25795794

A qualitative description of the development and evaluation of our voice, a health promotion magazine created by pediatric patients for hospitalized pediatric patients.

PubMed

Luca, Paola D; Chan, Melissa; Basak, Sanjukta; Segal, Audrey O; Porepa, Michelle; Pinard, Marie; Au, Hosanna; Birken, Catherine S

2013-01-01

To facilitate a peer-developed health promotion magazine that provides health education and engages hospitalized pediatric patients during a hospital admission. To evaluate patient satisfaction with the content and layout of the magazine and its impact on patients' attitudes toward healthy living. A pediatric resident-led multidisciplinary team collaborated with the Children's Council at The Hospital for Sick Children to create a health promotion magazine for inpatients. Articles included a scavenger hunt, healthy recipes, physical activities, hospital staff interviews, and patient stories. Patients 7 to 18 years of age admitted to Pediatric Medicine or Respirology were invited to read the magazine and complete a questionnaire 24 hours later on their satisfaction with the magazine and their attitudes regarding healthy living. Thirty-seven patients received a copy of the magazine, and 24 patients completed the questionnaire (mean 13.4 years, 54% female, 25% overweight/obese). Eleven of 24 (46%) read the entire magazine, and 19 of 23 (83%) reported learning. The exercises, recipes, and patient stories were most liked. Ten of 24 (42%) participants performed the exercises; the most common reason for not trying an exercise was pain. After reading the magazine, 15 of 24 (65%) patients reported that they will try to be more active, and 11 of 23 (48%) reported that they will try to eat more fruits and vegetables. Eighty-three percent were interested in a future edition. A health promotion magazine created by patients for patients changed patient-reported attitudes about healthy living. Peer-led interventions in the inpatient setting may be an important opportunity to promote healthy lifestyles and require further study.

Cochlear implant surgery in patients more than seventy-nine years old.

PubMed

Eshraghi, Adrien A; Rodriguez, Michael; Balkany, Thomas J; Telischi, Fred F; Angeli, Simon; Hodges, Annelle V; Adil, Eelam

2009-06-01

To evaluate the surgical complications, auditory performance, and hearing handicap following cochlear implantation in patients greater than 79 years of age. Retrospective trial, tertiary referral center. The study group was comprised of 21 patients implanted after 79 years of age from 1996 through 2006 with follow-ups past their 8th decade. Pre-op evaluation consisted of pure-tone audiometry and speech discrimination scores (Hearing in Noise Test and City University of New York sentence test). The results of these tests were compared to similar tests taken post-op. A validated hearing handicap questionnaire was used to evaluate the outcome. There were no permanent medical or surgical complications. However, two patients developed exacerbations of previous comorbid conditions (i.e., urinary retention and acute delirium). Implanted patients experienced a significant improvement in audiologic performance, post-op pure tone average, and post-op speech scores (P < .001). A majority of them were able to use the phone and reported that the cochlear implant was of great benefit to them. The post-op hearing handicap inventory for the elderly demonstrated a significant decrease of hearing handicap scores. This is the first study to focus on a patient group this advanced in age. With increasing life expectancy, we should begin to stratify risk versus benefit of cochlear implantation in this age group. Cochlear implantation improved audiologic performance and the quality of life in patients older than 79 years old. There were no permanent medical or surgical complications. Chronic pain and temporary vertigo were the most common complications reported in this elderly group. Laryngoscope, 2009.

Optic neuritis in paediatric patients: Experience over 27 years and a management protocol.

PubMed

Monge Galindo, L; Martínez de Morentín, A L; Pueyo Royo, V; García Iñiguez, J P; Sánchez Marco, S; López-Pisón, J; Peña-Segura, J L

2018-03-08

In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. We conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. Our neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients' age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. ON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer Patients in the Year of Diagnosis and Year of Death.

PubMed

Chen, Christopher T; Li, Ling; Brooks, Gabriel; Hassett, Michael; Schrag, Deborah

2017-07-26

To characterize spending patterns for Medicare patients with incident breast, prostate, lung, and colorectal cancer. 2007-2012 data from the Surveillance, Epidemiology, and End Results Program linked with Medicare fee-for-service claims. We calculate per-patient monthly and yearly mean and median expenditures, by cancer type, stage at diagnosis, and spending category, over the years of diagnosis and death. Over the year of diagnosis, mean spending was $35,849, $26,295, $55,597, and $63,063 for breast, prostate, lung, and colorectal cancer, respectively. Over the year of death, spending was similar across different cancer types and stage at diagnosis. Characterization of Medicare spending according to clinically meaningful categories may assist development of oncology alternative payment models and cost-effectiveness models. © Health Research and Educational Trust.

Motor recovery of stroke patients after rehabilitation: one-year follow-up study.

PubMed

Kuptniratsaikul, Vilai; Kovindha, Apichana; Suethanapornkul, Sumalee; Massakulpan, Pornpimon; Permsirivanich, Wutichai; Kuptniratsaikul, Patcharawimol Srisa-An

2017-01-01

Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p < 0.001). The percentage of patients with BMRS III- VI at 6 months was greater than that at discharge, but the recovery at 12 months was slightly higher than that at 6 months. It seems that motor recovery from stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) <30 d during the first admission and Barthel index at discharge ≥10 were related to the improvement of BMRS of the hand, arm and leg on multivariate analysis. Additionally, no complication at discharge was associated with the improvement of BMRS of the leg. Conclusions Approximately half of our stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.

Dobutamine stress myocardial perfusion imaging: 8-year outcomes in patients with diabetes mellitus.

PubMed

Boiten, Hendrik J; van Domburg, Ron T; Valkema, Roelf; Zijlstra, Felix; Schinkel, Arend F L

2016-08-01

Many studies have examined the prognostic value of myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) for the prediction of short- to medium-term outcomes. However, the long-term prognostic value of MPI in patients with diabetes mellitus remains unclear. Therefore, this study assessed the long-term prognostic value of MPI in a high-risk cohort of patients with diabetes mellitus. A high-risk cohort of 207 patients with diabetes mellitus who were unable to undergo exercise testing underwent dobutamine stress MPI. Follow-up was successful in 206 patients; 12 patients were excluded due to early revascularization. The current data are based on the remaining 194 patients. Follow-up end points were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction. The Kaplan-Meier survival curves were constructed, and univariable and multivariable analyses were performed to identify predictors of long-term outcome. During a mean follow-up of 8.1 ± 5.9 years, 134 (69%) patients died of which 68 (35%) died due to cardiac causes. Nonfatal myocardial infarction occurred in 24 patients (12%), and late (>60 days) coronary revascularization was performed in 61 (13%) patients. Survival analysis showed that MPI provided optimal risk stratification up to 4 years after testing. After that period, the outcome was comparable in patients with normal and abnormal MPI. Multivariable analyses showed that MPI provided incremental prognostic value up to 4 years after testing. In high-risk patients with diabetes mellitus, dobutamine MPI provides incremental prognostic information in addition to clinical data for a 4-year period after testing. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

A Prognostic Model for One-year Mortality in Patients Requiring Prolonged Mechanical Ventilation

PubMed Central

Carson, Shannon S.; Garrett, Joanne; Hanson, Laura C.; Lanier, Joyce; Govert, Joe; Brake, Mary C.; Landucci, Dante L.; Cox, Christopher E.; Carey, Timothy S.

2009-01-01

Objective A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognosis to patients or surrogate decision-makers. Our objective was to develop and validate a prognostic model for 1-year mortality in patients ventilated for 21 days or more. Design Prospective cohort study. Setting University-based tertiary care hospital Patients 300 consecutive medical, surgical, and trauma patients requiring mechanical ventilation for at least 21 days were prospectively enrolled. Measurements and Main Results Predictive variables were measured on day 21 of ventilation for the first 200 patients and entered into logistic regression models with 1-year and 3-month mortality as outcomes. Final models were validated using data from 100 subsequent patients. One-year mortality was 51% in the development set and 58% in the validation set. Independent predictors of mortality included requirement for vasopressors, hemodialysis, platelet count ≤150 ×109/L, and age ≥50. Areas under the ROC curve for the development model and validation model were 0.82 (se 0.03) and 0.82 (se 0.05) respectively. The model had sensitivity of 0.42 (se 0.12) and specificity of 0.99 (se 0.01) for identifying patients who had ≥90% risk of death at 1 year. Observed mortality was highly consistent with both 3- and 12-month predicted mortality. These four predictive variables can be used in a simple prognostic score that clearly identifies low risk patients (no risk factors, 15% mortality) and high risk patients (3 or 4 risk factors, 97% mortality). Conclusions Simple clinical variables measured on day 21 of mechanical ventilation can identify patients at highest and lowest risk of death from prolonged ventilation. PMID:18552692

[Study of a sample of alcoholic patients two years post-treatment].

PubMed

Avila Escribano, J J; Pérez Madruga, A; Rodríguez Treceño, M

1994-01-01

This survey analyzes the evolution of one sample of alcoholic patients two years after finishing treatment. Its target is to determine the percentage of patients that remain abstinent, their rate of retention, and what factors can have an influence on abstinence. In 1990, 72 alcoholic patients were treated in the Alcoholism Unit, who make up our study sample. The average age was 37.9 +/- 11.47 years old; 77.8% were diagnosed as being Alcohol-dependents and 22.2% as Alcohol-abusers; 19.4% dropped out the treatment early. In 1992 our sample of study was 53 patients (2 died and 17 refused to participate), of whom 77.7% were abstinent and 28.3% continued ingesting alcohol; the average abstinence was 22.92 +/- 8.73 months. An important finding of this study was that the diagnosis, sex, and treatment with aversives had not an influence on abstinence; however the percentage of abstinent patients in those who had attended Therapeutic Discussion Groups was significantly higher than in those who had not.

Assessment of surgical treatment and postoperative nutrition in gastric cancer patients older than 80 years.

PubMed

Nakanoko, Tomonori; Kakeji, Yoshihiro; Ando, Koji; Nakashima, Yuichiro; Ohgaki, Kippei; Kimura, Yasue; Saeki, Hiroshi; Oki, Eiji; Morita, Masaru; Maehara, Yoshihiko

2015-01-01

A gastrectomy for gastric cancer is sometimes required in patients older than 80 years due to the continuously increasing age of society. However, if a gastrectomy worsens the postoperative quality of life and daily activity in elderly patients because of poor nutrition, the procedure may not always be a useful treatment strategy. Clinicopathological data of patients with gastric cancer who underwent a gastrectomy at our Department between 1998 and 2008 (N=471) were collected and analyzed. The results of treatment for patients older than 80 years (N=41) were analyzed and compared against those of patients younger than 80 years (N=430). Patients older than 80 years had a higher frequency of preoperative co-morbidities than patients younger than 80 years. However, there was no statistical difference in postoperative complications regarding nutrition between the two groups. Older age is not a determinant of poor nutrition following gastrectomy. Gastrectomy for gastric cancer is, therefore, a useful treatment strategy, regardless of ageing. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

IDENTIFYING ELEVEN FACTORS OF SERVICE MARKETING MIX (4PS) EFFECTIVE ON TENDENCY OF PATIENTS TOWARD PRIVATE HOSPITAL.

PubMed

Hosseini, Seyed Mojtaba; Etesaminia, Samira; Jafari, Mehrnoosh

2016-10-01

One of the important factors of correct management is to identify the reasons for patient tendency toward private hospitals. This study measures these factors based on service marketing mixes. This study used a cross sectional descriptive methodology. The study was conducted during 6 months in 2015. The studied population included patients of private hospitals in Tehran. Random sampling was used (n = 200). Data was collected by an author-made questionnaire for service marketing factors. Reliability and validity of the questionnaire were confirmed. Data analysis was done using factor analysis test in SPSS 20. The results showed that constant attendance of physicians and nurses has the highest effect (0.707%) on patient tendency toward private hospitals.

[Ovarian tissue cryopreservation in cancer patients--six years of clinical experience].

PubMed

Huser, M; Záková, J; Crha, I; Smardová, L; Král, Z; Revel, A; Ventruba, P

2012-04-01

Presentation of clinical results and experience with this technique during past six years. Original paper. Gynekologicko-porodnická klinika LF MU a FN Brno, Interní hemato-onkologická klinika LF MU a FN Brno, Department of Obstetrics and Gynecology. Hadassah University Hospital Ein-Karem, Jerusalem, Izrael. Ovarian tissue cryopreservation (OTC) and its future auto-transplantation becomes an alternative for patients to prevent serious damage of ovarian function by oncology treatment. Patient is indicated to OTC in case of high risk of ovarian failure due to planned chemotherapy and impossibility to use other oncofertility techniques. Ovarian tissue harvesting is done by laparoscopy in short-term general anesthesia. After tissue processing the samples are cryopreserved in programmable automatic freezer or by vitrification. The auto-transplantation of ovarian tissue is planned after the complete cure of patient's malignancy. Our workplace doesn't have own experience with tissue transplantation - until now cryopreserved tissue has not yet been utilized by the patients. Clinical experience with this technique gained by our team during academic stay in abroad Israeli clinic is presented. During the years of 2005-2011 the OTC was performed in 19 cancer patients before chemotherapy. In majority of cases, patients suffered from blood or lymph node systemic malignancy (84%). Average age of women was 26 years. The patient set consisted of mostly nulliparous women (88%). Patient's average body mass index was 23,9 kg/m2. The length of systemic chemotherapy averaged 7.1 months. Time from fertility preservation counseling to chemotherapy was not exceeding one week (7.2 days on average). Ovarian tissue harvesting was conducted by laparoscopic surgery in all cases. The length of surgery did not exceed 60 minutes and no surgical complications were observed. The case of ovarian tissue transplantation performed on abroad university settings is discussed. In the consensus of with

Patient-Reported Outcomes, Quality of Life, and Satisfaction Rates in Young Patients Aged 50 Years or Younger After Total Knee Arthroplasty.

PubMed

Goh, Graham Seow-Hng; Liow, Ming Han Lincoln; Bin Abd Razak, Hamid Rahmatullah; Tay, Darren Keng-Jin; Lo, Ngai-Nung; Yeo, Seng-Jin

2017-02-01

Recent studies have shown a discrepancy between traditional functional outcomes and patient satisfaction, with some reporting less than 85% satisfaction in older patients undergoing total knee arthroplasty (TKA). As native knee biomechanics are not completely replicated, the resulting functional limitations may cause dissatisfaction in higher-demand individuals. Few studies have recorded patient-reported outcomes, health-related quality of life scores, and patient satisfaction in a young population undergoing TKA. One hundred thirty-six primary TKAs were performed in 114 patients aged 50 years or younger (mean age, 47.0 years; range, 30-50 years) at a single institution. The main diagnoses were osteoarthritis (85%) and rheumatoid arthritis (10%). The range of motion, Knee Society Score, Oxford Knee Score, and Physical and Mental Component Scores of Short Form-36 increased significantly (P < .001). At 2 years, 85.3% of patients had good/excellent knee scores, 71.3% had good/excellent function scores, 94.9% met the minimal clinically important difference for the Oxford Knee Score, and 84.6% met the minimal clinically important difference for the Physical Component Score. We found that 88.8% of patients were satisfied with their surgeries, whereas 86.8% had their expectations fulfilled. Survivorship using revision as an end point was 97.8% at a mean of 7 years (range, 3-16 years). Patients aged 50 years or younger undergoing TKA can experience significant improvements in their quality of life, have their expectations met, and be satisfied with their surgeries, at rates similar to those of non-age-restricted populations. Surgeons should inform them of these benefits and the potential risk of revision surgery in the future, albeit increasingly shown to be low. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of spirometry results in hospitalized patients aged over 65 years.

PubMed

Wróblewska, Izabela; Oleśniewicz, Piotr; Kurpas, Donata; Sołtysik, Mariusz; Błaszczuk, Jerzy

2015-01-01

The growing population of the elderly, as well as the occurrence of coexisting diseases and polypharmacy, is the reason why diseases of patients aged $65 years belong to the major issues of the contemporary medicine. Among the most frequent diseases of the elderly, there are respiratory system diseases. They are difficult to diagnose because of the patient group specificity, which is the reason for increased mortality among seniors, caused by underdiagnosis. The study objective was to assess the factors influencing spirometry results in hospitalized patients aged ≥65 years with respiratory system disorders. In the research, 217 (100%) patients aged ≥65 years who underwent spirometry at the Regional Medical Center of the Jelenia Góra Valley Hospital in Poland were analyzed. In the statistical analysis, the STATISTICA 9.1 program, the t-test, the Shapiro-Wilk test, the ANOVA test, and the Scheffé's test were applied. The majority of the patients (59.4%) were treated in the hospital. The most frequent diagnosis was malignant neoplasm (18%). The study showed a statistically significant dependence between the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC parameters and the time of hospitalization, as well as between the FVC and FEV1 parameters and the age of patients. The FVC parameter values turned out to be dependent on the main diagnosis. Highest results were noted in patients with the diagnosis of sleep apnea or benign neoplasm. A low FVC index can reflect restrictive ventilation defects, which was supported by the performed analyses. Highest FEV1/FVC values were observed in nonsmokers, which confirms the influence of nicotine addiction on the incidence of respiratory system diseases. The respondents' sex and the established diagnosis statistically significantly influenced the FVC index result, and the diet influenced the FEV1/FVC parameter result.

International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study.

PubMed

Luedtke, K; Boissonnault, W; Caspersen, N; Castien, R; Chaibi, A; Falla, D; Fernández-de-Las-Peñas, C; Hall, T; Hirsvang, J R; Horre, T; Hurley, D; Jull, G; Krøll, L S; Madsen, B K; Mallwitz, J; Miller, C; Schäfer, B; Schöttker-Königer, T; Starke, W; von Piekartz, H; Watson, D; Westerhuis, P; May, A

2016-06-01

A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache. Copyright © 2016 Elsevier Ltd. All rights reserved.

Safety of aspirin desensitization in patients with reported aspirin allergy and cardiovascular disease.

PubMed

McMullan, Kathryn L; Wedner, H James

2013-01-01

Aspirin (ASA) is the drug of choice in patients with coronary artery disease for primary and secondary prevention. This poses a problem for those patients reporting hypersensitivity to this drug or class of drugs. Desensitization to ASA may be carried out safely and effectively in patients with reported ASA or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity needing ASA for cardiac indications. Our 7-step protocol is one choice for a rapid desensitization protocol. A retrospective chart review was conducted evaluating ASA desensitization in patients with reported ASA or NSAID hypersensitivity and a cardiac indication for ASA. In 160 evaluations over 15 years, 89 desensitizations were performed in both the inpatient and outpatient setting with only 16 reactions (18%). Eleven of these 16 patients (68.7%) were able to take daily ASA. Twenty-six desensitization procedures were performed with our 7-step rapid desensitization protocol in 10 inpatients and 16 outpatients with 3 reactions (18.75% of reactions). Initial reaction to ASA involving angioedema and reacting to ASA within the past year increased the risk of having a reaction to desensitization. Desensitization may be safely performed in patients with reported ASA or NSAID hypersensitivity and a cardiac indication for ASA. Our 7-step rapid protocol may be used in both the inpatient and outpatient setting to desensitize these patients. Patients who had angioedema with ASA ingestion or a reaction to ASA within the past year are at higher risk for reaction during the desensitization protocol. The authors have no funding, financial relationships, or conflicts of interest to disclose. © 2012 Wiley Periodicals, Inc.

Prevalence of coeliac disease in Italian patients affected by Addison's disease.

PubMed

Biagi, Federico; Campanella, Jonia; Soriani, Alessandra; Vailati, Alberto; Corazza, Gino R

2006-03-01

It is well known that coeliac disease is associated with autoimmune endocrine diseases, such as autoimmune thyroid disease and insulin-dependent diabetes mellitus. Recently, coeliac disease has been shown in approximately 10% of patients with autoimmune Addison's disease. Addison's disease is the most common cause of primary adrenocortical insufficiency and it shares several clinical features with coeliac disease. Although hyperpigmentation and hypotension are the most specific signs, gastrointestinal symptoms are common and can be the first complaints of the patients. The aim of our study was to investigate the prevalence of coeliac disease in Italian patients with Addison's disease. Seventeen consecutive patients affected by Addison's disease (14 F, mean age 53.9 years, range 26-79 years) were enrolled in the study. Eleven of them were affected by Addison's disease associated with autoimmune thyroid disease and/or insulin-dependent diabetes mellitus; the other 6 patients were suffering from isolated Addison's disease. Diagnosis had been performed at the age of 40.5 years (range 23-55). Steroid treatment had already been started in 16 of the patients. Endomysial antibodies were tested in all of them and a duodenal biopsy was taken in those found to be positive for antiendomysial antibody (EMA). One out of 17 patients was found to be EMA positive. Duodenal biopsy confirmed the diagnosis of coeliac disease by showing subtotal villous atrophy. Although we studied only a small sample, our preliminary results confirmed that Addison's disease is associated with coeliac disease, being present in 5.9% of patients with Addison's disease. Since the symptoms can be similar and treatment of Addison's disease can mask coeliac disease, this association should always be actively investigated.

Brain atrophy and lesion load measures over 1 year relate to clinical status after 6 years in patients with clinically isolated syndromes.

PubMed

Di Filippo, M; Anderson, V M; Altmann, D R; Swanton, J K; Plant, G T; Thompson, A J; Miller, D H

2010-02-01

Conventional MRI lesion measures modestly predict long term disability in some clinically isolated syndrome (CIS) studies. Brain atrophy suggests neuroaxonal loss in multiple sclerosis (MS) with the potential to reflect disease progression to a greater extent than lesion measures. To investigate whether brain atrophy and lesion load, during the first year in patients presenting with CIS, independently predict clinical outcome (development of MS and disability at 6 years). 99 patients presenting with CIS were included in the study. T1 gadolinium enhanced and T2 weighted brain MRI was acquired at baseline and approximately 1 year later. Percentage brain atrophy rate between baseline and follow-up scans was analysed using SIENA. Mean annual brain atrophy rates were -0.38% for all patients, -0.50% in patients who had developed MS at 6 years and -0.26% in those who had not. Brain atrophy rate (p = 0.005) and baseline T2 lesion load (p<0.001) were independent predictors of clinically definite MS. While brain atrophy rate was a predictor of Expanded Disability Status Scale (EDSS) score in a univariate analysis, only 1 year T2 lesion load change (p = 0.007) and baseline gadolinium enhancing lesion number (p = 0.03) were independent predictors of EDSS score at the 6 year follow-up. T1 lesion load was the only MRI parameter which predicted Multiple Sclerosis Functional Composite score at the 6 year follow-up. The findings confirm that brain atrophy occurs during the earliest phases of MS and suggest that 1 year longitudinal measures of MRI change, if considered together with baseline MRI variables, might help to predict clinical status 6 years after the first demyelinating event in CIS patients, better than measurements such as lesion or brain volumes on baseline MRI alone.

5-years APAP adherence in OSA patients--do first impressions matter?

PubMed

van Zeller, Mafalda; Severo, Milton; Santos, Ana Cristina; Drummond, Marta

2013-12-01

Although continuous positive airway pressure (CPAP) is effective in treating obstructive sleep apnoea (OSA), inadequate adherence remains a major cause of treatment failure. This study aimed to determine long term adherence to auto adjusting-CPAP (APAP) and its influencing factors including the role of initial compliance. Eighty-eight male patients with newly diagnosed moderate/severe OSA were included. After initiation of APAP treatment, patients had periodic follow-up appointments at 2 weeks, 6 months and then annually for at least 5 years. Patient's compliance to therapy was assessed in each appointment and predictors to treatment abandonment and poor compliance were evaluated. The studied population had a mean age of 53.8 years and mean apnoea-hypopnoea index of 52.71/h. The mean time of follow-up was 5.2 (± 1.6) years, during that time 22 (25%) patients abandoned APAP, those who maintained treatment had good compliance to it since 94% of them used it more than 4 h/day for at least 70% of days. A significant negative association was found between age, % of days and mean time of APAP use on 12th day and 6th month and the risk of abandoning. APAP use lower than 33% and 57% of days at 12th day and 6th month, respectively had high specificity (≈ 100%) to detect treatment abandonment. the majority of patients adheres to long term APAP treatment and has good compliance after 5-years of follow-up. Age and initial compliance (% days of use and mean hour/day) have the ability to predict future adherence, as soon as 12 days and 6 months after initiation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Primary infectious spondylodiscitis in 51 patients over 75 years old: A comparative study.

PubMed

Dubost, Jean-Jacques; Lopez, Julien; Pereira, Bruno; Castagne, Benjamin; Tournadre, Anne; Soubrier, Martin; Couderc, Marion

2018-05-23

The incidence of infectious spondylodiscitis has been shown to rise with age; however, they had not been extensively investigated in the very elderly. This retrospective, monocentric study included patients hospitalized in our department of rheumatology for primary infectious spondylodiscitis between 2000 and 2015, and compared over 75-year-olds with younger patients. Of the 152 patients, 51 (33.6%) were≥75 years old, 59 were 61-74, and 42 were≤60. Patients≥75 years old were more often institutionalized (7.8 vs. 0; P=.02), were less often subject to infection risk factors (27.5 vs. 54.5%; P=.02), but did not differ from the others as regards the frequency of diabetes and cancer. Time to diagnosis was shorter for the under 60-year-olds (23 vs. 30 vs. 30 day for each age group, respectively; P<.05). There were no differences among the age groups in terms of spondylodiscitis localization, frequency of neurological symptoms and fever, frequency or intensity of inflammatory syndrome, imaging use, frequency of microorganism identification, blood culture positivity, or use and efficacy of disco-vertebral biopsy. Microorganism distribution was comparable among the groups, except for Gram-negative bacilli, with Escherichia coli more common in over 75-year-olds (7/8 vs. 4/14; P=.02). Duration of antibiotherapy and hospitalization was comparable across the age groups. Five patients died, all over 75 years old (5/51 vs. 0/101; P=.001). Age is a risk factor for primary spondylodiscitis, associated with significant mortality in over 75-year-olds (10%). For these elderly patients, spondylodiscitis does not bear any other distinguishing features. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Which patients are most challenging for second-year medical students?

PubMed

Walling, Anne; Montello, Martha; Moser, Scott E; Menikoff, Jerry A; Brink, Melanie

2004-01-01

Fostering appropriate attitudes toward patients begins with recognition of the physician's personal biases and preferences about patients. We sought to assist second-year medical students to identify those patient attributes that may influence their clinical behavior, especially in difficult patient encounters. This study's objectives were (1) to identify the principal patient characteristics reported by students to evoke negative or positive affective reactions sufficient to compromise the quality of patient care and (2) to examine differences between male and female students on these patient characteristics. An anonymous survey was made of all second-year medical students attending a seminar on medical errors. Students recorded the three principal patient characteristics that might evoke in them a negative personal reaction sufficient to compromise the quality of clinical care. Students then recorded three principal patient characteristics that might evoke a positive reaction sufficient to compromise the quality of clinical care. The data were analyzed to identify the primary concerns of the entire group of students and any significant differences between male and female students. Information on negative attitudes was provided by 67 of 71 (94%) students and on positive attitudes by 70 of 71 (99%). Content analysis identified four general categories of patient characteristics associated with negative attitudes (patients who are rude, contributed to medical problem, are abusive to others, and other attributes). Five general categories (patients with whom students have personal connection or patients who have physical and/or social attractiveness, vulnerability, power/influence, and other) were associated with positive attitudes by the students. The leading patient attributes reported as likely to influence clinical behavior were the positive attributes of "personal connection" and "attractiveness." These were reported by 60% and 53% of the class, respectively

Exercise-induced rhabdomyolysis - a patient series.

PubMed

Tazmini, Kiarash; Schreiner, Christoffer; Bruserud, Sidsel; Raastad, Truls; Solberg, Erik Ekker

2017-11-14

No guidelines are available for the treatment and follow up of exercise-induced rhabdomyolysis. The purpose of this study was to describe the treatment, complications and follow-up of patients with exercise-induced rhabdomyolysis at Diakonhjemmet Hospital. A retrospective observational study from 2011 up to and including 2015 of patients with exercise-induced rhabdomyolysis ≥ 18 years and with creatine kinase > 5 000 IU/l. We registered a total of 42 patients and obtained informed consent from 31. Twenty were treated as inpatients with a median hospitalisation time of 2.5 (1–6) days. Median creatine kinase was 36 797 (17 172–53 548) IU/l upon admission and 16 051 (11 845–26 505) IU/l at discharge. Median intravenous fluid volume was 6 000 (1 000–27 700) ml. Eleven patients underwent urinary alkalinisation. None developed severe kidney injury or other serious complications such as electrolyte imbalance, compartment syndrome or disseminated intravascular coagulation, either during hospitalisation or in the course of the study period. Healthy persons with exercise-induced rhabdomyolysis have a very low risk of complications. Our patients are treated as outpatients or considered for discharge with creatine kinase < 40 000 IU/l measured at least three days after their workout, and if they have no risk factors or other complications.

10-year results of the uncemented Allofit press-fit cup in young patients.

PubMed

Streit, Marcus R; Weiss, Stefan; Andreas, Franziska; Bruckner, Thomas; Walker, Tilman; Kretzer, J Philippe; Ewerbeck, Volker; Merle, Christian

2014-08-01

Uncemented acetabular components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the second decade in young and active patients. We report on a minimum 10-year follow-up of an uncemented press-fit acetabular component that is still in clinical use. We examined the clinical and radiographic results of our first 121 consecutive cementless THAs using a cementless, grit-blasted, non-porous, titanium alloy press-fit cup (Allofit; Zimmer Inc., Warsaw, IN) without additional screw fixation in 116 patients. Mean age at surgery was 51 (21-60) years. Mean time of follow-up evaluation was 11 (10-12) years. At final follow-up, 8 patients had died (8 hips), and 1 patient (1 hip) was lost to follow-up. 3 hips in 3 patients had undergone acetabular revision, 2 for deep infection and 1 for aseptic acetabular loosening. There were no impending revisions at the most recent follow-up. We did not detect periacetabular osteolysis or loosening on plain radiographs in those hips that were evaluated radiographically (n = 90; 83% of the hips available at a minimum of 10 years). Kaplan-Meier survival analysis using revision of the acetabular component for any reason (including isolated inlay revisions) as endpoint estimated the 11-year survival rate at 98% (95% CI: 92-99). Uncemented acetabular fixation using the Allofit press-fit cup without additional screws was excellent into early in the second decade in this young and active patient cohort. The rate of complications related to the liner and to osteolysis was low.

Three year naturalistic outcome study of panic disorder patients treated with paroxetine

PubMed Central

Dannon, Pinhas N; Iancu, Iulian; Cohen, Ami; Lowengrub, Katherine; Grunhaus, Leon; Kotler, Moshe

2004-01-01

Background This naturalistic open label follow-up study had three objectives: 1) To observe the course of illness in Panic Disorder patients receiving long-term versus intermediate-term paroxetine treatment 2) To compare the relapse rates and side-effect profile after long-term paroxetine treatment between patients with Panic Disorder and Panic Disorder with Agoraphobia. 3) To observe paroxetine's tolerability over a 24 month period. Methods 143 patients with panic disorder (PD), with or without agoraphobia, successfully finished a short-term (ie 12 week) trial of paroxetine treatment. All patients then continued to receive paroxetine maintenance therapy for a total of 12 months. At the end of this period, 72 of the patients chose to discontinue paroxetine pharmacotherapy and agreed to be monitored throughout a one year discontinuation follow-up phase. The remaining 71 patients continued on paroxetine for an additional 12 months and then were monitored, as in the first group, for another year while medication-free. The primary limitation of our study is that the subgroups of patients receiving 12 versus 24 months of maintenance paroxetine therapy were selected according to individual patient preference and therefore were not assigned in a randomized manner. Results Only 21 of 143 patients (14%) relapsed during the one year medication discontinuation follow-up phase. There were no significant differences in relapse rates between the patients who received intermediate-term (up to 12 months) paroxetine and those who chose the long-term course (24 month paroxetine treatment). 43 patients (30.1%) reported sexual dysfunction. The patients exhibited an average weight gain of 5.06 kg. All patients who eventually relapsed demonstrated significantly greater weight increase (7.3 kg) during the treatment phase. Conclusions The extension of paroxetine maintenance treatment from 12 to 24 months did not seem to further decrease the risk of relapse after medication discontinuation

Recall of Fertility Discussion by Adolescent Female Cancer Patients: A Survey-Based Pilot Study.

PubMed

Zarnegar, Sara; Gosiengfiao, Yasmin; Rademaker, Alfred; Casey, Robert; Albritton, Karen H

2018-04-01

Many adolescent female cancer patients will survive into their reproductive years. Pediatric oncologists are advised to discuss oncofertility during treatment planning. In this pilot study, 19 adolescent females completed a retrospective survey assessing recall of a fertility discussion, satisfaction with fertility knowledge, and multiple factors that may influence recall, including parental involvement in decision-making. Eleven respondents (58%) remembered a discussion about infertility risk and 9 (47%) about fertility preservation. Most who recalled a discussion were satisfied with their fertility knowledge (10/11, 90.9%). In this study, we validated the feasibility of survey administration and identified trends in oncofertility counseling at our center.

AIP mutations in Brazilian patients with sporadic pituitary adenomas: a single-center evaluation

PubMed Central

Kasuki, Leandro; de Azeredo Lima, Carlos Henrique; Ogino, Liana; Camacho, Aline H S; Chimelli, Leila; Korbonits, Márta

2017-01-01

Aryl hydrocarbon receptor-interacting protein (AIP) gene mutations (AIPmut) are the most frequent germline mutations found in apparently sporadic pituitary adenomas (SPA). Our aim was to evaluate the frequency of AIPmut among young Brazilian patients with SPA. We performed an observational cohort study between 2013 and 2016 in a single referral center. AIPmut screening was carried out in 132 SPA patients with macroadenomas diagnosed up to 40 years or in adenomas of any size diagnosed until 18 years of age. Twelve tumor samples were also analyzed. Leukocyte DNA and tumor tissue DNA were sequenced for the entire AIP-coding region for evaluation of mutations. Eleven (8.3%) of the 132 patients had AIPmut, comprising 9/74 (12%) somatotropinomas, 1/38 (2.6%) prolactinoma, 1/10 (10%) corticotropinoma and no non-functioning adenomas. In pediatric patients (≤18 years), AIPmut frequency was 13.3% (2/15). Out of the 5 patients with gigantism, two had AIPmut, both truncating mutations. The Y268* mutation was described in Brazilian patients and the K273Rfs*30 mutation is a novel mutation in our patient. No somatic AIP mutations were found in the 12 tumor samples. A tumor sample from an acromegaly patient harboring the A299V AIPmut showed loss of heterozygosity. In conclusion, AIPmut frequency in SPA Brazilian patients is similar to other populations. Our study identified two mutations exclusively found in Brazilians and also shows, for the first time, loss of heterozygosity in tumor DNA from an acromegaly patient harboring the A299V AIPmut. Our findings corroborate previous observations that AIPmut screening should be performed in young patients with SPA. PMID:29074612

Estimating 10-year cardiovascular disease risk in Asian patients with schizophrenia.

PubMed

Rekhi, Gurpreet; Khyne, Toe Toe; Lee, Jimmy

This study aims to describe the cardiovascular risk profile of Asian patients with schizophrenia. Data was extracted from the databases of 139 patients with schizophrenia and 206 controls from two previous studies conducted at the Institute for Mental Health (IMH), Singapore. Their medical and smoking histories were obtained, and anthropometric parameters measured. Framingham risk score (FRS) calculator using body mass index was used to compute the 10-year cardiovascular disease risk (FRS BMI ) and the vascular age (VA BMI ) for each participant. Data on fasting lipids were available for 80 patients and all the controls; hence the FRS for lipids (FRS lipids ) and VA (VA lipids ) were also computed. The difference between VA and actual age was computed as VA diff . The 10-year CVD risk and VA diff based on lipids as well as BMI were significantly higher for patients compared to controls (all p<0.01). There was a strong correlation between FRS lipids and FRS BMI (r=0.97, p<0.001). Significantly higher numbers of patients than controls were smokers and obese; and reported having dyslipidaemia. We found a high risk of CVD in patients with schizophrenia as compared to controls; and conclude that patients with schizophrenia need regular physical health monitoring, especially for cardiovascular risk factors. Copyright © 2016 Elsevier Inc. All rights reserved.

Definition of the upper reference limit for thyroglobulin antibodies according to the National Academy of Clinical Biochemistry guidelines: comparison of eleven different automated methods.

PubMed

D'Aurizio, F; Metus, P; Ferrari, A; Caruso, B; Castello, R; Villalta, D; Steffan, A; Gaspardo, K; Pesente, F; Bizzaro, N; Tonutti, E; Valverde, S; Cosma, C; Plebani, M; Tozzoli, R

2017-12-01

In the last two decades, thyroglobulin autoantibodies (TgAb) measurement has progressively switched from marker of thyroid autoimmunity to test associated with thyroglobulin (Tg) to verify the presence or absence of TgAb interference in the follow-up of patients with differentiated thyroid cancer. Of note, TgAb measurement is cumbersome: despite standardization against the International Reference Preparation MRC 65/93, several studies demonstrated high inter-method variability and wide variation in limits of detection and in reference intervals. Taking into account the above considerations, the main aim of the present study was the determination of TgAb upper reference limit (URL), according to the National Academy of Clinical Biochemistry guidelines, through the comparison of eleven commercial automated immunoassay platforms. The sera of 120 healthy males, selected from a population survey in the province of Verona, Italy, were tested for TgAb concentration using eleven IMA applied on as many automated analyzers: AIA-2000 (AIA) and AIA-CL2400 (CL2), Tosoh Bioscience; Architect (ARC), Abbott Diagnostics; Advia Centaur XP (CEN) and Immulite 2000 XPi (IMM), Siemens Healthineers; Cobas 6000 (COB), Roche Diagnostics; Kryptor (KRY), Thermo Fisher Scientific BRAHMS, Liaison XL (LIA), Diasorin; Lumipulse G (LUM), Fujirebio; Maglumi 2000 Plus (MAG), Snibe and Phadia 250 (PHA), Phadia AB, Thermo Fisher Scientific. All assays were performed according to manufacturers' instructions in six different laboratories in Friuli-Venezia Giulia and Veneto regions of Italy [Lab 1 (AIA), Lab 2 (CL2), Lab 3 (ARC, COB and LUM), Lab 4 (CEN, IMM, KRY and MAG), Lab 5 (LIA) and Lab 6 (PHA)]. Since TgAb values were not normally distributed, the experimental URL (e-URL) was established at 97.5 percentile according to the non-parametric method. TgAb e-URLs showed a significant inter-method variability. Considering the same method, e-URL was much lower than that suggested by manufacturers (m

Teaching About the Doctor-Patient Relationship in the First Postgraduate Year.

ERIC Educational Resources Information Center

Sledge, William H.; And Others

1987-01-01

Introduction of a course on the doctor-patient relationship in the clinically demanding first postgraduate year encountered two problems: student perceptions that the content was not necessary or was too burdensome, and the tendency of residents to feel guilty or inadequate in patient relationships at that stage of training. (MSE)

[Patients' satisfaction and waiting time in oncology day care centers in Champagne-Ardenne].

PubMed

Debreuve-Theresette, A; Jovenin, N; Stona, A C; Kraïem-Leleu, M; Burde, F; Parent, D; Hettler, D; Rey, J B

2015-12-01

Quality of life of patients suffering from cancer may be influenced by the way healthcare is organized and by patient experiences. Nowadays, chemotherapy is often provided in day care centers. This study aimed to assess patient waiting time and satisfaction in oncology day care centers in Champagne-Ardenne, France. This cross-sectional survey involved all patients receiving ambulatory chemotherapy during a one-week period in day care centers of Champagne-Ardenne public and private healthcare institutions participating in the study. Sociodemographic, medical and outpatient data were collected. Patient satisfaction was measured using the Out-Patsat35 questionnaire. Eleven (out of 16) oncology day care centers and 441 patients participated in the study. Most of the patients were women (n=252, 57.1%) and the mean age was 61±12 years. The mean satisfaction score was 82±14 (out of 100) and the mean waiting time between the assigned appointment time and administration of chemotherapy was 97±60 min. This study has shown that waiting times are important. However, patients are satisfied with the healthcare organization, especially regarding nursing support. Early preparation of chemotherapy could improve these parameters. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Non-alcoholic fatty liver: 10 years' experience at the Insituto Nacional de la Nutrición Salvador Zubirán].

PubMed

de la Mora, G; Olivera, M; de la Cerda, R; Arista, J; Kershenobich, D; Uribe, M

1994-01-01

To describe the characteristics of non-alcoholic steatohepatitis (NASH) at the Instituto Nacional de la Nutricion Salvador Zubiran. We reviewed all liver biopsy reports from January 1982 to December 1991. From patient records we obtained the following data: clinical, biochemical, imaging studies and we reviewed the histological material. We correlated clinical, biochemical and histological data. From 2963 biopsies reviewed we obtained 16 cases of NASH. We found a 7:1 female/male ratio. Median age was 30 years and six patients were obese. Eleven patients had concomitant disease (diabetes in seven) and nine were using drugs. All had been studied for biochemical abnormalities and were asymptomatic. Ten patients had hepatomegaly and six splenomegaly. Ultrasound suggested the diagnosis in 50% of the cases. All had steatosis, inflammatory infiltrate, necrosis, fibrosis and Mallory bodies at different stages. One case had cirrhosis on initial biopsy and two developed cirrhosis on follow-up (one and eight years later). We did not find any correlation between clinical, biochemical or imaging characteristics and histological findings. When we compared these findings between obese and non obese patients and primary and secondary NASH we did not find any differences between groups. NASH is infrequent in our institution. The underlying pathogenesis seems to be multifactorial. There is no biochemical-histological correlation. Cirrhosis can develop in some cases.

Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula.

PubMed

Zheng, Xiangyi; Lin, Yiwei; Chen, Bin; Zhou, Xianyong; Zhou, Xiaofeng; Shen, Yuehong; Xie, Liping

2013-12-01

Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation.

Stage I nonsmall cell lung cancer in patients aged > or =75 years: outcomes after stereotactic radiotherapy.

PubMed

Haasbeek, Cornelis J A; Lagerwaard, Frank J; Antonisse, Marilisa E; Slotman, Ben J; Senan, Suresh

2010-01-15

The number of patients aged > or =75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. Since 2003, 203 tumors in 193 patients aged > or =75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P = .001) and pre-SRT lung function (P = .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade > or =3 toxicity was observed in <10% of patients. SRT achieved high local control rates with minimal toxicity in patients aged > or =75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative.

Short-Term Outcomes Following Hip Fractures in Patients at Least 100 Years Old.

PubMed

Manoli, Arthur; Driesman, Adam; Marwin, Rebecca A; Konda, Sanjit; Leucht, Philipp; Egol, Kenneth A

2017-07-05

The number of hip fractures is rising as life expectancy increases. As such, the number of centenarians sustaining these fractures is also increasing. The purpose of this study was to determine whether patients who are ≥100 years old and sustain a hip fracture fare worse in the hospital than those who are younger. Using a large database, the New York Statewide Planning and Research Cooperative System (SPARCS), we identified patients who were ≥65 years old and had been treated for a hip fracture over a 12-year period. Data on demographics, comorbidities, and treatment were collected. Three cohorts were established: patients who were 65 to 80 years old, 81 to 99 years old, and ≥100 years old (centenarians). Outcome measures included hospital length of stay, estimated total costs, and in-hospital mortality rates. A total of 168,087 patients with a hip fracture were identified, and 1,150 (0.7%) of them had sustained the fracture when they were ≥100 years old. Centenarians incurred costs and had lengths of stay that were similar to those of younger patients. Despite the similarities, centenarians were found to have a significantly higher in-hospital mortality rate than the younger populations (7.4% compared with 4.4% for those 81 to 99 years old and 2.6% for those 65 to 80 years old; p < 0.01). Male sex and an increasing number of medical comorbidities were found to predict in-hospital mortality for centenarians sustaining extracapsular hip fractures. No significant predictors of in-hospital mortality were identified for centenarians who sustained femoral neck fractures. An increased time to surgery did not influence the odds of in-hospital mortality. Centenarians had increased in-hospital mortality, but the remaining short-term outcomes were comparable with those for the younger cohorts with similar fracture patterns. For this extremely elderly population, time to surgery does not appear to affect short-term mortality rates, suggesting a potential benefit to

Congenital portosystemic shunts: imaging findings and clinical presentations in 11 patients.

PubMed

Konstas, Angelos A; Digumarthy, Subba R; Avery, Laura L; Wallace, Karen L; Lisovsky, Mikhail; Misdraji, Joseph; Hahn, Peter F

2011-11-01

To evaluate the clinical anatomy and presentations of congenital portosystemic shunts, and determine features that promote recognition on imaging. Institutional review board approval was obtained for this HIPAA-compliant study. The requirement for written informed consent was waived. Radiology reports were retrospectively reviewed from non-cirrhotic patients who underwent imaging studies from January 1999 through February 2009. Clinical sources reviewed included electronic medical records, archived images and histopathological material. Eleven patients with congenital portosystemic shunts were identified (six male and five female; age range 20 days to 84 years). Seven patients had extrahepatic and four patients had intrahepatic shunts. All 11 patients had absent or hypoplastic intrahepatic portal veins, a feature detected by CT and MRI, but not by US. Seven patients presented with shunt complications and four with presentations unrelated to shunt pathophysiology. Three adult patients had four splenic artery aneurysms. Prospective radiological evaluation of five adult patients with cross-sectional imaging had failed prospectively to recognize the presence of congenital portosystemic shunts on one or more imaging examinations. Congenital portosystemic shunts are associated with splenic artery aneurysms, a previously unrecognized association. Portosystemic shunts were undetected during prospective radiologic evaluation in the majority of adult patients, highlighting the need to alert radiologists to this congenital anomaly. Copyright © 2010. Published by Elsevier Ireland Ltd.

Safety and efficacy of vismodegib in patients aged ≥65 years with advanced basal cell carcinoma.

PubMed

Chang, Anne Lynn S; Lewis, Karl D; Arron, Sarah T; Migden, Michael R; Solomon, James A; Yoo, Simon; Day, Bann-Mo; McKenna, Edward F; Sekulic, Aleksandar

2016-11-15

Because many patients with unresectable basal cell carcinoma (BCC) are aged ≥65 years, this study explores the efficacy and safety of vismodegib in these patients with locally advanced (la) or metastatic (m) basal cell carcinoma (BCC) in the ERIVANCE BCC trial and the expanded access study (EAS).We compared patients aged ≥65 years to patients aged <65 years taking vismodegib 150 mg/day, using descriptive statistics for response and safety. Patients aged ≥65 years (laBCC/mBCC) were enrolled in ERIVANCE BCC (33/14) and EAS (27/26). Investigator-assessed best overall response rate in patients ≥65 and <65 years was 46.7%/35.7% and 72.7%/52.6% (laBCC/mBCC), respectively, in ERIVANCE BCC and 45.8%/33.3% and 46.9%/28.6%, respectively, in EAS. These differences were not clinically meaningful. Safety was similar in both groups, although those aged ≥65 years had a higher percentage of grade 3-5 adverse events than those aged <65 years. Vismodegib demonstrated similar clinical activity and adverse events regardless of age.

The 3-Year Incidence of Gout in Elderly Patients with CKD.

PubMed

Tan, Vivian S; Garg, Amit X; McArthur, Eric; Lam, Ngan N; Sood, Manish M; Naylor, Kyla L

2017-04-03

The risk of gout across CKD stages is not well described. We performed a retrospective cohort study using linked health care databases from Ontario, Canada from 2002 to 2010. The primary outcome was the 3-year cumulative incidence of gout, on the basis of diagnostic codes. We presented our results by level of kidney function (eGFR≥90 ml/min per 1.73 m 2 , 60-89, 45-59, 30-44, 15-29, and chronic dialysis) and by sex. Additional analyses examined the risk of gout adjusting for clinical characteristics, incidence of gout defined by the receipt of allopurinol or colchicine, and gout risk in a subpopulation stratified by the level of eGFR and albuminuria. Of the 282,925 adults aged ≥66 years, the mean age was 75 years and 57.9% were women. The 3-year cumulative incidence of gout was higher in older adults with a lower level of eGFR. In women, the 3-year cumulative incidence of gout was 0.6%, 0.7%, 1.3%, 2.2%, and 3.4%, and in men the values were 0.8%, 1.2%, 2.5%, 3.7%, and 4.6%, respectively. However, patients on chronic dialysis had a lower 3-year cumulative incidence of gout (women 2.0%, men 2.9%) than those with more moderate reductions in kidney function ( i.e. , eGFR 15-44 ml/min per 1.73 m 2 ). The association between a greater loss of kidney function and a higher risk of diagnosed gout was also evident after adjustment for clinical characteristics and in all additional analyses. Patients with a lower level of eGFR had a higher 3-year cumulative incidence of gout, with the exception of patients receiving dialysis. Results can be used for risk stratification. Copyright © 2017 by the American Society of Nephrology.

Characteristics and outcomes of patients with multiple myeloma aged 21-40 years versus 41-60 years: a multi-institutional case-control study.

PubMed

Jurczyszyn, Artur; Nahi, Hareth; Avivi, Irit; Gozzetti, Alessandro; Niesvizky, Ruben; Yadlapati, Sujitha; Jayabalan, David S; Robak, Paweł; Pika, Tomas; Andersen, Kristian T; Rasche, Leo; Mądry, Krzysztof; Woszczyk, Dariusz; Raźny, Małgorzata; Usnarska-Zubkiewicz, Lidia; Knopińska-Posłuszny, Wanda; Wojciechowska, Małgorzata; Guzicka-Kazimierczak, Renata; Joks, Monika; Grosicki, Sebastian; Ciepłuch, Hanna; Rymko, Marcin; Vesole, David H; Castillo, Jorge J

2016-12-01

We compared the outcomes of multiple myeloma (MM) patients aged 21-40 and 41-60 years in the novel agent era. This case-control study included 1089 patients between 2000 and 2015. Cases and controls were matched for sex, International Staging System (ISS) stage and institution. There were 173 patients in the younger group and 916 patients in the older group. Younger patients presented with a higher incidence of lytic lesions (82% vs. 72%; P = 0·04) and high-risk cytogenetic abnormalities (83% vs. 68%; P = 0·007), but lower rate of elevated lactate dehydrogenase (21% vs. 44%; P < 0·001). Five- and 10-year overall survival (OS) in younger versus older patients was 83% vs. 67% and 56% vs. 39%, respectively (P < 0·001). Similar results were seen when studying the subset of 780 patients who underwent autologous transplantation. Younger patients with ISS stage 1 had a better OS than older patients (P < 0·001). There was no survival difference between younger and older patients with ISS stage 2 or 3. Younger MM patients, aged 21-40 years, treated in the era of novel agents have a better OS than their counterparts aged 41-60 years, but the survival advantage observed in younger patients was lost in more advanced stages of MM. © 2016 John Wiley & Sons Ltd.

On the Journey with the Dying: How General Practitioners Experience the Death of Their Patients

ERIC Educational Resources Information Center

Zambrano, Sofia C.; Barton, Christopher A.

2011-01-01

A grounded theory study was undertaken to understand how general practitioners (GPs) experience the death of their patients. Eleven GPs participated in semi-structured interviews. The participants explained their experience of a patient's death using the "death journey" metaphor. This journey, the Journey with the Dying, could be…

Predictors for 1-year mortality following hip fracture: a retrospective review of 465 consecutive patients.

PubMed

Heyes, G J; Tucker, A; Marley, D; Foster, A

2017-02-01

In Europe, trauma admissions and in particular hip fractures are on the rise. In recent years, health care systems have placed particular emphasis, including financial incentives, on delivering patients quickly and safely to surgery. At our unit, we have observed that hip fracture patients appear to be at significant risk of mortality even up to a year following injury. This study reviews a consecutive population of hip fracture patients to identify predictors of excess risk. Four hundred and sixty-five consecutive patients were treated over a 2-year period at our district general hospital with no ward-based orthogeriatricians. Follow-up was for 1 year following hip fracture admission. Statistical analysis of variables and their influence on 1-year mortality were performed by calculating odd's ratio (OR) using a logistic regression model and a p value <0.05 was considered statistically significant. Four patients were lost to follow-up, 18 patients (4.1 %) were managed conservatively, 16 were too unwell for surgery and their mortality rate at 1 year was 50 %. Following hip fracture, we found an overall 1-year mortality rate of 15.1 %. Patients with a time to surgery ≥36 h were at significantly increased risk of mortality even up to 1 year. We did not identify a further reduction in mortality in those operated on within 24 h. Raised ORs (p > 0.05) were found with increasing comorbidity, surgery type, independence on discharge, alcohol ingestion, history of smoking, readmission and several biochemical markers. Minimising mortality risk, even over the longer term, should begin on admission with prompt optimisation of any acute medical or biochemical abnormalities, followed by early surgery and intensive rehabilitation to maintain patients' functional independence.

Socioeconomic impact of alcohol in patients with alcoholic liver disease in eastern India.

PubMed

Singh, Shivaram Prasad; Padhi, Pradeep Kumar; Narayan, Jimmy; Singh, Ayaskanta; Pati, Girish Kumar; Nath, Preetam; Parida, Prasant Kumar; Mishra, Sunil

2016-11-01

The aim of this study is to estimate the socioeconomic impact of alcohol use on patients with alcoholic liver disease (ALD) and their families. The demographic and socioeconomic data were collected from hospitalized ALD patients and attendants using a self designed non validated questionnaire and analyzed. Study subjects included 100 consecutive ALD patients (all males). Sixty percent were between 30 and 50 years. Most were married (96 %), literate (63 %), either businessmen (37 %) or employed (30 %) and belonged to middle socioeconomic class. Ninety percent started alcohol use before age 30 years and half during teenage. Mean alcohol intake was 190 mL/day (mean duration 23 years); 60 % consumed alcohol daily. Concomitant tobacco abuse was noted in 79 %. Average expenditure on alcohol was Rs 3800/month. Average hospitalizations for ALD related problems was 2.6 times/year with average expenditure of INR 30,000 (~440 US$) during each hospitalization. For treatment expenses, 86 % of patients borrowed money from friends/relatives, 36 % used saving deposits, and 4 % sold personal belongings. Eleven percent lost their job, and 7 % sold immovable property. In 43 % of cases, children were deprived of education. Besides, 52 % had disturbed social and family life, 34 % abused their spouse, 20 % suffered accidents, and 37 % indulged in physical violence. Majority of ALD patients and their families had disturbed social and family life and incurred severe financial loss arising of alcohol use.

Patient-reported symptoms and changes up to 1 year after meniscal surgery.

PubMed

Skou, Søren T; Pihl, Kenneth; Nissen, Nis; Jørgensen, Uffe; Thorlund, Jonas Bloch

2018-06-01

Background and purpose - Detailed information on the symptoms and limitations that patients with meniscal tears experience is lacking. This study was undertaken to map the most prevalent self-reported symptoms and functional limitations among patients undergoing arthroscopic meniscal surgery and investigate which symptoms and limitations had improved most at 1 year after surgery. Patients and methods - Patients aged 18-76 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing arthroscopic meniscal surgery were included in this analysis of individual subscale items from the Knee Injury and Osteoarthritis Outcome Score and 1 question on knee stability. Severity of each item was scored as none, mild, moderate, severe, or extreme. Improvements were evaluated using Wilcoxon's signed-rank test and effect size (ES). Results - The most common symptoms were knee grinding and clicking, knee pain in general, pain when twisting and bending the knee and climbing stairs (88-98%), while the most common functional limitations were difficulty bending to the floor, squatting, twisting, kneeling, and knee awareness (97-99%). Knee pain in general and knee awareness improved most 1 year after meniscal surgery (ES -0.47 and -0.45; p < 0.001), while knee instability and general knee difficulties improved least (ES 0.10 and -0.08; p < 0.006). Interpretation - Adults undergoing surgery for a meniscal tear commonly report clinical symptoms and functional limitations related to their daily activities. Moderate improvements were observed in some symptoms and functional limitations and small to no improvement in others at 1 year after surgery. These findings can assist the clinical discussion of symptoms, treatments, and patients' expectations.

Rehabilitation activities, out-patient visits and employment in patients and partners the first year after ICU: a descriptive study.

PubMed

Agård, A S; Lomborg, K; Tønnesen, E; Egerod, I

2014-04-01

To describe the influence of critical illness on patients and their partners in relation to rehabilitation, healthcare consumption and employment during the first year after Intensive Care Unit discharge. Longitudinal, observational and descriptive. Five Danish Intensive Care Units. Data were collected from hospital charts, population registers and interviews with 18 patients and their partners at 3 and 12 months after intensive care discharge. Descriptive statistical analysis was performed. Post-discharge inpatient rehabilitation was median (range) 52 (15-174) days (n=10). Community-based training was 12 (3-34) weeks (n=15). Neuropsychological rehabilitation following brain damage was 13-20 weeks (n=3). Number of out-patient visits 1 year before and 1 year after were mean 3 versus 8, and General Practitioner visits were 12 versus 18. Three patients resumed work at pre-hospitalisation employment rates after 12 months. After the patients' stay in intensive care, partners' mean full-time sick leave was 17 (range 0-124) days and 21 (range 0-106) days part time. Partners often had long commutes. Most patients had comprehensive recovery needs requiring months of rehabilitation. Some partners needed extensive sick leave. The study reveals the human cost of critical illness and intensive care for patients and partners in the Danish welfare system. Copyright © 2013 Elsevier Ltd. All rights reserved.

Predictors of a favourable outcome in patients with fibromyalgia: results of 1-year follow-up.

PubMed

Kim, Ji-Eun; Park, Dong-Jin; Choi, Sung-Eun; Kang, Ji-Hyoun; Yim, Yi-Rang; Lee, Jeong-Won; Lee, Kyung-Eun; Wen, Lihui; Kim, Seong-Kyu; Choe, Jung-Yoon; Lee, Shin-Seok

2016-01-01

To determine the outcomes of Korean patients with fibromyalgia (FM) and to identify prognostic factors associated with improvement at 1-year follow-up. Forty-eight patients with FM were enrolled and examined every 3 months for 1 year. At the time of enrollment, we interviewed all patients using a structured questionnaire that recorded socio-demographic data, current or past FM symptoms, and current use of relevant medications. Tender point counts and scores were assessed by thumb palpation. Patients were asked to complete the Korean versions of the Fibromyalgia Impact Questionnaire (FIQ), the Brief Fatigue Inventory, the SF-36, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Self-Efficacy Scale, and the Social Support Scale. Tender points, FIQ scores, and the use of relevant medications were recorded during one year of follow-up. Of the 48 patients, 32 (66.7%) had improved FIQ scores 1 year after enrollment. Improved patients had higher baseline FIQ scores (68.4±13.9 vs. 48.4±20.8, p=0.001) and STAI-II scores (55.8±10.9 vs. 11.5±11.5, p=0.022). Patients treated with pregabalin were more likely to improve after 1 year, based on the FIQ scores (71.9% vs. 37.5%, p=0.031). On multivariate logistic regression analysis, a higher STAI-II score at the time of enrollment and pregabalin treatment during one year of follow-up were the predictors of improvement. Two-thirds of our Korean FM patients experienced some clinical improvement by 1-year follow-up. A high baseline STAI-II score and treatment with pregabalin were the important predictor of improved FM.

Incidence of late endocrine dysfunction following irradiation for childhood medulloblastoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abayomi, O.K.; Sadeghi-Nejad, A.

1986-06-01

A retrospective analysis of treatment in 20 patients who had received post-operative radiotherapy for medulloblastoma between 1969 and 1977 was completed. The patients were followed for a minimum of 60 months. Eleven patients survived for 5 or more years after treatment. The patients received 3600 cGy to the whole brain. The posterior fossa received 5600 cGY and the spinal axis 3600 cGY. Eight of eleven patients developed growth impairment; 6 of 7 patients had growth hormone deficiency. Since all endocrine gland failures are amenable to therapy, early attention to patients' growth rate and detection of hypothalamic-pituitary failure, would be ofmore » benefit to longterm survivors.« less

One-year survival of demented stroke patients: data from the Dijon Stroke Registry, France (1985-2008).

PubMed

Béjot, Y; Jacquin, A; Rouaud, O; Durier, J; Aboa-Eboulé, C; Hervieu, M; Osseby, G-V; Giroud, M

2012-05-01

  Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post-stroke dementia was a predictor of 1-year case-fatality and to evaluate factors that could influence survival in demented stroke patients. From 1985 to 2008, all first-ever strokes were recorded in the population-based stroke registry of Dijon, France (150, 000 inhabitants). Dementia was diagnosed during the first month following stroke, according to DSM-III and DSM-IV criteria. Survival was evaluated at 1 year and multivariate analyses were performed using Cox proportional hazards to identify independent predictive factors.   We recorded 3948 first-ever strokes. Among these stroke patients, 3201 (81%) were testable, and of these, 653 (20.4%) had post-stroke dementia (337 women and 316 men). Demented patients had lower 1-year survival than patients without dementia (82.9% vs. 86.9%, P = 0.013). However, in multivariate analysis, dementia did not appear as an independent predictor of 1-year death. In demented stroke patients, age >80 years old, severe handicap at discharge, recurrent stroke within the first year and subarachnoid haemorrhage were associated with a higher risk of 1-year death, and the risk was lower in the study period 2003-2008.   Dementia after stroke is not independently associated with an increased risk of death at 1 year. In recent years, 1-year case-fatality decreased in demented as well as in and non-demented patients suggesting that improvements in the management of stroke also benefited the most fragile patients. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

Effect of patient socioeconomic status on perceptions of first- and second-year medical students

PubMed Central

Woo, James K.H.; Ghorayeb, Sahar H.; Lee, Cheong K.; Sangha, Harpreet; Richter, Suzanne

2004-01-01

Background Physician decision-making and perceptions of patients are affected by a patient's socioeconomic status (SES). We sought to determine if the perceptions of first- and second-year medical students are similarly affected. We also wanted to determine whether a student's own SES affects his or her perceptions of patients from a low or high SES background. Methods Two similar videos of a physician–patient interview were created. One video featured a patient of apparently high SES and the other featured a patient of apparently low SES. Differences in SES were portrayed by means of clothing, accessories and dialogue. First- and second-year medical students at the University of Western Ontario were recruited to view 1 of the videos and to answer a questionnaire using a 5-point Likert scale. Results Responses were obtained from 205 (89%) of the 231 medical students invited to participate. Respondents' perceptions of the low SES and high SES patients were significantly different in the following respects. The low SES patient was perceived to be less compliant in taking medications and less likely to return for follow-up visits; was perceived to have a lower level of social support, poorer overall health and a worse prognosis; and was perceived to be more adversely affected in his occupational duties by illness (p < 0.05). Furthermore, second-year students who watched the video with the low SES patient were less inclined to want that patient in their practice than second-year students who watched the video with the high SES patient (p = 0.032). One hundred and six students (52%) were categorized as having high SES and 37 (18%) as having low SES (the remaining students were categorized as having mid-level SES). Among students who watched the video with the low SES patient, the level of agreement with the statement “This person is the kind of patient I would like to have in my practice” was greater among low SES students than among high SES students (p = 0

Alopecic and Aseptic Nodules of the Scalp/Pseudocyst of the Scalp: Clinicopathological and Therapeutic Analyses in 11 Korean Patients.

PubMed

Seol, Jung Eun; Park, In Ho; Kim, Do Hyeong; Park, So Hee; Kang, Jeong Nan; Kim, Hyojin; Seo, Jong Keun

2016-01-01

Alopecic and aseptic nodule of the scalp (AANS) is a rare disease entity first reported in 1992 as pseudocyst of the scalp (PCS). Controversy exists regarding the histopathology and etiology of reported cases. We performed this study to analyze the clinical and histopathologic features of AANS/PCS in Korean patients. A retrospective review of medical records from 2008 to 2013 at Inje University Busan Paik Hospital was performed. Eleven patients were enrolled. All patients were male, and their mean age was 21.6 years. Most patients had a solitary nodule (10/11) located predominantly on the vertex. The mean nodule size was 20 mm. Inflammatory cell infiltration in the deep dermis was a histologic feature of AANS/PCS. Eight patients showed granulomatous infiltration. All patients were treated with short-term antibiotics and intralesional steroid injection. Our results suggest that dermatologists should consider AANS when diagnosing an alopecic nodule on the scalp. © 2015 S. Karger AG, Basel.

Long-Term Outcomes and Complications in Patients With Craniopharyngioma: The British Columbia Cancer Agency Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lo, Andrea C., E-mail: andrealo@gmail.com; Department of Surgery, University of British Columbia, Vancouver, British Columbia; Howard, A. Fuchsia

2014-04-01

Purpose: We report long-term outcomes and complications of craniopharyngioma patients referred to our institution. Methods and Materials: Between 1971 and 2010, 123 consecutive patients received primary treatment for craniopharyngioma in British Columbia and were referred to our institution. The median age was 30 years (range, 2-80 years). Thirty-nine percent of patients were treated primarily with subtotal resection (STR) and radiation therapy (RT), 28% with STR alone, 15% with gross total resection, 11% with cyst drainage (CD) alone, 5% with CD+RT, and 2% with RT alone. Eight percent of patients received intracystic bleomycin (ICB) therapy. Results: Median follow-up was 8.9 years,more » and study endpoints were reported at 10 years. Ten-year Kaplan-Meier progression-free survival (PFS) was 46%. Patients treated with STR+RT or CD+RT had the highest PFS (82% and 83%, respectively). There were no significant differences between PFS after adjuvant versus salvage RT (84% vs 74%, respectively; P=.6). Disease-specific survival (DSS) was 88%, and overall survival (OS) was 80%. Primary treatment modality did not affect DSS or OS, while older age was a negative prognostic factor for OS but not DSS. Kaplan-Meier rates for visual deterioration, anterior pituitary hormone deficiency, diabetes insipidus, seizure disorder, and cerebrovascular events (CVE) due to treatment, not tumor progression, were 27%, 76%, 45%, 16%, and 11%, respectively. The CVE rate was 29% in patients who received ICB compared to 10% in those who did not (P=.07). Conclusions: We report favorable PFS in patients with craniopharyngioma, especially in those who received RT after surgery. DSS and OS rates were excellent regardless of primary treatment modality. We observed a high incidence of hypopituitarism, visual deterioration, and seizure disorder. Eleven percent of patients experienced CVEs after treatment. There was a suggestion of increased CVE risk in patients treated with ICB.« less

Complete mitochondrial genomes of eleven extinct or possibly extinct bird species.

PubMed

Anmarkrud, Jarl A; Lifjeld, Jan T

2017-03-01

Natural history museum collections represent a vast source of ancient and historical DNA samples from extinct taxa that can be utilized by high-throughput sequencing tools to reveal novel genetic and phylogenetic information about them. Here, we report on the successful sequencing of complete mitochondrial genome sequences (mitogenomes) from eleven extinct bird species, using de novo assembly of short sequences derived from toepad samples of degraded DNA from museum specimens. For two species (the Passenger Pigeon Ectopistes migratorius and the South Island Piopio Turnagra capensis), whole mitogenomes were already available from recent studies, whereas for five others (the Great Auk Pinguinis impennis, the Imperial Woodpecker Campehilus imperialis, the Huia Heteralocha acutirostris, the Kauai Oo Moho braccathus and the South Island Kokako Callaeas cinereus), there were partial mitochondrial sequences available for comparison. For all seven species, we found sequence similarities of >98%. For the remaining four species (the Kamao Myadestes myadestinus, the Paradise Parrot Psephotellus pulcherrimus, the Ou Psittirostra psittacea and the Lesser Akialoa Akialoa obscura), there was no sequence information available for comparison, so we conducted blast searches and phylogenetic analyses to determine their phylogenetic positions and identify their closest extant relatives. These mitogenomes will be valuable for future analyses of avian phylogenetics and illustrate the importance of museum collections as repositories for genomics resources. © 2016 John Wiley & Sons Ltd.

Predicting early cognitive decline in newly-diagnosed Parkinson's patients: A practical model.

PubMed

Hogue, Olivia; Fernandez, Hubert H; Floden, Darlene P

2018-06-19

To create a multivariable model to predict early cognitive decline among de novo patients with Parkinson's disease, using brief, inexpensive assessments that are easily incorporated into clinical flow. Data for 351 drug-naïve patients diagnosed with idiopathic Parkinson's disease were obtained from the Parkinson's Progression Markers Initiative. Baseline demographic, disease history, motor, and non-motor features were considered as candidate predictors. Best subsets selection was used to determine the multivariable baseline symptom profile that most accurately predicted individual cognitive decline within three years. Eleven per cent of the sample experienced cognitive decline. The final logistic regression model predicting decline included five baseline variables: verbal memory retention, right-sided bradykinesia, years of education, subjective report of cognitive impairment, and REM behavior disorder. Model discrimination was good (optimism-adjusted concordance index = .749). The associated nomogram provides a tool to determine individual patient risk of meaningful cognitive change in the early stages of the disease. Through the consideration of easily-implemented or routinely-gathered assessments, we have identified a multidimensional baseline profile and created a convenient, inexpensive tool to predict cognitive decline in the earliest stages of Parkinson's disease. The use of this tool would generate prediction at the individual level, allowing clinicians to tailor medical management for each patient and identify at-risk patients for clinical trials aimed at disease modifying therapies. Copyright © 2018. Published by Elsevier Ltd.

Clinical Outcome, Social Impact and Patient Expectation: a Purposive Sampling Pilot Evaluation of Patients in Benin Seven Years After Surgery.

PubMed

White, Michelle C; Randall, Kirsten; Avara, Esther; Mullis, Jenny; Parker, Gary; Shrime, Mark G

2018-05-01

Access to affordable and timely surgery is not equitable around the world. Five billion people lack access, and while non-governmental organizations (NGOs) help to meet this need, long-term surgical outcomes, social impact or patient experience is rarely reported. In 2016, Mercy Ships, a surgical NGO, undertook an evaluation of patients who had received surgery seven years earlier with Mercy Ships in 2009 in Benin. Using purposive sampling, patients who had received maxillofacial, plastics or orthopedic surgery were invited to attend a surgical evaluation day. In this pilot study, we used semi-structured interviews and questionnaire responses to assess patient expectation, surgical and social outcome. Our results show that seven years after surgery 35% of patients report surgery-related pain and 18% had sought further care for a clinical complication of their condition. However, 73% of patients report gaining social benefit from surgery, and overall patient satisfaction was 89%, despite 35% of patients saying that they were unclear what to expect after surgery indicating a mismatch of doctor/patient expectations and failure of the consent process. In conclusion, our pilot study shows that NGO surgery in Benin provided positive social impact associated with complication rates comparable to high-income countries when assessed seven years later. Key areas for further study in LMICs are: evaluation and treatment of chronic pain, consent and access to further care.

Body composition in untreated adult patients with Laron syndrome (primary GH insensitivity).

PubMed

Laron, Zvi; Ginsberg, Shira; Lilos, Pearl; Arbiv, Mira; Vaisman, Nahum

2006-07-01

To quantify body adiposity and its distribution in untreated adult patients with Laron syndrome (LS; primary GH insensitivity) caused by molecular defects of the GH receptor gene or postreceptor pathways and characterized by dwarfism, obesity, insulin resistance and hyperlipidaemia. Eleven LS patients (seven females and four males) aged 28-53 years were studied. Seven healthy males and six healthy females served as controls. Body composition of the total body trunk, upper and lower extremities was determined using dual-energy X-ray absorptiometry (DEXA). Statistical analysis using an analysis of variance (anova) and Mann-Whitney nonparametric methods was performed separately in males and females. Percentage body fat in the LS patients was much higher (P < 0.01) than that in the control population and the female LS patients were significantly more obese (59% total body fat) than the male patients (39% total body fat) (P < 0.002). It was also evident that in these types of patients with markedly increased body fat and decreased muscle and bone mass, body mass index (BMI) does not accurately reflect the body composition. Lifelong congenital IGF-I deficiency leads to extreme adiposity.

Food hypersensitivity in patients over 14 years of age suffering from atopic dermatitis.

PubMed

Celakovská, Jarmila; Ettler, K; Ettlerová, K; Vaněčková, J

2014-05-01

Patients suffering from atopic dermatitis often describe food hypersensitivity. Rising prevalence of food hypersensitivity and severe allergic reactions to foods have been reported, but the data are scarce. Evaluation of food hypersensitivity reactions in patients suffering from atopic dermatitis. The dermatological examination was performed in patients of age 14 years and above and the detailed history was taken concerning the food hypersensitivity. A total of 228 patients were examined-72 men, 156 women, average age 26.2 (SD 9.5) years. The food hypersensitivity reactions were recorded in 196 patients from 228 (86%), no reactions were recorded in 32 patients (24%). Foods with the most often recorded reactions are: Nuts (in 35% of patients), tomatoes (in 20%), and kiwi (in 17, 5%), apples and spices (in 16%), tangerines and oranges (in 15%), capsicum (in 13%), fishes (in 12%), celery (in 9%), and chocolate (in 7%). Food hypersensitivity reactions are recorded in 86% of patients suffering from atopic dermatitis. Nuts, tomatoes, and pollen-associated foods play a role in the majority of patients suffering from atopic dermatitis.

Long-term Effect of Home Nursing Intervention on Cost and Healthcare Utilization for Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study.

PubMed

Matsumura, Takuro; Takarada, Kana; Oki, Yutaro; Fujimoto, Yukari; Kaneko, Hiromi; Ohira, Mineko; Ishikawa, Akira

2015-01-01

The present study aimed to examine the long-term effects of a home nursing intervention on healthcare utilization and costs among patients with chronic obstructive pulmonary disease (COPD). A 3-year retrospective study. Eleven COPD patients who had received home nursing intervention after hospital discharge were enrolled. We retrospectively investigated their healthcare utilization and costs for 1 year before the intervention and during 2 years of the intervention. The number and length of hospitalizations decreased gradually from the pre-intervention period through the second year. The number of hospital and home nursing visits increased from the pre-intervention period through the first and second years. The hospitalization costs were decreased by approximately half from the pre-intervention period through the first year and from the first year through the second year. The total medical cost did not change significantly. Our home nursing intervention decreased the number and length of hospitalizations and the hospitalization costs; however, it did not affect the total medical cost. It is possible that the continuation of home nursing interventions may decrease the number of hospitalizations, number of home nursing visits, and the total medical cost by maintaining the health condition of patients. © 2014 Association of Rehabilitation Nurses.

The 11-year long-term follow-up study from the randomized BENEFIT CIS trial

PubMed Central

Edan, Gilles; Freedman, Mark S.; Montalbán, Xavier; Hartung, Hans-Peter; Hemmer, Bernhard; Fox, Edward J.; Barkhof, Frederik; Schippling, Sven; Schulze, Andrea; Pleimes, Dirk; Pohl, Christoph; Sandbrink, Rupert; Suarez, Gustavo; Wicklein, Eva-Maria

2016-01-01

Objective: To assess outcomes for patients treated with interferon beta-1b immediately after clinically isolated syndrome (CIS) or after a short delay. Methods: Participants in BENEFIT (Betaferon/Betaseron in Newly Emerging MS for Initial Treatment) were randomly assigned to receive interferon beta-1b (early treatment) or placebo (delayed treatment). After conversion to clinically definite multiple sclerosis (CDMS) or 2 years, patients on placebo could switch to interferon beta-1b or another treatment. Eleven years after randomization, patients were reassessed. Results: Two hundred seventy-eight (59.4%) of the original 468 patients (71.3% of those eligible at participating sites) were enrolled (early: 167 [57.2%]; delayed: 111 [63.1%]). After 11 years, risk of CDMS remained lower in the early-treatment arm compared with the delayed-treatment arm (p = 0.0012), with longer time to first relapse (median [Q1, Q3] days: 1,888 [540, not reached] vs 931 [253, 3,296]; p = 0.0005) and lower overall annualized relapse rate (0.21 vs 0.26; p = 0.0018). Only 25 patients (5.9%, overall; early, 4.5%; delayed, 8.3%) converted to secondary progressive multiple sclerosis. Expanded Disability Status Scale scores remained low and stable, with no difference between treatment arms (median [Q1, Q3]: 2.0 [1.0, 3.0]). The early-treatment group had better Paced Auditory Serial Addition Task–3 total scores (p = 0.0070). Employment rates remained high, and health resource utilization tended to be low in both groups. MRI metrics did not differ between groups. Conclusions: Although the delay in treatment was relatively short, several clinical outcomes favored earlier treatment. Along with low rates of disability and disease progression in both groups, this supports the value of treatment at CIS. ClinicalTrials.gov identifier: NCT01795872. Classification of evidence: This study provides Class IV evidence that early compared to delayed treatment prolongs time to CDMS in CIS after 11 years. PMID

Defining Medical Student Patient Care Responsibilities Before Intern Year: Results of a National Survey.

PubMed

King, Christopher J; Bolton, Andrew; Guerrasio, Jeannette; Trosterman, Adam

2017-12-01

Program directors have noted that first-year residents struggle with many of the patient care responsibilities they assume as they enter the US graduate medical education system. A national description of medical students' patient care experience in advance of graduation has not been published. We sought to describe the experience of US medical students during their clinical training by surveying the student representatives of each school. We developed a mixed-methods survey that was delivered to representatives of 82 schools via an e-mail link to an online survey. Our response rate was 54% (44/82). Of those responding, 28% reported that students do not write any patient care orders at their institution and 34% reported not receiving pages related to patient care. Only 26% of institutions provide an increased patient load to students during their final year of training. Students identified many areas to improve the role of fourth-year medical students, including writing patient care orders, answering pages, increasing autonomy, defining their role better, and providing them with a longer subinternship experience. Our survey suggests that students are graduating from the undergraduate medical education system and moving to the graduate medical education system in the United States without a guarantee of having answered a page related to patient care or having placed a patient care order. Further studies of students' experiences should be conducted to explore whether exposure to these skills improves first-year resident performance.

Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up.

PubMed

Chang, Dong-Gune; Yang, Jae Hyuk; Lee, Jung-Hee; Kim, Jin-Hyok; Suh, Seung-Woo; Ha, Kee-Yong; Suk, Se-Il

2016-08-01

OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4-18.0 years), and the mean length of follow-up was 12.8 years (range 10.1-18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

Mounier-Kuhn syndrome (tracheobronchomegaly): An analysis of eleven cases.

PubMed

Akgedik, Recep; Karamanli, Harun; Kizilirmak, Deniz; Kurt, Ali Bekir; Öztürk, Hasan; Yildirim, Berna Botan; Çakir, Lütfullah

2018-03-01

Mounier-Kuhn syndrome (MKS) is a congenital disorder characterized by tracheobronchomegaly resulting from the absence of elastic fibers in the trachea and main bronchi or atrophy and thinning of the smooth muscle layer. In this syndrome, dead space associated with tracheobronchomegaly increases and discharge of secretions decreases because of ineffective coughing. The most common complications are recurrent lower respiratory tract infections and bronchiectasis. We examined the clinical characteristics, radiological features, and related complications of patients with MKS. The cases were obtained between September 2007 and November 2015. Computed tomography scans of the chest were used to diagnose tracheobronchomegaly. All cases (a total of 11) were males with a mean age of 63 ± 13 (range, 38-80) years. The mean diameter of the trachea was 31.53 ± 2.99 mm; the mean transverse diameter was 31.69 ± 3.10 mm and the mean sagittal diameter was 31.36 ± 3.01 mm. Complaints at the time of presentation included chronic cough, purulent sputum, dyspnea, and hemoptysis. There were recurrent pulmonary infections in seven cases, bronchiectasis in six, and tracheal diverticulum in four at the time of diagnosis. In this article, 11 cases with various rarely seen complications are presented and evaluated in the light of current literature. We recommend that if chronic cough, recurrent pulmonary infections, and bronchiectasis seen in a patient, MKS should be kept in mind. © 2017 John Wiley & Sons Ltd.

Analysis of spirometry results in hospitalized patients aged over 65 years

PubMed Central

Wróblewska, Izabela; Oleśniewicz, Piotr; Kurpas, Donata; Sołtysik, Mariusz; Błaszczuk, Jerzy

2015-01-01

Introduction and objective The growing population of the elderly, as well as the occurrence of coexisting diseases and polypharmacy, is the reason why diseases of patients aged $65 years belong to the major issues of the contemporary medicine. Among the most frequent diseases of the elderly, there are respiratory system diseases. They are difficult to diagnose because of the patient group specificity, which is the reason for increased mortality among seniors, caused by underdiagnosis. The study objective was to assess the factors influencing spirometry results in hospitalized patients aged ≥65 years with respiratory system disorders. Material and methods In the research, 217 (100%) patients aged ≥65 years who underwent spirometry at the Regional Medical Center of the Jelenia Góra Valley Hospital in Poland were analyzed. In the statistical analysis, the STATISTICA 9.1 program, the t-test, the Shapiro–Wilk test, the ANOVA test, and the Scheffé’s test were applied. Results The majority of the patients (59.4%) were treated in the hospital. The most frequent diagnosis was malignant neoplasm (18%). The study showed a statistically significant dependence between the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC parameters and the time of hospitalization, as well as between the FVC and FEV1 parameters and the age of patients. The FVC parameter values turned out to be dependent on the main diagnosis. Highest results were noted in patients with the diagnosis of sleep apnea or benign neoplasm. A low FVC index can reflect restrictive ventilation defects, which was supported by the performed analyses. Highest FEV1/FVC values were observed in nonsmokers, which confirms the influence of nicotine addiction on the incidence of respiratory system diseases. Conclusion The respondents’ sex and the established diagnosis statistically significantly influenced the FVC index result, and the diet influenced the FEV1/FVC parameter result

Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.

PubMed

Folbert, E C; Hegeman, J H; Vermeer, M; Regtuijt, E M; van der Velde, D; Ten Duis, H J; Slaets, J P

2017-01-01

To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4-5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1-2 OR 1.46, CCI 3-4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail

[Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience].

PubMed

Vodička, J; Doležal, J; Vejvodová, Š; Šafránek, J; Špidlen, V; Třeška, V

2016-01-01

PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma

Valvular replacement for aortic stenosis in patients over 70 years: immediate risk and long-term results (from a consecutive series of 355 patients).

PubMed

Rioux, C; Logeais, Y; Leguerrier, A; Langanay, T; Delambre, J F; Le Couls, H; Le Normand, J P; Boulvard, J

1988-04-01

From 1971 to 1985, 355 patients over 70 years of age (mean age 73.7) underwent isolated aortic valve replacement, most of them for pure calcified stenosis (78.6%). Mechanical valves (group A) were used in 112 cases (109 Bjork-Shiley; 3 SJM) and bioprostheses (group B) exclusively implanted since 1981 (192 Edwards-Carpentier; 51 Ionescu-Shiley). Thirty-six patients died post-operatively (10.1%). 36% of the deaths were related to cardiac causes, and 14% to cerebral damage. The follow-up involved 100% of the 319 survivors and spanned 12 years (1 month to 11.8 years), with an average of 3.2 years. The follow-up was almost equally distributed between groups A and B: 474 and 453 patient-years, respectively. Sixty late deaths (18.8%) occurred: 26.7% of them related to cardiac causes, and 20% to cerebral accidents. Twenty-nine cases were in group A (6.1% patient-years), and 31 in group B (5.7% patient-years). Acturial analysis shows that, at five years, 94.1% of patients in group A and 96% in group B were free of valve-related complications, and that 88.9% in group A and 89% in group B were free of valve-related non-lethal complications. Actuarial calculation of survival rates shows that, at five years, the probability of survival was 70.8% for the entire series, including the operative deaths. This curve of survival is similar to that of the normal population of the same age. Moreover, the functional status is dramatically improved by surgery: 99.6% of patients are in the NYHA classes I or II.

[Long-term experience with multidisciplinary therapy of twenty-six patients with dermatofibrosarcoma protuberans].

PubMed

Mátrai, Zoltán; Liszkay, Gabriella; Plotár, Vanda; Orosz, Zsolt; Székely, Judit; Hitre, Erika; Bartal, Alexandra; Langmár, Zoltán; Bocs, Katalin; Rényi Vámos, Ferenc; Sávolt, Akos; Tóth, László

2009-10-11

Dermatofibrosarcoma protuberans is a low or moderate grade malignant, uncommon soft tissue tumor. The tumor is characterized by slow, but locally aggressive growth, low metastatic potential and high recurrence rate. Initial treatment is the radical surgical excision, using traditional wide excision or Mohs surgery. In case of positive surgical margin or local recurrence, radio-chemotherapy and recently imatinib mesylate is used as adjuvant therapy. Twenty-six patients treated multidisciplinary for dermatofibrosarcoma protuberans were followed up. Mean age of the patients was 44.7 years; mean follow-up time was 60.57 months. In fifteen cases (57.7%) R0 resection was performed, while eleven patients (42,3%) received only R1 resection. An average of 1.87 resections was necessary in order to achieve R0 resection. Six patients (23%) received adjuvant radiotherapy and two patients (7.6%) adjuvant chemotherapy following the removal of the primary tumor. Sixteen patients had no local recurrence. Ongoing treatments were needed in the case of ten patients (38.4%) who developed local recurrence. One patient has deceased due to distant metastases. Using statistical methods we examined the effects indicated as prognostic factors in the literature on local recurrence, precisely, the effect of age above 50 years and surgical radicalism. Dermatofibrosarcoma protuberans can be successfully treated with multidisciplinary therapy. A larger number of cases and randomized multicenter investigations are needed in order to reach more accurate conclusion.

Patient satisfaction 8-14 years after dental implant therapy - a questionnaire study.

PubMed

Adler, Lottie; Liedholm, Eva; Silvegren, Malin; Modin, Carolina; Buhlin, Kåre; Jansson, Leif

2016-07-01

The aim of this questionnaire study was to investigate patient satisfaction 8-14 years after dental implant therapy and complications influencing the degree of satisfaction. A questionnaire was sent by post to 587 patients at a specialist clinic of periodontology. The questionnaire consisted of 19 statements or questions such as the degree of satisfaction with the implants and knowledge of complications. In nine of the questions, respondents were asked to grade the extent of their agreement with a statement by selecting from fixed answers. Three of the questions were designed to be answered using a visual analog scale. In total, 400 individuals (81%) responded to the questionnaire. The mean time elapsed since implant installation was 10 years. A great majority (81%) experienced a high chewing comfort and was satisfied or sufficiently satisfied (94%) with the aesthetic aspects of their implant restorations, while 32% of the individuals had experienced problems with their implant reconstructions. The disadvantage that patients remarked on was the cost of the treatment. Those who had experienced problems with their implant reconstructions were also less satisfied with the treatment. A great majority of the patients expressed a high degree of satisfaction with their dental implants 8-14 years after the treatment. Patients were less satisfied if they had experience of problems with their implant reconstructions and in cases when the clinicians were unable to resolve their complications.

Potential determinants of efficacy of mirror therapy in stroke patients--A pilot study.

PubMed

Brunetti, Maddalena; Morkisch, Nadine; Fritzsch, Claire; Mehnert, Jan; Steinbrink, Jens; Niedeggen, Michael; Dohle, Christian

2015-01-01

Mirror therapy (MT) was found to improve motor function after stroke. However, there is high variability between patients regarding motor recovery. The following pilot study was designed to identify potential factors determining this variability between patients with severe upper limb paresis, receiving MT. Eleven sub-acute stroke patients with severe upper limb paresis participated, receiving in-patient rehabilitation. After a set of pre-assessments (including measurement of brain activity at the primary motor cortex and precuneus during the mirror illusion, using near-infrared spectroscopy as described previously), four weeks of MT were applied, followed by a set of post-assessments. Discriminant group analysis for MT responders and non-responders was performed. Six out of eleven patients were defined as responders and five as non-responders on the basis of their functional motor improvement. The initial motor function and the activity shift in both precunei (mirror index) were found to discriminate significantly between responders and non-responders. In line with earlier results, initial motor function was confirmed as crucial determinant of motor recovery. Additionally, activity response to the mirror illusion in both precunei was found to be a candidate for determination of the efficacy of MT.

Factors associated with mortality of patients with myxoedema coma: prospective study in 11 cases treated in a single institution.

PubMed

Rodríguez, I; Fluiters, E; Pérez-Méndez, L F; Luna, R; Páramo, C; García-Mayor, R V

2004-02-01

This study was carried out to investigate the clinical and biochemical factors which might be of importance in predicting the outcome of patients with myxoedema coma. Eleven patients (ten female) aged 68.1+/-19.5 years attended our institution over a period of 18 years. Glasgow and APACHE II scores and serum free thyroxine and TSH were measured in all the patients on entry. Patients were selected at random to be treated with two different regimens of l-thyroxine. Four patients died with the mortality rate being 36.4%. The patients in coma at entry had significantly higher mortality rates than those with minor degrees of consciousness (75% vs 14.3% respectively, P=0.04). The surviving patients had significantly higher Glasgow scores than those who died (11.85+/-2.3 vs 5.25+/-2.2 respectively, P<0.001). Comparison of the mean values of APACHE II scores between the surviving group and those who died was significantly different (18.0+/-2.08 vs 31.5+/-2.08 respectively, P<0.0001). The degree of consciousness, the Glasgow score and the severity of the illness measured by APACHE II score on entry were the main factors that determined the post-treatment outcome of patients with myxoedema coma.

Characterization of potential zones of dust generation at eleven stations in the southern Sahara

NASA Astrophysics Data System (ADS)

Clark, I.; Assamoi, P.; Bertrand, J.; Giorgi, F.

Synoptic wind data for multi-decadal periods at eleven stations located in the southern Sahara region (Agadez, Atar, Bilma, Dori, Gao, Kayes, Nema, Niamey, Nouadhibou, Ouagadougou and Tessalit) are used to study the monthly dust deflation power over the region. We found that, regardless of the conditions of the soil, the deflation power (or wind efficiency) is not sufficient to generate significant amounts of aerosols south of 15°N. North of this latitude, the deflation power is much larger, with potential zones of either very strong deflation (Nouadhibou and Bilma) or severe deflation (Gao, Tessalit, Nema, Atar, Agadez). Stations in the Sahel region such as Gao, Agadez and Tessalit are characterized by a gradual reinforcement of the deflation power between 1970 and 1984 in correspondence of increasing desertification over the region. During this same period, Bilma, a well know region of dust source, experienced a major reduction in deflation power due to shifts in large scale wind patterns.

Cervical spine fractures in patients 65 years or older: a 3-year experience at a level I trauma center.

PubMed

Damadi, Amir A; Saxe, Andrew W; Fath, John J; Apelgren, Keith N

2008-03-01

Cervical spine fractures in the elderly carry a mortality as high as 26%. We reviewed our experience to define the level of injury, prevalence of neurologic deficits, treatments employed, and the correlation between patients' pre- and posthospital residences. Also, we correlated the prevalence of advanced directives with length of stay. We queried the data collected prospectively at an American College of Surgeons verified Level I hospital (National TRACS, American College of Surgeons) regarding patients aged 65 years or older presenting with cervical spine fractures (International Classification of Diseases-9 code 805.X) in calendar years 2000 through 2003. We identified 58 patients (ages 65-94). Mortality was 24%. Twelve patients had quadriplegia or paraplegia and seven of these patients died. Respiratory failure was the primary cause of death. Application of rigid collars and a halo brace were the most commonly employed therapies. Mortality rates for halo stabilization and rigid collar and halo stabilization were similar (23% vs. 29%). Despite having a higher mean Injury Severity Score, the 16 patients with advanced directives had an intensive care unit length of stay similar to that of patients without advanced directives but a statistically significant shorter overall length of stay (13 vs. 6.9 days). Eighteen of 45 patients living at home at the time of injury returned home. Cervical spine injury in the elderly does not inevitably relegate patients to a setting of more acute nursing care. The health and social factors that allowed many to return to living at home warrant investigation, as support of these factors may assist others with this injury.

Determinants of 1-year survival in critically ill acute leukemia patients: a GRRR-OH study.

PubMed

Tavares, Márcio; Lemiale, Virginie; Mokart, Djamel; Pène, Frédéric; Lengliné, Etienne; Kouatchet, Achille; Mayaux, Julien; Vincent, François; Nyunga, Martine; Bruneel, Fabrice; Rabbat, Antoine; Lebert, Christine; Perez, Pierre; Meert, Anne-Pascale; Benoit, Dominique; Darmon, Michael; Azoulay, Elie

2018-06-01

Acute leukemia (AL) is the most common hematological malignancy requiring intensive care unit (ICU) management. Data on long-term survival are limited. This is a post hoc analysis of the prospective multicenter data from France and Belgium: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique [A Research Group on Acute Respiratory Failure in Onco-Hematological Patients (French)] Study, to identify determinants of 1-year survival in critically ill AL patients. A total of 278 patients were admitted in the 17 participating ICUs. Median age was 58 years and 70% had newly diagnosed leukemia. ICU mortality rate was 28.6 and 39.6% of the patients alive at 1 year. Admission for intensive monitoring was independently associated with better 1-year survival by multivariate analysis. Conversely, relapsed/refractory disease, secondary leukemia, mechanical ventilation and renal replacement therapy were independently associated with 1-year mortality. This study confirms the impact of organ dysfunction on long-term survival in ICU patients with AL. Follow-up studies to assess respiratory and renal recovery are warranted.

Psychosis among "healthy" siblings of schizophrenia patients

PubMed Central

Arajärvi, Ritva; Ukkola, Jonna; Haukka, Jari; Suvisaari, Jaana; Hintikka, Jukka; Partonen, Timo; Lönnqvist, Jouko

2006-01-01

Background Schizophrenia aggregates in families and accurate diagnoses are essential for genetic studies of schizophrenia. In this study, we investigated whether siblings of patients with schizophrenia can be identified as free of any psychotic disorder using only register information. We also analyzed the emergence of psychotic disorders among siblings of patients with schizophrenia during seven to eleven years of follow-up. Methods A genetically homogenous population isolate in north-eastern Finland having 365 families with 446 patients with a diagnosis of schizophrenia was initially identified in 1991 using four nationwide registers. Between 1998 and 2002, 124 patients and 183 siblings in 110 families were contacted and interviewed using SCID-I, SCID-II and SANS. We also compared the frequency of mental disorders between siblings and a random population comparison group sample. Results Thirty (16%) siblings received a diagnosis of psychotic disorder in the interview. 14 siblings had had psychotic symptoms already before 1991, while 16 developed psychotic symptoms during the follow-up. Over half of the siblings (n = 99, 54%) had a lifetime diagnosis of any mental disorder in the interview. Conclusion Register information cannot be used to exclude psychotic disorders among siblings of patients with schizophrenia. The high rate of emergence of new psychotic disorders among initially healthy siblings should be taken into account in genetic analysis. PMID:16448569

[Cardiovascular risk by Framingham and SCORE in patients 40-65 years old].

PubMed

González, Carmen; Rodilla, Enrique; Costa, José A; Justicia, Jorge; Pascual, José M

2006-04-15

The aim of this study was to compare the clinical and treatment implications of 2 cardiovascular risk stratification systems in a population of patients 40-65 years old. 929 non diabetic patients (40-65 years old) (51% female) with no evidence of previous cardiovascular disease were included in the study. The risk of cardiovascular death was assessed with the charts of the Systematic Coronary Risk Evaluation (SCORE), and coronary risk by the Framingham function (National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults -NCEP-ATP-III-). Patients were considered of high risk if risk of cardiovascular death was >or= 5% and coronary risk was > 20%, respectively. 4.1% of patients were considered as high risk by SCORE and 2.5% by Framingham. Only 0.2% of females were classified as high risk with either system. 8.2% and 4.8% of male population were considered as high risk by SCORE and Framingham, respectively. There was a low level of concordance between both systems. Patients classified as high risk by SCORE but not by Framingham were older, smoke less and had a better lipid profile. According to European Guidelines 28% of male and 23% of female were candidates to hypolipemic treatment, that proportion was higher, 43% of males and 28% of females, by NCEP-ATP-III guidelines. In Spanish patients 40-65 years old, SCORE charts almost duplicate the number of high risk individuals compared to Framingham. although the number of patients candidates to hypolipemic treatment is lower with the European than ATP-III guidelines. Differences were more evident in male.

Comparative Study of Fatty Acids Profile in Eleven Wild Mushrooms of Boletacea and Russulaceae Families.

PubMed

Dimitrijevic, Marija V; Mitic, Violeta D; Jovanovic, Olga P; Stankov Jovanovic, Vesna P; Nikolic, Jelena S; Petrovic, Goran M; Stojanovic, Gordana S

2018-01-01

Eleven species of wild mushrooms which belong to Boletaceae and Russulaceae families were examined by gas chromatography (GC) and gas chromatography-mass spectrometry (GC/MS) analysis for the presence of fatty acids. As far as we know, the fatty acid profiles of B. purpureus and B. rhodoxanthus were described for the first time. Twenty-six fatty acids were determined. Linoleic (19.5 - 72%), oleic (0.11 - 64%), palmitic (5.9 - 22%) and stearic acids (0.81 - 57%) were present in the highest contents. In all samples, unsaturated fatty acids dominate. Agglomerative hierarchical clustering was used to display the correlation between the fatty acids and their relationships with the mushroom species. Based on the fatty acids profile in the samples, the mushrooms can be divided into two families: Boletaceae and Russulaceae families, using cluster analysis. © 2018 Wiley-VHCA AG, Zurich, Switzerland.

[Short and long term results of aortic valve replacement in patients 80 years of age and older].

PubMed

Mortasawi, A; Gehle, S; Yaghmaie, M; Schröder, T; Ennker, I C; Rosendahl, U; Albert, A; Ennker, J

2001-03-01

Due to demographic changes in average life expectancy the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement with or without concomitant coronary grafting. From 1.1.1995 until 31.12.1999, 126 patients (93 women, 33 men between 80 and 89 years, 82.8 +/- 2.4) underwent aortic valve replacement. 64 patients (group A) received isolated valve replacement, 62 (group B) underwent myocardial revascularization as well. The 30-day hospital mortality rate was 6.3% for group A and 14.5% for group B. The follow-up time ranged between 3 and 63 months (32 +/- 16). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were observed by one patient from group A 3 years after the operation. Of the 15 deaths during the follow-up period seven (47%) were cardiac in nature and two (13%) related to stroke. Acturial survival rates for group A were 89%, 85% and 77% at 1, 2 and 3 years, and for group B 76%, 72% and 70%. Permanent nursing care was not required 1 year after the operation by 100% of patients in group A (2 years: 98%, 3 years 95%) and by 100% of patients in group B (2 years: 93%, 3 years: 90%). At an interval of 1 year after the operation 96% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 96%, 3 years: 94%). The rates for group B were 88%, 81% and 75%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Surgical Management of Benign Acquired Tracheoesophageal Fistulas: A Ten-Year Experience.

PubMed

Bibas, Benoit Jacques; Guerreiro Cardoso, Paulo Francisco; Minamoto, Helio; Eloy-Pereira, Leandro Picheth; Tamagno, Mauro Federico L; Terra, Ricardo Mingarini; Pêgo-Fernandes, Paulo Manoel

2016-10-01

Benign tracheoesophageal fistulas (TEFs) are rare, and surgical correction is the ideal method of treatment. The objective of this study was to evaluate the results of operative treatment of benign TEFs in patients from a tertiary referral center. Retrospective study of patients with benign TEFs who were treated between January 2005 and December 2014. Preoperative evaluation included computed tomography of the chest, bronchoscopy, and upper endoscopy. Preoperative treatment included nutritional support by gastrostomy and treatment of lung infections. Surgical repair was done with tracheal resection and reconstruction, laryngotracheal resection, or membranous tracheal repair without resection. Esophageal management consisted of two-layer closure. Twenty patients (11 men) with mean age 48 ± 17 years were included. The most frequent cause was postintubation injury (n = 16; 80%). The median TEF length was 9 mm (interquartile range [IQR], 2 to 25 mm). The most commonly used surgical approaches were cervicotomy (n = 15; 75%) and cervicosternotomy (n = 3; 15%). Eleven patients required tracheal resection; median length was 3 cm (IQR, 3 to 5.5 cm). Seven patients (35%) required intraoperative tracheostomy. Complications occurred in 55% of patients. There was one dehiscence of the tracheal anastomosis, and one procedure-related death. Ninety-five percent of patients had complete closure of the TEF occurred in 95% of cases. Two patients had tracheal stenosis recurrence, and one patient had both TEF and tracheal stenosis recurrence. Two patients have indwelling silicone tracheal stents. Surgical treatment of TEF is effective. Nonetheless, morbidity and mortality are not negligible, even when performed at a referral center and after appropriate preoperative evaluation. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Aneurysmal subarachnoid hemorrhage in patients under 35-years-old: a single-center experience.

PubMed

Chalouhi, Nohra; Teufack, Sonia; Chandela, Sid; Dalyai, Richard; Tjoumakaris, Stavropoula; Hasan, David M; Dumont, Aaron S; Gonzalez, L Fernando; Rosenwasser, Robert H; Jabbour, Pascal M

2013-06-01

Aneurysmal subarachnoid hemorrhage (SAH) is relatively uncommon in young adults. There is a paucity of data pertaining to the management of aneurysmal SAH in young patients, especially with endovascular therapy. We reviewed all SAH patients under the age of 35 years treated at Jefferson Hospital for Neuroscience, Philadelphia, USA, from 2004 to 2009. A total of 40 patients (15 males and 25 females) under the age of 35 were treated for aneurysmal SAH. The average patient age was 30 years (17-35 yo); 25 (62.5%) were smokers. Seventeen patients presented with a Hunt and Hess Grade I or II (42.5%), 20 with a Grade III (50%), and 3 with a Grade IV (7.5%). Thirty-two aneurysms (80%) were located in the anterior circulation and 8 (20%) in the posterior circulation. Thirty-five patients (87.5%) were treated with coil embolization versus 5 with craniotomy and clipping. The endovascular and microsurgical occlusion rates were 90.6% and 100%, respectively. There were no procedural complications with endovascular therapy. Of 35 patients undergoing endovascular treatment, 24 (68.6%) had excellent outcomes at time of discharge with a Glasgow outcome scale of 5. There were no deaths in the series. No patient experienced a rehemorrhage after endovascular treatment. Smoking, female sex, and anterior circulation aneurysms are highly prevalent in young adults with SAH. Endovascular treatment resulted in an overall favorable outcome with no rehemorrhages in patients under the age of 35 years. Our results suggest that endovascular therapy is a reasonable treatment for young patients with SAH. Copyright © 2012 Elsevier B.V. All rights reserved.

Sandwich allografts for long-bone nonunions in patients with osteogenesis imperfecta: a retrospective study.

PubMed

Puvanesarajah, Varun; Shapiro, Jay R; Sponseller, Paul D

2015-02-18

Patients with osteogenesis imperfecta often develop nonunions, as internal fixation has limited applicability in this condition. We report the outcomes of a modified "sandwich technique" in the treatment of long-bone nonunions in patients with osteogenesis imperfecta; this technique brings circumferential stabilization and normal collagen to the nonunion site. From May 2003 through February 2012, twelve patients (eight females, four males; median age, 39.0 years; range, eleven to seventy-eight years) who had osteogenesis imperfecta (Sillence type I [three], type III [eight], and type IV [one]) and a combined total of thirteen nonunions (two humeral, two radial, three femoral, four tibial, and two ulnar; median duration, 15.0 months; range, six to 204 months) were treated at our institution with compressed sandwich allograft cortical struts. The struts were fashioned to be wide enough to allow for increased osteoconductive surface area and to approximate a hemicylindrical shape. Treatment history and demographics data were acquired through retrospective chart review. Follow-up radiographs were analyzed by two attending orthopaedic surgeons to determine radiographic findings. The median follow-up time was 4.6 years (range, 2.1 to 10.3 years). All thirteen nonunions, including one requiring a second graft procedure, healed with abundant, smooth allograft incorporation, resulting in an initial healing rate of 92% because of a refracture in one patient. This patient's nonunion ultimately healed with additional allograft struts and a new intramedullary rod. One patient required removal of prominent screws. The final follow-up examinations revealed no pain or refracture at the original nonunion site. All patients regained their prefracture level of function. Sandwich allograft struts constitute a durable, safe method for the stabilization and healing of persistent long-bone nonunions in patients with osteogenesis imperfecta. All patients showed incorporation of the

Characteristics and Outcomes of Patients with Ewing Sarcoma Over 40 Years of Age at Diagnosis

PubMed Central

Karski, Erin E.; Matthay, Katherine K.; Neuhaus, John M.; Goldsby, Robert E.; DuBois, Steven G.

2012-01-01

Background The peak incidence of Ewing sarcoma (EWS) is in adolescence, with little known about patients who are ≥ 40 years at diagnosis. We describe the clinical characteristics and survival of this rare group. Methods This retrospective cohort study utilized the Surveillance Epidemiology and End Results database. 2780 patients were identified; including 383 patients diagnosed ≥ 40 years. Patient characteristics between age groups were compared using chi-squared tests. Survival from diagnosis to death was estimated via Kaplan-Meier methods, compared with log-rank tests, and modeled using multivariable Cox methods. A competing risks analysis was performed to evaluate death due to cancer. Results Patients ≥ 40 years of age were more likely to have extra-skeletal tumors (66.1% v 31.7%; p<0.001), axial tumors (64.0% v 57.2%; p=0.01), and metastatic disease at diagnosis (35.5% v 30.0%; p=0.04) compared to younger patients. Five-year survival for those age ≥ 40 and age < 40 were 40.6% and 54.3%, respectively (p<0.0001). A Cox multivariable model controlling for differences between groups confirmed inferior survival for older patients (hazard ratio for death of 2.04; 95% CI 1.63 - 2.54; p < 0.0001); though treatment data were unavailable and not controlled for in the model. A competing risks analysis confirmed increased risk of cancer-related death in older patients. Conclusion Patients ≥ 40 years at diagnosis with EWS are more likely to have extra-skeletal tumors, metastatic disease, and axial primary tumors suggesting a difference in tumor biology. Independent of differences in these characteristics, older patients also have a lower survival rate. PMID:22959474

Characteristics and outcomes of patients with Ewing sarcoma over 40 years of age at diagnosis.

PubMed

Karski, Erin E; Matthay, Katherine K; Neuhaus, John M; Goldsby, Robert E; Dubois, Steven G

2013-02-01

The peak incidence of Ewing sarcoma (EWS) is in adolescence, with little known about patients who are ≥40 years at diagnosis. We describe the clinical characteristics and survival of this rare group. This retrospective cohort study utilized the Surveillance Epidemiology and End Results database. 2780 patients were identified; including 383 patients diagnosed ≥40 years. Patient characteristics between age groups were compared using chi-squared tests. Survival from diagnosis to death was estimated via Kaplan-Meier methods, compared with log-rank tests, and modeled using multivariable Cox methods. A competing risks analysis was performed to evaluate death due to cancer. Patients ≥40 years of age were more likely to have extra-skeletal tumors (66.1% vs. 31.7%; p < 0.001), axial tumors (64.0% vs. 57.2%; p = 0.01), and metastatic disease at diagnosis (35.5% vs. 30.0%; p = 0.04) compared to younger patients. Five-year survival for those age ≥40 and age <40 were 40.6% and 54.3%, respectively (p < 0.0001). A Cox multivariable model controlling for differences between groups confirmed inferior survival for older patients (hazard ratio for death of 2.04; 95% CI 1.63-2.54; p < 0.0001); though treatment data were unavailable and not controlled for in the model. A competing risks analysis confirmed increased risk of cancer-related death in older patients. Patients ≥40 years at diagnosis with EWS are more likely to have extra-skeletal tumors, metastatic disease, and axial primary tumors suggesting a difference in tumor biology. Independent of differences in these characteristics, older patients also have a lower survival rate. Copyright © 2012 Elsevier Ltd. All rights reserved.

Removal of Polyacrylamide Gel (Aquamid®) from the Lip as a Solution for Late-Onset Complications: Our 8-Year Experience.

PubMed

Kästner, Sonja; Gonser, Phillipp; Paprottka, Felix; Kaye, Kai O

2018-06-01

The polyacrylamide hydrogel Aquamid ® has been used as a permanent filler to enhance facial soft tissue volume and correct wrinkles since 2001. Various long-term studies have proved the safety of the product. Nonetheless, if complications such as migration occur, they can be difficult to treat. Eleven patients suffering from late-onset complications after taking Aquamid ® injections in the lips underwent product removal and subsequent labial reconstruction between 2009 and 2017. The reconstruction was performed using a modified bikini reduction technique combined, in eight cases, with immediate autologous fat grafting. In all the patients, general fibrosis and a diffused distribution of the product within all three layers of the lips resulted in the need for labial reconstruction. Migration, as far as in the mucosa and perioral skin, accounted for macroscopically visible yellowish accumulations. In ten out of eleven cases, an individually modified bikini reduction technique, with or without any combination of autologous fat grafting, led to an esthetically satisfying result. One patient developed a severe upper lip necrosis. Contradictory to several previous studies attesting to the lack of migration after Aquamid ® application to the lips, capsule formation around the product is impaired, allowing for migration even years after the injection. Product aspiration is not possible in these cases, thus necessitating complex lip reconstruction. Bikini reduction and fat grafting are valuable tools for labial reconstruction. Product residuals within the mucosa have to be accepted. Special care has to be taken while treating smokers. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Eleven-year descriptive analysis of closed court verdicts on medical errors in Spain and Massachusetts

PubMed Central

Giraldo, Priscila; Sato, Luke; Martínez-Sánchez, Jose M; Comas, Mercè; Dwyer, Kathy; Sala, Maria; Castells, Xavier

2016-01-01

Objectives To evaluate and compare the characteristics of court verdicts on medical errors allegedly harming patients in Spain and Massachusetts from 2002 to 2012. Design, setting and participants We reviewed 1041 closed court verdicts obtained from data on litigation in the Thomson Reuters Aranzadi Westlaw databases in Spain (Europe), and 370 closed court verdicts obtained from the Controlled Risk and Risk Management Foundation of Harvard Medical Institutions (CRICO/RMF) in Massachusetts (USA). We included closed court verdicts on medical errors. The definition of medical errors was based on that of the Institute of Medicine (USA). We excluded any agreements between parties before a judgement. Results Medical errors were involved in 25.9% of court verdicts in Spain and in 74% of those in Massachusetts. The most frequent cause of medical errors was a diagnosis-related problem (25.1%; 95% CI 20.7% to 31.1% in Spain; 35%; 95% CI 29.4% to 40.7% in Massachusetts). The proportion of medical errors classified as high severity was 34% higher in Spain than in Massachusetts (p=0.001). The most frequent factors contributing to medical errors in Spain were surgical and medical treatment (p=0.001). In Spain, 98.5% of medical errors resulted in compensation awards compared with only 6.9% in Massachusetts. Conclusions This study reveals wide differences in litigation rates and the award of indemnity payments in Spain and Massachusetts; however, common features of both locations are the high rates of diagnosis-related problems and the long time interval until resolution. PMID:27577585

Alcohol and other psychoactive drugs in trauma patients aged 10–14 years

PubMed Central

Li, G.; Chanmugam, A.; Rothman, R.; DiScala, C.; Paidas, C.; Kelen, G.

1999-01-01

Objective—To examine the prevalence of alcohol and/or other psychoactive drugs, such as marijuana and cocaine (AODs), involved in preteen trauma patients. Methods—Toxicological testing results were analyzed for 1356 trauma patients aged 10–14 years recorded in the National Pediatric Trauma Registry for the years 1990–95. Results—Of the 1356 patients who received toxicological screening at the time of admission, 116 (9%) were positive for AODs. AOD involvement increased with age. Patients with pre-existing mental disorders were nearly three times as likely as other patients to be AOD positive (23% v 8%, p<0.01). AOD involvement was more prevalent in intentional injuries and in injuries that occurred at home. Conclusions—AODs in preteen trauma are of valid concern, in particular among patients with mental disorders or intentional injuries. The role of AODs in childhood injuries needs to be further examined using standard screening instruments and representative study samples. PMID:10385826

Persistence of impaired health status of Q fever patients 4 years after the first Dutch outbreak.

PubMed

Limonard, G J M; Peters, J B; Besselink, R; Groot, C A R; Dekhuijzen, P N R; Vercoulen, J H; Nabuurs-Franssen, M H

2016-04-01

A significant proportion of Q fever patients from the first Dutch Q fever outbreak in 2007 showed impairment in health status up to 1 year after infection. Interested in whether this decrease in health status persisted, we set out to determine the health status in the same cohort of patients, 4 years after primary infection and to compare health status scores at the individual patient level between 1 and 4 years follow-up. Health status was assessed with the Nijmegen Clinical Screening Instrument (NCSI). Patients were serologically tested to exclude patients with possible, probable or proven chronic Q fever. Results on the NCSI sub-domains at group level [2008 (n = 54) and 2011 (n = 46)] showed a persistent significant percentage of patients exhibiting clinically relevant ('severe') scores for all NCSI sub-domains. After 4 years, undue fatigue was present in 46% and exactly half of all patients experienced a severely impaired general quality of life. Patients with NCSI scores available in both 2008 and 2011 (n = 37) showed no difference in all sub-domain scores, except for a small decrease in dyspnoea emotions in 2011. In this group, a significant proportion of patients either improved or worsened in one or more sub-domains of health status. We conclude that at the group level, health status of Q fever patients remained impaired 4 years after primary infection. At the individual patient level, health status may change.

The 3-Year Incidence of Gout in Elderly Patients with CKD

PubMed Central

Tan, Vivian S.; Garg, Amit X.; McArthur, Eric; Lam, Ngan N.; Sood, Manish M.

2017-01-01

Background and objectives The risk of gout across CKD stages is not well described. Design, setting, participants, & measurements We performed a retrospective cohort study using linked health care databases from Ontario, Canada from 2002 to 2010. The primary outcome was the 3-year cumulative incidence of gout, on the basis of diagnostic codes. We presented our results by level of kidney function (eGFR≥90 ml/min per 1.73 m2, 60–89, 45–59, 30–44, 15–29, and chronic dialysis) and by sex. Additional analyses examined the risk of gout adjusting for clinical characteristics, incidence of gout defined by the receipt of allopurinol or colchicine, and gout risk in a subpopulation stratified by the level of eGFR and albuminuria. Results Of the 282,925 adults aged ≥66 years, the mean age was 75 years and 57.9% were women. The 3-year cumulative incidence of gout was higher in older adults with a lower level of eGFR. In women, the 3-year cumulative incidence of gout was 0.6%, 0.7%, 1.3%, 2.2%, and 3.4%, and in men the values were 0.8%, 1.2%, 2.5%, 3.7%, and 4.6%, respectively. However, patients on chronic dialysis had a lower 3-year cumulative incidence of gout (women 2.0%, men 2.9%) than those with more moderate reductions in kidney function (i.e., eGFR 15–44 ml/min per 1.73 m2). The association between a greater loss of kidney function and a higher risk of diagnosed gout was also evident after adjustment for clinical characteristics and in all additional analyses. Conclusions Patients with a lower level of eGFR had a higher 3-year cumulative incidence of gout, with the exception of patients receiving dialysis. Results can be used for risk stratification. PMID:28153936

Long-term treatment of Cushing's disease with pasireotide: 5-year results from an open-label extension study of a Phase III trial.

PubMed

Petersenn, S; Salgado, L R; Schopohl, J; Portocarrero-Ortiz, L; Arnaldi, G; Lacroix, A; Scaroni, C; Ravichandran, S; Kandra, A; Biller, B M K

2017-07-01

Treating hypercortisolism in patients with Cushing's disease after failed surgery often requires chronic medication, underlining the need for therapies with favourable long-term efficacy and safety profiles. In a randomised, double-blind study, 162 adult patients with persistent/recurrent or de novo Cushing's disease received pasireotide. Patients with mean urinary free cortisol at/below the upper limit of normal or clinical benefit at month 12 could continue receiving pasireotide during an open-ended, open-label phase, the outcomes of which are described herein. Sixteen patients received 5 years of pasireotide treatment. Among these, median (95% confidence interval) percentage change from baseline in mean urinary free cortisol was -82.6% (-89.0, -41.9) and -81.8% (-89.8, -67.4) at months 12 and 60. Eleven patients had mean urinary free cortisol ≤ upper limit of normal at month 60. Improvements in clinical signs were sustained during long-term treatment. The safety profile of pasireotide at 5 years was similar to that reported after 12 months. Fifteen of 16 patients experienced a hyperglycaemia-related adverse event; glycated haemoglobin levels were stable between months 6 and 60. Adverse events related to hyperglycaemia, bradycardia, gallbladder/biliary tract, and liver safety were most likely to first occur by month 6; adverse event severity did not tend to worsen over time. This represents the longest prospective trial of a medical therapy for Cushing's disease to date. A subset of patients treated with pasireotide maintained biochemical and clinical improvements for 5 years, with no new safety signals emerging. These data support the use of pasireotide as an effective long-term therapy for some patients with Cushing's disease.

The Relationship between Early Suicide Behaviors and Mental Health: Results from a Nine-Year Panel Study

ERIC Educational Resources Information Center

MacDonald, Ryan; Taylor, John; Clarke, Diana

2009-01-01

This paper employs community-level data to examine the relationship between suicide behaviors, measured at age eleven, and two mental health outcomes assessed nine-years later. Specifically, we assess the role and significance of suicide ideation and suicide attempts in substance dependence and depressive symptomatology. We evaluate these linkages…

Outcomes of Bariatric Surgery in Patients with Inflammatory Bowel Disease.

PubMed

Aminian, Ali; Andalib, Amin; Ver, Maria R; Corcelles, Ricard; Schauer, Philip R; Brethauer, Stacy A

2016-06-01

Obesity has become prevalent in patients with inflammatory bowel disease (IBD). Bariatric surgery can be considered to be contraindicated in IBD patients. We aimed to evaluate feasibility, safety, and efficacy of bariatric surgery in IBD patients. We retrospectively identified all morbidly obese patients with a known diagnosis of IBD, who underwent bariatric surgery between January 2005 and December 2012. Postoperative outcomes and status of IBD in patients on maintenance therapy for their disease were assessed. We identified 20 IBD patients including 13 ulcerative colitis (UC) and 7 Crohn's disease (CD) patients with a mean age of 54.0 ± 10.5 years, BMI of 50.1 ± 9.0 kg/m(2), and duration of IBD of 11.3 ± 5.2 years. Eleven patients were on medication for IBD at baseline. Bariatric procedures included sleeve gastrectomy (N = 9), gastric bypass (N = 7), gastric banding (N = 3), and one conversion of band to gastric bypass. There were no intraoperative complications, but two conversions to laparotomy due to adhesions. Mean BMI change and excess weight loss at 1 year was 14.3 ± 5.7 kg/m(2) and 58.9 ± 21.1 %, respectively. Seven early postoperative complications occurred including dehydration (N = 5), pulmonary embolism (N = 1), and wound infection (N = 1). During a mean follow-up of 34.6 ± 21.7 months, five patients developed complications including pancreatitis (N = 2), ventral hernia (N = 2), and marginal ulcer (N = 1). Nine out of ten eligible patients experienced improvement in their IBD status. Bariatric surgery is feasible and safe in morbidly obese patients suffering from IBD. In addition to being an effective weight loss procedure, bariatric surgery may help mitigate symptoms in this patient population.

[Evolution of nutritional status in hemodialysis patients during 4 years of follow].

PubMed

Fernández Castillo, Rafael; Fernández Gallegos, Ruth

2011-12-01

Protein-calorie malnutrition as well as systemic inflammation and metabolic disorders are common among patients with chronic renal failure undergoing renal replacement therapy (hemodialysis), which contributes to their morbidity and mortality. This work has followed 90 patients of both sexes with chronic kidney disease who were treated with hemodialysis periodically in our unit for four years. All patients were performed quarterly measurements of plasma albúmina (A1b), total cholesterol (TC), total protein (TP) and monthly transferrin (Tr), Anthropometric measurements of height and weight were taken on all patients by using a balance/stadiometer (Perperson 113481); weight was measured in kilograms and height in centimetres. BMI was calculated with this formula: weight/height2 and classified according to the WHO criteria: BMI < 18.50: Underweight; from 18.50 to 24.99: Normal range; from 25.00 to 29.99: Overweight; and BMI > or =30.00: Obese. The aim of this work was evaluate the nutritional status of these patients through the assessment of biochemical parameters and anthropometric parameters and determine if these patients suffer alterations suggesting nutritional deterioration directly related to the time on dialysis. During the 4 years all patients showed a significant decline of biochemical parameters, on the other hand the BMI did not significant changes in relation to malnutrition. Malnutrition in patients on dialysis is therefore evident, the BMI does not correspond with the biochemical parameters observed, so nutritional deterioration of these patients is mainly manifested by biochemical parameters studied.

Older patients with chronic myeloid leukemia (≥65 years) profit more from higher imatinib doses than younger patients: a subanalysis of the randomized CML-Study IV.

PubMed

Proetel, Ulrike; Pletsch, Nadine; Lauseker, Michael; Müller, Martin C; Hanfstein, Benjamin; Krause, Stefan W; Kalmanti, Lida; Schreiber, Annette; Heim, Dominik; Baerlocher, Gabriela M; Hofmann, Wolf-Karsten; Lange, Elisabeth; Einsele, Hermann; Wernli, Martin; Kremers, Stephan; Schlag, Rudolf; Müller, Lothar; Hänel, Mathias; Link, Hartmut; Hertenstein, Bernd; Pfirrman, Markus; Hochhaus, Andreas; Hasford, Joerg; Hehlmann, Rüdiger; Saußele, Susanne

2014-07-01

The impact of imatinib dose on response rates and survival in older patients with chronic myeloid leukemia in chronic phase has not been studied well. We analyzed data from the German CML-Study IV, a randomized five-arm treatment optimization study in newly diagnosed BCR-ABL-positive chronic myeloid leukemia in chronic phase. Patients randomized to imatinib 400 mg/day (IM400) or imatinib 800 mg/day (IM800) and stratified according to age (≥65 years vs. <65 years) were compared regarding dose, response, adverse events, rates of progression, and survival. The full 800 mg dose was given after a 6-week run-in period with imatinib 400 mg/day. The dose could then be reduced according to tolerability. A total of 828 patients were randomized to IM400 or IM800. Seven hundred eighty-four patients were evaluable (IM400, 382; IM800, 402). One hundred ten patients (29 %) on IM400 and 83 (21 %) on IM800 were ≥65 years. The median dose per day was lower for patients ≥65 years on IM800, with the highest median dose in the first year (466 mg/day for patients ≥65 years vs. 630 mg/day for patients <65 years). Older patients on IM800 achieved major molecular remission and deep molecular remission as fast as younger patients, in contrast to standard dose imatinib with which older patients achieved remissions much later than younger patients. Grades 3 and 4 adverse events were similar in both age groups. Five-year relative survival for older patients was comparable to that of younger patients. We suggest that the optimal dose for older patients is higher than 400 mg/day. ClinicalTrials.gov identifier: NCT00055874

Retrospective Review of Pediatric Blunt Renal Trauma: A Single Institution's Five Year Experience

PubMed Central

Clark, Margaret E; Sutherland, Ronald S; Woo, Russell K

2017-01-01

Children are at higher risk of renal injury from blunt trauma than adults due to a variety of anatomic factors such as decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. Non-operative management is gaining in popularity for even major injuries, although there are no universally accepted guidelines. We present a retrospective review of pediatric major blunt renal injuries (grade 3 or higher) at a children's hospital in Hawai‘i over a 5-year period. Medical records were examined between January 2009 and September 2014 from Kapi‘olani Medical Center for Women and Children in Honolulu, Hawai‘i. Inclusion criteria were a diagnosis of renal trauma, or the diagnosis of blunt abdominal trauma with hematuria. Exclusion criteria were grade I or II renal injury or death due to an additional traumatic injury. Mechanism of injury, clinical characteristics on admission, blood product requirements, surgical interventions performed, and hospital length of stay were retrospectively analyzed. Eleven total patient records were examined, nine of which fit inclusion criteria. Uniquely, 33% of patients sustained their renal injury while surfing. No patients required laparotomy or nephrectomy, though 22% of patients received a blood transfusion and 44% of patients underwent ureteral stent placement. Non-operative management of major renal injuries in children is feasible and allows for preservation of renal tissue. A novel mechanism of surfing as a cause of major renal trauma is seen in the state of Hawai‘i. PMID:28484665

Retrospective Review of Pediatric Blunt Renal Trauma: A Single Institution's Five Year Experience.

PubMed

Richards, Carly R; Clark, Margaret E; Sutherland, Ronald S; Woo, Russell K

2017-05-01

Children are at higher risk of renal injury from blunt trauma than adults due to a variety of anatomic factors such as decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. Non-operative management is gaining in popularity for even major injuries, although there are no universally accepted guidelines. We present a retrospective review of pediatric major blunt renal injuries (grade 3 or higher) at a children's hospital in Hawai'i over a 5-year period. Medical records were examined between January 2009 and September 2014 from Kapi'olani Medical Center for Women and Children in Honolulu, Hawai'i. Inclusion criteria were a diagnosis of renal trauma, or the diagnosis of blunt abdominal trauma with hematuria. Exclusion criteria were grade I or II renal injury or death due to an additional traumatic injury. Mechanism of injury, clinical characteristics on admission, blood product requirements, surgical interventions performed, and hospital length of stay were retrospectively analyzed. Eleven total patient records were examined, nine of which fit inclusion criteria. Uniquely, 33% of patients sustained their renal injury while surfing. No patients required laparotomy or nephrectomy, though 22% of patients received a blood transfusion and 44% of patients underwent ureteral stent placement. Non-operative management of major renal injuries in children is feasible and allows for preservation of renal tissue. A novel mechanism of surfing as a cause of major renal trauma is seen in the state of Hawai'i.

A 5-Year Retrospective Review of Fungal Keratitis at Hospital Universiti Sains Malaysia

PubMed Central

Mohd-Tahir, Fadzillah; Norhayati, A.; Siti-Raihan, Ishak; Ibrahim, M.

2012-01-01

Background. Corneal blindness from healed infected keratitis is one of the most preventable causes of monocular blindness in developing countries, including Malaysia. Our objectives were to identify the causative fungi, predisposing risk factors, the proportion of correct clinical diagnosis, and visual outcome of patients treated in our hospital. Methods. A retrospective review of medical and microbiology records was conducted for all patients who were treated for fungal keratitis at Hospital Universiti Sains Malaysia from January 2007 until December 2011. Results. Forty-seven patients (47/186, 25.27%) were treated for fungal keratitis during the study period. This demonstrated that the incidence of fungal keratitis has increased each year from 2007 to 2011 by 12.50%, 17.65%, 21.21%, 26.83%, and 28.57%, respectively. The most common predisposing factors were injury to the eye followed by use of topical steroid, and preexisting ocular surface disease. Fusarium species were the most common fungal isolated, followed by Candida species. Clinical diagnosis of fungal keratitis was made in 26 of the 41 (63.41%) cases of positive isolates. Of these, in eleven cases (23.40%) patients required surgical intervention. Clinical outcome of healed scar was achieved in 34 (72.34%) cases. Conclusions. The percentage of positive fungal isolated has steadily increased and the trend of common fungal isolated has changed. The latest review regarding fungal keratitis is important for us to improve patients' outcome in the future. PMID:23304138

Patient perceptions of having 1st- and 2nd-year medical students involved in their care.

PubMed

Isaacson, J Harry; Neides, Daniel; Mayer, Mark; Nottingham, Kelly

2014-01-01

Medical student education has shifted to earlier clinical experiences and increased use of ambulatory settings. Little is known about patient perceptions of having 1st- and 2nd-year medical students involved in their care. The purpose of this article is to study patient perceptions of having 1st- and 2nd-year medical students involved in their care in an ambulatory setting. In 2011 we surveyed 314 patients seen in 2 primary care clinics who saw 1st- or 2nd-year medical students. The survey included questions regarding patient visit satisfaction and perception of overall quality of the visit, adequacy of visit time, benefit of having a student involved in their care, and willingness to see a student in clinic again. Comparisons were made for patients who saw a student and a preceptor (n = 201) and patients who saw only the preceptor (n = 113). Overall visit satisfaction was very high for patients who saw students (83% very satisfied) and patients who saw only the preceptor (91% very satisfied). More than 95% of patients were satisfied with the visit time, and all patients rated the overall quality of their visit as good or excellent. Eighty-five percent of patients would want to see a student again or had no preference. Forty-three percent of patients felt the presence of a student added value to their visit. White patients were more likely than non-White patients to be very satisfied with their visit and rated the overall quality of the visit as excellent. There were no differences based on student gender or year of training. Our results suggest that 1st- and 2nd-year students can be successfully integrated into clinical settings while maintaining patient satisfaction and perceived value of the care they receive.

Evaluation of the effect of cognitive therapy on perioperative anxiety and depression among Nigerian surgical patients.

PubMed

Osinowo, H O; Olley, B O; Adejumo, A O

2003-12-01

Surgical paients have been known to benefit immensely from psychological interventions. This study set out to assess the pre and postoperative anxiety levels and depression and the effect of cognitive therapy among Nigerian surgical patients. The effects of gender and educational status on perioperative anxiety and depression were also evaluated. The study utilized a controlled outcome design to evaluate the efficacy of self-instructional training (SIT) and rational emotive therapy (RET) in surgical patients. Preoperative anxiety and depression scores were used as co-variants. Thirty-three (33) elective surgical patients were sampled randomly, divided into 3 groups of eleven (11) patients each. Eight (8) subjects underwent gynaecological procedures while the remaining 25 subjects had general surgical procedures. The mean age was 32.72 +/- 15.83 years (range = 17-16 years.) The major instruments used in the study were the State Anxiety Subscale of the Speilberger State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Inventory. SIT had the potential to reduce anxiety level among subjects postoperatively (t = 2.06; df = 10; p < 0.05). The use of RET reduced depression among surgical patients (t = 1.23; df = 10; p < 0.05). It was concluded that surgical patients manifest varying degrees of anxiety preoperatively and postoperatively. Patient's pre and postoperative anxiety and depression can be reduced by the introduction of SIT and RET.

Cost-related dental non-attendance in older adulthood: evidence from eleven European countries and Israel.

PubMed

Listl, Stefan

2016-06-01

Although relevant for health policy, so far only little is known about the extent to which persons avoid dental attendance because of associated costs. To examine the cost-relatedness of dental non-attendance in various older adulthood populations. Secondary analyses were conducted of data from wave 1 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes unique information on recent dental non-attendance and care foregone due to costs by persons aged 50+ from eleven European countries and Israel. Multivariate logistic regression analysis was used to detect differences in the extent to which dental non-attendance is attributable to associated costs. The study sample comprised 13 935 persons who did not access dental care within the past year. Levels of cost-related non-attendance differed between the twelve examined countries, ranging from 6.8% in Israel to 0.5% in Austria. Cost-related non-attendance was 47% less likely among persons with good as compared to compromised chewing ability (Odds Ratio: 0.53; 95% CI: 0.43-0.66). Cost-related non-attendance was 33% less likely among persons with tertiary as compared to (pre-) primary educational attainment (Odds Ratio: 0.67; 95% CI: 0.47-0.96). Cost-related dental non-attendance was significantly more likely among persons with low levels of general health (Odds Ratio for lowest vs. highest level of general health: 3.05; 95% CI: 1.88-4.95). The findings of the present study suggest that a relatively small proportion of dental non-attendance in older adulthood is cost-related. For specific population subgroups in various countries, however, dental care costs may still pose a relevant barrier to dental care. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Eleven-year descriptive analysis of closed court verdicts on medical errors in Spain and Massachusetts.

PubMed

Giraldo, Priscila; Sato, Luke; Martínez-Sánchez, Jose M; Comas, Mercè; Dwyer, Kathy; Sala, Maria; Castells, Xavier

2016-08-30

To evaluate and compare the characteristics of court verdicts on medical errors allegedly harming patients in Spain and Massachusetts from 2002 to 2012. We reviewed 1041 closed court verdicts obtained from data on litigation in the Thomson Reuters Aranzadi Westlaw databases in Spain (Europe), and 370 closed court verdicts obtained from the Controlled Risk and Risk Management Foundation of Harvard Medical Institutions (CRICO/RMF) in Massachusetts (USA). We included closed court verdicts on medical errors. The definition of medical errors was based on that of the Institute of Medicine (USA). We excluded any agreements between parties before a judgement. Medical errors were involved in 25.9% of court verdicts in Spain and in 74% of those in Massachusetts. The most frequent cause of medical errors was a diagnosis-related problem (25.1%; 95% CI 20.7% to 31.1% in Spain; 35%; 95% CI 29.4% to 40.7% in Massachusetts). The proportion of medical errors classified as high severity was 34% higher in Spain than in Massachusetts (p=0.001). The most frequent factors contributing to medical errors in Spain were surgical and medical treatment (p=0.001). In Spain, 98.5% of medical errors resulted in compensation awards compared with only 6.9% in Massachusetts. This study reveals wide differences in litigation rates and the award of indemnity payments in Spain and Massachusetts; however, common features of both locations are the high rates of diagnosis-related problems and the long time interval until resolution. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

One-Year Outcomes following Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in Japanese Patients: The APOLLO Study.

PubMed

Oshima, Yuji; Kimoto, Kenichi; Yoshida, Noriko; Fujisawa, Kimihiko; Sonoda, Shozo; Kubota, Toshiaki; Murata, Toshinori; Sakamoto, Taiji; Yoshida, Shigeo; Sonoda, Koh-Hei; Ishibashi, Tatsuro

2017-01-01

To evaluate 1-year outcomes of intravitreal injections of aflibercept (IVA) in Japanese polypoidal choroidal vasculopathy (PCV) patients. In this prospective, open-label, single-arm multicenter clinical trial, treatment-naïve PCV patients received IVA (2.0 mg) every 2 months, after 3 initial monthly doses. The primary endpoint assessed was the proportion of patients maintaining baseline best-corrected visual acuity (BCVA) at 1 year. Fifty eyes with PCV were included in the study. BCVA was maintained or improved in 97.6% of the patients. Mean logMAR BCVA at baseline was 0.33, and had improved to 0.12 logMAR 1 year after the initiation of aflibercept treatment (p < 0.001). Mean central foveal thickness decreased from 356 to 239 μm (p < 0.001). Complete regression of polypoidal lesions was seen in 72.5% after 1 year of treatment. One year of IVA resulted in stabilization of BCVA and anatomical improvement in Japanese PCV patients. © 2017 S. Karger AG, Basel.

Sustained reduction in health care costs after adjunctive treatment of graded intensive short-term dynamic psychotherapy in patients with psychotic disorders.

PubMed

Abbass, Allan; Bernier, Denise; Kisely, Steve; Town, Joel; Johansson, Robert

2015-08-30

The aim of this pilot study was to evaluate the changes in symptom severity and long-term health care cost after intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with psychotic disorders undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 13 one-hour sessions of graded ISTDP to 38 patients with psychotic disorders. Costs for health care services were compiled for a one-year period prior to the start of ISTDP (baseline) along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Results revealed that health care cost reductions were significant for the one-year post-treatment period relative to baseline year, for both physician costs and hospital costs, and the reductions were sustained for the follow-up period of four post-treatment years. Furthermore, at treatment termination self-reported symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and reduce costs in selected patients with psychotic disorders, and that gains are sustained in long-term follow-up. Future research directions are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study.

PubMed

Huang, Dong-Dong; Chen, Xiao-Xi; Chen, Xi-Yi; Wang, Su-Lin; Shen, Xian; Chen, Xiao-Lei; Yu, Zhen; Zhuang, Cheng-Le

2016-11-01

One-year mortality is vital for elderly oncologic patients undergoing surgery. Recent studies have demonstrated that sarcopenia can predict outcomes after major abdominal surgeries, but the association of sarcopenia and 1-year mortality has never been investigated in a prospective study. We conducted a prospective study of elderly patients (≥65 years) who underwent curative gastrectomy for gastric cancer from July 2014 to July 2015. Sarcopenia was determined by the measurements of muscle mass, handgrip strength, and gait speed. Univariate and multivariate analyses were used to identify the risk factors associated with 1-year mortality. A total of 173 patients were included, in which 52 (30.1 %) patients were identified as having sarcopenia. Twenty-four (13.9 %) patients died within 1 year of surgery. Multivariate analysis showed that sarcopenia was an independent risk factor for 1-year mortality. Area under the receiver operating characteristic curve demonstrated an increased predictive power for 1-year mortality with the inclusion of sarcopenia, from 0.835 to 0.868. Solely low muscle mass was not predictive of 1-year mortality in the multivariate analysis. Sarcopenia is predictive of 1-year mortality in elderly patients undergoing gastric cancer surgery. The measurement of muscle function is important for sarcopenia as a preoperative assessment tool.

Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy

PubMed Central

May, Margaret T.; Vehreschild, Janne; Obel, Niels; Gill, Michael John; Crane, Heidi; Boesecke, Christoph; Samji, Hasina; Grabar, Sophie; Cazanave, Charles; Cavassini, Matthias; Shepherd, Leah; d’Arminio Monforte, Antonella; Smit, Colette; Saag, Michael; Lampe, Fiona; Hernando, Vicky; Montero, Marta; Zangerle, Robert; Justice, Amy C.; Sterling, Timothy; Miro, Jose; Ingle, Suzanne; Sterne, Jonathan A. C.

2016-01-01

Objectives To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996–1999 and survived for more than ten years. Methods We used data from 18 European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA. Results During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was <5% in 60% of all patients, and in 30% of those aged over 60 years. Conclusions Viral replication, lower CD4 count, prior AIDS, and transmission via injecting drug use continue to predict higher all-cause and AIDS-related mortality in patients treated with combination antiretroviral therapy for over a decade. Deaths from AIDS and non-AIDS infection are less frequent than deaths from other non-AIDS causes. PMID:27525413

Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula

PubMed Central

2013-01-01

Background Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. Case presentation We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Conclusions Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation. PMID:24289138

Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV-Hartofilakidis Type 3 Developmental Dysplasia of the Hip.

PubMed

Binazzi, Roberto

2015-05-01

High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term. Copyright © 2014 Elsevier Inc. All rights reserved.

Implementation of a non-lethal biopsy punch monitoring program for mercury in smallmouth bass, Micropterus dolomieu Lacepède, from the Eleven Point River, Missouri

USGS Publications Warehouse

Ackerson, J.R.; Schmitt, C.J.; McKee, M.J.; Brumbaugh, W.G.

2013-01-01

A non-lethal biopsy method for monitoring mercury (Hg) concentrations in smallmouth bass (Micropterus dolomieu; smallmouth) from the Eleven Point River in southern Missouri USA was evaluated. A biopsy punch was used to remove a muscle tissue plug from the area immediately below the anterior dorsal fin of 31 smallmouth. An additional 35 smallmouth (controls) were held identically except that no tissue plug was removed. After sampling, all fish were held in a concrete hatchery raceway for 6 weeks. Mean survival at the end of the holding period was 97 % for both groups. Smallmouth length, weight and Fulton’s condition factor at the end of the holding period were also similar between plugged and non-plugged controls, indicating that the biopsy procedure had minimal impact on growth under these conditions. Tissue plug Hg concentrations were similar to smallmouth Hg data obtained in previous years by removing the entire fillet for analysis.

Endoscopic endonasal transsphenoidal surgery for patients aged over 80 years with pituitary adenomas: Surgical and follow-up results.

PubMed

Fujimoto, Kenji; Yano, Shigetoshi; Shinojima, Naoki; Hide, Takuichiro; Kuratsu, Jun-Ichi

2017-01-01

With the rapid aging of the general population, the number of pituitary adenoma (PA) diagnosed in elderly patients is increasing. The aim of this study was to evaluate the efficacy of endoscopic endonasal transsphenoidal surgery (ETSS) for PA in patients aged ≥80 years. We retrospectively reviewed the medical records of all patients aged ≥80 years who underwent ETSS for PA at our hospital from January 2001 through December 2014. Treatment results were assessed by the extent of surgical removal, symptom improvement, postoperative complications, and Karnofsky performance status (KPS). The results were also compared with the surgical result of PA patients aged <80 years. Twelve patients aged ≥80 years underwent ETSS for PA. Recovery of visual function was observed in 11 patients (91.7%). Postoperative cerebrospinal fluid (CSF) leakage was observed in 3 patients. New hormonal replacement therapy was required in 2 patients. These complications had not affected patient prognosis. During the follow-up periods, deterioration of KPS was observed in 2 patients due to pneumonia or cerebral infarction. In total, 150 PA patients aged <80 years were compared with the patients aged ≥80 years. The percentage of total removal was significantly higher in the younger patient group than that in the older one (54.0% vs 16.6%, respectively; P = 0.016). Visual improvement was observed in 93.2% of the younger patient group, which was almost equal to that in the older one. ETSS is a safe and effective surgical technique in PA patients aged ≥80 years.

Lung cancer in patients younger than 40 years in a multiracial Asian country.

PubMed

Liam, C K; Lim, K H; Wong, C M

2000-12-01

This study aimed to determine whether the clinicopathological features of lung cancer in patients younger than 40 years differ from that of older patients in an Asian country. We undertook a review of the clinicopathological data of all patients with confirmed primary lung cancer at the Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia, from October 1991 to September 1999. Of the 580 patients with lung cancer, 36 (6.2%; 23 males, 13 females) were 21-39 years old at diagnosis. The percentage of people who had never smoked was higher among the younger patients (58.3% vs 19.1%, P < 0.001). Although adenocarcinoma was the most common cell type in both groups, its incidence was higher in the younger patients (24/36 (66.7%) vs 228/544 (41.9%), P = 0.007). The mean World Health Organization performance status at presentation was worse in the younger patients (2.4 vs 2, P = 0.007). In the case of non-small cell lung cancer, all the younger patients presented with either stage IIIb or metastatic disease compared to 77.2% of the older patients (P < 0.001). Younger lung cancer patients were more likely than older patients to have never smoked, to have adenocarcinoma, and to present with poorer performance status and with more advanced-stage non-small cell lung cancer.

Emergency Department Patient Burden from an Electronic Dance Music Festival.

PubMed

Chhabra, Neeraj; Gimbar, Renee P; Walla, Lisa M; Thompson, Trevonne M

2018-04-01

Electronic dance music (EDM) festivals are increasingly common and psychoactive substance use is prevalent. Although prehospital care can obviate the transfer of many attendees to health care facilities (HCFs), little is known regarding the emergency department (ED) burden of patients presenting from EDM festivals. This study describes the patient volume, length of stay (LOS), and presenting complaints of patients from a 3-day EDM festival in close proximity to an area ED. Medical charts of patients presenting to one HCF from an EDM festival were reviewed for substances used, ED LOS, and sedative medications administered. Additionally, preparedness techniques are described. Over the 3-day festival, 28 patients presented to the ED (median age 21 years; range 18-29 years). Twenty-five had complaints related to substance use including ethanol (n = 18), "molly" or "ecstasy" (n = 13), and marijuana (n = 8). Three patients required intensive care or step-down unit admission for endotracheal intubation, rhabdomyolysis, and protracted altered mental status. The median LOS for discharged patients was 265 min (interquartile range 210-347 min). Eleven patients required the use of sedative medications, with cumulative doses of 42 mg of lorazepam and 350 mg of ketamine. All patients presented within the hours of 5:00 pm and 2:15 am. The majority of ED visits from an EDM festival were related to substance use. ED arrival times clustered during the evening and were associated with prolonged LOS. Few patients required hospital admission, but admitted patients required high levels of care. HCFs should use these data as a guide in planning for future events. Copyright © 2017 Elsevier Inc. All rights reserved.

Excess primary intestinal lymphoproliferative disorders in patients with inflammatory bowel disease.

PubMed

Sokol, Harry; Beaugerie, Laurent; Maynadié, Marc; Laharie, David; Dupas, Jean-Louis; Flourié, Bernard; Lerebours, Eric; Peyrin-Biroulet, Laurent; Allez, Matthieu; Simon, Tabassome; Carrat, Fabrice; Brousse, Nicole

2012-11-01

It remains to be shown whether inflammatory bowel disease (IBD) is associated with an increased risk of primary intestinal lymphoproliferative disorders (PILD). We assessed this risk in the CESAME French nationwide prospective observational cohort. In all, 680 gastroenterologists enrolled 19,486 patients with IBD (Crohn's disease in 60.3%) from May 2004 to June 2005. Follow-up ended on 31 December 2007. Available biopsy samples and surgical specimens from patients with PILD (n = 14) were centralized for review. The reference incidence of PILD in the general population was obtained from the Côte d'Or registry and was used as a comparator to assess the standardized incidence ratio (SIR). The influence of thiopurine exposure was explored in a nested case-control study. In the CESAME population the crude incidence of PILD was 0.12/1000 patient-years, with a corresponding SIR of 17.51 (95% confidence interval [CI], 6.43-38.11; P < 0.0001). The risk was highest in patients exposed to thiopurines (SIR 49.52, 95% CI 13.49-126.8; P < 0.0001), while it did not reach statistical significance in patients naïve to thiopurines (SIR 4.83, 95% CI, 0.12-26.91; P = 0.37). The odds ratio associated with ongoing thiopurine exposure (vs. naïve) was 2.97 (95% CI, 0.30-infinity; P = 0.38). All 14 cases of PILD were non-Hodgkin's B-cell LD, 78.6% occurred in males, 85.7% arose in IBD lesions, and 45.5% were Epstein-Barr virus-positive. Eleven cases occurred in patients with Crohn's disease. Mean (SD) age at PILD diagnosis was 55.1 (5.6) years and the median time since IBD onset was 8.0 years (interquartile range, 3.0-15.8). Patients with IBD have an increased risk of developing PILD. Copyright © 2012 Crohn's & Colitis Foundation of America, Inc.