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Close Observation (close + observation)
Selected AbstractsReed-Sternberg cells in atypical primary EBV infectionACTA PAEDIATRICA, Issue 2 2001M Bitsori The presence of Epstein-Barr virus (EBV) in the Hodgkin's/Reed-Sternberg (HRS) cells of a significant proportion of cases of Hodgkin's lymphoma (HL) is a matter of consideration when a case of presumptive HL has to be differentiated from infectious mononucleosis (IM). A 15-y-old boy was admitted with a presumptive diagnosis of extranodal HL, based on the biopsy of a painless ulcer on the right mandibular alveolar crest. Histologic examination of the lesion was consistent with mixed cellularity HL. The patient additionally presented with hepatosplenomegaly and regional lymphadenopathy. Serology for EBV was indicative of acute infection. Histological examination of regional lymphoid tissue was consistent with immunologic activation due to primary EBV infection. The patient was left untreated, under close observation. All clinical findings resolved within 3 mo and EBV viral capsid antigen (VCA) IgM antibodies converted to negative after 6 mo. A 3-y follow-up period was uneventful. [source] ENDOSCOPIC IDENTIFICATION OF HELICOBACTER PYLORI GASTRITIS IN CHILDRENDIGESTIVE ENDOSCOPY, Issue 2 2010Nao Hidaka Aim:, The role of endoscopic findings in deciding whether to biopsy the gastric mucosa of children remains unclear. The present study attempted, for the first time, to identify the value of endoscopic features for diagnosis of Helicobacter pylori (Hp) infection in children. Methods:, Hp status of consecutive children receiving esophagogastroduodenoscopy (EGD) was established by combinations of histology, 13C-urea breath test, and serum Hp immunoglobulin (Ig)G antibody. After routine EGD using a conventional endoscope, the presence of RAC (regular arrangement of collecting venules) was scored by close observation, which was carried out at two sites of lower corpus lesser curvature and upper corpus greater curvature. RAC-positive was defined as the presence of minute red points in a regular pattern. Antral nodularity was also scored as present/absent. Results:, Eighty-seven consecutive children (38 boys, median age 13 years, range 9,15 years) were evaluated; 25 (29%) were Hp positive. Antral nodularity was seen in 21 (84%) all of whom were Hp positive. The RAC-negative pattern based on examination of the upper and lower corpus yielded a sensitivity, specificity, positive predictive value and negative predictive value for the presence of Hp infection of 100%, 90%, 81%, and 100%. Magnifying endoscopy confirmed that the RAC pattern corresponded to collecting venules in the gastric corpus. Conclusions:, The absence of RAC pattern suggests that gastric mucosa biopsies should be taken despite otherwise normal-appearing gastric mucosa for the diagnosis of Hp infection in children. [source] Discrimination of Normal Gastric Mucosa from Helicobacter pylori Gastritis using Standard Endoscopes and a Single Observation Site: Studies in Children and Young AdultsHELICOBACTER, Issue 2 2004Yoshiko Nakayama ABSTRACT Background., In the Helicobacter pylori -negative normal stomach, collecting venules are visible in the gastric corpus as numerous minute points. This finding has been termed ,regular arrangement of collecting venules' (RAC). The aim of the present study was to investigate the reliability of the presence of the RAC pattern for discrimination of normal gastric mucosa from H. pylori gastritis in pediatric patients. Methods., Fifty-two consecutive children, adolescents and young adults (male:female 24 : 28; median age 15 years, range 8,29 years) referred for endoscopy and assessed for H. pylori infection were prospectively studied. The lower lesser curvature of the corpus near the incisura was evaluated for the RAC pattern using a standard endoscope with the tip close to, but not in contact with, the gastric surface. Gastric biopsies were taken after the endoscopic observation. Results., In all the 29 RAC-positive patients, active H. pylori gastritis was absent, whereas H. pylori gastritis was found in 20 of 23 RAC-negative patients (86.9%). Conclusions., Identification of the RAC pattern at the lower lesser curvature of the corpus using close observation with a standard endoscope proved to be an effective and practical marker to discriminate normal histology from H. pylori gastritis among both children and young adults. Absence of the RAC pattern should prompt gastric mucosal biopsies despite otherwise normal-appearing gastric mucosa. [source] Medical dominance in multidisciplinary teamwork: a case study of discharge decision-making in a geriatric assessment unitJOURNAL OF NURSING MANAGEMENT, Issue 1 2001DipSocAdmin, DipSocWork, G. Gair MA Aim, To investigate the degree of medical dominance in multidisciplinary teams in a geriatric assessment unit by focusing on decision-making with regard to patient discharge. Background, The persistence of medical dominance in multidisciplinary teamwork has been widely assumed but insufficiently researched, particularly through close observation of team practice. The present study seeks to rectify this by examining the extent of medical dominance in two multidisciplinary teams working in a hospital-based geriatric assessment unit. Methods, Team practice was analysed by observing and audiotaping five case review meetings in each team and by semi-structured interviews with team members. Results, In terms of level of contribution, the issues raised at meetings, and the team responses to discharge initiation, a lower than expected level of medical dominance was identified. This lower than expected level is related to consultants' views on the nature of rehabilitation, leading to a consensus amongst team members as to the purpose of geriatric assessment, and to a high level of team stability. Conclusion, Reducing the level of medical dominance encourages the contributions of all team members and thus enhances patient care. More training in team skills would also be beneficial, including interprofessional training. [source] Pericardial involvement at diagnosis in pediatric Hodgkin lymphoma patientsPEDIATRIC BLOOD & CANCER, Issue 5 2007Hamid Bashir MD Abstract Background Because most cases are clinically silent, the incidence, clinical course, and outcome of pericardial involvement in Hodgkin lymphoma are unknown. Methods Records of all patients with newly diagnosed Hodgkin lymphoma treated at our institution between 1991 and 2004 were reviewed. Pericardial involvement was identified by computerized tomography (CT) as focal thickening or nodularity present at the time of diagnosis, and by echocardiography as pericardial effusion. Outcomes measured were incidence of pericardial involvement, relapse-free survival, and overall survival. Results Thirteen of 273 patients (5%) had pericardial involvement. All patients with pericardial involvement had nodular sclerosing tumors versus 183 of 260 patients without pericardial involvement (P,=,0.02); 9 (67%) had a bulky mediastinal mass versus 27% (P,=,0.002). Two patients required pericardial drainage to drain very large effusions (n,=,2). Both patients were symptomatic with either shortness of breath or superior vena cava syndrome. In the 11 cases that did not undergo surgical drainage, the effusion resolved within days after starting chemotherapy. Two patients experienced distant relapse but underwent successful salvage therapy. All 13 patients remain alive and free of disease at a median follow-up of 9.7 years (range, 1.7,12.9 years) with normal cardiac function. Conclusions Pericardial involvement by lymphoma is usually asymptomatic unless accompanied by substantial pericardial effusion. In most cases, pericardial involvement resolves with treatment of the underlying malignancy, but close observation for hemodynamic complications is required. A symptomatic effusion, once treated, does not affect survival. Pediatr Blood Cancer 2007;49:666,671. © 2006 Wiley-Liss, Inc. [source] Periocular Hemangiomas: What Every Physician Should KnowPEDIATRIC DERMATOLOGY, Issue 1 2004Emily J. Ceisler M.D. Most hemangiomas remain asymptomatic and can be managed by close observation; however, immediate treatment is indicated for hemangiomas that may cause significant complications. Periocular hemangiomas warrant close evaluation and early, active treatment of those with the potential to threaten or permanently compromise vision. Herein we review the clinical features of periocular hemangiomas, differential diagnosis, possible ophthalmologic complications and sequelae, and therapeutic modalities. [source] Design, Meanings, and Radical Innovation: A Metamodel and a Research Agenda,THE JOURNAL OF PRODUCT INNOVATION MANAGEMENT, Issue 5 2008Roberto Verganti Recent studies on design management have helped us to better comprehend how companies can apply design to get closer to users and to better understand their needs; this is an approach usually referred to as user-centered design. Yet analysis of design-intensive manufacturers such as Alessi, Artemide, and other leading Italian firms shows that their innovation process hardly starts from a close observation of user needs and requirements. Rather, they follow a different strategy called design-driven innovation in this paper. This strategy aims at radically change the emotional and symbolic content of products (i.e., their meanings and languages) through a deep understanding of broader changes in society, culture, and technology. Rather than being pulled by user requirements, design-driven innovation is pushed by a firm's vision about possible new product meanings and languages that could diffuse in society. Design-driven innovation, which plays such a crucial role in the innovation strategy of design intensive firms, has still remained largely unexplored. This paper aims at providing a possible direction to fill this empty spot in innovation management literature. In particular, first it proposes a metamodel for investigating design-driven innovation in which a manufacturer's ability to understand, anticipate, and influence emergence of new product meanings is built by relying on external interpreters (e.g., designers, firms in other industries, suppliers, schools, artists, the media) that share its same problem: to understand the evolution of sociocultural models and to propose new visions and meanings. Managing design-driven innovation therefore implies managing the interaction with these interpreters to access, share, and internalize knowledge on product languages and to influence shifts in sociocultural models. Second, the paper proposes a possible direction to scientifically investigate the management of this networked and collective research process. In particular, it shows that the process of creating breakthrough innovations of meanings partially mirrors the process of creating breakthrough technological innovations. Studies of design-driven innovation may therefore benefit significantly from the existing body of theories in the field of technology management. The analysis of the analogies between these two types of radical innovations (i.e., meanings and technologies) allows a research agenda to be set for exploration of design-driven innovation, a relevant as well as underinvestigated phenomenon. [source] | ||||||||||