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Different Clinical Situations (different + clinical_situation)
Selected AbstractsSkin Angiosarcoma Arising in an Irradiated Breast: Case-Report and Literature ReviewDERMATOLOGIC SURGERY, Issue 3 2006FAUSTO CATENA MD BACKGROUND Angiosarcoma (AS) is a rare, invasive malignancy originating from endothelial cells caused by many different clinical situations. AS following radiotherapy for breast cancer after conservative surgery is a rare but well-known association. OBJECTIVE The aim of this article is to describe a case of AS after breast conserving surgery and to review the literature to date. RESULTS We report the case of an 84-year-old woman who developed AS four years after she was subjected to quadrantectomy for invasive ductal cancer, followed by 30 tangent field radiotherapy sessions. She presented with a one-month history or red papular skin eruptions on the operated breast. Skin lesions were submitted for biopsy, and they were positive for AS. The patients was subjected to surgical excision of the remaining breast including all AS lesions. She is alive with no evidence of disease after 10 months follow-up. CONCLUSION Post-radiotherapy AS is rare neoplasm, but it should be considered in the case of patients with red lesions after breast conserving surgery and adjuvant radiotherapy. [source] Diagnosis of Helicobacter pylori InfectionHELICOBACTER, Issue 2006Katarzyna Dzier, anowska-Fangrat Abstract A growing interest in non-invasive tests for the detection of Helicobacter pylori has been observed recently, reflecting a large number of studies published this year. New tests have been validated, and the old ones have been used in different clinical situations or for different purposes. Stool antigen tests have been extensively evaluated in pre- and post-treatment settings both in adults and children, and the urea breath test has been studied as a predictor of bacterial load, severity of gastric inflammation, and response to eradication treatment. Several studies have also explored the usefulness of some serologic markers as indicators of the gastric mucosa status. With regard to invasive tests, molecular methods are being used more and more, but the breakthrough this year was the direct in vivo observation of H. pylori during endoscopy. [source] Assessment of pulp vitality: a reviewINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2009VELAYUTHAM GOPIKRISHNA Background., One of the greatest diagnostic challenges in clinical practice is the accurate assessment of pulp status. This may be further complicated in paediatric dentistry where the practitioner is faced with a developing dentition, traumatized teeth, or young children who have a limited ability to recall a pain history for the tooth in question. A variety of pulp testing approaches exist, and there may be confusion as to their validity or appropriateness in different clinical situations. Aim., The aim of this paper is to provide the clinician with a comprehensive review of current pulp testing methods. A key objective is to highlight the difference between sensitivity testing and vitality testing. A biological basis for pulp testing is also provided to allow greater insight into the interpretation of pulp testing results. The rationale for, and methods of, assessing pulpal blood flow are described. [source] Validation of a questionnaire for assessment of asthma patient knowledge and behaviourALLERGY, Issue 1 2009F. Trebuchon Background:, For several years, educational programmes have been highlighted because care success depends on patient's knowledge and patient's asthma management. However, no tool is available to assess change in patient knowledge and behaviour before and after completing an educational programme. Objective:, To validate a questionnaire measuring the knowledge and behaviour of asthmatics participating in an educational programme and to gauge the benefit of such a programme. Methods:, The Asthma Behaviour Change (ABC) questionnaire was generated from literature, patient surveys and clinical situations. It was organized in eight dimensions assessing patient behaviour in seven different clinical situations and two assessing patient (pathophysiology and therapeutic) knowledge. A total of 139 asthmatics filled out the questionnaire before, during and after the educational programme. Results:, The principal component analysis confirmed the structure empirically made by clinical situations. Internal consistency analysis yielded high Cronbach's alpha values. Different dimensions and the two global scores were able to discriminate patients according to asthma severity. Finally, the effect size of difference before and after educational programme was at least 0.47, and was larger than 0.74 for both global behaviour and knowledge scores. The difference between visit 1 and 3 for global behaviour and knowledge scores reached 18.84 ± 20.83 (P < 0.001, 95% CI: 13.18,24.43) and 11.06 ± 14.98 (P < 0.001, 95% CI: 7.10,15.03), respectively. Conclusion:, ABC questionnaire is a valid tool to assess asthmatics' knowledge and behaviour. Furthermore, this study confirmed that educational programmes lead to better awareness of asthma by patients. [source] The transferential chimera: a clinical approachTHE JOURNAL OF ANALYTICAL PSYCHOLOGY, Issue 5 2006Winning article of the Special Michael Fordham 50th Anniversary Prize Abstract:, The author presents four quite different clinical situations which he believes show the development of an aspect of the transference as a genuinely autonomous psychical neo-reality of the transferential inter-space, which, in the words of Michel de M'Uzan, he calls the transferential chimera. Basing himself on a reading of ,The psychology of the transference', he goes on to propose a more general application of this particular transferential dynamic whose origin lies in matriarchal incest and which develops around the alchemical quaternio of the cross-projective space of the transference-counter transference and in the analytic setting. Finally, he examines the four clinical situations in the light of this application of the transference in order to propound an understanding of his reading, and proposes a hypothesis for the constitution of the transferential chimera out of the intermingling of the de-integrated parts of the self of the analyst and those of the analysand. Translations of Abstract L'auteur aborde ici quatre situations cliniques très différentes qui illustrent à ses yeux une dimension du transfert se développant comme une véritable néoréalité psychique autonome de l'entre-deux transférentiel, ce qu'il nomme, à la suite de Michel de M'Uzan, la chimère transférentielle. Il propose ensuite, en s'appuyant sur sa lecture de Psychologie du Transfert, une topique dynamique de cette chimère transférentielle dont la source énergétique est l'inceste à la mère, et qui s'organise autour du quaternio alchimique, de l'espace projectif/contre-projectif du transfert/contre-transfert, et du cadre analytique. Enfin il reprend les situations cliniques à la lumière de cette topique afin d'en proposer sa lecture, et il fait l'hypothèse de la constitution de cette chimère transférentielle à partir de l'intrication des parts dé-intégrées du soi de l'analyste et de celles du soi de l'analysant. Cet article sera suivi d'un second papier sur le sujet où l'auteur abordera plus précisément les aspects théoriques de cette notion de la chimère transférentielle. Der Autor stellt vier unterschiedliche klinische Situationen dar, von denen er glaubt, dass sie die Entwicklung eines Aspekts der Übertragung als eine echte autonome psychische Neorealität im Zwischenraum der Übertragung zeigen. Mit den Worten Michel de M'Uzans bezeichnet der Autor dies als die übertragende Chimäre. Er beruft sich dabei auf die Lektüre der Psychologie der Übertragung. Dann geht er einen Schritt weiter, um eine allgemeinere Anwendung dieser besonderen Übertragungsdynamik vorzuschlagen, deren Ursprung im matriarchalen Inzest liegt und die sich um die alchemistische Quaternio im Raum der sich überkreuzenden Projektionen der Übertragung/Gegenübertragung und im psychoanalytischen Setting entwickelt. Schließlich untersucht er die vier klinischen Situationen im Lichte dieser Anwendung der Übertragung, um sein Verständnis der Lektüre vorzulegen, und er schlägt eine Hypothese für die Konstitution der übertragenden Chimäre vor, die aus der Vermischung der deintegrierten Selbstanteile des Analytikers/der Analytikerin mit denen des Analysanden/der Analysandin entstehen. L'autore presenta quattro situazioni cliniche del tutto differenti fra loro che pensa possano mostrare lo sviluppo di un aspetto del tranfert come la costruzione genuinamente autonoma di una neo-realtà psichica dell'interspazio transferale, che, con le parole di Michel de M'Uzan, egli chiama la chimera transferale. Partendo da una personale lettura della Psicologia della Traslazione, va avanti proponendo una applicazione più generale di questa particolare dinamica transferale le cui origini giaccioni nell'incesto patriarcale e che si sviluppa intorno al quaternio alchemico dello spazio prospettico incrociato del tranfer e del controtranfert e nel setting analitico. In fine egli esamina le quattro situazioni cliniche alla luce di questa formulazione del transfert in modo da rendere comprensibile la sua lettura e propone un'ipotesi per il costituirsi della chimera tranferale fuori dal rimescolio delle parti de-integrate del sé dell'analista e di quelle dell'analizzando. El autor presenta cuatro situaciones clínicas muy diferentes las cuales según el cree, muestran el desarrollo de un aspecto de la transferencia como genuinamente y físicamente autónomo en el espacio neo-real del inter-espacio transferencial, el cual Michel de M'Uzan, denomina la quimera transferencial. Basándose en sus lecturas de Psicología de la Transferencia, llega a proponer una aplicación mas general para esta particular dinámica transferencial cuyo origen reposa en el incesto matriarcal y que crece alrededor del quaternio del espacio proyectivo de la transferencia-contratransferencia y en el encuadre analítico. Finalmente, examina las cuatro situaciones clínicas a la luz de esta aplicación de la transferencia para proponer un entendimiento de su lectura, y lanza la hipótesis para la constitución de la quimera transferencial desde la interconexión de las partes desintegradas del self del analista y las del analizando. [source] Pathogenesis, diagnosis and treatment of neuromyelitis optica: Changing concept of an old diseaseCLINICAL AND EXPERIMENTAL NEUROIMMUNOLOGY, Issue 3 2010Zsolt Illes Abstract The concept of neuromyelitis optica (NMO) has changed considerably during the past few years. The identification of autoantibodies in the sera generated against the water channel aquaporin 4 (AQP4) has increased the specificity of diagnosis and modified guidelines. A pathogenic role of anti-AQP4 antibodies has recently been indicated; they evoke the pathological and clinical hallmarks of the disease on transfer and cause necrosis of astrocytes expressing AQP4. The diagnosis of NMO is based on clinical, neuroimaging and serological criteria. Early therapy preventing relapses is mandatory, because neurological impairment accumulated during relapses is the main cause of permanent disability. In a number of cases defined as NMO spectrum diseases, the clinical manifestation is spatially limited. Such events of separate myelitis or relapsing/bilateral optic neuritis challenge diagnosis and might delay proper therapy. Here, current concepts of diagnosis and treatment of NMO and NMO spectrum diseases are summarized. Diagnostic and treatment decisions in different clinical situations are shown by discussion of cases. (Clin. Exp. Neuroimmunol. doi: 10.1111/j.1759-1961.2010.00011.x, 2010) [source] Treatment of extremely preterm infants: parents'attitudesACTA PAEDIATRICA, Issue 6 2003B Mølholm Hansen Aim: To conduct a survey of the attitude towards treatment of extremely preterm infants by comparing the attitude towards life-saving treatment between a group of parents of extremely preterm children and parents in the general population. The importance the two groups of respondents assigned to parental preferences was also investigated. Methods: A Danish national cohort of children born from 1994 to 1995 with a birthweight below 1000 g or a gestational age below 28 wk were assessed in a 5-y follow-up study including a reference group of children born at term. The parents of the children were given a sequence of case vignettes presenting different clinical situations, which formed part of a questionnaire. Results: More than 80% of 222 possible index respondents and 76 possible reference respondents fulfilled the vignettes. Both groups of respondents were positive towards life-saving treatment of extremely preterm infants. The recommendations given by both groups were significantly influenced by the hypothetical child's risk of having a serious handicap and the parents'preferences. The results suggest that parents of extremely preterm children do not have a more conservative attitude towards life-saving treatment of extremely preterm infants than parents in the general population, and also support the view that parents'preferences should influence treatment decisions; although many believe that these should not be decisive. Conclusion: Compared to the general population, parents of children born extremely preterm did not express a more conservative attitude towards life-saving treatment of extremely preterm infants. [source] | ||||||||||