Major Indications (major + indication)

Distribution by Scientific Domains

Selected Abstracts

Outcomes of emergency common bile duct exploration: impact of preoperative endoscopic decompression

Joyce S. B. Koh
Background: Emergency common bile duct exploration (CBDE) is still required in patients acutely ill with complicated biliary tract stone disease when endoscopic decompression fails to reverse their condition. This study looks at the clinical profile of patients requiring emergency CBDE and examines the various factors influencing the postoperative outcome. Methods: Clinical records of patients with emergency CBDE in Singapore General Hospital from January 1991 to December 1998 were reviewed. Factors influencing postoperative outcomes, for example, pre-existing medical problems, hepatic para­-­m­eters, the impact of endoscopic procedures (if any) and indications for surgery, were correlated with postoperative morbidity and 30-day mortality. Results: The records of 100 patients were available for review. Major indications for emergency CBDE were cholangitis (51%) and intraoperative findings of common bile duct obstruction during emergency laparotomy (23%). Six patients had emergency CBDE because of iatrogenic complication of attempted therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) for biliary stones. Overall mortality was 14.0% and 8.0% had retained stones. Mortality was significantly influenced by age, prior biliary disease, preoperative endoscopic biliary decompression in acute cholangitis (33.3%vs 9.4%, P = 0.035) and endoscopic complications. Conclusions: Among patients requiring emergency CBDE, uncomplicated preoperative endoscopic biliary decompression ben­efits patients with acute cholangitis. [source]

TNC Strategies and Variations in Intra-firm Trade: The Case of Foreign Manufacturing Affiliates in Sweden

Inge Ivarsson
The aim of this paper is to contribute to the understanding of the forms and determinants of intra-firm trade, i.e. international trade between different units under common TNC ownership, this being a major indication of ,deep economic integration' between developed countries in the 1990s. Theoretically, intra-firm trade can be explained by the existence of economies of common governance and are often found to be associated with R&D-intensive industries and economies of scale. In empirical studies, intra-firm trade is often found to consist of intermediate inputs goods, resulting in vertically integrated production chains. The study is based on detailed firm-level data from around 300 foreign majority-owned affiliates (MOFAs) in manufacturing, in Sweden in 1993. The results show that intra-firm sales by MOFAs in Sweden are as high as those found in studies of manufacturing affiliates of US TNCs. Almost all of MOFAs' intra-firm exports are finished products, while intra-firm imports consist of material inputs and finished products for resale. This suggests that these MOFAs are only marginal involved in vertically integrated production chains, especially in terms of exports. The results of a regression analysis complement earlier studies by showing that the level and composition of intra-firm trade is significantly affected by the international strategy applied by TNCs when operating foreign manufacturing affiliates. Intra-firm exports of finished products and material inputs are positively associated with efficiency-seeking FDI, e.g. affiliates engaged in rationalised production. Market-seeking FDI is associated with intra-firm imports of complementary finished products for resale. By contrast, resource-seeking and strategic asset-seeking FDI was negatively associated with intra-firm trade. [source]

Modelling current trends in Northern Hemisphere temperatures

Terence C. Mills
Abstract Fitting a trend is of interest in many disciplines, but it is of particular importance in climatology, where estimating the current and recent trend in temperature is thought to provide a major indication of the presence of global warming. A range of ad hoc methods of trend fitting have been proposed, with little consensus as to the most appropriate techniques to use. The aim of this paper is to consider a range of trend extraction techniques, none of which require ,padding' out the series beyond the end of the available observations, and to use these to estimate the trend of annual mean Northern Hemisphere (NH) temperatures. A comparison of the trends estimated by these methods thus provides a robust indication of the likely range of current trend temperature increases and hence inform, in a timely quantitative fashion, arguments based on global temperature data concerning the nature and extent of global warming and climate change. For the complete sample 1856,2003, the trend is characterised as having long waves about an underlying increasing level. Since around 1970, all techniques display a pronounced warming trend. However, they also provide a range of trend functions so that extrapolation far into the future would be a hazardous exercise. Copyright © 2006 Royal Meteorological Society. [source]

Indications, results, and complications of tacrolimus conversion in pediatric renal transplantation

Joseph T. Flynn
Abstract: It is the practice of many pediatric renal transplant programs to ,convert' children taking cyclosporin A (CsA) to tacrolimus, although the indications for, outcome, and complications of this practice remain obscure. To better understand these aspects of tacrolimus ,conversion', a fax survey was sent to 119 North American pediatric renal transplant centers. Analyzable responses were received from 52 centers (44%), and included data from ,,1,815 pediatric renal transplants performed between 1991 and 98. Strong indications for tacrolimus conversion were: antibody-resistant rejection, CsA-resistant rejection, and CsA intolerance (strong indication in 72%, 65%, and 52% of centers, respectively). Steroid-resistant rejection and cosmetic side-effects were considered strong indications less often. Initial anti-rejection therapy was usually increased corticosteroid dose (47/52 centers). Antibody therapy was most commonly used for steroid-resistant rejection (44 centers). For steroid- and antibody-resistant rejection, tacrolimus conversion was most common (33 centers). Tacrolimus conversion for antibody-resistant rejection led to improvement of serum creatinine (SCr) in 27% of patients, stabilization of SCr in 46%, worsening of SCr in 11%, and graft loss in 16%. Reported complications after tacrolimus conversion included hyperglycemia, hyperkalemia, lymphoproliferative disorder, infection, and neurologic problems. We conclude that the major indication for tacrolimus conversion in pediatric transplant programs appears to be rejection. Outcome after tacrolimus conversion appears good, with the majority of patients experiencing stable or improved allograft function. These data provide direction for further study, including timing of tacrolimus conversion and interaction with other therapies. [source]

Is oxidative stress involved in the aetiology of pre-eclampsia?

L Poston
Pre-eclampsia is one of the major indications for elective premature delivery. Several lines of evidence suggest that pre-eclampsia is associated with a state of oxidative stress, offering hope of prevention by antioxidant supplementation. It was recently shown by the present authors that supplementation with vitamin C and E from early in pregnancy leads to a reduction in the incidence of the disease in "high-risk" women. [source]

Variation in practice of ileal intubation among diverse endoscopy settings: results from a national endoscopic database

Summary Background:, Terminal ileum intubation rates at colonoscopy are variable. One of the major indications for terminal ileum intubation is to identify Crohn's disease. Signs and symptoms which raise a suspicion of Crohn's include abdominal pain/bloating, anaemia and diarrhoea. Aim:, To determine the proportion of terminal ileal intubation in patients undergoing evaluation of abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy. Methods:, The Clinical Outcomes Research Initiative national endoscopic database was analysed to determine the proportion of terminal ileum intubation in patients undergoing evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy and to characterize this population of patients. Patients with known or suspected inflammatory bowel disease were excluded from the analysis. Results:, Between January 2000 and December 2003, 21 638 patients underwent complete colonoscopy for evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal colon findings. Overall, 3858 patients (18%) underwent terminal ileum evaluation. Intubation rates differed according to procedure indication: abdominal pain (13%), anaemia (13%), diarrhoea (28%). Terminal ileum assessment declined with advancing patient age and was least frequent in Black patients (12% vs. 18% in non-Blacks, P < 0.0001). Ileal intubation rates also varied among endoscopy site types: community (17%), academic (21%), Veterans Affairs Medical Centres (17%), P < 0.0001. Multiple logistic regression identified patients with the indication of diarrhoea (OR: 2.58) as more likely to undergo terminal ileum intubation when compared with those with abdominal pain/bloating. Patients in Veterans Affairs (OR: 1.26) and academic (OR: 1.29) sites were more likely to undergo terminal ileum intubation compared with community sites. Conclusion:, Less than one-fifth of patients with either abdominal pain/bloating, anaemia or diarrhoea underwent ileal intubation in the setting of a normal colonoscopy. Significant practice variation was observed in rates of terminal ileum evaluation. Further study is required to determine whether terminal ileum examination impacts patient management or outcome. [source]

High incidence of obstetric interventions after successful external cephalic version

Louis Yik-Si Chan
Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case,control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann,Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0,2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3,4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5,2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4,2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions. [source]

A study of the indications and changing trends of evisceration in north India

Tanuj Dada MD
Abstract Aim: To study the demographic pattern and indications for evisceration in north India and to evaluate the changing trends over the last decade. Methods: In a retrospective hospital-based study, case records of all patients who underwent evisceration at Rajendra Prasad Centre for Ophthalmic Sciences from January 1990 to December 1999 were reviewed. The parameters evaluated were the age and sex distribution, the place of residence (urban/rural) and the indications for evisceration. The aetiology responsible for evisceration was determined on the basis of history, clinical examination and investigations as determined from previous records. Results: One hundred and sixty-four patients had one eye eviscerated during the study period. The mean age of the patients was 51 ± 13.84 years (range 6 months to 90 years). Panophthalmitis was the most common indication for evisceration (78.6%, n = 129), followed by irreparable globe injury (21.3%, n = 35). There was a significant decrease in the eviscerations performed due to pano-phthalmitis from 104 cases during the period 1990,1994, to 25 cases in the period 1995,1999. Conclusion: Panophthalmitis and severe ocular injury are the major indications of evisceration in north India. There has been a significant decrease in the number of eviscerations related to panophthalmitis over the last decade. [source]