Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Unsatisfactory

  • unsatisfactory state

  • Selected Abstracts

    Unsatisfactory (vs. nondiagnostic) thyroidal aspirates: A Semantic issue?

    Yolanda C. Oertel M.D.Article first published online: 20 JAN 200
    No abstract is available for this article. [source]

    Effects of mechanical loading on collagen propeptides processing in cartilage repair

    Rosmarie Hardmeier
    Abstract Injured articular cartilage has poor reparative capabilities and if left untreated may develop into osteoarthritis. Unsatisfactory results with conventional treatment methods have brought as an alternative treatment the development of matrix autologous chondrocyte transplants (MACTs). Recent evidence proposes that the maintenance of the original phenotype by isolated chondrocytes grown in a scaffold transplant is linked to mechanical compression, because macromolecules, particularly collagen, of the extracellular matrix have the ability to ,self-assemble'. In load-bearing tissues, collagen is abundantly present and mechanical properties depend on the collagen fibre architecture. Study of the active changes in collagen architecture is the focus of diverse fields of research, including developmental biology, biomechanics and tissue engineering. In this review, the structural model of collagen assembly is presented in order to understand how scaffold geometry plays a critical role in collagen propeptide processing and chondrocyte development. When physical forces are applied to different cell-based scaffolds, the resulting specific twist of the scaffolds might be accompanied by changes in the fibril pattern synthesis of the new collagen. The alteration in the scaffolds due to mechanical stress is associated with cellular signalling communication and the preservation of N-terminus procollagen moieties, which would regulate both the collagen synthesis and the diameter of the fibre. The structural difference would also affect actin stabilization, cytoskeleton remodelling and proteoglycan assembly. These effects seemed to be dependent on the magnitude and duration of the physical stress. This review will contribute to the understanding of mechanisms for collagen assembly in both a natural and an artificial environment. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Chronic pelvic pain in women: still a challenge

    BJU INTERNATIONAL, Issue 9 2008
    Orietta Dalpiaz
    Chronic pelvic pain (CPP), a common condition particularly in reproductive-aged women, causes disability and distress, and significantly compromises quality of life and affects healthcare costs. The pathogenesis of CPP is still poorly understood and consequently poorly managed. Furthermore, the lack of a consensus on the definition of CPP greatly hinders epidemiological studies. Patients present with various associated problems, including bladder or bowel dysfunction, gynaecological pathologies or sexual dysfunction, and other systemic or constitutional symptoms. Other conditions, e.g. depression, anxiety and drug addiction, can also coexist. Effective management presupposes an integrated knowledge of all pelvic organs and other systems, including musculoskeletal, neurological and psychiatric systems. The key to treating CPP is to treat it as the complex disease it is. Treatment options range from conservative medical therapy to surgical intervention, and are primarily directed towards symptom relief. Unsatisfactory results of treatment render this condition a frustrating problem for both patients and physicians. [source]

    Assessment of specimen adequacy reproducibility: An Italian experience

    Gioia Montanari M.D.
    Abstract Interobserver disagreement on smear adequacy may influence the evaluation of the performance of samplers as well as Pap test sensitivity and follow-up. In 1998, the Italian Group for Cervical Cancer Screening (GISCi) promoted a study on the reproducibility of adequacy criteria using a modified version of the Bethesda system. A set of 200 smears was circulated among six Italian laboratories situated in different parts of the country. For each smear, participants were requested to provide a summary judgment on its adequacy and on the cause(s) of inadequacy, if any. Agreement was measured using kappa-type statistics. The agreement among laboratories was generally good. In comparisons, among five laboratories, kappa values ranged from 0.47 to 0.66. At the consensus meeting on 42 slides, on which at least 2 laboratories dissented from the majority, agreement was reached unanimously for 31 reviewed slides and among 5,6 centers for 11. In this article, some guidance is given in order to attribute to one of the two categories satisfactory/unsatisfactory those smears that have been traditionally considered as candidates for the category of "satisfactory but limited by ," (SBLB). New Italian guidelines on adequacy proposed the GISCi are presented and the recommendation is made to eliminate the SBLB category. Diagn. Cytopathol. 2003;28:224,226. © 2003 Wiley-Liss, Inc. [source]

    Early motor development of premature infants with birthweight less than 2000 grams

    ACTA PAEDIATRICA, Issue 12 2000
    SJ Pedersen
    The aim was to assess motor function during infancy in order to predict later function, mainly cerebral palsy. The neuromotor development of a population-based cohort of 209 of 236 (89%) survivors with a birthweight less than 2000 g was assessed using the Infant Neurological International Battery (INFANIB) and detailed neurological assessment. The infants were classified as being normal, dystonic, hypotonic or having suspected cerebral palsy (CP) at 4, 7, 13 and 18 mo corrected age if birthweight was less than 1500 g (n= 119) and at 7 and 13 mo if birthweight was 1500,1999 g (n= 90). Those with dystonia or suspected CP were followed until diagnosed as normal or as having CP after at least 36 mo of age. Fourteen (7%) finally developed CP. Motor function at 4 mo was inaccurate in predicting function at 7 mo and later. All who were normal at 7 mo remained normal in the follow-up period. Eight of 65 who were dystonic at 7 mo developed suspected CP, and three judged as suspected CP were eventually normal. The 14 who developed CP were judged as suspected CP (n= 5) or dystonic (n= 8) and one as hypotonic at 7 mo of age. Conclusions: The specificity of motor evaluation at 7 mo corrected age regarding CP is unsatisfactory, since dystonia at this age is most often transient. A normal neuromotor assessment at 7 mo is highly predictive of subsequent normal motor function. [source]

    On web communities mining and recommendation

    Yanchun Zhang
    Abstract Because of the lack of a uniform schema for web documents and the sheer amount and dynamics of web data, both the effectiveness and the efficiency of information management and retrieval of web data are often unsatisfactory when using conventional data management and searching techniques. To address this issue, we have adopted web mining and web community analysis approaches. On the basis of the analysis of web document contents, hyperlinks analysis, user access logs and semantic analysis, we have developed various approaches or algorithms to construct and analyze web communities, and to make recommendations. This paper will introduce and discuss several approaches on web community mining and recommendation. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    What really happens with the electron gas in the famous Franck-Hertz experiment?

    F. Sigeneger
    Abstract The interpretation of the anode current characteristics obtained in the famous Franck-Hertz experiment of 1914 led to the verification of Bohr's predictions of quantised atomic states. This fundamental experiment has been often repeated, and nowadays is generally part of the curriculum in modern physics education. However, the interpretation of the experiment is typically based upon significant simplifying assumptions, some quite unrealistic. This is the case especially in relation to the kinetics of the electron gas, which is in reality quite complex, due mainly to non-uniformities in the electric field, caused by a combination of accelerating and retarding components. This non-uniformity leads to a potential energy valley in which the electrons are trapped. The present state of understanding of such effects, and their influence upon the anode characteristics, is quite unsatisfactory. In this article a rigorous study of a cylindrical Franck-Hertz experiment is presented, using mercury vapour, the aim being to reveal and explain what really happens with the electrons under realistic experimental conditions. In particular, the anode current characteristics are investigated over a range of mercury vapour pressures appropriate to the experiment to clearly elaborate the effects of elastic collisions (ignored in typical discussions) on the power budget, and the trapping of electrons in the potential energy valley. [source]

    Thyroid fine needle aspiration: the morphological features on ThinPrep® slide preparations.

    CYTOPATHOLOGY, Issue 6 2003
    Eighty cases with histological control
    This study had several purposes: to define cytomorphological features of thyroid cells that might be modified by alcohol fixation; to optimize May-Grünwald,Giemsa (MGG) staining on ThinPrep® (TP; Cytyc Inc., Bexborough, MA, USA) slides and to compare the diagnostic accuracy of slides prepared by a liquid-based method with those obtained by conventional technique. This study included 120 cases of ultrasound-guided fine needle aspiration (FNA) of the thyroid and 55 FNAs performed on surgically resected thyroid specimens. Histological control was available in 80 cases. In the first group of 120 FNAs, a split-sample technique was used for the TP. Three screenings were performed: first, an individual screening of the conventional smears (CS) and of the TP, a second screening to compare cells observed on the TP with the histological control and a third screening to assess the previously defined diagnostic criteria. Twenty-seven TP cases (22%) were considered unsatisfactory for diagnosis compared with 10 in CS (8%). The high rate of unsatisfactory cases with TP is likely to be due to the use of the split-sample technique. The sensitivity was 94% for CS and 81% for TP. The specificity was 67% and 60% for CS and TP, respectively. Two occult papillary carcinomas were missed by both methods. As for the MGG staining, the modified technique used for TP resulted in the same quality as the standard procedure. Conversely, TP did however induce uncommon morphological features. In this study, sensitivity and specificity levels are higher for CS than for TP; the difference may be explained by the fact that the methanol fixative used for TP induces some cytological alterations, especially in oncocytic tumours and lymphocytic thyroïditis. [source]

    Comparative study: conventional cervical and ThinPrep® Pap tests in a routine clinical setting

    CYTOPATHOLOGY, Issue 4 2002
    A. Grace
    The conventional Papanicolaou smear is associated with variable false positive and false negative rates, difficulties with interpretation and high unsatisfactory and suboptimal rates. Newer fluid-based methods such as the ThinPrep® 2000 system (Cytyc Corp., Boxborough, MA) are said to overcome these difficulties. The aim of this study was to compare the conventional smear with the ThinPrep® method in a busy, routine cytology screening laboratory setting. One thousand split samples were evaluated. Using ThinPrep®, the results showed an increased sensitivity and a dramatic improvement in specimen adequacy, with a combined 17.2% reduction in ,unsatisfactory' and ,suboptimal' reports. Screening time per slide was also reduced to 3,4 min. In conclusion, we report an increase in sensitivity, a reduction in screening time and a dramatic improvement in specimen adequacy with the ThinPrep® method. [source]

    Level of information concerning dental injuries and their prevention in Swiss basketball , a survey among players and coaches

    Sandra Perunski
    Abstract,,, Basketball carries a medium risk of dental injuries. Swiss data are not available in this respect. Using a standardized questionnaire 302 basketball players from 29 Swiss teams and their 29 coaches were interviewed. The questions focused on the frequency of dental accidents, their prevention and subsequent procedure. The participating 302 players came from three divisions: semi-professional players of National League A and B (102), amateurs of Regional League 2 and 3 (100) and young people of up to the age of 18 (100). The data were evaluated in relation to division, sex and team function. Of the 331 interviewed persons 102 had already seen a dental trauma in basketball and 55 had already had a dental trauma. Only four of the interviewed persons wore mouthguards. The awareness of the procedure following a dental trauma was unsatisfactory. The results of the survey show that significantly more information and education is required in Swiss basketball not only through sports associations but also through coaches and dentists. [source]

    Cryosurgery in the Treatment of Earlobe Keloids: Report of Seven Cases

    Tomas Fikrle MD
    Background. Keloids are benign cutaneous lesions that result from excessive collagen synthesis and deposition. Earlobe keloids in particular are seen as a complication of plastic surgery or piercing. Many different treatment modalities have been used, often with unsatisfactory results. Methods. We have made a retrospective analysis of seven young patients (ages 9 to 22 years) with earlobe keloids. Scarring followed plastic surgery in six cases and piercing in one case. All patients were treated with cryosurgery as the monotherapy. The freeze time and the number of sessions varied depending on the clinical findings, the effect of the treatment, and the patients' tolerance. Cryotherapy was started 6 to 24 months after keloid development. Results. Scar volume was reduced in all cases. Complete flattening in five patients and a pronounced reduction to a maximum of 25% of the previous thickness in one other patient were achieved. One patient discontinued the therapy because of soreness after only partial improvement. The procedure was painful for all patients; no further side effects were noticed. No recurrence was observed within 1 to 4.5 years of follow-up. Conclusion. We present an excellent effect of cryosurgery as the monotherapy for the treatment of earlobe keloid scars of young patients. TOMAS FIKRLE, MD, AND KAREL PIZINGER, MD, PHD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

    Hair Removal Using a Long-Pulsed Nd:YAG Laser: Comparison at Fluences of 50, 80, and 100 J/cm2

    David J. Goldberg MD
    Background. Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal have proved unsatisfactory. A variety of laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. Optimal laser parameters continue to require further investigation. Objective. To evaluate the efficacy and safety of a long-pulse millisecond Nd:YAG hair removal laser utilizing fluences of either 50, 80, or 100 J/cm2. Methods. Fifteen subjects were treated with a contact cooled 50 msec Nd:YAG laser at fluences 30, 50, or 100 J/cm2. Reduction in hair regrowth was measured at 3 months after treatment by comparing the terminal hair count to the baseline values. Potential complications were also evaluated. Results. Average hair reduction at 3 months after treatment was 29%, 29%, and 27% in areas treated with a 50-msec Nd:YAG laser at fluences of 50, 80, and 100 J/cm2, respectively. Although short-term blistering was noted in two subjects, no hyperpimentation, hypopigmentation, or scarring was observed at 3 months after treatment. Conclusion. Long-pulse millisecond Nd:YAG laser hair removal with fluences of either 50, 80, or 100 J/cm2 leads to similar efficacy with no significant adverse effects. [source]

    Double Butterfly Suture for High Tension: A Broadly Anchored, Horizontal, Buried Interrupted Suture

    Helmut Breuninger MD
    Background. The excision of skin lesions such as tumors, nevi, and scars frequently results in tension on surgical wound margins. This tension is commonly counteracted surgically with buried, intracutaneous, interrupted sutures of absorbable material which are anchored vertically in the corium. Method. The horizontal, buried, intracutaneous butterfly suture has been described elsewhere. It is firmly anchored in the corium, everts wound margins, and adapts them nearly as broadly as two vertical sutures. It can also be laid as a double butterfly suture, as described here, and then has the shape of an "8." This double butterfly suture is equivalent to three vertical sutures because of its broad base in the corium. Moreover, it can cope with much greater tension because of its "pulley" effect. A single double butterfly suture usually suffices for small defects, particularly when the wound edges are cut obliquely with a longer rim of epidermis. Materials. We have laid the traditional butterfly suture in more than 35,000 skin lesion excisions since 1985 and the double butterfly suture alone or as a supplement in more than 10,000 sutures since 1992. We use 2-0 to 6-0 polydioxanone for these procedures, since it has proven in trials to be the best-absorbed suture material. Results. In most cases, the resulting scars were narrow and smooth in spite of high tension. Results were unsatisfactory in only 6.2% of procedures. Conclusion. The double butterfly suture described here has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium. [source]

    Diabetes service provision: a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

    DIABETIC MEDICINE, Issue 9 2006
    J. Lawton
    Abstract Aims To explore Pakistani and Indian patients' experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services. Design Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews. Results Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health-care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly. Conclusions Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability. [source]

    Comparison of conventional Papanicolaou smears and fluid-based, thin-layer cytology with colposcopic biopsy control in central Italy: A consecutive sampling study of 461 cases

    Siavash Rahimi M.D.
    Abstract The aim of this study was to compare the cytologic diagnosis and specimen adequacy of conventional Papanicolaou (CP) and fluid-based, thin-layer [ThinPrep (TP), Cytyc, Boxborough, MA] cervical cytology in a population from central Italy. CP and TP samples were collected simultaneously using a consecutive sampling method on women presenting for cervical screening. Colposcopy was performed as clinically indicated, and biopsy results were compared with cytologic diagnoses. Among the 461 patients included in the study, 413 were negative at both CP and TP, 9 had unsatisfactory results at both tests and 39 patients presented abnormal results at CP, TP or both. Cohen's Kappa was 0.77 showing good agreement between CP and TP test results. Histological data were available for 20 (51.28%) of the 39 patients with at least one positive test. Among the 13 patients with HSIL at histology, 7 had HSIL at CP (sensitivity 53.85%) and 5 at TP (sensitivity 38.46%). For all three patients with squamous cell carcinoma (SCC) at histology, CP and TP had shown the same diagnosis (sensitivity 100%). The positive predictive values were 33.33% for CP and 25.0% for TP regarding the LSIL diagnosis and 100% for both CP and TP regarding HSIL and SCC diagnoses. Our results may be influenced by the consecutive sampling procedure. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source]

    Fine-needle aspiration cytology in the diagnosis of superficial lymphadenopathy: a 5-year Brazilian experience

    M.Sc., Marcos Roberto Martins M.D.
    Abstract To determine the accuracy of fine-needle aspiration (FNA) in the diagnostic assessment of lymphadenopathies, a retrospective study was conducted on 627 cases of FNA of the lymph nodes performed at Department of Pathology, UNIFESP (Federal University of São Paulo), between 1997 and 2001. Cytology results were compared to the results of biopsies if available. The cytological diagnosis was unsatisfactory in 14.7% of cases, positive in 46%, and negative in 39.3%. Among the positive cases, 79.4% were classified as metastases, 14.2% as lymphoma, and 6.4% as indeterminate. Anatomopathological exams for the determination of cytohistological correlation were available in 218 of the 627 cases. There were three (1.88%) false-negative and two (1.25%) false-positive cases. Accuracy tests revealed 97.41% sensitivity, 95.45% specificity, and 96.88% efficacy, with cytohistological agreement being almost perfect (, = 0.92). The high accuracy of this study based only on cytomorphological criteria associated to the variety of malignant neoplasias diagnosed by the procedure demonstrates its relevance on patient care, especially in areas of limited financial resources. Diagn. Cytopathol. 2006; 34:130,134. © 2006 Wiley-Liss, Inc. [source]

    Thyroid fine-needle aspiration biopsy in children and adolescents: Experience with 218 aspirates

    Mojghan Amrikachi M.D.
    Abstract To evaluate the role of fine-needle aspiration (FNA) biopsy of thyroid nodules in pediatric and adolescent patients, the cytology reports of 218 thyroid FNA biopsies performed on children and adolescents ranging from10 to 21 yr of age were reviewed. The cytology diagnoses were categorized into four groups: unsatisfactory, benign, suspicious, and malignant. One hundred nineteen (54%) of the aspirates were diagnosed as "benign," 20 (9%) were diagnosed as suspicious for malignancy; and 17 (8%) were diagnosed as malignant. Sixty-two (28%) of the aspirates were read as unsatisfactory for interpretation. Sensitivity of thyroid FNA in diagnosing thyroid malignancy relative to final histological diagnoses was 100%, and specificity was 65%. FNA of thyroid nodules in the pediatric and adolescent population is comparably as sensitive and specific as in the adult population. The acceptance of this procedure in the routine evaluation of young patients' thyroid nodules should reduce the number of unnecessary surgeries for benign thyroid disease. Diagn. Cytopathol. 2005;32:189,192. © 2005 Wiley-Liss, Inc. [source]

    Split sample comparison of ThinPrep and conventional smears in endoscopic retrograde cholangiopancreatography-guided pancreatic fine-needle aspirations,

    Momin T. Siddiqui M.D.
    Abstract Fine-needle aspiration (FNA) of pancreatic lesions is a common procedure to establish a tissue diagnosis before chemotherapy or surgery. In this study, the authors attempt to compare the diagnostic value of the ThinPrep (TP) method with conventional smears (CSs) in samples obtained by endoscopic retrograde cholangiopancreatography (ERCP)-guided pancreatic FNAs. Material obtained, prospectively, from ERCP-guided pancreatic FNAs was split to prepare CSs (2,5 slides) first, the remainder being rinsed in PreservCyte, and in the laboratory, 1 TP slide was prepared. The diagnostic categories of unsatisfactory, benign, reactive, suspicious for malignancy, and malignant were compared. Fifty-one pancreatic FNAs prepared by split sample method yielded the following results: TP yielded unsatisfactory, 6 cases; benign, 3 cases; reactive, 5 cases; suspicious for malignancy, 11 cases; and malignant, 26 cases; in contrast, CS yielded unsatisfactory, 13 cases; benign, 4 cases; reactive, 3 cases; suspicious for malignancy, 13 cases; and malignant, 18 cases. Histological follow-up was available in 21 cases (reactive, 8 cases; suspicious for malignancy, 1 case, and malignant, 12 cases). The foregoing data indicate a higher sensitivity in detection of pancreatic adenocarcinoma by the TP method (TP, 91% vs. 58% CS) with equivalent specificity (100%). In addition, TP provides better preservation and cytological detail. Diagn. Cytopathol. 2005;32:70,75. © 2005 Wiley-Liss, Inc. [source]

    Role of Pap Test terminology and age in the detection of carcinoma invasive and carcinoma in situ in medically underserved California women

    Lydia P. Howell M.D.
    Abstract Our goals were to evaluate Pap Test findings classified by the Bethesda system, and follow up biopsies from participants in the California Breast and Cervical Cancer Control Program (Ca-BCCCP) for: 1) correlation in the detection of carcinoma in situ (CIS) and carcinoma invasive (CI), and 2) age-related trends, with discussion in the context of the 2001 ASCCP Management Guidelines. Women (n = 52,339) who had their initial screening Pap Tests with Ca-BCCCP between January 1995,December 1999 were followed for diagnostic services through December 2000. Descriptive and analytical methods were used in the analysis. Of the Pap results, 81.9% were negative, 10.6% showed infection, 4.7% showed an epithelial abnormality as defined by the Bethesda system (atypical squamous cells of undertermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL)), 0.1% showed squamous-cell cancer (SCC), and 2.7% showed other or unsatisfactory. Subsequent to the initial Pap Test, follow-up results of carcinoma in situ (CIS) and carcinoma invasive (CI) accounted for 0.36% and 0.05% of the population, respectively. Among HSIL Pap Tests (n = 285), 40.7% had follow-up showing CIS. Among SCC Pap Tests, 17.9% had follow-up results of CIS and 28.6% CI. Of the 191 patients with CIS as a follow-up finding, the initial Pap smear showed: HSIL 60.7%, SCC 2.6%, LSIL 10.5%, ASCUS 13.6%, and negative or infection 9.9%. Of the 27 patients with CI, the initial Pap Test showed: HSIL 40.7%, SCC 29.6%, LSIL 7.4%, ASCUS 7.4%, and negative or infection 11.1%. Pap diagnoses of other or unsatisfactory accounted for 2.6% of the Pap results from patients with CIS and 3.7% of Pap results from patients with CI. Except for LSIL, there was an increasing age trend in the number of cases in each of Pap results, with the exception of age 65+ yr. However, the ratio of LSIL and ASCUS to negative cases decreased with age. (P < 0.0001 and 0.0293, respectively). HSIL Pap results indicate a reasonably high probability of CIS and CI. However, approximately 1/3 of patients with CIS and 1/4 of patients with CI presented with Pap diagnoses of less severity than HSIL. When a negative Pap Test result is chosen as reference group, there is a negative age trend for LSIL and ASCUS, and no age trend for other results. These findings all have important implications in the design of follow-up strategies, and support the 2001 ASCCP Consensus Guidelines for the Management of Women with Cervical Abnormalities. Diagn. Cytopathol. 2004;30:227,234. © 2004 Wiley-Liss, Inc. [source]

    Diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes: A study of 210 cases

    F.I.A.C., Raj K. Gupta M.D.
    Abstract The aim of this study was to evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes, which were analyzed in 210 cases. NAC in all the cases were performed by the conventional aspiration method and cytologic examination was done on site after staining smears with the Papanicolaou method. In addition, Diff-Quik-stained air-dried smears, Papanicolaou-stained fixed smears, and filter preparations from needle washings and hematoxylin-eosin-stained sections of cell blocks were studied. The NAC diagnosis was supported by examining cell blocks in 92/210 cases which showed a reliable histologic architecture; further support was also obtained with a tissue biopsy in 9/12 cases of inflammatory lesions, 7/7 cases with a suspicious diagnosis, 20/26 cases of melanomas, 15/15 cases of lymphomas, and/or a comparison with the primary tumor in other cases of metastatic tumors. Additionally, immunoperoxidase and/or histochemical stains were done. Twelve cases were diagnosed as inflammatory lesions and 88 cases were regarded as negative (normal cellular elements n = 40; reactive elements n = 48). In 58 cases a variety of metastatic tumors were diagnosed (melanoma n = 26; others n = 32) and in 15 cases a diagnosis of lymphoma was made. Seven cases were diagnosed as suspicious of malignancy and 30 cases were unsatisfactory due to scanty/acellular samples (despite 2,3 repeat samplings). However, in five of these malignant tumors were later found on a biopsy which was done due to a persistent and continued enlargement of lymph node(s). The sensitivity was 91.7%, specificity 98.2%, positive predictive value (PPV) 97.7.%, and negative predictive value (NPV) was 95.45%. Based on our study we feel that NAC as a first line of investigation is not only useful in the diagnosis of lesions in inguinal lymph nodes, but can also help in deciding on an appropriate management. Also, histologic architecture from cell blocks can be correlated with cytology and such material can be used for histochemical and immunomarker studies. Diagn. Cytopathol. 2003;28:175,180. © 2003 Wiley-Liss, Inc. [source]

    Clinical and diagnostic significance of blood in cervical smears

    Mathilde E. Boon M.D., Ph.D.
    Abstract A heavy admixture of blood in cervical smears can be problematic for the screener, as the presence of blood can influence the staining quality of the cancer cell nuclei. However, it might also be a blessing in disguise. A retrospective study of 40 clinically important smears, 34 originally signed out as negative for squamous cell carcinoma of the cervix and 6 smears as unsatisfactory, was carried out in comparison with 100 smears from healthy women. Sample parameters were analyzed by macroscopy and neural network scanning. Differences between the two study groups were measured by Pearson's ,2 test. Of the 40 study cases, one case featured insufficient material, while 16 cases (40%) could confidently be classified as malignant or negative for malignancy. The most important macroscopic parameter of the smears was an admixture of blood. This background feature was also highlighted by the NNS system. Angiogenesis was visualized by the expression of CD34 in many sampled capillary fragments included in the smears. In conclusion, blood in cervical smears may have clinical and diagnostic significance. The rate of "failed smears" in routine cervical screening might thus by CD34 be considerably decreased. Diagn. Cytopathol. 2003;28:181,185. © 2003 Wiley-Liss, Inc. [source]

    Utility and outcomes of fine-needle aspiration biopsy in Hodgkin's disease

    Wendy S. Moreland M.D.
    Abstract We present our 10-year experience, including clinical utilization and outcomes, with fine-needle aspiration biopsy (FNAB) in Hodgkin's disease (HD). Eighty-six cases from 68 patients with HD that were evaluated by FNAB were identified over a 10-year period. Medical records of these 68 patients were reviewed. Thirty-seven patients with primary HD underwent 41 aspirates. A diagnosis of HD was yielded in 12 and suggested in 13 cases (sensitivity 86.2%, false-positive 0%). Nine were diagnosed as atypical lymphoid cells, four as hyperplasia/other, and three as unsatisfactory. With these diagnoses, six patients began treatment without tissue exam. Thirty-five patients with suspected recurrent HD underwent 45 FNABs. Recurrent HD was confirmed in 15 and suggested in 12 aspirates (sensitivity 81.3%, false-suspicious 14.3%). With these diagnoses, 22 patients began treatment for recurrence without tissue exam. FNAB is useful both for establishing a primary diagnosis and confirming recurrence in HD and thus has a high utilization at our institution. In many instances, patients can begin therapy, negating the need for formal tissue exam. Diagn. Cytopathol. 2002;26:278,282. © 2002 Wiley-Liss, Inc. [source]

    Capital quality improvement and the sources of economic growth in the euro area

    ECONOMIC POLICY, Issue 42 2005
    Plutarchos Sakellaris
    SUMMARY Capital quality improvement and Euroland growth Sources of growth Europe's growth slowed in the 1990s, reinforcing the overall impression of a need to catch up with the US regarding standards of living. In reaction, EU leaders adopted the famous Lisbon Agenda in 2000. The Agenda is now under review, the aim being to determine why progress on its pro-growth goals has been unsatisfactory and what can be done about it. The first crucial step in this process is to understand the true sources of the European growth slowdown. Sources-of-growth calculations have always been imprecise, but evidence from the US suggests that ,quality upgrading', especially in capital goods , has substantially worsened the precision problem since the 1990s. Unfortunately, quality adjusted sources-of-growth calculations, however, have not performed satisfactorily for Europe, so Europe's leaders are working with potentially misleading accounts of Europe's growth slowdown. Redressing this omission is the goal of this paper. Failure to account properly for capital quality improvements leads to two mistakes. First, overall GDP is underestimated. Our calculations, for example, show that euro area GDP growth was underestimated on average by 0.7 percentage points annually in the late 1990s. However, similar quality-adjustment figures raise US growth figures in the same period by even more, so quality-adjusting suggests that the US,EU growth gap was even more pronounced than previously believed. Secondly, the sources-of-growth calculations used to prioritize Europe's pro-growth policies are skewed. Our calculations show that the contribution of the slowdown in disembodied technical progress to the overall slowdown is more pronounced after quality adjustment. Our findings point to the need for adoption of microeconomic measures aimed at enhancing overall efficiency and boosting innovation activity. Such measures would aim at a better business environment, e.g. by easing regulatory and administrative burden and liberalizing energy and telecommunications markets. , Plutarchos Sakellaris and Focco Vijselaar [source]

    Computer-assisted 2-D agarose electrophoresis of Haemophilus influenzae type B meningitis vaccines and analysis of polydisperse particle populations in the size range of viruses: A review

    ELECTROPHORESIS, Issue 4 2007
    Dietmar Tietz Dr.
    Abstract When protein,polysaccharide conjugated vaccines were first developed for the immunization of small children against meningitis caused by infection with Haemophilus influenzae type b (Hib), the vaccine preparations varied in immunogenicity. Testing for immunogenicity was time-consuming and alternative analytical procedures for determining vaccine quality were unsatisfactory. For example, due to the very high molecular weight of the vaccine particles, immunogens could only be physically characterized as a fraction in the void volume of Sepharose gel filtration. In search of better analytical methods, a computer-assisted electrophoretic technique for analyzing such vaccines was developed in the period from 1983 to 1995. This new approach made it possible to analyze highly negatively charged particles as large as or larger than intact viruses. 2-D gel patterns were generated that varied depending on the conditions of the particular vaccine preparation and were therefore characteristic of each vaccine sample. Thus, vaccine particle populations with a continuous size variation over a wide range (polydisperse) could be characterized according to size and free mobility (related to particle surface net charge density). These advances are reviewed in this article, since the developed methods are still a promising tool for vaccine quality control and for predicting immunogen effectiveness in the production of vaccines. The technique is potentially beneficial for Hib immunogens and other high-molecular-mass vaccines. Additional biomedical applications for this nondenaturing electrophoretic technique are briefly discussed and detailed information about computational and mathematical procedures and theoretical aspects is provided in the Appendices. [source]

    Searching PubMed for molecular epidemiology studies: The case of chromosome aberrations

    Donatella Ugolini
    Abstract The available tools for searching literature in the field of Molecular Epidemiology are largely unsatisfactory. To identify major problems in retrieving information on this discipline, we comment here on the results of a literature search on cytogenetic biomarkers in children exposed to environmental pollutants. The search, done on the PubMed/MedLine database, was based on a strategy combining descriptors listed in the PubMed Medical Subject Headings (MeSH) Thesaurus and other available tools (free text or phrase search tools). 178 articles were retrieved by searching the period from January 1, 1980 to November 30, 2004. Only 2 of the 178 articles were indexed by the MeSH term "Epidemiology, molecular" (introduced in 1994) and 30 of 178 by the MeSH term "Biological markers" (introduced in 1989). The case of chromosome aberration (CA) was emblematic of the problem: 44 of 78 articles (56.4%) were not pertinent to the search. The reasons for this poor performance are reported and discussed. Authors and indexers may be able to improve the efficiency of article retrieval in the field of molecular epidemiology by using relevant terms in the title and abstract. This may suggest appropriate MeSH terms to the indexers for the indexing process. As regards the difficulty in identifiyng population studies using CA, the introduction of a specific MeSH term for chromosome aberrations when used as a biomarker would improve the search process. Environ. Mol. Mutagen., 2006. © 2006 Wiley-Liss, Inc. [source]

    Organisation of proficiency testing for plant health diagnostic tests: the experience of FAPAS®

    EPPO BULLETIN, Issue 1 2010
    A. Reynolds
    Proficiency testing (PT) is an established quality assurance measure and is based on the comparison of laboratories' results in an inter-laboratory trial. It highlights problems in laboratory analysis and is an educational tool to help improve data quality. This article describes how PT is organised by FAPAS®. FAPAS® is an international PT provider (external quality assessments) for food chemistry, food microbiology, genetically modified material and water/environmental samples. Since 2007, FAPAS® have organized plant health proficiency tests in conjunction with the Plant Pest and Disease Identification Programme at the Food and Environment Research Agency (Fera). Up until 2009, FAPAS® has organised seven plant health proficiency tests that covered the identification of lyophilised bacteria, viruses in leaves and fungi in agar plugs. In 2009, FAPAS® organized over 10 plant health proficiency tests under the banner of ,PhytoPAS', including Potato spindle tuber viroid, Phytophthora ramorum, Thrips palmi, Erwinia amylovora, Clavibacter michiganensis subsp. sepedonicus, etc. DNA extracts, cyst nematodes (Globodera pallida) and slides/immunofluorescence (IF) slides have been added to the programme. The organization of the plant health proficiency tests follows a similar pattern. Suitable test materials are prepared and tested for quality before distribution to requesting participants. Laboratories usually have 1,2 months to analyze their samples and return their results. A report is then compiled for issue to laboratories and these contain all results in an anonymous form, so that laboratories can compare their results with those of other participants. If a laboratory's performance is unsatisfactory then it is up to them to investigate the situation. Thus, the primary purpose of PT is the detection of inaccuracy in a laboratory's results, so that they can investigate the problems and initiate corrective procedures. [source]

    GMO Food Labelling in the EU: Tracing ,the Seeds of Dispute'

    EUROCHOICES, Issue 1 2003
    Maria L. Loureiro
    Summary GMO Food Labelling in the EU: Tracinq ,the Seeds of Dispute' Genetically modified (GM) food labelling has become a critical issue in the international trade arena. Policymakers and consumers in the European Union (EU) seem to agree on the need to control the use of biotechnology in the food industry. As a consequence, recently the EU Commission approved a measure that establishes strict rules on genetically modified organisms (GMOs), but which lifts the moratorium on GMO production and marketing. This new Directive deals with mandatory labelling of GM foods and their traceability along the food chain. In spite of the substantial effort made to reconcile the different opinions in the escalating debate about biotechnology, the new GMO regulation seems to be unsatisfactory for too many interest groups. A system of total traceability from ,farm to fork' and mandatory labelling for genetically modified products may be considered too complex and too expensive to implement, particularly by those countries or industries that have produced GMO foods for many years. Yet, giving European consumers the freedom to choose GMOs may be the only option that there is until Europeans restore their confidence in the food system and food regulators. A market or consumer-driven solution may eventually terminate the GMO dispute between the two transatlantic trading blocks. , Assurance , Revenud a ns , Agriculture Européenne ,étiquetage des aliments contenant des organismes génétiquement modifyés (OGM) est devenu une question cruciale sur la scène du commerce international. Tant les décideurs politiques que les citoyens de , Union européenne semblent s'accorder sur la nécessité de soumettre à contrôle , utilisation des biotechnologies dans , industrie alimentaire. En conséquence, la Commission européenne a récemment approuvé une mesure qui établit des règies strictes sur les OGM, mais qui lève le moratoire sur leur production et leur commercialisation. Cette nouvelle directive concerne ,étiquetage obligatoire des aliments contenant des OGM et la façon ? en assurer le suivi dans les filières alimentaires. Ce nouveau règlement OGM, en dépit des efforts réels effectués pour réconcilier les différents points de vue dans la montée du débat sur les biotechnologies, semble inconciliable avec trop de groupes ? intérêts pour être satisfaisant. Un système assurant une traçabilité totale, ,du champ à la fourchette' et un étiquetage obligatoire pour tout produit contenant des OGM, paraît bien trop complexe et coûteux à mettre en ,uvre, en particulier pour les pays ou les industries qui produisent des aliments génétiquement modifyés depuis des années. Et pourtant, il se pourrait bien que la seule façpn de restaurer la confiance perdue des Européens dans le système alimentaire et ses institutions soit justement de leur donner le droit de choisir. La fin de la querelle des OGM entre les blocs commerciaux des deux rives de , Atlantique peut venir de solutions apportées par le marché et issues des consommateurs. Einkommenversicherung in der Europäischen Landwirtschaft Die Kennzeichnung von genetisch veränderten Lebensmitteln ist zu einer der bedeutendsten Streitfragen auf dem Gebiet des internationalen Handels geworden. Politische Entscheidungsträger und Verbraucher in der Europäischen Union scheinen dahingehend überein zu stimmen, dass der Einsatz von Biotechnologie in der Nahrungsmittel-industrie kontrolliert werden sollte. Als Reaktion darauf hat die EU-Kommission kürzlich einer Maßnahme zugestimmt, welche ein strenges Regelwerk für genetisch veränderte Organismen (GVO) festschreibt, mit der aber gleichzeitig das Moratorium für die Produktion und Vermarktung von GVO aufgehoben wird. Die neue Richtlinie beschäftigt sich mit der Pflichtkennzeichnung von genetisch veränderten Nahrungsmitteln und mit ihrer Rückverfolgbarkeit entlang der Nahrungsmittelkette. Trotz der erheblichen Anstrengungen, die verschiedenen Standpunkte in der eskalierenden Debatte um Biotechnologie zu berücksichtigen, scheint die neue GVO Richtlinie in den Augen (zu) vieler Interessengruppen unbefriedigend zu sein. Ein System der vollständigen Rückverfolgbarkeit vom Stall bis zum Teller und die Pflichtkennzeichnung von genetisch veränderten Nahrungsmitteln mag in der Umsetzung als zu komplex und zu teuer betrachtet werden, insbesondere von den Ländern oder Industriezweigen, welche seit vielen Jahren GVO-Nahrungsmittel hergestellt haben. Dennoch könnte der Ansatz, den europäischen Verbrauchern die freie Wahl für oder gegen GVO zu gewähren, der einzig gangbare Weg sein, bis die Europäer ihr Vertrauen in das Produktions- und Kontrollsystem für Nahrungsmittel zurückgewonnen haben. Eine markt- oder verbraucherorientierte Lösung könnte letztlich den Streit um GVO zwischen den beiden transatlantischen Handelsblöcken beenden. [source]

    Prevalence and impact of pain in diabetic neuropathy

    M Geerts M
    Abstract Background: Diabetic neuropathy (DNP) is a serious and common complication of diabetes mellitus, with a prevalence of around 30-50%. Aims: To describe the prevalence, severity and medical treatment of painful DNP (PDNP) experienced by patients treated in secondary care; to determine quality of life (QoL) impact and the relationship between severity of pain and severity of DNP. Methods: Cross-sectional, two-phase survey. First, a pain interview was conducted by telephone (219 DNP patients), which covered types of pain, location and duration. Secondly, 50 patients were visited at home. Patients completed the Brief Pain Inventory, the Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale. Results: Prevalence of PDNP was 57.5%. Average and worst pain scores were 5.3 ± 2.1 and 6.4 ± 2.2, respectively (0-10 scale, 10 = worst pain imaginable). In 70% of patients, average pain was severe (score ,5). Substantial interference by pain (score ,4) was found in walking ability, sleep and normal activities. PDNP patients had a decreased QoL for all SF-36 domains (p,0.01) except for health change. Moreover, symptoms of anxiety (36%) and depression (34%) were reported frequently. Medical treatment was prescribed in 46% of patients, in whom treatment was ineffective in 39%. Physical functioning scores were lower in patients with severe versus moderate DNP (p,0.01). Conclusions: The prevalence of severe PDNP was high. Severity of DNP was not related to pain severity. PDNP was associated with loss of QoL and with symptoms of anxiety and depression. A considerable proportion of patients did not have medical treatment and, if treatment was given, its impact was disappointing. Medical treatment of PDNP was unsatisfactory and clearly needs to be improved. Copyright © 2009 FEND [source]

    Correlation of anatomy and function in medulla oblongata infarction

    C. Eggers
    Background:, A presentation of all aspects of the dorsolateral medulla oblongata syndrome is clinically very rare to find. In most cases patients present with fragmentary symptoms, e.g. ipsilateral axial lateropulsion, nystagmus, dysarthria, dysphagia or hemiataxia. However, the clinical presentation and lesion anatomy at the level of the medulla oblongata is still unsatisfactory. The aim of this study was to correlate the functional deficit with structural MRI-data. Methods:, We included thirteen patients (eight male, five female, mean age 65.5) with medulla oblongata infarction with clinically predominant ipsilateral axial lateropulsion and correlated clinical with structural deficits. Results:, Magnetic resonance imaging lesion mapping demonstrated ipsilateral axial lateropulsion to result from lesions of the spinocerebellar tract, the inferior cerebellar peduncle or the inferior vestibular nucleus. Nystagmus was associated with lesions of the inferior vestibular nucleus, dissociated sensory loss with the spinothalamic tract and hemiataxia with the spinocerebellar tract. Conclusions:, Correlating dysfunction and lesion anatomy is a promising approach to enhance our knowledge on medulla oblongata topography. [source]

    EFNS guidelines on pharmacological treatment of neuropathic pain

    N. Attal
    Neuropathic pain treatment remains unsatisfactory despite a substantial increase in the number of trials. This EFNS Task Force aimed at evaluating the existing evidence about the pharmacological treatment of neuropathic pain. Studies were identified using first the Cochrane Database then Medline. Trials were classified according to the aetiological condition. All class I and II controlled trials (according to EFNS classification of evidence) were assessed, but lower-class studies were considered in conditions that had no top level studies. Only treatments feasible in an outpatient setting were evaluated. Effects on pain symptoms/signs, quality of life and comorbidities were particularly searched for. Most of the randomized controlled trials included patients with postherpetic neuralgia (PHN) and painful polyneuropathies (PPN) mainly caused by diabetes. These trials provide level A evidence for the efficacy of tricyclic antidepressants, gabapentin, pregabalin and opioids, with a large number of class I trials, followed by topical lidocaine (in PHN) and the newer antidepressants venlafaxine and duloxetine (in PPN). A small number of controlled trials were performed in central pain, trigeminal neuralgia, other peripheral neuropathic pain states and multiple-aetiology neuropathic pains. The main peripheral pain conditions respond similarly well to tricyclic antidepressants, gabapentin, and pregabalin, but some conditions, such as HIV-associated polyneuropathy, are more refractory. There are too few studies on central pain, combination therapy, and head-to-head comparison. For future trials, we recommend to assess quality of life and pain symptoms or signs with standardized tools. [source]