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Underlying Pathology (underlying + pathology)
Selected AbstractsClinical outcomes of laparoscopic adrenalectomy according to tumor sizeINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2005ISAO HARA Objectives: In order to evaluate the indication and usefulness of laparoscopic adrenalectomy, clinical outcomes of laparoscopic adrenalectomy for patients with adrenal tumors were examined. Whether tumor size affects surgical outcome was analysed, along with the long-term clinical outcome for these patients. Patients and methods: A total of 63 patients with adrenal tumor underwent laparoscopic adrenalectomy in our institute between 1999 and 2003. A laparoscopic transperitoneal approach was used in all cases. Underlying pathologies comprised Cushing syndrome (n = 12), pheochromocytoma (n = 13), primary aldosteronism (n = 21), non-functioning adenoma (n = 12) and others (n = 5). Results: No open conversion was performed. Mean operative duration was 239 min, and mean estimated blood loss was 134 mL. Tumor diameter was significantly smaller for primary aldosteronism than for Cushing syndrome, which in turn was significantly smaller than for adrenocorticotropic hormone-independent macronodular hyperplasia (AIMAH). No significant differences in surgical outcome and postoperative recovery were noted between large (,5 cm) and small (<5 cm) tumors. Long-term clinical outcome was better for patients with pheochromocytoma or primary aldosteronism than for patients with Cushing syndrome. Conclusions: Laparoscopic adrenalectomy for benign tumor offers excellent surgical outcomes and convalescence. This is true for both small and large tumors. [source] Assessing optic nerve pathology with diffusion MRI: from mouse to humanNMR IN BIOMEDICINE, Issue 9 2008Junqian Xu Abstract The optic nerve is often affected in patients with glaucoma and multiple sclerosis. Conventional MRI can detect nerve damage, but it does not accurately assess the underlying pathologies. Mean diffusivity and diffusion anisotropy indices derived from diffusion tensor imaging have been shown to be sensitive to a variety of central nervous system white matter pathologies. Despite being sensitive, the lack of specificity limits the ability of these measures to differentiate the underlying pathology. Directional (axial and radial) diffusivities, measuring water diffusion parallel and perpendicular to the axonal tracts, have been shown to be specific to axonal and myelin damage in mouse models of optic nerve injury, including retinal ischemia and experimental autoimmune encephalomyelitis. The progression of Wallerian degeneration has also been detected using directional diffusivities after retinal ischemia. However, translating these findings to human optic nerve is technically challenging. The current status of diffusion MRI of human optic nerve, including imaging sequences and protocols, is summarized herein. Despite the lack of a consensus among different groups on the optimal sequence or protocol, increased mean diffusivity and decreased diffusion anisotropy have been observed in injured optic nerve from patients with chronic optic neuritis. From different mouse models of optic nerve injuries to the emerging studies on patients with optic neuritis, directional diffusivities show great potential to be specific biomarkers for axonal and myelin injury. Copyright © 2008 John Wiley & Sons, Ltd. [source] Trends in the clinical characteristics of the U.S. cystic fibrosis patient population from 1995 to 2005PEDIATRIC PULMONOLOGY, Issue 8 2008Donald R. VanDevanter Abstract Rationale Respiratory signs and symptoms (cough, sputum production, or crackles) are considered bellwethers of underlying cystic fibrosis (CF) lung disease. If respiratory signs and symptoms predict future lung function loss, then improvements in population lung function over the past decade should have been paralleled by a decrease in the prevalence of these variables in the same population. Additionally, changes in these variables over the past decade may provide insight into the improving health of the CF population. Methods Cross-sectional data from the Epidemiologic Study of Cystic Fibrosis for each year between 1995 and 2005 were analyzed to characterize changes in pulmonary function and respiratory signs and symptoms over time. Patients were separated into five age groups: <6, 6,12, 13,17, 18,24, and ,25 years. Results Serial cross-sectional analyses of an average of 13,381 patients per year indicated that mean pulmonary function for the CF population improved and the percent of patients reporting cough or sputum production or having crackles or wheeze at their clinic visit decreased over the study period. Observed changes in pulmonary function were not consistently mirrored by changes in symptoms, which differed as a function of the variable studied and the age group. Conclusions Reductions in respiratory signs and symptoms have paralleled improvements in pulmonary function. Both the absolute and relative magnitude of changes in prevalence for cough, sputum production, crackles, and wheeze differed among age groups and among variables. These results suggest the possibility that differences in respiratory signs and symptoms may arise from different underlying pathologies and may be influenced differently by therapeutic interventions. Pediatr Pulmonol. 2008; 43:739,744. © 2008 Wiley-Liss, Inc. [source] Review of non-convulsive status epilepticus and an illustrative case history manifesting as deliriumAUSTRALASIAN JOURNAL ON AGEING, Issue 3 2009Daniel Epstein Non-convulsive status epilepticus can result in significant morbidity and mortality. The condition can be difficult to recognise, and can mimic delirium due to other underlying pathologies. There are several clinical subtypes, although these can be difficult to distinguish by their clinical features alone. Electroencephalogram is the key diagnostic tool to making the diagnosis, but this investigation is a limited resource in many institutions. In this review, we present a case of non-convulsive status epilepticus, manifesting as delirium, and then proceed to a literature review on this important diagnosis. [source] Correlations between welfare initiatives and breastfeeding rates: a 10-year follow-up studyACTA PAEDIATRICA, Issue 1 2009Bruno Mordini Abstract Aim: To evaluate the prevalence of full breastfeeding during the first 6 months of age and to discover if training programs for health caregivers and welfare initiatives at the community level could improve breastfeeding rates. Methods: Newborn babies with gestational age ,36 weeks and birth weight ,2500 g, discharged from the hospital within the first week of life, without any underlying pathologies, were enrolled in 3-month long sample periods between 1997 and 2006. A questionnaire was distributed to the mothers, to be completed and submitted before hospital discharge. Data were collected from phone interviews at 1, 3 and 6 months. Results: Full breastfeeding rates at hospital discharge showed an oscillation between 69.9% and 87%. The rate decreased in the following months and reached very low levels at 6 months of age (<24%), with the exception of the last sample period in 2006 (44.9%). Conclusion: A simple questionnaire, combined with standardized phone interviews, can be easily reproduced and may be used as an indicator for quality of neonatal care at hospital nurseries. A social and cultural change of the whole community towards breastfeeding promotion will result in increasing breastfeeding rates. [source] The platelet as a peripheral marker in psychiatric illnessHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 3 2001Helein Plein Abstract The identification of peripheral markers of psychiatric illness is important if an improvement in the diagnosis and treatment of various diseases with overlapping symptomatology is desired. There are many disorders that not only have overlapping symptomatology, but also have similar biological disturbances. The functional capability of the neurons involved in the disease processes may be at the crux of the underlying pathology. The platelet intracellular calcium response to neurotransmitter stimulation has previously been used as a peripheral marker of psychiatric illness. This review discusses evidence in support of the extended use of the platelet as a peripheral marker. The use of the platelet intracellular calcium response to neurotransmitter stimulation as a state or trait marker in major depression, the specificity and selectivity of this response, and the possible use of the platelet as a peripheral marker in psychotic disorders such as schizophrenia, mania and psychotic depression are shown. Finally, a proposed mechanism for the association between certain psychiatric disorders and cardiovascular disease is discussed. Copyright © 2001 John Wiley & Sons, Ltd. [source] Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instabilityINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2007Choong Ng BMedSci(Melb) Abstract Background, Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives, Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy, A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria, Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results, Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P > 0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions, Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. [source] Mitral Regurgitation After Partial Left Ventriculectomy As the Cause of Ventricular RedilatationJOURNAL OF CARDIAC SURGERY, Issue 2 2001Akira T. Kawaguchi M.D. Background: It remains unclear whether ventricular redilatation after partial left ventriculectomy (PLV) is due to underlying pathology or to continued volume overload amenable to surgery. Methods: Among patients undergoing PLV, 32 had Doppler echocardiography preoperatively, immediately after surgery (> 1 week), early after surgery (1,3 months), and late after surgery (8,14 months). Patients were divided into groups with mitral regurgitation (MR; MR+, n = 16) and without postoperative MR (MR-, n = 16) and were compared for ventricular size, performance, and survival. Results: After initial surgical reduction, left ventricular dimension on average gradually increased back to the preoperative level in subgroups of patients with valvular disease and cardiomyopathy and in all patients combined. Most patients showed drastically reduced left ventricular dimension early after PLV. In MR+ patients, dimension increased back to the preoperative level within 3 months after surgery, whereas the MR- group maintained reduced dimension throughout the first year in all patients combined and in a subgroup of patients with cardiomyopathy. Occurrence of significant MR after PLV appeared to be related to severity of fibrosis in excised myocardium but not to severity of preexisting MR, etiology, or performance of mitral valvuloplasty. Conclusions: Early postoperative MR, residual or new, appeared to play an important role in dictating early hemodynamics and late outcome in patients undergoing PLV. Results suggest an aggressive simultaneous approach to abolish MR. Causative role of myocardial fibrosis remains unclear and needs further study. [source] Bilateral Internal Carotid Artery Dissection Mimicking Inflammatory Demyelinating DiseaseJOURNAL OF NEUROIMAGING, Issue 4 2003C. Lie MD ABSTRACT Background and Purpose. Internal carotid artery (ICA) dissection (ICAD) may be extremely difficult to diagnose only on the basis of historical information and clinical signs, and even standard brain imaging (computed tomography [CT], T2-weighted magnetic resonance imaging [MRI]) may not be sufficient to delineate the underlying pathology clearly, as shown in this case. Methods. The clinical presentation and parenchymal lesion pattern on CT were suggestive of inflammatory demyelinating disease, and additional multiparametric MRI was per-formed. Results. Diffusion-weighted MRI, magnetic resonance angiography, and perfusion-weighted MRI revealed acute ischemic lesions, bilateral ICA obstruction, and bilateral hypoperfusion in the middle cerebral artery territories. Bilateral ICAD was confirmed by Doppler and duplex ultrasound, and anticoagulation therapy was initiated. A follow-up examination showed recanalization of the obstructed ICAs and the normalization of cerebral perfusion. Conclusion. This case illustrates the importance of demonstrating the pathology and the value of multiparametric MRI techniques for the diagnosis and monitoring of ICAD and its hemodynamic consequences. [source] Epidural haemorrhage of the cervical spinal cord: a post-mortem artefact?NEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 3 2005G. N. Rutty Spinal epidural haemorrhage is a rare entity that occurs uncommonly in adults and rarely in children. It has a typical clinical presentation, although to date, the cause for the majority of cases remains unknown. We present a series of cases where epidural haemorrhage was identified at post-mortem, principly to the cervical cord, in cases outside the age range usually reported for clinical epidural haemorrhage, and with no underlying pathology to account for the finding. We present a hypothesis for a post-mortem cause for this finding and consider that, in the absence of any other identifiable causation, then this is a post-mortem occurrence similar to that of the Prinsloo,Gordon artefact of the soft tissues of the neck. This finding must be interpreted with care so as not to make the mistaken diagnosis of a nonaccidental head injury based on its finding, especially in the absence of intracranial, cranial nerve, optic nerve or eye pathologies. [source] Cerebrospinal fluid brain-derived proteins in the diagnosis of Alzheimer's disease and Creutzfeldt,Jakob diseaseNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 6 2002A. J. E. GreenArticle first published online: 24 NOV 200 The differential diagnosis of dementia can be difficult in the early stages of disease, and with the emergence of new therapeutic agents for Alzheimer's disease (AD) there is an increasing need for reliable and accurate diagnostic tests. The concept of brain-specific proteins was first proposed in the 1960s and, since that time, methods have developed to measure these proteins in the cerebrospinal fluid (CSF). The concentration of individual brain-specific proteins can be altered in disease, and these changes are thought to reflect the underlying pathology. CSF tau protein and amyloid peptide A,42 concentrations are altered in AD and have been proposed as early diagnostic tests for this disease. The data from a number of studies suggest that these proteins may be of value, but are less specific than previously thought and further studies with neuropathological confirmation are required before these tests can be introduced into clinical practice. The detection of 14-3-3 in the CSF is an accurate test for sporadic Creutzfeldt,Jakob disease (CJD) and this accuracy has lead the World Health Organization to revise the clinical criteria for probable sporadic CJD to include a positive CSF 14-3-3. However, CSF 14-3-3 is less useful in the diagnosis of variant CJD, where studies are underway investigating the value of other CSF proteins. [source] Correlation of single photon emission computed tomography with pathology and seizure outcome in children undergoing epilepsy surgeryNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 2 2002J. H. Cross Introduction:, Single photon emission computed tomography (SPECT) imaging regional cerebral blood flow (rCBF) can help localize the seizure focus in partial epilepsies during presurgical evaluation. Few studies have explored the possible relationship between preoperative SPECT and underlying pathology, or any relationship to postsurgical outcome. Study group:, Thirty-five children with medically intractable epilepsy undergoing resective surgery between the ages of 11 months and 18 years had presurgical ictal and interictal rCBF and post surgery follow up of 3,6 years. Results:, Pathological examination revealed 13 to have hippocampal sclerosis (HS): of these 11 had relatively low interictal rCBF perfusion on the side of seizure onset, and eight had hyperfusion ictally. Eight children had morphological evidence of cortical dysplasia: all had a localizing ictal rCBF concordant with the area resected whereas only six demonstrated localized reduction in perfusion on interictal rCBF. All three patients with Rasmussens encephalitis had informative rCBF scans, concordant with the seizure focus. However, infarct, tumours and nonspecific pathology demonstrated poor localization of the seizure focus. No SPECT parameter correlated independently with outcome, although overall the HS group had the best outcome, particularly those with localizing ictal SPECT. Comment:, Ictal SPECT appears predictive of underlying cortical dysplasia. Although in this small group of HS in children, ictal SPECT added little to interictal SPECT for seizure localization, it may be useful in the prediction of outcome. SPECT adds little to the evaluation of children being considered for hemispherectomy over and above the abnormalities detectable on MRI scan. [source] Assessing optic nerve pathology with diffusion MRI: from mouse to humanNMR IN BIOMEDICINE, Issue 9 2008Junqian Xu Abstract The optic nerve is often affected in patients with glaucoma and multiple sclerosis. Conventional MRI can detect nerve damage, but it does not accurately assess the underlying pathologies. Mean diffusivity and diffusion anisotropy indices derived from diffusion tensor imaging have been shown to be sensitive to a variety of central nervous system white matter pathologies. Despite being sensitive, the lack of specificity limits the ability of these measures to differentiate the underlying pathology. Directional (axial and radial) diffusivities, measuring water diffusion parallel and perpendicular to the axonal tracts, have been shown to be specific to axonal and myelin damage in mouse models of optic nerve injury, including retinal ischemia and experimental autoimmune encephalomyelitis. The progression of Wallerian degeneration has also been detected using directional diffusivities after retinal ischemia. However, translating these findings to human optic nerve is technically challenging. The current status of diffusion MRI of human optic nerve, including imaging sequences and protocols, is summarized herein. Despite the lack of a consensus among different groups on the optimal sequence or protocol, increased mean diffusivity and decreased diffusion anisotropy have been observed in injured optic nerve from patients with chronic optic neuritis. From different mouse models of optic nerve injuries to the emerging studies on patients with optic neuritis, directional diffusivities show great potential to be specific biomarkers for axonal and myelin injury. Copyright © 2008 John Wiley & Sons, Ltd. [source] Incidence and Severity of Epidural Fibrosis after Back Surgery: An Endoscopic StudyPAIN PRACTICE, Issue 1 2010FIPP, Hemmo A. Bosscher MD Abstract Background: Epidural fibrosis has been implicated in the etiology of persistent pain after back surgery (Failed Back Surgery Syndrome [FBSS]). Using spinal endoscopy to view the lumbosacral epidural cavity, the incidence, severity, and appearance of epidural fibrosis was evaluated in patients with FBSS. Methods: A prospective cohort observational study using epidural endoscopy was done involving 78 patients with persistent pain after back surgery. Patients were evaluated prospectively for the presence of epidural fibrosis and fibrosis was rated using a 4-level grading system based on appearance and resistance to epiduroscope advancement. The incidence of fibrosis detected by epiduroscopy vs. the incidence as reported in magnetic resonance imaging (MRI) studies for the same patients were compared. Results: As diagnosed with epiduroscopy, 83.3% of all patients with persistent pain after back surgery had severe (grade 3 or 4) epidural fibrosis, while 91.0% had significant (grade 2, 3, or 4) fibrosis. In patients who had undergone more extensive surgery, severe fibrosis was present in 91.1% and significant fibrosis in 95.6%. Using MRI, epidural fibrosis was diagnosed only in 16.1% of these patients. All patients with severe epidural fibrosis had a filling defect on epidurography. Concordant pain was present in 84.3% of patients and depended on the severity of fibrosis. Results were statistically evaluated using analysis of frequencies and t -test. P < 0.05 was considered statistically significant. Conclusions: Epiduroscopy demonstrates that the prevalence of severe epidural fibrosis after FBSS is substantially higher than is generally reported in MRI evaluations. Severe epidural fibrosis is an underlying pathology in most patients with FBSS. [source] The ageing male reproductive tract,THE JOURNAL OF PATHOLOGY, Issue 2 2007N Sampson Abstract Ageing of the male reproductive system is characterized by changes in the endocrine system, hypogonadism, erectile dysfunction and proliferative disorders of the prostate gland. Stochastic damage accumulating within ageing leads to progressive dysregulation at each level of the hypothalamic,pituitary,gonadal (HPG) axis and in local auto/paracrine interactions, thereby inducing morphological changes in reproductive target organs, such as the prostate, testis and penis. Despite age-related changes in the HPG axis, endocrine functions are generally sufficient to maintain fertility in elderly men. Ageing of the male reproductive system can give rise to clinically relevant manifestations, such as benign prostatic hyperplasia (BPH), prostate cancer (PCa) and erectile dysfunction (ED). In this review, we discuss morphological/histological changes occurring in these organs and current views and concepts of the underlying pathology. Moreover, we emphasize the molecular/cellular pathways leading to reduced testicular/penile function and proliferative disorders of the prostate gland. Copyright © 2007 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Portal venous gas , case report and review of the literatureANAESTHESIA, Issue 4 2007A. H. Mohammed Summary A 74-year-old man with chronic renal failure was admitted to the renal unit with non-specific symptoms and positive blood cultures. He later deteriorated and was admitted to the Intensive Care Unit with septic shock, respiratory failure and deranged liver function. Initial improvement was followed by abdominal distension and discomfort. Portal venous gas (PVG) and thrombosis were diagnosed on computed tomography. A conservative line of management was adopted. Improvement was soon followed by deterioration with septic shock. Extensive portal venous gas and free intra-abdominal gas were now evident on repeat computed tomography. The patient was too unwell to withstand surgery and a decision was made not to escalate therapy. He died on day 16. Portal venous gas is not a disease; it is a diagnostic clue in patients who may be harbouring an intra-abdominal catastrophe. Successful management of these cases requires early identification of the underlying pathology and can range from simple observation to extensive surgical intervention. [source] Cognitive reserve hypothesis: Pittsburgh Compound B and fluorodeoxyglucose positron emission tomography in relation to education in mild Alzheimer's diseaseANNALS OF NEUROLOGY, Issue 1 2008Nina M. Kemppainen MD Objective The reduced risk for Alzheimer's disease (AD) in high-educated individuals has been proposed to reflect brain cognitive reserve, which would provide more efficient compensatory mechanisms against the underlying pathology, and thus delayed clinical expression. Our aim was to find possible differences in brain amyloid ligand 11C-labeled Pittsburgh Compound B ([11C]PIB) uptake and glucose metabolism in high- and low-educated patients with mild AD. Methods Twelve high-educated and 13 low-educated patients with the same degree of cognitive deterioration were studied with PET using [11C]PIB and 18F-fluorodeoxyglucose as ligands. The between-group differences were analyzed with voxel-based statistical method, and quantitative data were obtained with automated region-of-interest analysis. Results High-educated patients showed increased [11C]PIB uptake in the lateral frontal cortex compared with low-educated patients. Moreover, high-educated patients had significantly lower glucose metabolic rate in the temporoparietal cortical regions compared with low-educated patients. Interpretation Our results suggesting more advanced pathological and functional brain changes in high-educated patients with mild AD are in accordance with the brain cognitive reserve hypothesis and point out the importance of development of reliable markers of underlying AD pathology for early AD diagnostics. Ann Neurol 2007 [source] Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal PainACADEMIC EMERGENCY MEDICINE, Issue 5 2008Esther H. Chen MD Abstract Objectives:, Oligoanalgesia for acute abdominal pain historically has been attributed to the provider's fear of masking serious underlying pathology. The authors assessed whether a gender disparity exists in the administration of analgesia for acute abdominal pain. Methods:, This was a prospective cohort study of consecutive nonpregnant adults with acute nontraumatic abdominal pain of less than 72 hours' duration who presented to an urban emergency department (ED) from April 5, 2004, to January 4, 2005. The main outcome measures were analgesia administration and time to analgesic treatment. Standard comparative statistics were used. Results:, Of the 981 patients enrolled (mean age ± standard deviation [SD] 41 ± 17 years; 65% female), 62% received any analgesic treatment. Men and women had similar mean pain scores, but women were less likely to receive any analgesia (60% vs. 67%, difference 7%, 95% confidence interval [CI] = 1.1% to 13.6%) and less likely to receive opiates (45% vs. 56%, difference 11%, 95% CI = 4.1% to 17.1%). These differences persisted when gender-specific diagnoses were excluded (47% vs. 56%, difference 9%, 95% CI = 2.5% to 16.2%). After controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia. There was no gender difference in the receipt of nonopioid analgesia. Women waited longer to receive their analgesia (median time 65 minutes vs. 49 minutes, difference 16 minutes, 95% CI = 3.5 to 33 minutes). Conclusions:, Gender bias is a possible explanation for oligoanalgesia in women who present to the ED with acute abdominal pain. Standardized protocols for analgesic administration may ameliorate this discrepancy. [source] Alterations of intraretinal layers in acute central serous chorioretinopathyACTA OPHTHALMOLOGICA, Issue 5 2009Christian Ahlers Abstract. Purpose:, Optical coherence tomography (OCT) is restricted by its low scanning speed and limited resolution. High-definition raster-scanning OCT (HD-OCT) was used to evaluate changes in retinal microstructure in patients with acute central serous chorioretinopathy (CSCR) and to find new morphological features. Methods:, Eighteen patients with subretinal fluid accumulation caused by acute CSCR were imaged in a cross-sectional study design. High-speed frequency-domain HD-OCT was used to image an area of 6 × 6 mm in the macular retina. Three-dimensional analyses were performed using en-face imaging and section analysis of single HD-OCT scans. Results:, Detailed information about fluid accumulation can be obtained in all compartments. Discrete changes in reflectivity are visualized within the outer nuclear or plexiform layers in > 90% of patients. Subretinal fluid appears as a dome-shaped pool of fluid and is not associated with a loss of photoreceptor layer integrity. Deposits are demarcated beneath the outer cone segments. Multiple small pigment epithelial detachments are present in > 60% of patients. Conclusions:, High-definition OCT provides extensive information regarding precise topographic and layer-specific localization of discrete morphological changes. Along with well-known changes in the retinal microstructure, hyper-reflectivity can be imaged in the outer nuclear or plexiform layers and may represent intraretinal changes indicating the presence of subretinal pathologies or retinal maladjustment caused by the underlying pathology. [source] Quantitative neuropathological analysis of Sudden Infant Death SyndromeCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2002T. Ansari Abstract Detailed stereological analyses of specific regions of brains of children who had died from Sudden Infant Death Syndrome (SIDS) was undertaken to determine whether global evidence of an underlying pathology exists, contributing to an increased susceptibility to SIDS. A significant reduction in the total number of neocortical neurones and neurone volume was observed in SIDS normal birth weight (NBW) infants in comparison to controls. A significant reduction in both volume and total neurone number were also noted in the dorsal motor nucleus of the vagus in SIDS NBW group when compared with controls. Anomalies in regions of the brain involved with cardiorespiratory control (brainstem) and arousal (brainstem and neocortex) may play a crucial role in the chain of events resulting in a SIDS event. [source] Sequence microdiversity at the ribosomal RNA operons of Escherichia coli pyelonephritogenic strainsCLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2001A. I. Anton Objective To determine whether Escherichia coli strains isolated from patients with uncomplicated acute pyelonephritis can be distinguished from those isolated from patients with complicated acute pyelonephritis on the basis of the genetic background. Methods In total, 103 E. coli strains isolated from patients with acute pyelonephritis (59 uncomplicated pyelonephritis (UAP) and 44 complicated pyelonephritis (CAP)) were characterized by RFLP of the intergenic spacer region 16S,23S rRNA, the presence of three alternative sequences found in the polymorphic V6 loop of the 16S rRNA gene, the presence of the pap gene, and antibiotic susceptibility. Results At similarity levels of 70%, four RFLP groups (,1, ,2, ,1 and ,2) were discerned. Strains from UAP were statistically significant for , RFLP, with a strong association with the presence of the pap gene, V6-I sequence and antibiotic multisensitivity. Strains from CAP randomly belonged to the , or , RFLP groups, with a very low presence of the pap gene, and random presence of V6 sequences, and were multiresistant to antibiotics. When the CAP strains were distributed according to underlying pathology, non-obstructive cases had RFLP and V6 polymorphisms similar to those of UAP cases, while obstructive cases were clearly distinct. Conclusions UAP and non-obstructive CAP E. coli strains are sensitive to antimicrobials, show a high level of the pap gene and belong to the selective, homogeneous and highly protected molecular ,2 group, where no recombinations, deletions or insertions are present. On the contrary, obstructive and vesicorenal reflux E. coli strains show significant antimicrobial resistance, high intercistronic heterogenicity (wide presence of block nucleotidic substitutions, deletions or insertions) and significantly lower virulence. [source] | |||||||||||||||||||||||||