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Varying Combinations (varying + combination)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

The chronic fatigue syndrome , an update

ACTA NEUROLOGICA SCANDINAVICA, Issue 2007
Vegard Bruun Wyller
Background ,, In this article, current scientific knowledge on the chronic fatigue syndrome (CFS) is reviewed. The US case definition of CFS (the CDC-definition) is most widespread in research and clinical practice. Estimates of prevalence vary from 0.2% to above 2%. The female,male ratio is approximately 3:1. Clinical Features ,, Severe fatigue is the dominating complaint; it is worsened from exertions and not substantially relieved by rest. In addition, the patients might have a varying combination of accompanying symptoms. Clinical evaluation should be based upon standardized guidelines, including an assessment of functional impairments. Pathophysiology ,, The pathophysiology should be interpreted within a biopsychosocial framework. Present knowledge suggests that certain genetic polymorphisms and personality traits might be regarded as predisposing factors, some infections and severe psychosocial stress constitute precipitating factors, whereas disturbances of immunity, skeletal muscle, cognitive abilities, endocrine control and cardiovascular homeostasis are possible perpetuating factors. Treatment ,, Cognitive behavioural therapy and graded exercise therapy are of proven value in randomized controlled trials. Several pharmaceutical measures have been explored and found to have no beneficial effect. Most patients might expect long-term improvement, but full recovery is rare; however, the prognosis is better among adolescents. [source]

Cutaneous composite hemangioendothelioma with satellitosis and lymph node metastases

JOURNAL OF CUTANEOUS PATHOLOGY, Issue 2 2008
Luis Requena
The term hemangioendothelioma has been used in recent years to name a heterogeneous group of vascular neoplasms, intermediate in both biological behavior and histopathologic appearance between benign tumors (hemangiomas) and frankly malignant tumors (angiosarcomas). Thus, within the spectrum of hemangioendothelioma have been successively included epithelioid hemangioendothelioma, spindle cell hemangioendothelioma, retiform hemangioendothelioma, kaposiform hemangioendothelioma, polymorphous hemagioendothelioma of the lymph nodes, papillary intralymphatic angioendothelioma (PILA) and composite hemangioendothelioma. The latter is a vascular neoplasm showing varying combinations of benign, low-grade malignant and malignant vascular components. We herein report a case of composite hemangioendothelioma showing a combination of retiform hemangioendothelioma, epithelioid hemangioendothelioma, spindle cell hemangioma and PILA. The neoplasm showed a more aggressive behavior than other reported cases of composite hemangioendothelioma and it developed satellitosis and metastases to the inguinal lymph nodes. Neoplastic cells expressed immunoreactivity for Prox-1, supporting a lymphatic line of differentiation. [source]

An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnoea contraindicated?

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007
Adam G. Elshaug BA BSc(Hons) MPH
Abstract Rationale, aims and objectives, Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). The role of these operations remains controversial, with perspectives on treatment efficacy varying considerably. Despite this, their use is proliferating. Objectives, In this paper, we present the degree of variability that occurs in the application of these procedures, and examine the effectiveness of surgical intervention as a treatment for OSA. Method, A multi-centre retrospective clinical audit of consecutive, unselected surgical cases presenting at the sleep disorder clinics of two teaching hospitals in a major Australian city. Patients acted as their own historical controls, undergoing polysomnography pre and post surgery to gauge effectiveness. Results, On variability demonstrate 94 individuals in this cohort received 220 individual upper airway surgical procedures, 184 occurred in their first operation (mean 2.5 per person; range 1,7) and 36 occurred in a second operation (n = 18; cumulative mean of 4 per person; range 3,7). These 94 individuals received 41 varying combinations of surgery. Results on effectiveness demonstrate an overall physiological success rate of 13% (87% fail). One operation reduced OSA severity by 20% (patients still had severe OSA), and two operations by 35% (still moderate OSA). In contrast, conventional Continuous Positive Airway Pressure therapy controlled OSA (n = 64). Conclusions, This case study demonstrates substantial procedural variability and limited effectiveness. This raises questions as to the quality of care, the treatment-derived health outcomes of this population and of efficient resource allocation. This issue requires greater policy attention. [source]

Carbon black and lung cancer,testing a novel exposure metric by multi-model inference

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 11 2009
Peter Morfeld PhD
Abstract Background In a recent analysis of a UK cohort Sorahan and Harrington [2007: Am J Ind Med 50: 555,564] assessed the most recent 15 years of exposure ("lugging") to support their hypothesis that carbon black acts as a late stage lung carcinogen. We tested this metric in a German cohort of 1,528 carbon black workers. Methods We used a multi-model Cox regression approach (720 models) to explore the impact of duration and cumulative exposure to carbon black "lugged" by 0, 5, 10, 15, and 20 years. This approach covered four sub-cohorts, including an inception cohort, different exposure scenarios and varying combinations of confounders. Results Seven hundred nineteen models returned negative coefficients. Only one model estimated a small positive, but clearly non-significant coefficient (P,=,0.8). Conclusions Despite extensive searching, no exposure scenario suggested an adverse effect of "lugged" carbon black exposure on lung cancer mortality. Our analysis does not support the hypothesis of carbon black being a late stage carcinogen. Am. J. Ind. Med. 52:890,899, 2009. © 2009 Wiley-Liss, Inc. [source]