Home About us Contact
|
Home About us Contact | ||
|
|
||
Common Finding (common + finding)
Selected AbstractsAcanthosis Nigricans: A Common Finding in Overweight YouthPEDIATRIC DERMATOLOGY, Issue 6 2007Wendy J. Brickman M.D. Youth (7,17 years) at nine pediatric practices completed surveys on demographics and family history of diabetes and had weight and height measured. Acanthosis nigricans was scored and digital photography of the neck performed. A total of 618 youth were included in the analysis: mean age 11.5 years; 51% female; 61% African American, 27% Hispanic, 12% Caucasian, and 32% with body mass index ,95th percentile. Acanthosis was found in 19%, 23%, and 4% of the African American, Hispanic, and Caucasian youth, respectively, and in 62% of youth with a body mass index ,98th percentile. Using multiple logistic regression, we found increasing body mass index z -score, presence of maternal gestational diabetes, female gender, and not being Caucasian each were independently associated with acanthosis nigricans. Acanthosis was common among overweight youth and was associated with risk factors for glucose homeostasis abnormalities. Acanthosis nigricans can be a trigger to counsel families on its causes and consequences; and thus motivate them to make healthy lifestyle changes that can decrease the risk of developing cardiovascular disease or diabetes. [source] Persistent, recurrent, and acquired infection of the root canal system post-treatmentENDODONTIC TOPICS, Issue 1 2003Markus Haapasalo Apical periodontitis is an inflammatory process in the periradicular tissues caused by microorganisms in the necrotic root canal. Accordingly, to achieve healing of apical periodontitis, the main goal of the treatment must be elimination of the infection and prevention of re-infection. As shown by recent epidemiological studies in several countries around the world, post-treatment endodontic disease is a far too common finding. To understand the reasons for survival of resistant bacteria in the filled root canal, it is important to know in detail the interaction between treatment procedures and the root canal flora in primary apical periodontitis. Therefore, in the first half of this review, the focus is placed on control of infection in primary apical periodontitis. This is followed by a detailed description of the resistant root canal microflora and a discussion about the present and future strategies to eliminate even the most resistant microbes in post-treatment disease. [source] On the Association Between Valproate and Polycystic Ovary SyndromeEPILEPSIA, Issue 3 2001Pierre Genton Summary: Recent studies by Isojärvi et al. have raised the issue of an increased incidence of polycystic ovary syndrome (PCOS) in women with epilepsy treated with valproate (VPA) and have proposed replacement with lamotrigine (LTG). Polycystic ovaries (PCO) are a common finding, with a prevalence >20% in the general population, and are easily detected by pelvic or vaginal ultrasonography, whereas PCOS is comparatively rare: few women with PCO have fully developed PCOS, which includes hirsutism, acne, obesity, hypofertility, hyperandrogenemia, and menstrual disorders. From an extensive review of the current literature, it appears that there are no reliable data on the actual prevalence of PCOS in normal women and in women with epilepsy. The pathogenesis of PCO is multifactorial, including genetic predisposition and the intervention of environmental factors, among which weight gain and hyperinsulinism with insulin resistance may play a part. The roles of central (hypothalamic/pituitary), peripheral, and local ovarian factors are still debated. PCO and PCOS appear to be more frequent in women with epilepsy, but there are no reliable data showing a greater prevalence after VPA. The recent studies by Isojärvi et al. may have been biased by the retrospective selection of patients. To date, there is no reason to contraindicate the use of VPA in women with epilepsy. However, patients should be informed about the risk of weight gain and its consequences. [source] Redefining monosomy 5 by molecular cytogenetics in 23 patients with MDS/AMLEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2007Angèle Herry Abstract Deletion of the long arm of chromosome 5 [del(5q)] or loss of a whole chromosome 5 (,5) is a common finding, arising de novo in 10% of patients with myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) and in 40% of patients with therapy-related MDS or AML. We investigated by molecular cytogenetics 23 MDS/AML patients for whom conventional cytogenetics detected a monosomy 5. Monosomy 5 was redefined as unbalanced or balanced translocation and ring of chromosome 5. Loss of 5q material was identified in all 23 patients, but one. One copy of EGR1(5q31) or CSF1R(5q33,34) genes was lost in 22 of the 23 patients. Chromosome 5p material was a constant chromosomal component of derivative chromosomes or rings in all patients, but one. Sequential fluorescent in situ hybridization studies with whole chromosome paints and region-specific probes, used as a complement to conventional cytogenetic analysis, allow a better interpretation of karyotypes in MDS/AML patients. [source] Risk factors for symptomatic hyponatraemia: the role of pre-existing asymptomatic hyponatraemiaINTERNAL MEDICINE JOURNAL, Issue 3 2007M. Bissram Abstract Background: Hyponatraemia is associated with substantial morbidity and mortality. Identification of the risk factors associated with the development of symptomatic hyponatraemia is important in determining preventive strategies. Methods: A retrospective analysis of the risks factors associated with the development of severe, symptomatic hyponatraemia requiring hospital admission over the past 3 years at our institution was carried out. Results: Forty-seven patients (26 women, 21 men) with a hospital admission serum sodium <134 mmol/L were identified. Of these patients, 31 (65.9%) had associated changes in the mental status that improved with the treatment of the hyponatraemia suggesting causality. The average admission sodium level of this cohort was 118.8 mmol/L. Symptomatic hyponatraemia was associated with volume depletion (32.6%), congestive heart failure (26%), syndrome of inappropriate antidiuretic hormone (26%), thiazide diuretic use (26%) and selective serotonin re-uptake inhibitor use (26%). In 21.7% of cases, the cause was multifactorial (congestive heart failure, syndrome of inappropriate antidiuretic hormone or medication use with volume depletion). In 11% of cases, patients were taking both thiazide diuretics and serotonin re-uptake inhibitors. Most importantly, 70.9% of all patients admitted with symptomatic hyponatraemia had pre-existing hyponatraemia that was untreated and believed to be asymptomatic (P < 0.05). This was the most common risk factor identified. We next investigated the prevalence of presumed asymptomatic hyponatraemia in the outpatient setting. Out of 27 496 patients analysed, 14% had serum sodium levels less than or equal to 134 mEq/L and 4% had values less than 130 mEq/L. Conclusion: Pre-existing asymptomatic hyponatraemia is a common finding and is associated with a high risk for the development of worsening hyponatraemia with altered mental status. [source] Internal apical resorption and its correlation with the type of apical lesionINTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2004F. V. Vier Abstract Aim, To determine the presence of various periapical pathologies and their association with the presence and extent of internal apical inflammatory root resorption in human teeth. Methodology, A total of 75 root apices from extracted teeth with periapical lesions were examined. Semi-serial sections of soft tissue lesions were stained with HE. The lesions were classified as non-cystic or cystic, and according to the degree of abscess severity: 0, 1, 2 or 3. The apices were reduced to 3 mm in length and longitudinally cut so that the internal aspect could be analyzed under scanning electron microscopy (SEM). Internal root resorption was also classified as 0, 1, 2 or 3 according to the extent of the resorbed area. Additionally, six vital teeth were used as a control. Results, Non-cystic lesions with severe abscesses were the most common finding (70.7%), while 20% of the lesions were cystic (4% little or no abscess; 16% severe abscesses). Non-cystic lesions with little or no abscess comprised 9.3% of the sample. Of the root canals containing periapical lesions, 48% had internal apical resorption in more than half of the area, while 25.3% of the sample had no internal resorption. Resorption degree 1 was identified in 12% of the cases, and 14.7% showed resorption degree 2. The control group displayed significantly less internal resorption than the test groups. Conclusions, Most periapical lesions (86.7%), whether cystic (16.0%) or non-cystic (70.7%), showed large collections of acute inflammatory cells. Apical internal resorption was present in 74.7% of roots and was associated with periapical lesions. There was no correlation between internal apical resorption and the histological diagnosis of the lesions. [source] Longitudinal evaluation of GCF IFN-, levels and periodontal status in HIV+ patientsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2003T. Alpagot Abstract Background/Aim: Loss of periodontal support and related tooth loss is a common finding among HIV+ patients. The etiology of this destruction may be an increase in the levels of pro-inflammatory cytokines and subsequent increase in periodontal disease activity. The purpose of this study was to investigate the associations between gingival crevicular fluid interferon gamma (GCF IFN- ,) and clinical measures of periodontal disease in HIV+ individuals. We monitored GCF IFN- , and periodontal status of selected sites in 33 HIV+ subjects over a 6-month period. Method: Clinical measurements including gingival index, plaque index, bleeding on probing, probing depth, attachment loss (AL), and GCF samples were taken from four lower incisors and the upper right posterior sextant of each patient at baseline and 6-month visits by means of sterile paper strips. GCF levels of IFN- , were determined by sandwich ELISA assays. A progressing site was defined as a site that had 2 mm or more AL during the 6-month study period. Results: Twenty-five of the 264 examination sites showed 2 mm or more clinical AL during the 6-month study period. Significantly higher GCF levels of IFN- , were found at progressing sites than in nonprogressing sites (p<0.001). GCF levels of IFN- , were highly correlated with clinical measurements taken at baseline and 6-month visits (0.001 Complications and limitations related to periprostatic local anesthesia before TRUS-guided prostate biopsyJOURNAL OF CLINICAL ULTRASOUND, Issue 2 2008Ahmet T. Turgut MD Abstract Purpose To assess the frequency of complications specifically related to local anesthetic infiltration prior to transrectal ultrasound (TRUS)-guided prostate biopsy. Methods A total of 200 patients receiving 10 cm3 (5 cm3 on each side) of 2% lidocaine injected around the periprostatic nerve plexus under TRUS guidance before prostate biopsy were included. Various complications presumed to be associated with local anesthesia were noted during and after the biopsy procedure. Two weeks later, periprostatic tissue integrity and vascularization were re-examined with TRUS Doppler examination to assess for fibrosis or infection. Results The most common finding was pain due to puncture with the needle used for local anesthesia (27%). Also recorded were the need for repeated injections during the biopsy procedure (4.5%), symptoms associated with systemic lidocaine toxicity (2%), urinary incontinence (1.5%), and degradation of the image resolution due to anesthetic injection (1%). Increased vascularization within the periprostatic region was uncommon (2%) on the 2-week follow-up examination. No TRUS finding consistent with rectal wall hematoma or other periprostatic change and no erectile dysfunction associated with the procedure occurred. There was a significant difference in overall pain scores between the subgroups of patients (p < 0.001). Conclusion TRUS-guided periprostatic nerve blockade is an effective method for relieving discomfort from prostate biopsy with very few complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] Literature Review and suggested protocol for managing ultrasound soft markers for Down syndrome: Thickened nuchal fold, echogenic bowel, shortened femur, shortened humerus, pyelectasis and absent or hypoplastic nasal boneJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2007Article first published online: 10 MAY 200, M Bethune Summary Mid-trimester soft markers have been linked with Down syndrome and other aneuploidies. There are many other prenatal screening tests available with better detection rates for Down syndrome than the mid-trimester ultrasound. Many patients confronted with the diagnosis of a soft marker become anxious and may request a diagnostic test (amniocentesis) despite the associated risk of miscarriage. This is also despite the fact that most fetuses with an isolated soft marker are chromosomally normal. The management of a pregnancy with a soft marker must therefore be planned in a manner designed to minimize patient anxiety. Likelihood ratios can be used to modify a patient's ,prior risk' (based on age or prior screening tests) and create a new risk. This calculation may help identify a subset of patients suitable for further investigation. It has been proposed that ,negative' likelihood ratios can be used to reduce a patient's risk if no soft marker is found at a mid-trimester ultrasound. There remain concerns about this approach and further research is required before this approach enters common practice. The published work surrounding the management of thickened nuchal fold, echogenic bowel, shortened femur, shortened humerus, pyelectasis (renal pelvis dilatation) and hypoplastic nasal bone is reviewed. Each soft marker has different associations and individual management plans for each of these soft markers are presented. Although isolated single umbilical artery is not usually considered a soft marker of aneuploidy, a management plan for this common finding is also included. [source] Executive Functioning and Working Memory in Fetal Alcohol Spectrum DisorderALCOHOLISM, Issue 8 2005Carmen Rasmussen The goal of this report is to critically review research on executive functioning (EF) and working memory in individuals with fetal alcohol spectrum disorder (FASD). Individuals with FASD exhibit EF deficits in the areas of cognitive flexibility, planning and strategy use, verbal reasoning, some aspects of inhibition, set shifting, fluency, working memory, and, recently, on tests of emotion-related or hot EF. Some researchers have linked prenatal alcohol exposure to abnormalities in the development of the frontal cortex of affected individuals or animals. One common finding is that these EF deficits persist regardless of whether the individual has facial dysmorphology. Furthermore, EF deficits are not simply due to a low IQ in these individuals. More research with larger sample sizes, smaller age ranges, and consistent measurement tools is needed in this area to ameliorate some inconsistencies in the literature. Furthermore, researchers should now focus on studying the pattern of weakness in EF in individuals with FASD as well as relations among working memory and EF, which will help to identify specific areas of weakness, to enhance diagnosis, and to improve treatment. There is limited research on the development of EF in individuals with FASD, which can have important implications for understanding of how these deficits unfold from childhood through adulthood. [source] Thin basement membrane nephropathy and IgA glomerulonephritis: Can they be distinguished without renal biopsy?NEPHROLOGY, Issue 5 2007DAVID K PACKHAM SUMMARY: Background: Thin basement membrane nephropathy (TBMN) and IgA glomerulonephritis (IgA gn) are the most common primary glomerular conditions diagnosed on renal biopsy, performed for microscopic haematuria or microscopic haematuria with proteinuria. While up to 50% of patients with IgA gn will develop chronic renal failure, most patients with TBMN enjoy an excellent prognosis. Because TBMN is estimated to occur in up to 1% of the general population, differentiation between the two conditions without resort to renal biopsy is desirable. Methods: This retrospective analysis of 248 patients diagnosed on renal biopsy as having either TBMN or IgA gn, sought to identify clinical or biochemical factors which would have enabled confident differentiation between the two conditions to be made without resort to renal biopsy. Results: No single clinical or pathological variable adequately discriminated between the two conditions. Impaired renal function and heavy proteinuria were highly specific for IgA gn but lacked sensitivity in differentiating from TBMN. Isolated microscopic haematuria (IMH) was a more common finding in patients diagnosed with TBMN but, as a discriminator between TBMN and IgA gn, lacked sufficient specificity. However, if assumptions were made based on the differing incidence of a positive family history between IgA gn and TBMN, then specificity of >99% could be achieved. Conclusion: TBMN and IgA gn cannot be distinguished on the basis of clinical or pathological variables alone. However, in patients with IMH and a positive family history of either IMH or biopsy-proven TBMN, there is usually no need for renal biopsy. [source] Role of Left Ventricular Scar and Purkinje-Like Potentials During Mapping and Ablation of Ventricular Fibrillation in Dilated CardiomyopathyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2009ANIL-MARTIN SINHA M.D., D.Phil. Background: Purkinje-like potentials (PLPs) have been described as important contributors to initiation of ventricular fibrillation (VF) in patients with normal hearts, ischemic cardiomyopathy, and early after-myocardial infarction. Methods: Of the 11 consecutive patients with VF storm, nonischemic cardiomyopathy (68 ± 22 years, left ventricular ejection fraction 28 ± 8%) who were given antiarrhythmic drugs and/or heart failure management, five had recurrent VF and underwent electrophysiology study (EPS) and catheter ablation. Results: At EPS, frequent monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia did not occur. With isoproterenol, VF was induced in three patients, and sustained monomorphic PVCs were induced in one patient. Three-dimensional electroanatomical mapping using CARTO (Biosense-Webster Inc., Diamond Bar, CA) revealed posterior wall scar in four of the five patients. PLP in sinus rhythm were recorded around the scar border in these four patients, and radiofrequency ablation targeting PLP was successfully performed at these sites. The patient without PLP did not undergo ablation. During follow-up (12 ± 5 months), only the patient without PLP had four VF recurrences requiring implantable cardioverter-defibrillator (ICD) shocks. Conclusion: In patients with VF and dilated cardiomyopathy, left ventricular posterior wall scar in the vicinity of the mitral annulus seems to be a common finding. Targeting PLP along the scar border zone for ablation seems to efficiently prevent VF recurrence in these patients. [source] Alternans in QRS Amplitude During Ventricular TachycardiaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2002PHILIPPE MAURY MAURY, P., et al.: Alternans in QRS Amplitude During Ventricular Tachycardia. Although the value of T wave alternans as an index of electrical instability has been extensively investigated, little is known about QRS alternans during VT. Intracardiac electrograms of 111 episodes of spontaneous monomorphic regular VT retrieved from implantable defibrillators in 25 patients were retrospectively selected. Three beat series, representing the total amplitudes and amplitudes from baseline to summit and from baseline to lower point of 16 or 32 successive QRS complexes before deliverance of electrical therapy were generated for each episode. Spectral analysis was then performed using the fast Fourrier transform. VT was considered as alternans if the magnitude of the spectral power at the 0.5-cycle/beat frequency was greater than the mean ± 3 SD of the noise in at least one of the three spectral curves. QRS alternans was present in 23 (20%) of 111 episodes and in 9 (36%) of 25 patients. Alternans was not related to the VT cycle length, QRS duration, QRS amplitude, signal amplification, nor to clinical variables. Alternans was more frequently detected in unipolar configuration and when a higher number of complexes was included in analysis. Failure of antitachycardia pacing was more frequent in case of alternans VT (50% vs 75% success in non-alternans VT, P = 0.05). Spontaneous termination before deliverance of therapy occurred in 16 nonalternans VT but never in alternans episodes (P = 0.02). Alternans in QRS amplitude is a relatively common finding during VT and could be associated with failure of antitachycardia pacing and lack of spontaneous termination. Lower efficacy of electrical therapies in case of QRS alternans must be confirmed in a way to improve the effectiveness of antitachycardia pacing. [source] Bone marrow biopsy in patients with hepatitis C virus infection: Spectrum of findings and diagnostic utility,AMERICAN JOURNAL OF HEMATOLOGY, Issue 2 2010Jeffery M. Klco Patients with hepatitis C virus (HCV) infection develop a number of hematologic disorders, with benign and malignant B-cell proliferations being the most common. HCV-infected patients are also prone to developing peripheral cytopenias, the etiologies of which are multifactorial and include hypersplenism and/or antiviral medications. Some of these patients may undergo bone marrow biopsy but no study has systematically recorded the bone marrow findings in this patient group. Here, we report on the range of bone marrow findings in 47 adult HCV-infected patients. These patients, who lacked concurrent human immunodefiency virus (HIV) infection, most commonly presented for a bone marrow biopsy due to abnormal peripheral cell counts. The bone marrow biopsies displayed a range of findings. Dyserythropoiesis, present in 19% of the cases, was the most common finding. Patients with pancytopenia(n = 6), as defined by current World Health Organization standards, were the most likely to have bone marrow abnormalities; two pancytopenic patients had acute myeloid leukemia, and one patient had a primary myelodysplastic syndrome. There was no correlation in bone marrow findings and antiviral medications, MELD score, cirrhosis or splenomegaly, suggesting that the degree of bone marrow dysfunction is independent of stage of HCV. The results of this study suggest that bone marrow biopsy in HCV-infected patients, even those with features of hypersplenism and/or documented antiviral therapy, can be a valid test for hematologic evaluation, especially for patients with severe pancytopenia and/or sudden alterations in peripheral cell counts. Am. J. Hematol. 85:106,110, 2010. © 2009 Wiley-Liss, Inc. [source] Flexible fiberoptic bronchoscopy in children with heart diseases: A twelve years experiencePEDIATRIC PULMONOLOGY, Issue 4 2007Jaime Cerda MD Abstract In children, cardiac diseases and respiratory disorders are tightly linked entities whose evaluation should be performed integrally. Flexible fiberoptic bronchoscopy (FB) presents a diagnostic and therapeutic role by assessing the airway anatomically, dynamically, and through the performance of several procedures. The present study describes our experience on FB assessment in children with congenital and acquired cardiac diseases, providing a characterization of the principal demographic and clinical features. Records of 72 patients under 14 years (mean age 21 months) with heart diseases, corresponding to 104 FB performed between January 1993 and October 2004 were reviewed. The principal cardiac diseases were left-to-right shunt (51.9%), followed by right-to-left shunt (17.3%) and miscellaneous cardiopathies (8.7%). The main indications for FB assessment were study of atelectasis (35%), stridor (14%), and pneumonia (14%). Airway malacias, as a group, were the commonest finding, represented mainly by left main bronchus malacia (24%). The second most common finding was stenosis by extrinsic compression, and among these, 75% corresponded to left main bronchus compression. Sixteen different types of clinically meaningful utilities were obtained. No mortality was reported and in only one procedure was there a major complication, which was easily managed. We concluded that FB is an important and safe diagnostic,therapeutic tool in the health care of neonates, infants, and children with a variety of cardiac diseases. Pediatr Pulmonol. 2007; 42:319,324. © 2007 Wiley-Liss, Inc. [source] Patients' attitudes and beliefs about back pain and its management after physiotherapy for low back painPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2007Stephen May Abstract Background and Purpose.,Contemporary guidelines for the management of low back pain often consider patient involvement and responsibility an essential component; however, there has been little exploration of patients' opinions about back pain and its management. Method.,A qualitative study of patients' perspectives of back pain in the UK; 34 semi-structured interviews were conducted with participants who had recently received physiotherapy for back pain; interviews were transcribed and analysed using framework analysis. A topic guide was used to steer the interview and themes were extracted from the data. Results.,Thirteen key themes were revealed; seven of these related to issues of satisfaction with physiotherapy and are described elsewhere. The six themes considered here dealt with the participants' experience of and attitudes to back pain and its management. Themes were: the impact of back pain on their life; perspectives about back pain; its management; their involvement in its management; what strategies they had for self-management; and expectations about the episode of physiotherapy beforehand. Conclusions.,In this group of participants with a history of back pain and physiotherapy treatment a common finding was a degree of acceptance of the back pain problem and the belief that patient involvement in management was essential. These findings would suggest that many patients with back pain may respond positively to the message of self-management. However, acceptance of this message was not automatic, but generally occurred gradually in line with patients' experience of back pain and treatment. Copyright © 2007 John Wiley & Sons, Ltd. [source] Fetal morbidity and mortality after acute human parvovirus B19 infection in pregnancy: prospective evaluation of 1018 casesPRENATAL DIAGNOSIS, Issue 7 2004Martin Enders Abstract Objective To determine more precisely the incidence of fetal complications following maternal parvovirus B19 infection at various gestational ages. Methods An observational prospective study of 1018 pregnant women whose acute B19 infection was serologically confirmed in our laboratory. Results The observed rate of fetal death throughout pregnancy was 6.3% (64/1018) (95% confidence interval [CI]: 4.9, 8.0). The fetal death rate for those infected within the first 20 weeks of gestation (WG) was 64/579 (11.0%). Fetal death was only observed when maternal B19 infection occurred before the completed 20 WG. The observed stillbirth proportion was 0.6% (6/960). Three of six stillbirth cases presented with fetal hydrops. The overall risk of hydrops fetalis was 3.9% (40/1018) (95% CI: 2.8, 5.3). Three of 17 cases with non-severe hydrops and 13 of 23 cases with severe hydrops received intrauterine transfusion(s). The proportion of fetuses with severe hydrops that survived following fetal transfusions was 11/13 (84.6%). All of the non-transfused fetuses with severe hydrops died. Conclusion Our data demonstrate a relevant B19-associated risk of fetal death, which is largely confined to maternal B19 infection in the first 20 WG. Timely intrauterine transfusion of fetuses with severe hydrops fetalis reduces the risk of fetal death. Parvovirus B19-associated stillbirth without hydropic presentation is not a common finding. Copyright © 2004 John Wiley & Sons, Ltd. [source] The role of international design orientation and market intelligence in the export performance of US machine tool companiesR & D MANAGEMENT, Issue 2 2000Alan MacPhersonArticle first published online: 17 DEC 200 This paper looks at the role of product design in the export performance of US manufacturing firms in the machine tool (MT) industry. Evidence from a survey of 173 MT companies points to stronger export results among firms that initiate the design process with respect to the needs of foreign buyers. In contrast, firms that enter foreign markets with products that were originally designed for domestic clients typically exhibit weaker export sales. Firms in the latter category spend less on market intelligence than their more internationally-oriented counterparts. For both groups of firms, however, a common finding is that recent interest in export expansion has been driven by rising import penetration (loss of domestic market share). The paper concludes with a brief discussion of the implications of the empirical results for future research on export marketing. [source] The Use of Stereotaxic Core Biopsy and Stereotaxic Aspiration Biopsy as Diagnostic Tools in the Evaluation of Mammary CalcificationTHE BREAST JOURNAL, Issue 6 2000Joan F. Cangiarella MD Abstract: We compared stereotaxic fine needle aspiration biopsy (SFNA) with stereotaxic core needle biopsy (SCB) in the evaluation of radiographically clustered mammary microcalcification, a common finding at screening mammography. Over a 4-year period, 181 specimens were obtained from 175 patients who underwent both SFNA and SCB of clustered microcalcification. Aspiration and core biopsies were performed by radiologists at a community-based diagnostic radiology facility. All aspiration smears were air dried, stained on site, and assessed for adequacy by the radiologists, then sent to the cytopathologists at New York University for interpretation. Core biopsy specimens were formalin fixed, paraffin embedded, hematoxylin and eosin stained, and interpreted by surgical pathologists at a community hospital. Of 181 SFNA specimens, 133 (74%) were benign, 18 (10%) were atypical, 13 (7%) were suspicious, and 16 (9%) were malignant. One (0.5%) aspiration biopsy was nondiagnostic. Excisional biopsies were performed after 12 benign SFNAs and in 46 of the 47 cases with an atypical, suspicious, or malignant diagnosis on SFNA. Mammographic follow-up in 111 of the 133 cases (92%) diagnosed as benign showed no radiologic change (mean 29.2 months, range 6,60 months). The false-negative rate for cancer was 4% (6 cases) for SFNA alone. There were no false-positive diagnoses for SFNA. There was one false-positive diagnosis on core biopsy [focal cribriform ductal carcinoma in situ (DCIS)], which at excisional biopsy and correlation with the core biopsy was diagnosed as ductal hyperplasia; the false-negative rate for cancer was 8% (13 cases) for SCB alone. Aspiration biopsy identified calcification in 180 procedures, core needle biopsy revealed calcification in 170. SFNA was superior to SCB for the confirmation of clustered mammary microcalcification (99% versus 94%) and in the identification of cancer associated with microcalcification (false negative rate of 4% versus 8%). Patients with benign findings on stereotaxic aspiration and core biopsy can reasonably be followed mammographically. [source] Effectiveness of Adenotonsillectomy in the Resolution of Nocturnal Enuresis Secondary to Obstructive Sleep ApneaTHE LARYNGOSCOPE, Issue 6 2005Suzanne Basha MD Abstract Objectives: To investigate the relationship between obstructive sleep apnea (OSA) syndrome and nocturnal enuresis (NE) in patients who required tonsillectomy or adenoidectomy. Study Design: Retrospective chart review with prospective collection of data. Methods: All charts of patients ages 2 to 18 years that had tonsillectomy or adenoidectomy over a 44 month period were reviewed for presence of NE and indication for surgery. Those patients with a positive history of both NE and OSA were surveyed to determine whether there was no change in enuresis, decreased enuresis, or no enuresis postoperatively. Results: Three hundred twenty-six children who had undergone tonsillectomy or adenotonsillectomy had data regarding enuresis available in their charts. One hundred seven of these 326 (32.8%) children had a positive history of enuresis. Of the 107 children with a positive history, 44 (41.1%) were female, and 63 (58.9%) were male. All 107 children with enuresis underwent adenotonsillectomy for OSA. None of the children who had a history of recurrent adenotonsillitis or chronic tonsillitis reported enuresis as a presenting symptom. Of the 107 children with a positive preoperative history of NE, 57 (53.3%) agreed to participate in the second phase of the study. Postoperatively, 61.4% (35) of the children were free of enuresis, 22.8% (13) had a decrease in enuresis, and 15.8% (9) had no change in enuresis. A chi-square test showed a statistically significant difference among the groups (P < .0001). Conclusions: NE is a relatively common finding in children with OSA symptoms. NE resolves or markedly improves in the vast majority of these patients postoperatively. [source] Activation of innate immunity by prostate specific antigen (PSA),THE PROSTATE, Issue 15 2006James A. Kodak Abstract BACKGROUND Prostate specific antigen (PSA) is a serine protease secreted by the prostatic epithelium. The only known function of the protein is to cleave seminogelin. We wished to determine if PSA activated peripheral blood mononuclear cells (PBMC). METHODS PBMC and selected sub-populations were cultured with purified PSA. Secretion of IFN, was measured by cytokine capture flow cytometry and enzyme-linked immunosorbent assay. RESULTS We observed secretion of IFN, and a proliferative response in PBMC cultured with PSA. We found that NK cells were the source of the IFN, but NK cells were not directly stimulated by PSA. Rather, a soluble factor secreted primarily by CD14 monocytes in response to PSA stimulated NK cells to secrete IFN,. DISCUSSION PSA induces a pro-inflammatory response that results in the secretion of INF, by NK cells. The presence of large amounts of PSA could contribute to the common finding of inflammatory infiltrates in the prostate. Prostate 66: 1592,1599, 2006. Published 2006 Wiley-Liss, Inc. [source] Identification of QTL for dorso-caudal chronic pleuritis in 12 crossbred porcine familiesANIMAL GENETICS, Issue 5 2010V. R. Gregersen Summary Pleuropneumonia is a major problem in pig production. At the time of slaughter, chronic pleuritis (CP) developed from pleuropneumonia is a common finding, and breeding for a reduced incidence of CP using marker-assisted selection (MAS) would be advantageous. Before applying MAS, quantitative trait loci (QTL) or markers associated with the prevalence of CP should be identified. In this study, 7470 pigs from crosses between 12 Danish Duroc boars and 604 sows (Danish Landrace × Danish Large White) were evaluated for CP located on the dorso-caudal part of the lungs. Quantitative trait loci were identified within boar families using both a Binomial logistic regression method and a chi-square test of association. Significant QTL for CP were detected on Sus scrofa chromosomes (SSC) 2, 8, 12, 13, 14 and 18 using both methods. One QTL on SSC 8 was also detected across families. For the QTL identified within families, the odds-ratio of having CP was approximately twice as high for the unfavourable allele compared to the favourable one. These QTL and closely linked markers show promise for the development of gene-specific markers associated with a reduced incidence of CP located on the dorso-caudal part of the lungs. [source] Incidence of open-angle glaucoma in central SwedenACTA OPHTHALMOLOGICA, Issue 7 2008Curt Ekström Abstract. Purpose:, To estimate the incidence rate of open-angle glaucoma (OAG) in a population in which pseudoexfoliation is a common finding. Methods:, A population-based survey of 760 people aged 65,74 years was conducted in the municipality of Tierp, in central Sweden, during 1984,86. Visual fields (VFs) were tested with the Competer 350 automated perimeter. The present report concerns 711 people, all of whom participated in the survey and were not diagnosed with glaucoma. Since 1988, a follow-up study of the 530 individuals in this cohort with normal and reliable VFs has been in progress. Incident cases of OAG were identified among study participants and patients seeking medical attention at the Eye Department in Tierp. Records of prescriptions for anti-glaucoma drugs were used to search for unidentified patients. A time-weighted mean intraocular pressure (IOP) for all visits was calculated. Results:, By the end of the study in May 2006, 51 new cases of definite OAG had been identified, 31 with capsular and 20 with chronic simple glaucoma. Of these, 46 cases were detected in the follow-up study, corresponding to an incidence of 7.11 (95% confidence interval 5.06,9.17) per 1000 person-years. Twelve of the 51 cases were classified as normal-tension glaucoma, all of which were found in the follow-up study. Open-angle glaucoma with a mean IOP , 23 mmHg tended to emerge closer to the baseline examination than OAG with a mean IOP < 23 mmHg. Conclusions:, The incidence of OAG was high compared with that reported for other studies conducted in White populations. [source] Isolated extraocular muscle involvement as the ophthalmic manifestation of leukaemiaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2009Hayyam Kiratli MD Abstract Background:, Clinical and imaging features of patients with orbital leukaemia primarily involving extraocular muscles were evaluated. Methods:, This retrospective case series includes patients with leukaemia whose only ophthalmic manifestation was extraocular muscle enlargement. Demographic data, clinical information on the systemic disease, prominent ocular signs and symptoms, computed tomography and magnetic resonance imaging characteristics, treatments applied and the outcomes were collected. Results:, Five patients were diagnosed as leukaemic infiltration of extraocular muscle between 1995 and 2008. The age at presentation ranged between 3 and 61 years. Acute myeloid leukaemia was the diagnosis in two patients, and chronic lymphocytic leukaemia, chronic myeloid leukaemia and biphenotypic acute leukaemia were found in one patient each, respectively. One patient had bilateral involvement. The lateral rectus muscle was affected in four patients and the superior rectus muscle in one case. Restricted ocular motility was the most common finding. In one patient who had no prior history of leukaemia, an incisional biopsy established the diagnosis. All patients received multi-agent chemotherapy. Four patients expired after a rapid decline of the systemic status within a mean period of 7 months. Conclusions:, Leukaemic infiltration of extraocular muscles is a rare and late manifestation of the advanced disease associated with relapse and there seems to be a predilection for the lateral rectus muscle. Systemic prognosis remains dismal despite intensive chemotherapy. [source] Rest and exercise hemodynamics before and after valve replacement-A combined doppler/catheter studyCLINICAL CARDIOLOGY, Issue 1 2000G. Inselmann M.D. Abstract Background: Hemodynamic improvement is a common finding following valve replacement. However, despite a normally functioning prosthesis and normal left ventricular ejection fraction, some patients may show an abnormal hemodynamic response to exercise. Methods: In a combined catheter/Doppler study, rest and exercise hemodynamics were evaluated in 23 patients following aortic (n = 12) (Group 1) or mitral valve (n = 11) (Group 2) replacement and compared with preoperative findings. Patient selection was based on absence of coronary artery disease and left ventricular failure as shown by preoperative angiography. Cardiac output, pulmonary artery pressure, pulmonary capillary pressure, and pulmonary resistance were measured by right heart catheterization, whereas the gradient across the valve prosthesis was determined by Doppler echocardiography. Postoperative evaluation was done at rest and during exercise. The mean follow-up was 8.2 ± 2.2 years in Group 1 and 4.2 ± 1 years in Group 2. Results: With exercise, there was a significant rise in cardiac output in both groups. In Group 1, mean pulmonary pressure/capillary pressure decreased from 24 ± 9/18 ± 9 mmHg preoperatively to 18 ± 2/12 ± 4 mmHg postoperatively (p < 0.05), and increased to 43 ± 12/30 ± 8 mmHg with exercise (p < 0.05). The corresponding values for Group 2 were 36 ± 12/24 ± 6 mmHg preoperatively, 24 ± 7/17 ± 6 mmHg postoperatively (p < 0.05), and 51 ± 2/38 ± 4 mmHg with exercise (p < 0.05). Pulmonary vascular resistance was 109 ± 56 dyne·s·cm -5 preoperatively, 70 ± 39 dyne·s·cm -5 postoperatively (p < 0.05), and 70 ± 36 dyne·s·cm -5 with exercise in Group 1. The corresponding values for Group 2 were 241 ± 155 dyne·s·cm -5, 116 ± 39 dyne·s·cm -5 (p < 0.05), and 104 ± 47 dyne·s·cm -5. There was a significant increase in the gradients across the valve prosthesis in both groups, showing a significant correlation between the gradient at rest and exercise. No correlation was found between valve prosthesis gradient and pulmonary pressures. Conclusion: Exercise-induced pulmonary hypertension and abnormal left ventricular filling pressures seem to be a frequent finding following aortic or mitral valve replacement. Both hemodynamic abnormalities seem not to be determined by obstruction to flow across the valve prosthesis and may be concealed, showing nearly normal values at rest but a pathologic response to physical stress. [source] The GH,IGF-I axis and the cardiovascular system: clinical implicationsCLINICAL ENDOCRINOLOGY, Issue 3 2008Annamaria Colao Summary Background, GH and IGF-I affect cardiac structure and performance. In the general population, low IGF-I has been associated with higher prevalence of ischaemic heart disease and mortality. Both in GH deficiency (GHD) and excess life expectancy has been reported to be reduced because of cardiovascular disease. Objective, To review the role of the GH,IGF-I system on the cardiovascular system. Results, Recent epidemiological evidence suggests that serum IGF-I levels in the low-normal range are associated with increased risk of acute myocardial infarction, ischaemic heart disease, coronary and carotid artery atherosclerosis and stroke. This confirms previous findings in patients with acromegaly or with GH-deficiency showing cardiovascular impairment. Patients with either childhood- or adulthood-onset GHD have cardiovascular abnormalities such as reduced cardiac mass, diastolic filling and left ventricular response at peak exercise, increased intima-media thickness and endothelial dysfunction. These abnormalities can be reversed, at least partially, after GH replacement therapy. In contrast, in acromegaly chronic GH and IGF-I excess causes a specific cardiomyopathy: concentric cardiac hypertrophy (in more than two-thirds of the patients at diagnosis) associated to diastolic dysfunction is the most common finding. In later stages, impaired systolic function ending in heart failure can occur, if GH/IGF-I excess is not controlled. Abnormalities of cardiac rhythm and of cardiac valves can also occur. Successful control of acromegaly is accompanied by decrease of the left ventricular mass and improvement of cardiac function. Conclusion, The cardiovascular system is a target organ for GH and IGF-I. Subtle dysfunction in the GH,IGF-I axis are correlated with increased prevalence of ischaemic heart disease. Acromegaly and GHD are associated with several abnormalities of the cardiovascular system and control of GH/IGF-I secretion reverses (or at least stops) cardiovascular abnormalities. [source] Segmental colonic transit studies: comparison of a radiological and a scintigraphic methodCOLORECTAL DISEASE, Issue 4 2007E. Lundin Abstract Objective, Colonic transit studies are used to diagnose slow transit constipation (STC) and to evaluate segmental colonic transit before segmental or subtotal colectomy. The aim of the study was to compare a single X-ray radio-opaque marker method with a scintigraphic technique to assess total and segmental colonic transit in patients with STC. Method, Thirty-one female patients (median age 46 years) with severe constipation and a prolonged or borderline prolonged colonic transit time on radio-opaque marker study were included in the study. They were subsequently investigated with 111Indium-DTPA colonic transit scintigraphy, with a median time between the investigations of 4(range 1,27) months. Normal values of healthy female controls were used for comparison. Results, There was no difference between the two methods in terms of prolonged or normal total colonic transit time. Twenty-nine of 31 female patients had a prolonged transit time only in one or two segments on the marker study. On scintigraphy, the transit time was prolonged for patients in the left (P < 0.05 to P < 0.001), but not in the right colon. With respect to prolonged or normal segmental transit time, there was a significant difference between the two methods only in the descending colon (P = 0.02). However, the results varied considerably for individual patients. Conclusion, Segmental colonic delay was a common finding. The two methods gave similar results for groups of patients, except in the descending colon. The variation of the results for individuals suggests that a repeated transit test may improve the assessment of total and segmental transit. [source] Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature reviewDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010Akihiko Kawahara C.T., C.M.I.A.C., Ph.D. Abstract Cystadenocarcinoma is a rare malignant tumor, with an estimated incidence of 2% of malignant salivary gland tumors. Cytological diagnosis of cystadenocarcinoma is important for differential diagnosis between benign lesions and malignant tumors with cystic growth. We report a case of cystadenocarcinoma causing difficulty in cytological diagnosis. A 23-year-old man presented with an asymptomatic mass in the left parotid gland that had been present for 2 years. The mass was elastic hard, measuring 30 × 35 mm in diameter. Preoperative fine-needle aspiration cytology (FNAC) showed a small number of tumor cell clusters in the cystic fluid. The cluster was arranged in a ball-like structure and was cohesive with overlapping. Tumor cells had a small vacuolated, soap-bubble appearance in the cytoplasm. The papillary-cystic variant of acinic cell carcinoma (ACC-PCV) was suggested from these findings on FNAC. Histologically, the tumor was not encapsulated, but formed large cystic spaces against a background of fibrous connective tissue. The tumor cells in the cystic dilated duct showed papillary structures, which were continuous with the lining cuboidal cells. There was neither a definite double-layered arrangement in cystic ducts and solid islands nor histological findings characteristic of the papillary-cystic or follicular pattern of ACC-PCV. As tumor cells with a small vacuolated, soap-bubble appearance of the cytoplasm are common findings of both cystadenocarcinoma and ACC-PCV, they are of little use for differentiation; however, they are so characteristic that the majority of benign salivary gland lesions with cystic structures can be excluded, if enough attention is paid. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis: a case series of nine patients and review of the literatureINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2007Camille E. Introcaso MD Background, Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis (NFD/NSF) is a fibrosing cutaneous disorder recently recognized to have systemic manifestations. The disease is characterized clinically by an acute onset of hardening and thickening of the skin of the extremities and trunk, often resulting in flexion contractures, and histologically by an increase in spindle-shaped cells, collagen, and sometimes mucin deposition in the dermis. The only common exposure amongst patients is acute or chronic renal failure. The pathophysiology of the disease remains to be elucidated, and there is currently no consistently effective treatment for this unremitting disease. Methods, We report a case series of nine patients seen at the University of Pennsylvania between 1998 and mid-2004. The clinical, laboratory, and pathologic data of these patients are reviewed. Results, All patients had renal disease, received peritoneal or hemodialysis, and five had received at least one renal transplant. All patients had characteristic fibrotic cutaneous lesions involving the trunk, extremities, or both, and eight of the nine patients had scleral plaques. There were no other common findings amongst the histories, medications, or laboratory results of the patients. Conclusion, Our report confirms the clinical and histologic characteristics of NFD that have been described previously, and raises new issues regarding the possible subtypes. A review of the current literature stresses that further basic science and translational studies are necessary to understand the disease mechanism and to propose effective therapy, and emphasizes the importance of recognizing the systemic effects of NFD. [source] Spontaneous splenic haematoma in a multiple myeloma patient receiving pegfilgrastim supportINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2006E. HATZIMICHAEL Summary Growth factors are a significant advance in the supportive care of patients with cancer with a wide range of indications. Frequent side effects of G-CSF include bone pain, headache, fatigue and nausea. We report a case of subcapsular splenic haematoma following pegfilgrastim administration in a 65-year old patient with multiple myeloma. Proposed mechanisms accounting for splenic enlargement include extramedullary haemopoiesis, intrasplenic infiltration by mature and immature myeloid cells and intrasplenic stem cell homing and proliferation. The risk of spontaneous splenic rupture is difficult to quantify. Physicians should be aware of this life-threatening condition and early diagnosis can be difficult since anemia and splenomegaly are common findings in haematologic patients. [source]
| | ||||||||||||||||||||||||||||||