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Considerable Risk (considerable + risk)
Selected AbstractsResidual risk for acute stroke in patients with type 2 diabetes and hypertension in primary care: Skaraborg Hypertension and Diabetes ProjectDIABETES OBESITY & METABOLISM, Issue 5 2006K. Junga Aim:, The aim of this study was to investigate the risk of acute stroke in subgroups of patients treated for hypertension and type 2 diabetes in primary care. Methods:, Patients with hypertension only (n = 695), type 2 diabetes only (n = 181) or both (n = 240), who consecutively attended an annual control in primary care in Skara, Sweden during 1992,1993, were evaluated for cardiovascular disease risk factors and enrolled in this study. Subjects with neither hypertension nor type 2 diabetes (n = 824) who participated in a population survey in the same community served as controls. Possible events of acute stroke through 2002 were validated using hospital records and death certificates. Results:, During a mean follow-up time of 8.4 years, 190 first events of acute stroke, fatal or non-fatal, were ascertained. Risk factor levels were generally higher in all patient categories than in controls. Stroke risk was significantly increased in all male patients: hazard ratio 4.2 (95% CI 2.1,8.4) in patients with both conditions, 3.3 (1.5,7.0) in those with type 2 diabetes alone and 2.8 (1.5,5.3) in those with hypertension alone (adjusted for age, total cholesterol, current smoking, BMI and physical activity). Corresponding findings in women were 2.9 (1.5,5.8) in patients with type 2 diabetes only and 2.4 (1.2,4.7) in those with both conditions. However, in women with hypertension only, a significant risk was seen first when subjects were truncated at 85 years of age. There were too few fatal stroke events for conclusive results on stroke mortality. Conclusions:, A considerable risk of acute stroke remains in patients with type 2 diabetes and hypertension. Strategies for stricter multiple risk factor interventions should be implemented in primary care. [source] Salvage treatment for recurrent oropharyngeal squamous cell carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2010Christof Röösli MD Abstract Background. This study evaluates the oncological outcome of patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after primary radiation therapy ± chemotherapy, primary surgical therapy, and surgical therapy followed by radiation therapy ± chemotherapy. Methods. A total of 156 patients (36%) of a cohort of 427 treated for OPSCC between 1990 and 2006 developed recurrent disease. Fifty-one patients (12%) qualified for salvage treatment. Study endpoints were 5-year overall survival (OS) and disease-specific survival (DSS). Results. The 5-year OS and DSS rates after salvage treatment were 29% and 40%; after initial primary radiation therapy, 25% and 40%; after initial surgery followed by radiation therapy, 40% and 40%; and after initial surgery alone, 20% and 40%. Conclusions. Patients with an advanced OPSCC have a considerable risk for recurrence. Despite poor ultimate outcome, salvage treatment should be attempted in patients with resectable disease, good performance status, and absence of distant metastases. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source] Survival of Salmonella in bathrooms and toilets in domestic homes following salmonellosisJOURNAL OF APPLIED MICROBIOLOGY, Issue 1 2000J. Barker The survival and environmental spread of Salmonella bacteria from domestic toilets was examined in homes, where a family member had recently suffered an attack of salmonellosis. In four out of six households tested, Salmonella bacteria persisted in the biofilm material found under the recess of the toilet bowl rim which was difficult to remove with household toilet cleaners. In two homes Salmonella bacteria became incorporated into the scaly biofilm adhering to the toilet bowl surface below the water line. Salmonella enteritidis persisted in one toilet for 4 weeks after the diarrhoea had stopped, despite the use of cleaning fluids. Salmonellas were not isolated from normally dry areas such as, the toilet seat, the flush handle and door handle. Toilet seeding experiments were set up with Salmonella enteritidis PT4 to mimic environmental conditions associated with acute diarrhoea. Flushing the toilet resulted in contamination of the toilet seat and the toilet seat lid. In one out of three seedings, Salmonella bacteria were also isolated from an air sample taken immediately after flushing, indicating that airborne spread of the organism could contaminate surfaces in the bathroom. In the seeded toilet Salmonella bacteria were isolated from the biofilm in the toilet bowl below the waterline for up to 50 d after seeding, and also on one occasion from the bowl water. The results suggest that during diarrhoeal illness, there is considerable risk of spread of Salmonella infection to other family members via the environment, including contaminated hands and surfaces in the toilet area. [source] Involvement with peers: comparisons between young children with and without Down's syndromeJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 5 2002M. J. Guralnick Abstract Background It has been well established that heterogeneous groups of young children with mild intellectual disability are at considerable risk of becoming socially isolated from their peers in school, home and community settings. Method Matched groups of young children with and without Down's syndrome (DS) were compared in terms of the children's involvement with peers, maternal arranging and monitoring of peer play, and maternal beliefs about inclusion. Results Despite aetiology-specific expectations for children with DS, no differences were found for a variety of measures of peer involvement focusing on the frequency of contacts and the characteristics of children's peer social networks. Maternal arranging of activities with peers was similarly related to peer involvement for both groups of children. Higher ratings of the benefits of inclusion were obtained from mothers of children with DS, but these maternal beliefs were unrelated to maternal arranging or peer involvement. Conclusions Parental adaptations to the aetiology-specific behavioural patterns of children and the general influence of children's experiences within a developmental framework are discussed in the context of interpreting aetiology-specific findings. [source] Risk of hepatitis A infection following travelJOURNAL OF VIRAL HEPATITIS, Issue 6 2002M. Ciccozzi summary.,Travel to endemic areas is one of the most frequently reported risk factors for infection with the hepatitis A virus (HAV). We evaluated the association between HAV infection and travel, by area of destination. We conducted a case,control study on all cases of HAV infection reported to the Italian National Surveillance System for Acute Viral Hepatitis in the period 1996,2000. The study population consisted of 9695 persons with HAV infection (cases) and 2590 with HBV infection (controls). The risk of acquiring HAV was highest for travel to Asia, Africa and Latin America [Odds Ratio=9.30 (95%CI=6.71,12.9)]; a three-fold statistically significant excess of risk was found for travel to southern Italy (OR=3.03) and to the Mediterranean Area and Eastern Europe (OR=3.15). Travel was implicated in 28% of the cases of HAV infection. When stratifying the analysis by area of residence (northern and central Italy vs southern Italy and the Islands), the above-mentioned risks were confirmed only for those residing in northern and central Italy, with no significant risk for those residing in southern Italy and the Islands. Travel to areas endemic for HAV infection constitutes a considerable risk. Our results highlight the importance of developing health policies for improving environmental and hygienic conditions, as well as the prevention of certain eating habits. Vaccination before travelling to a medium or high endemic area could be a safe and effective means of preventing travel-related HAV infection. [source] Spinal anesthesia for emergency abdominal surgery in uncontrolled hyperthyroidismACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2005A. Varela Patients with uncontrolled hyperthyroidism presenting as an emergency are at considerable risk. The anesthetic management of a thyrotoxic patient undergoing incidental emergency surgery is discussed. We focus on the intraoperative problems and, above all, postoperative pain management with regional anesthesia. [source] The Ablation of Atrial Fibrillation with the Loop Catheter Design: What We Have Learned From the Animal ModelPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2001BOAZ AVITALL AVITALL, B., et al.: The Ablation of Atrial Fibrillation with the Loop Catheter Design: What We Have Learned From the Animal Model. Ablation of chronic atrial fibrillation (AF) with the use of transcutaneous catheter ablation is yet to become a clinical tool. This article summarizes the development of the technology and the technique for the ablation of AF that was tested on the rapidly paced AF dog model. The current ablation technology using the standard ablation technique used in humans is not suitable for the creation of transmural contiguous linear lesions, and such technology is subjecting the patient to the prolonged procedures with considerable risk of complication. The use of the loop catheter design or other designs of ablation technology, which is specifically targeted for the creation of linear lesions, should be developed if the catheter approach for the ablation of AF is to succeed. This article describes the data available for the loop catheter design that is currently undergoing human feasibility studies. [source] Emanuel Miller Lecture: Early onset depressions , meanings, mechanisms and processesTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 12 2008Ian M. Goodyer Background:, Depressive syndromes in children and adolescents constitute a serious group of mental disorders with considerable risk for recurrence. A more precise understanding of aetiology is necessary to improve treatment and management. Methods:, Three neuroactive agents are purported to be involved in the aetiology of these disorders: serotonin, brain-derived neurotrophic factor and cortisol. A literature review was conducted to determine their contributions to the emergence of unipolar depressions in the adolescent years. Results:, Serotonin, brain-derived neurotrophic factor and cortisol may operate in concert within two distinct functional frameworks: atypical early epigenesis arising in the first few years of life and resulting in the formation of a vulnerable neuronal network involving in particular the amygdala and ventral prefrontal cortex. Individuals with this vulnerability are likely to show impaired mood regulation when faced with environmental demands during adolescence and over the subsequent decades; and acquired neuroendangerment, a pathological brain process leading to reduced synaptic plasticity, in particular in the hippocampus and perhaps the nucleus accumbens and ventral tegmentum. This may result in motivational, cognitive and behavioural deficits at any point in the lifespan most apparent at times of environmental demand. Conclusions:, The characteristics, course and outcome of a depressive episode may depend on the extent of the involvement of both atypical early neurogenesis and acquired neuroendangerment. [source] Increased Expression of Laminin-5 and Its Prognostic Significance in Hypopharyngeal Cancer,THE LARYNGOSCOPE, Issue 7 2004Meijin Nakayama MD Objectives: We investigated the clinicopathologic significance of laminin-5 ,2 chain (LN,2) expression in 26 surgically removed hypopharyngeal cancers and compared the results with conventional prognostic factors elicited from hematoxylin-eosin (H&E) stained whole-mount laryngeal sections. Study Design: Stainability of LN,2 was mainly evaluated at the invasive front of the cancer nests. Scoring was performed on the basis of a semiquantitative scale defined according to the number of immunopositive cancer cells (score 3, 2, 1, and 0). Stainability of LN,2 was also evaluated macroscopically at different tumor locations such as surface center, interstitial space, and invasive front. Status of cartilage and vascular invasion and patterns of tumor extension were evaluated from H&E stained sections. The results of LN,2 expression correlated with the tumor stages, neck node status, pathologic differentiation, and prognoses. Results: Among the 26 cases, 24 demonstrated positive LN,2 expression. Of these cases, 1, 14, 9, and 0 showed scores of 3, 2, 1, and 0, respectively. Positive expression of LN,2 at the invasive front was more prominent in the high-expression group, and surface center was often positive in the cases of low-expression group. Among the H&E stained prognostic factors, vascular invasion and infiltrative pattern demonstrated significant correlations with clinical outcome. Vascular invasion and infiltrative pattern were also closely related to positive LN,2 expression. Five-year survival rates of patients who showed high LN,2 expression were significantly poorer than in patients with low expression. Conclusion: Hypopharyngeal cancers positive for LN,2 indicate a considerable risk for cancer progression and are closely related to prognosis. Increased LN,2 expression might be a prognostic indicator for squamous cell carcinomas of the hypopharynx. [source] THE CONUNDRUM OF CLAUDICATIONANZ JOURNAL OF SURGERY, Issue 10 2006Ramon L. Varcoe Stable claudication has traditionally been treated conservatively by many clinicians as operative therapies involve considerable risk for a condition that is often slowly progressive and non-fatal. The relative safety of less invasive endovascular techniques brings potential survival benefits from the increased exercise tolerance that result. We aimed to revisit and clarify the aetiologies of intermittent claudication in a review of the rarer causes that can mimic atherosclerotic occlusive disease. An extensive search of Medline, Embase and the Cochrane databases was carried out to compile published work addressing the aetiology of claudication and specific non-atherosclerotic causes. The reference lists of these manuscripts were also searched for relevant articles. There are several vasculogenic and neurogenic causes for intermittent claudication, many of which are unrelated to atherosclerosis. Recognition of these rarer syndromes is essential when planning endovascular or operative management strategies. Consideration of non-atherosclerotic differential diagnoses is recommended when assessing the patient with intermittent claudication. This is particularly critical in the young patient whose pattern of symptoms and risk factors may not fit precisely with atherosclerosis. [source] Efficacy and Safety of Anticoagulation With Heparin Versus Heparin Plus Epoprostenol in Patients Undergoing Extracorporeal Liver Support With PrometheusARTIFICIAL ORGANS, Issue 1 2010Peter Krisper Abstract Anticoagulation for extracorporeal liver support is delicate due to underlying coagulation disorders in patients with liver failure and to the associated elevated bleeding risk. To date, there has been no detailed report on anticoagulation issues in patients treated with Prometheus, a device based on the principle of fractionated plasma separation and adsorption. We studied 17 patients from two centers treated with Prometheus, comparing standard anticoagulation with heparin (15 treatments) and a combination of heparin and the synthetic prostacyclin epoprostenol (22 treatments). Standard coagulation tests, proteins C and S, and thrombin,antithrombin (TAT) complex were determined, and adverse events were recorded. All but two treatments could be completed as scheduled, although filter exchange due to filter clotting was required in 24% of the treatments. Three out of 17 patients developed severe bleeding complications within 24 h of treatment. There were no overt thrombotic events. Addition of epoprostenol neither reduced coagulation-related adverse events nor improved standard coagulation parameters. Protein C, but not protein S, showed a significant reduction (23 ± 18%) after Prometheus treatments, but levels rebounded to baseline within 18 h. TAT levels,a measure for activation of coagulation,were only altered by Prometheus in patients where TAT was already elevated before treatment. In conclusion, anticoagulation of Prometheus with heparin is feasible but still associated with a relatively high frequency of filter clotting and a considerable risk of severe bleeding in this high-risk patient population. As addition of epoprostenol did not prove beneficial, other strategies, such as regional anticoagulation with citrate, should be further evaluated. [source] The feasibility of recruiting young men in rural areas from community football clubs for STI screeningAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2007Judy Gold Abstract Objective: To investigate the feasibility of recruiting young men from rural football clubs for screening for sexually transmitted infections (STIs). Methods: Young men aged 16 to 29 were recruited from four football clubs outside of metropolitan areas in Victoria, Australia, and completed a questionnaire about sexual activity, knowledge and history of STIs, and alcohol and drug use, and provided a urine sample for STI testing. Results: One hundred and eight participants completed the questionnaire and 92 (85.2%) also provided a urine sample. More than 90% of eligible players present at the clubs on the night of the study participated. Eighty-seven participants (80.6%) had ever had penetrative sex, with 33 (39.3%) reporting a new sexual partner in the past three months. Among those who had ever had sex, the prevalence of chlamydia was 3.9% (95% CI 0.8-11.0). While the majority of participants visited their doctor in the past year (78.7%) and were comfortable with the idea of an annual STI screen, few had ever discussed sex or STIs with their doctor or had a previous STI test. Conclusion: Young men from rural areas may be at considerable risk of STIs and many have not been previously tested. However, most are willing to participate in screening programs and the high participation rate achieved in this pilot project demonstrates the potential for screening to be successfully extended into non-medical settings such as sporting clubs. Implications: Young people at risk of STIs can be successfully recruited for STI screening from community settings. [source] Long-term outcome for men with teratoma found at postchemotherapy retroperitoneal lymph node dissection,CANCER, Issue 6 2009Robert S. Svatek MD Abstract BACKGROUND: Patients with pure teratoma within the postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimen traditionally have been considered at low risk for disease progression. The objectives of this study were to determine the disease-related outcomes of patients who had pure teratoma identified at the time of PC-RPLND and to examine the prognostic value of clinical variables that were identified previously as important predictors of disease recurrence in these patients. METHODS: Between 1980 and 2003, 97 patients with metastatic nonseminomatous germ cell tumor and pure teratoma histology at the time of PC-RPLND were identified. The medical records of these patients were reviewed retrospectively for pertinent clinical and treatment-related outcomes. RESULTS: At a median follow-up of 7.4 years, 21 patients (22%) developed recurrent disease after PC-RPLND. The 5-year and 10-year probabilities (±standard error) of freedom from disease recurrence were 81% ± 4% and 76% ± 5%, respectively. The postchemotherapy ,-fetoprotein (AFP) level and mediastinal involvement at presentation were statistically significant predictors of disease recurrence on multivariate analysis. Nine of 97 patients (9.3%) died from testis cancer, and 4 patients died from other causes. CONCLUSIONS: In patients with pure teratoma histology at PC-RPLND, mediastinal involvement at presentation and the presence of an elevated AFP level before PC-RPLND predicted an unfavorable outcome. The absence of mediastinal involvement and normal AFP level, however, did not confirm freedom from disease recurrence. Patients who had teratoma at the time of PC-RPLND remained at considerable risk for disease progression because of the unpredictable nature of teratoma and the presence of unrecognized, active germ cell disease outside the retroperitoneum. Cancer 2009. © 2009 American Cancer Society. [source] Expression of estrogen receptor, progesterone receptor, and insulin-like growth factor receptor-1 and of MIB-1 in patients with recurrent pleomorphic adenoma of the parotid glandCANCER, Issue 8 2002Afina S. Glas M.D. Abstract BACKGROUND Patients with recurrent pleomorphic adenomas of the parotid gland are difficult to manage without considerable risk of facial nerve injury. The prognostic significance of progesterone receptor (PR) and estrogen receptor (ER) reported in these adenomas was evaluated in patients with recurrent pleomorphic adenomas, comparing the results in a group of patients with primary adenomas without recurrences during 10 years of follow-up. METHODS Paraffin embedded tumor samples from 52 patients with recurrent pleomorphic adenoma of the parotid gland were collected and stained immunohistochemically. Expression of PR, ER, Ki-67 antigen, and insulin-like growth factor receptor-1 (IGFR-1) was analyzed in resected samples of recurrent tumors and was compared with samples from a control group of patients with primary pleomorphic adenoma. RESULTS A difference (P < 0.05) in the type of tumor was observed between the recurrent group (more cell-poor variants) and the control group. ER expression was low in both groups (19% and 17%, respectively), but immunoreactivity for ER was higher (48%) in normal parotid gland tissue. PR expression in the recurrent group (96%) was higher compared with PR expression in the control group (61%; P < 0.001). PR expression and IGFR-1 expression were correlated weakly (correlation coefficient = 0.660; P = 0.053) in the recurrent group. The expression of growth fraction (Ki-67 score) and IGFR-1 was similar in both groups but was more extensive compared with normal parotid gland tissue. CONCLUSIONS PR seems to be a prognostic factor in recurrent pleomorphic adenoma of the parotid gland. The PR pathway can be considered a potential target for hormone treatment in patients with these recurrent adenomas. Cancer 2002;94:2211,16. © 2002 American Cancer Society. DOI 10.1002/cncr.10445 [source] Combined catheter ventricular septal defect closure and multivessel coronary stenting to treat postmyocardial infarction ventricular septal defect and triple-vessel coronary artery disease: A case reportCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2004Rajaram Anantharaman Abstract Ventricular septal defect following acute myocardial infarction is a rare but life-threatening complication. Early surgical closure improves survival but carries a considerable risk. Percutaneous transcatheter closure is an alternative but experience to date is limited. We report a case of successful transcatheter closure of postmyocardial infarction ventricular septal defect (VSD) in a 55-year-old male with the Amplatzer muscular VSD occluder device and complete percutaneous revascularization with successful multivessel coronary stenting for three-vessel disease as a staged procedure. The technique and its potential use as an alternative to surgical approach for treatment of acute myocardial infarction and its complication (VSD) are discussed. Catheter Cardiovasc Interv 2004;63:311-313 © 2004 Wiley-Liss Inc. [source] A Strategic Approach to Multistakeholder NegotiationsDEVELOPMENT AND CHANGE, Issue 2 2001David Edmunds Environment and development practitioners increasingly are interested in identifying methods, institutional arrangements and policy environments that promote negotiations among natural resource stakeholders leading to collective action and, it is hoped, sustainable resource management. Yet the implications of negotiations for disadvantaged groups of people are seldom critically examined. We draw attention to such implications by examining different theoretical foundations for multistakeholder negotiations and linking these to practical problems for disadvantaged groups. We argue that negotiations based on an unhealthy combination of communicative rationality and liberal pluralism, which underplays or seeks to neutralize differences among stakeholders, poses considerable risks for disadvantaged groups. We suggest that negotiations influenced by radical pluralist and feminist post-structuralist thought, which emphasize strategic behaviour and selective alliance-building, promise better outcomes for disadvantaged groups in most cases, particularly on the scale and in the historical contexts in which negotiations over forest management usually take place. [source] Natural Resources and Regional Development: An Assessment of Dependency and Comparative Advantage ParadigmsECONOMIC GEOGRAPHY, Issue 1 2003Thomas Gunton Abstract: The role of natural resources in regional development is the subject of a debate between dependency theorists, who argue that natural resources impede development, and comparative-advantage theorists, who argue that resources can expedite development. This debate is assessed by a case study analysis of the impact of resource development on a regional economy. The case study uses a model to estimate the comparative advantage of the resource sector. The results show that natural resources have the potential to provide a significant comparative advantage relative to other economic sectors by virtue of generating resource rent, which is a surplus above normal returns to other factors of production. The case study also shows that there are considerable risks in resource-led growth, including the propensity to dissipate rent and increase community instability by building surplus capacity. These risks are amenable to mitigation because they are largely the result of poor management of resource development. The case study demonstrates that the most productive analytical approach for understanding the role of natural resources in the development process is a synthetic approach, which combines the insights of the dependency and comparative-advantage paradigms into a unified framework. It also demonstrates that the concept of resource rent, which has frequently been ignored in development theory, must be reintegrated into the unified framework to improve the understanding of the role of natural resources in the regional development process. [source] Experiences of alcohol drinking among Swedish youths with type 1 diabetesEUROPEAN DIABETES NURSING, Issue 1 2009A Leger RN Diabetes Nurse Abstract Background: Alcohol consumption in Europe and North America is greatest in 18,25-year-olds. This behaviour can be seen as a transitional stage from childhood to adulthood, where consuming alcohol is perceived as a typical feature of adult behaviour. Youths often start to consume alcohol when they are 14,15 years of age, and one in five youngsters around 15 years of age report binge drinking. Studies of alcohol consumption among youths with type 1 diabetes have not been undertaken but it is well known that, in these people, alcohol drinking can cause hypoglycaemia and worsen the capacity to feel and interpret the symptoms of hypoglycaemia. Aim: The overall aim was to explore experiences of alcohol consumption among youths with type 1 diabetes. Another objective was to identify strategies as to how they deal with situations when they drink alcohol. Methods: Semistructured interviews with ten 18-year-old youths with type 1 diabetes, using Burnard's content analysis method. Results: This study illustrates that informants strive for security, independence and control. Frequency of binge drinking did not seem to differ from rates in other teenagers. Informants exposed themselves to considerable risks and many had met with serious incidents. Moreover, the result exemplifies how symptoms of diabetic ketoacidosis (such as nausea and vomiting) can easily be misinterpreted as a hang-over or gastroenteritis. Informants lacked age-appropriate knowledge about diabetes and the effects of alcohol, but had tested things out themselves; some involved their friends in their diabetes treatment. Moreover, three strategies occurred with the aim of normalisation and security: the 'low-consumption' strategy, the ,ambitious' strategy and the ,rather-high-than-dead' strategy. Fear of hypoglycaemia was a significant concern and the consequence was poor diabetes control. Conclusion: To increase youths' independence and security, the diabetes care team should provide adequate and relevant information about alcohol. Treatment plans might contain practical steps such as advice about responsible alcohol intake and adjustments of insulin and meals, and could also encourage young people with diabetes to carry diabetes ID and inform friends about hypoglycaemia (and how to handle situations involving alcohol). Copyright © 2009 FEND [source] | ||||||||||||||||||||||