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Selected AbstractsLongitudinal development of hand function in children with unilateral cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2010MARIE HOLMEFUR PHD REG OT Aim The aim of this study was to describe how the usefulness of the hemiplegic hand develops in children with unilateral cerebral palsy (CP) aged between 18 months and 8 years. Method A prospective longitudinal study of 43 children (22 males, 21 females) with unilateral CP was conducted. Inclusion age was 18 months to 5 years 4 months (mean 2y 8mo [SD 1y 1mo]). Children were assessed with the Assisting Hand Assessment (AHA) 3 to 11 times per child over a mean period of 4 years 6 months. Two models were used for grouping children: by AHA score at 18 months and by Manual Ability Classification System (MACS) levels. Estimated average motor development curves were fitted with a nonlinear mixed-effects model. Results Children with a high AHA score (high ability level) at 18 months reached a significantly higher ability level and at a higher progression rate than children with a low 18-month AHA score. Limits of development differed between the three MACS levels. Interpretation Results indicate that the AHA score at 18 months can be used to discuss future development of affected hand use in bimanual tasks in children with unilateral CP. [source] Long-term follow-up of achalasic patients treated with botulinum toxinDISEASES OF THE ESOPHAGUS, Issue 2 2000D'Onofrio Botulinum toxin A (BoTx), a potent inhibitor of acetylcholine release from nerve endings both within the myenteric plexus and at the nerve,muscle junction, has been shown to decrease the lower esophageal sphincter (LES) pressure in patients with achalasia. Because of this property, the esophageal injection of BoTx has been suggested as an alternative treatment in achalasia. The objective of this study was to determine the long-term efficacy and safety of intrasphincteric injection of BoTx in a group of achalasic patients. Nineteen patients (mean age 56.1 ± 19.2 years) were enrolled in the study. All of them were injected endoscopically with 100 U of BoTx by sclerotherapy needle at different sites of the LES. Symptom score (dysphagia, regurgitation and chest pain, each on a 0,3 scale), esophageal manometer and esophageal radionuclide emptying were assessed before the treatment and at 4 weeks, 3 months and 1 year after BoTx injection. In case of failure or relapse (symptom score >2), the treatment was repeated. All but five patients (74%) were in clinical remission at 1 month. Mean symptom score after 1 month of BoTx decreased from 7.1 ± 0.9 to 2.2 ± 2.5 (p < 0.05). LES pressure decreased from 38.4 ± 13.7 to 27.4 ± 13.5 mmHg (p < 0.05) and 10-min radionuclide retention decreased from 70.9 ± 20.7% to 33.8 ± 27.0% (p < 0.05). Side-effects (transient chest pain) were mild and infrequent. At 12 months, the clinical score was 0.9 ± 0.5 (p < 0.05 vs. basal); mean LES pressure was 22.0 ± 7.1 (p < 0.05 vs. basal) and 10-min radionuclide retention was 15.8 ± 6.0% (p < 0.05 vs. basal). The efficacy of the first injection of BoTx lasted for a mean period of 9 months (range 2,14 months). At the time of writing (follow-up period mean 17.6 months, range 2,31), 14 patients (10 with one injection) were still in remission (74%). Our results showed that one or two intrasphincteric injections of BoTx resulted in clinical and objective improvement in about 74% of achalasic patients and are not associated with serious adverse effects; the efficacy of BoTx treatment was long lasting; this procedure could be considered an attractive treatment, especially in elderly patients who are poor candidates for more invasive procedures. [source] Active Vegetations Can Be Differentiated from Chronic Vegetations by Visual Inspection of Standardized Two-Dimensional EchocardiogramsECHOCARDIOGRAPHY, Issue 2 2000PH.D., TAHIR TAK M.D. The ability to differentiate active from chronic valvular vegetations (VEGs) by digital image processing and by visual observation was evaluated in 18 patients with a clinical diagnosis of infective endocarditis (IE). Two-dimensional echocardiographic (2-DE) examinations were performed on all patients at diagnosis and after a mean period of 52 days. Two comparable images (active and chronic) from the same patient and in the same phase of the cardiac cycle were digitized, magnified, and displayed on a high resolution monitor. The mean pixel intensity (MPI) was 72 ± 14 in the active stage and 143 ± 23 in the chronic stage (P < 0.0001). The VEG size was 0.64 ± 0.15 cm2 in the active stage and decreased to 0.46 ± 0.17 cm2 in the chronic stage (P < 0.001). Two experienced echocar-diographers, who were blinded to the age of the VEGs, identified each echocardiographic image as active or chronic based on visual observation of density of the VEGs. The VEGs were correctly identified as active or chronic in 17 out of the 18 patients. In summary, although digital image processing of 2-DE may be useful, the density of VEGs assessed by visual inspection will help differentiate between active and chronic VEGs of IE. The standardization procedure at the time of the initial study and use of identical gain settings in subsequent studies are key factors in making this distinction. [source] Dysautonomia after severe traumatic brain injuryEUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2010H. T. Hendricks Background:, Dysautonomia after traumatic brain injury (TBI) is characterized by episodes of increased heart rate, respiratory rate, temperature, blood pressure, muscle tone, decorticate or decerebrate posturing, and profuse sweating. This study addresses the incidence of dysautonomia after severe TBI, the clinical variables that are associated with dysautonomia, and the functional outcome of patients with dysautonomia. Methods:, A historic cohort study in patients with severe TBI [Glasgow Coma Scale (GCS) , 8 on admission]. Results:, Seventy-six of 119 patients survived and were eligible for follow-up. The incidence of dysautonomia was 11.8%. Episodes of dysautonomia were prevalent during a mean period of 20.1 days (range 3,68) and were often initiated by discomfort. Patients with dysautonomia showed significant longer periods of coma (24.78 vs. 7.99 days) and mechanical ventilation (22.67 vs. 7.21 days). Dysautonomia was associated with diffuse axonal injury (DAI) [relative risk (RR) 20.83, CI 4.92,83.33] and the development of spasticity (RR 16.94, CI 3.96,71.42). Patients with dysautonomia experienced more secondary complications. They tended to have poorer outcome. Conclusions:, Dysautonomia occurs in approximately 10% of patients surviving severe TBI and is associated with DAI and the development of spasticity at follow-up. The initiation of dysautonomia by discomfort supports the Excitatory: Inhibitory Ratio model as pathophysiological mechanism. [source] Treatment results of bisphosphonate-related osteonecrosis of the jaws,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2008Arno Wutzl MD Abstract Background. Osteonecrosis of the jaws occurs after the administration of bisphosphonates. An unequivocal treatment strategy is yet to be devised. We assess the treatment of patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ). Methods. The investigators studied a prospective cohort of 58 patients 6 months after surgical treatment of BRONJ. Outcome variables were the status of the mucosa, the visual analog score of pain, and prosthetic rehabilitation. Preoperative staging results were compared with the postoperative outcome and statistically evaluated. Results. Of 58 patients, 41 surgically treated patients could be followed up after a mean period of 189 (±23) days. Twenty-four (58.5%) were free of pain and had an intact mucosa. A statistically significant improvement was registered between preoperative and postoperative staging (p <.01); 11 of 12 patients who had been treated with a flap procedure for soft tissue closure had an intact mucosa. Conclusions. This is the first prospective study to report the outcome of treatment in a cohort of patients with BRONJ. Minimal resection of necrotic bone and local soft tissue closure might be a feasible treatment strategy in patients with established BRONJ. © 2008 Wiley Periodicals, Inc. Head Neck 2008 [source] Mass balance of a slope glacier on Kilimanjaro and its sensitivity to climateINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 7 2008Thomas Mölg Abstract Meteorological and glaciological measurements obtained at 5873 m a.s.l. on Kersten Glacier, a slope glacier on the southern flanks of Kilimanjaro, are used to run a physically-based mass balance model for the period February 2005 to January 2006. This shows that net shortwave radiation is the most variable energy flux at the glacier-atmosphere interface, governed by surface albedo. The majority of the mass loss (,65%) is due to sublimation (direct conversion of snow/ice to water vapour), with melting of secondary importance. Sensitivity experiments reveal that glacier mass balance is 2,4 times more sensitive to a 20% precipitation change than to a 1 °C air temperature change. These figures also hold when the model is run with input data representative of a longer term (1979,2004) mean period. Results suggest that a regional-scale moisture projection for the 21st century is crucial to a physically-based prediction of glacier retention on Africa's highest mountain. Copyright © 2007 Royal Meteorological Society [source] Synoptic climatological influences on the spatial and temporal variability of aerosols over North AmericaINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 6 2006Helen C. Power Abstract The spatial and temporal variability of atmospheric aerosols is not well understood, as most studies have been constrained to data sets that include few stations and are of short duration. Furthermore, all methods for quantifying atmospheric turbidity suffer from a major constraint in that they require cloudless sky conditions. This restriction produces gaps in the turbidity record and sampling bias, which has led to questionable inferences about the variability of aerosols. In this research, we address these concerns via analyses at scales broader than all previous studies. We analyzed the spectral aerosol optical depth at 500 nm (,a5) and Ångström's wavelength exponent (,), which represents the relative size distribution of aerosols. A total of 27 sites, with a mean period of record of 7.3 years, are included. Beyond seasonal and spatial summaries of aerosol variability, we have divided observations by synoptic condition, utilizing the Spatial Synoptic Classification (SSC). Our results show that atmospheric turbidity across North America is greatest over the east. Seasonality of both parameters was shown, most notably a greater ,a5 during summertime. Utilizing the SSC, we have uncovered significant differences across weather types. Moist weather types, especially moist tropical, display considerably higher turbidity, while the colder, drier dry polar weather type is associated with low aerosol optical depth. Certain weather types show considerable seasonal variability; the dry tropical weather type is associated with relatively low values in winter, but high values in summer, when convection is significant. Cluster analyses of stations yielded three general regions, each with similar synoptic variability: a western cluster with low aerosol optical depth and minimal synoptic variability, an eastern cluster with higher turbidity and variability, and a cluster located on the periphery of the eastern cluster, associated with moderate levels of turbidity but very high variability, suggesting a varied influence of nearby industrial areas. Copyright © 2006 Royal Meteorological Society. [source] Prevalence and clinical significance of antineutrophil cytoplasmic antibody in Graves' patients treated with propylthiouracilINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2009M.Ozduman Cin Summary Development of antineutrophil cytoplasmic antibody (ANCA) during therapy with propylthiouracil (PTU) is not uncommon and PTU-induced ANCA-positive vasculitis is also reported. The aim of this study was to assess the presence and clinical significance of ANCA positivity in Graves' patients treated with PTU. Newly diagnosed Graves' disease patients (prospective group, n = 58) were evaluated before and during therapy with PTU to investigate the development of ANCA positivity. ANCA positivity is also investigated in previously diagnosed Graves' patients who had already been receiving PTU treatment (cross-sectional group, n = 51). Comparisons with Hashimoto thyroiditis (n = 55) and toxic nodular goitre (n = 20) patients, and healthy control subjects (n = 20) were carried out to define the possible influence of hyperthyroidism and/or thyroid autoimmunity on ANCA positivity. At baseline evaluation, ANCA was negative in all newly diagnosed Graves' patients. Only 28 of the 58 patients in prospective group completed 2 years of follow-up which occurred at 3-month intervals. ANCA positivity was detected 32.1% (n = 9) in a mean period of 11.7 ± 6.1 months in prospective group. Only two (3.9%) patients in a cross-sectional group had ANCA positivity in a mean treatment period of 7.6 ± 4.6 months. None of the patients with ANCA positivity developed symptoms and signs related to vasculitis. None of the patients with Hashimoto thyroiditis and toxic nodular goitre, and healthy control subjects had ANCA positivity. PTU therapy is associated with asymptomatic production of ANCA in a time-dependent manner, which mostly disappears after discontinuation of therapy. Hyperthyroidism or autoimmunity per se does not appear to have effect on development of ANCA positivity. [source] The incidence of dementia in an Australian community population: the Sydney older persons studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2001Louise M. Waite Abstract Objectives Limited Australian dementia incidence data are available. This study aimed to identify the incidence of dementia and its subtypes in an Australian community dwelling population. Method A community dwelling sample of 647 subjects aged ,75 years at recruitment were followed for a mean period of 3.2 years (range 2.6,4.5 years). The incidence of dementia (measured in person years at risk) was identified for different levels of severity of dementia, Alzheimer's disease and vascular dementia. Results Incidence figures were slightly higher than those previously reported. The incidence of dementia and of Alzheimer's disease increased with age but was not affected by gender. The incidence of vascular dementia was not affected by age. Conclusion This study provides the largest body of data on the incidence of dementia in Australia, indicating a slightly higher incidence of dementia than previous reports. Further Australian data are required to confirm these findings. Copyright © 2001 John Wiley & Sons, Ltd. [source] Does Mediastinitis Affect the Graft Patency?JOURNAL OF CARDIAC SURGERY, Issue 3 2005Denyan Mansuro, lu M.D. There are many studies that have focused on the graft patency. But, till now, no study has been done to detect the effects of mediastinitis to graft patency. So, we aimed to detect the effect of mediastinitis on the graft patency in patients who have undergone coronary artery bypass surgery. Sixteen of 45 patients who have been operated upon for coronary artery bypass surgery and developed mediastinitis, which was treated with open drainage and mediastinal irrigation with late wound closure, were included in the study. The mean age of the patients was 55 ± 11 (range 35,69) and nine of the patients were male. The graft patency was evaluated with control coronary angiographies after a mean period of 30.42 ± 43.17 months (range 1,132). The left internal thoracic artery was patent in all patients (100%). Right internal thoracic artery patency rate was 50% (1/2). One individual bypassed radial artery was patent, whereas the sequential bypassed graft was occluded. The patency ratio of radial artery anastomosis was 33% (1/3). Twelve of the 17 saphenous vein grafts were patent (70.58%). The total number of patent distal anastomosis was 30/38 (78.94%). When compared with the graft patency of patients without infection, it was found that mediastinitis does not affect the graft patency rates adversely. [source] Natural course of hepatic focal nodular hyperplasia: A long-term follow-up study with sonographyJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2009Yuan-Hung Kuo MD Abstract Purpose. We aimed to investigate the natural course of hepatic focal nodular hyperplasia (FNH) in a long-term follow-up study with sonography. Method. This study comprised 30 patients (24 women and 6 men) with 34 FNHs. Diagnosis of FNH was made using color Doppler sonography, contrast-enhanced CT, or MRI in combination with needle biopsy. Patients were followed every 3 to 6 months with sonography. Regression or progression of tumor was defined as a change of over 30% in maximal diameter. Disappearance was defined as no vizualization of the tumor on at least 3 follow-up sonographic examinations. Results. Thirty-four FNHs were followed over a mean period of 42 months (range, 7,95 months). Twenty-four lesions (70.6%) were stable in size, 1 (2.9%) progressed, and 9 (26.5%) regressed. Of those that regressed, 6 (17.6%) disappeared over a mean period of 59 ± 30 months (range, 20,95 months). Older age (OR 1.26, 95% CI 1.02,1.56; p < 0.05) and longer follow-up time (OR 1.11, 95% CI 1.01,1.21; p < 0.05) were the independent factors associated with complete regression of FNH. Conclusion. Most FNHs were stable or regressed/disappeared after a long follow-up period. Based on the benign course, conservative treatment for asymptomatic FNH should be advocated. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound 2009. [source] Mesalazine with or without cholestyramine in the treatment of microscopic colitis: Randomized controlled trialJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2007Carlo Calabrese Abstract Background:, Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic inflammatory diseases of the colon with a benign and sometimes relapsing course. Frequency among patients with chronic diarrhea and normal looking colonoscopy is around 10,15%. To date, treatment of CC and LC is not well defined. Data about these conditions are mostly derived from retrospective studies. The aim of the present study was to evaluate the response to treatment and the clinical course of CC and LC in a large group of patients prospectively diagnosed. Methods and Results:, A total of 819 patients underwent a colonoscopy because of chronic watery diarrhea and among them we found 41 patients with LC and 23 with CC. These patients were later randomized and assigned to treatment with mesalazine or mesalazine + cholestyramine for 6 months. Fifty-four patients (84.37%) had resolved diarrhea in less than 2 weeks. After 6 months a colonoscopy with biopsies was repeated. Clinical and histological remission was achieved in 85.36% of patients with LC and in 91.3% with CC, with a better result in patients with CC treated with mesalazine + cholestyramine. During a mean period of 44.9 months, 13% of patients relapsed; four with LC and three with CC. They were retreated for another 6 months. At the end of this period one patient with CC was still symptomatic and persistence of CC was confirmed at histology. Conclusions:, Treatment with mesalazine seems to be an effective therapeutic option for LC to date, while mesalazine + cholestyramine seems to be more useful in the treatment of CC. [source] Oral pre-cancer and the associated risk factors among industrial workers in Japan's overseas enterprises in the UKJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 5 2003Toru Nagao Abstract Background: ,Screening at industries has been advocated as a method of early detection for cancer. This study describes the prevalence of oral pre-cancerous lesions and other mucosal diseases following oral mucosal screening, and associated risk factors among Japanese industrial workers in the UK. Methods: ,Oral mucosal screening was by invitation at 51 industrial locations in the UK. A self-administered questionnaire was used to record socio-behavioural factors and frequency of daily intake of fruits and vegetables. Results: ,Four hundred and eighty-four subjects attended for oral mucosal screening (mean age 39.9 ± 8.3 years) and their mean period of residence in UK was 5.3 ± 4.5 years. 63.4% examined were male. 31.3% of males and 26.6% of females smoked daily. The gender differences were striking compared with Japan's national rates. A higher proportion of managerial staff was regular heavy (20+ per day) smokers. The intake of more than five portions per day of vegetables and/or fruits during the weekend was significantly higher in females than in males (P = 0.022). One hundred and six subjects (22%) were detected with oral mucosal lesions, including 16 leukoplakia lesions (3.3%) and three with oral lichen planus (1%). The rate of positive detections was higher in managers (7.5%). Odds ratios were estimated by socio-behavioural variables. Among subjects positive for oral leukoplakia, managers accounted for 68.8% (OR 5.26; 95% CI, 1.24,22.29). 87.5% of subjects detected with oral leukoplakia smoked daily and had done so for the past 10 years (OR 28.40; 95% CI, 5.63,143.28). Though regular alcohol drinking was a common feature among male leukoplakia cases, heavy alcohol misuse was not encountered. None reported an intake of five or more portions of fruits or vegetables. Conclusions: ,The Japanese nationals working in managerial positions in the UK and daily regular smokers in the industries visited were found to be at a high risk of oral pre-cancer. Regular dental/oral check up and tobacco education programmes are encouraged for oral cancer/pre-cancer control in industrial settings. [source] Main mutations in the hepatitis B virus basic core promoter (A1762T/G1764A) before HBeAg loss are markers that identify patients who will require long-term treatmentALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010D. Tabernero Aliment Pharmacol Ther 2010; 32: 97,104 Summary Background, Some patients continue to have detectable HBV-DNA levels with liver disease progression after hepatitis B e antigen (HBeAg) loss. It is important to identify these patients, candidates for long-term treatment. Aims, To evaluate hepatitis B virus (HBV) genotype and the main mutations in the basic core promoter (BCP, A1762T/G1764A) and precore (G1896A) sequences as markers of persistent HBV-DNA after HBeAg loss. Methods, We analysed 60 serum samples from 20 Caucasian, HBeAg-positive, chronic hepatitis B patients, who lost HBeAg and were followed-up longitudinally. HBV genotype and precore and BCP mutations were determined before, at the time of, and after HBeAg loss. Results, After HBeAg loss, eight (40%) patients continued to have undetectable HBV-DNA and 12 (60%) had persistent HBV-DNA (median level 4.7 log10 copies/mL). The presence of BCP mutations prior to therapy was the only variable associated with persistently detectable viraemia (P = 0.017). Four patients with genotype A and no mutations in the BCP region experienced hepatitis B surface antigen (HBsAg) loss after a mean period of 35 months from baseline. Conclusions, Main BCP mutations in HBeAg-positive patients are useful markers to identify patients who will not have sustained virological suppression after HBeAg loss and therapy discontinuation and could benefit from long-term treatment. [source] Leprous neuropathy: a clinical and neurophysiological studyJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2004E Ghiglione Leprosy is one of the most common treatable causes of neuropathy in the world. Peripheral nerves and skin are commonly affected. We reported the clinical features and electrophysiological findings in 46 patients with leprosy. The aim of our study was to evaluate the nature of damage in the nerve fibres, especially in the first phase of disease. Forty-six patients (mean age: 44.8 ± 17.8) with diagnosed leprosy were studied by neurological examination and nerve conduction studies (NCS). Twenty-eight patients were examined for a mean period of 34.8 months. The number of tests for patients varied from 1 to 13 controls. Amplitude of sensory and motor action potentials (SNAP and MAP), sensory-motor conduction velocity of median, ulnar, tibialis, peroneal and sural nerves were evaluated. Abnormalities were found in 282 of 647 nerves investigated (37.56%), sensory nerve abnormalities being more frequent than motor (50.16% 29.45). Of 282 nerves with neurophysiological abnormalities, 123 were clinically asymptomatic (43.62%). A statistically significant correlation between duration of disease and number of electrophysiological abnormalities was demonstrated. In 19 nerves partial "conduction-block"(reduction of cMAP > 50% in the proximal response) was individuated. The first electrophysiological alteration, suggesting segmental demyelination, was detected in 41 nerves of 21 patients (33.3 %). According to this view, our data support the hypothesis that leprosy induces a neuropathy of demyelinating nature in the first phase. [source] Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation?LIVER TRANSPLANTATION, Issue 7 2001048 liver transplantations with a mean follow-up of 6 years, prognostic factors in Tacrolimus has proven to be a potent immunosuppressive agent in liver transplantation (LT). Its introduction has led to significantly less frequent and severe acute rejection. Little is known about the rate of chronic rejection (CR) in primary LT using tacrolimus therapy. The aim of the present study is to examine the long-term incidence of CR, risk factors, prognostic factors, and outcome after CR. The present study evaluated the development of CR in 1,048 consecutive adult primary liver allograft recipients initiated and mostly maintained on tacrolimus-based immunosuppressive therapy. They were evaluated with a mean follow-up of 77.3 ± 14.7 months (range, 50.7 to 100.1 months). To assess the impact of primary diagnosis on the rate and outcome of CR, the population was divided into 3 groups. Group I included patients with hepatitis C virus (HCV)- or hepatitis B virus (HBV)-induced cirrhosis (n = 312); group II included patients diagnosed with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), or autoimmune hepatitis (AIH; n = 217); and group III included patients with all other diagnoses (n = 519). Overall, 32 of 1,048 patients (3.1%) developed CR. This represented 13 (4.1%), 12 (5.5%), and 7 patients (1.3%) in groups I, II, and III, respectively. The relative risk for developing CR was 3.2 times greater for group I and 4.3 times greater for group II compared with group III. This difference was statistically significant (P = .004). The incidence of acute rejection and total number of acute rejection episodes were significantly greater in patients who developed CR compared with those who did not (P < .0001). Similarly, the mean donor age for CR was significantly older than for patients without CR (43.0 v 36.2 years; P = .02). Thirteen of the 32 patients (40.6%) who developed CR retained their original grafts for a mean period of 54 ± 25 months after diagnosis. Seven patients (21.9%) underwent re-LT, and 12 patients (38.3%) died. Serum bilirubin levels and the presence of arteriopathy, arterial loss, and duct loss on liver biopsy at the time of diagnosis of CR were significantly greater among the 3 groups of patients. In addition, patient and graft survival for group I were significantly worse compared with groups II and III. We conclude that CR occurred rarely among patients maintained long term on tacrolimus-based immunosuppressive therapy. When steroid use is controlled, the incidence of acute rejection, mean donor age, HBV- and/or HCV-induced cirrhosis, or a diagnosis of PBC, PSC, or AIH were found to be predictors of CR. Greater values for serum bilirubin level, duct loss, arteriopathy, arteriolar loss, and presence of HCV or HBV were found to be poor prognostic factors for the 3 groups; greater total serum bilirubin value (P = .05) was the only factor found to be significant between patients who had graft loss versus those who recovered. [source] The analysis of indexed astronomical time series , X. Significance testing of O,C dataMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 2 2006Chris Koen ABSTRACT It is assumed that O,C (,observed minus calculated') values of periodic variable stars are determined by three processes, namely measurement errors, random cycle-to-cycle jitter in the period, and possibly long-term changes in the mean period. By modelling the latter as a random walk, the covariances of all O,C values can be calculated. The covariances can then be used to estimate unknown model parameters, and to choose between alternative models. Pseudo-residuals which could be used in model fit assessment are also defined. The theory is illustrated by four applications to spotted stars in eclipsing binaries. [source] Atrial Evoked Response Integral for Automatic Capture Verification in Atrial PacingPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p2 2003GIUSEPPE BORIANI BORIANI, G.,et al.:Atrial Evoked Response Integral for Automatic Capture Verification in Atrial Pacing. Beat-by-beat Autocapture is currently limited to operation in the ventricle with bipolar leads. The authors investigated the integral of the negative-going portion of the atrial evoked response integral (AERI) as a potential resource for verification of atrial capture. Intracardiac electrogram signals were collected from 59 patients (ages 67.8 ± 15.1 years) with bipolar, low polarization atrial leads. The signals were collected over a mean period of 6.1 months (minimum 4 days) after lead implantation. St. Jude Medical Affinity pulse generators were used to perform automatic capture threshold tests while the electrogram signals were recorded by a Model 3510 programming device. These signals were transferred to a personal computer in digital form for later analysis. The AERI was calculated at each programmable pacing voltage until capture was lost. The difference between the polarization integral at loss of capture and evoked response integral with successful capture was sufficient to justify enabling the atrial Autocapture feature in 53 of 59 patients in whom bipolar pacing and unipolar sensing was performed. The authors developed a calibration routine to identify automatically those patients in whom atrial Autocapture could be programmed On, based on the polarization integral at loss of capture, the estimated maximum polarization integral, and the AERI. Preliminary analysis indicated that the AERI is a practical resource for beat-by-beat atrial capture detection when used with low polarization leads. (PACE 2003; 26[Pt. II]:248,252) [source] Feasibility of Pulmonary Vein Ostia Radiofrequency Ablation in Patients with Atrial Fibrillation: A Multicenter Study (CACAF Pilot Study)PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p2 2003GIUSEPPE STABILE STABILE, G., et al.: Feasibility of Pulmonary Vein Ostia Radiofrequency Ablation in Patients with Atrial Fibrillation: A Multicenter Study (CACAF Pilot Study)Radiofrequency (RF) catheter ablation has been proposed as a treatment of atrial fibrillation (AF). Several approaches have been reported and success rates have been dependent on procedural volume and operator's experience. This is the first report of a multicenter study of RF ablation of AF. We treated 44 men and 25 women with paroxysmal(n = 40)or persistent(n = 29), drug refractory AF. Circular pulmonary vein (PV) ostial lesions were deployed transseptally, during sinus rhythm(n = 42)or AF(n = 26), under three-dimensional electroanatomic guidance. Cavo-tricuspid isthmus ablation was performed in 27 (40%) patients. The mean procedure time was215 ± 76minutes (93,530), mean fluoroscopic exposure32 ± 14minutes (12,79), and mean number of RF pulses per patient56 ± 29(18,166). The mean numbers of separate PV ostia mapped and isolated per patient were3.9 ± 0.5, and3.8 ± 0.7, respectively. Major complications were observed in 3 (4%) patients, including pericardial effusion, transient ischemic attack, and tamponade. At 1-month follow-up, 21 of 68 (31%) patients had had AF recurrences, of whom 8 required electrical cardioversion. After the first month, over a mean period of9 ± 3(5,14) months, 57 (84%) patients remained free of atrial arrhythmias. RF ablation of AF by circumferential PV ostial ablation is feasible with a high short-term success rate. While the procedure and fluoroscopic exposure duration were short, the incidence of major cardiac complications was not negligible. (PACE 2003; 26[Pt. II]:284,287) [source] Assessment of right ventricular diastolic filling parameters by Doppler echocardiographyPEDIATRICS INTERNATIONAL, Issue 3 2003Ayten Pamukcu Uyan AbstractBackground: Right ventricular diastolic function has been evaluated in various diseases by the pulsed Doppler technique. Right ventricular diastolic filling parameters show changes with age, heart rate and respiration. Evidences of diastolic left and right ventricular dysfunctions have been reported by echocardiographic studies in asthmatic patients. In the present study, before and after treatment of asthma the right ventricular diastolic filling parameters were compared in children with moderate asthma by Doppler echocardiography (a non-invasive technique). Methods: The study group consisted of 20 children (eight girls, 12 boys) with asthma. During the present study these patients were treated with inhaled steroid and beta-2 agonist daily. Before treatment all patients were evaluated by Doppler echocardiography. At 4,6 weeks after treatment 15 patients that had shown improvement in their symptoms according to the symptom score were also evaluated by Doppler echocardiography. Results: The mean age was 8.6 ± 2.69 years and mean period of symptoms were 56.4 ± 35.8 months. When compared with results of echocardiography before and after treatment, the right ventricular diastolic filling parameters (acceleration time: P < 0.01, deceleration time: P < 0.01 and isovolumetric relaxation time: P < 0.05) were found to be significantly different. Conclusions: We observed significant improvement of right ventricular diastolic filling parameters by Doppler echocardiography after treatment in children with asthma. [source] Water deprivation tolerance and humidity response in a larval dragonfly: a possible adaptation for survival in drying pondsPHYSIOLOGICAL ENTOMOLOGY, Issue 2 2007MANUELA REBORA Abstract Water deprivation tolerance is investigated in the last larval stadium of Libellula depressa under various conditions of relative humidity (60,100% relative humidity; RH). Most of the larvae maintained at 100% RH emerge and, at lower RH levels show some resistance to dehydration because they die after a mean period ranging from 1.4 days at 60% RH up to 6.7 days at 90% RH. In dual-choice chambers with humidity gradients from 63,74% RH and from 68,84% RH, larvae spend most of the time in the moist side of the chamber. In a Y-tube olfactometer, the larvae reveal a positive hygrotaxis to two airstreams carrying different amounts of water vapour (98% vs. 50%) and spend most of their time in the ,humid' arm. The ecological significance of desiccation tolerance and hygropositive response in the last larval stadium of L. depressa is discussed in relation to the presence of hygroreceptors in dragonfly larvae. [source] The use of basal insulin (NPH) compared with pre-mixed biphasic insulin in patients with type 2 diabetes mellitusPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2007A single centre experience Abstract The aim of this retrospective study was to compare glycaemic control and weight gain in patients with type 2 diabetes (T2DM) commenced on basal insulin (BI) or mixed insulin (MI). Subjects had T2DM (mean duration seven years) poorly controlled while treated with oral hypoglycaemic agents. Two hundred patients (BI 131 [65%], MI 69 [35%], median age 60 years [range 30,97]) were investigated. Follow up was over a mean period of 3.8 years. Patients started on BI had a significantly lower HbA1c (mean 10.6% vs 11.1%, p = 0.007) and higher body mass index (31.8kg/m2vs 29.6, p = 0.005) compared to those on MI. At 3.5 years patients injecting BI were on a lower daily dose of insulin (BI 66.6units vs MI 99.1units, p = 0.02) and a higher proportion were taking metformin (88% vs 62%, p = 0.01). There was no significant difference in HbA1c (8.5% vs 8.4%, p = 0.36) at the end of follow up. At 2.5 years subjects injecting BI had less weight gain (BI mean 4.0kg vs MI mean 8.0kg, p = 0.02). At 3.5 years the difference in weight gain was not statistically significant (mean 5.0kg vs 7.8kg, p = 0.20). In our experience BI, used in combination with metformin, is an effective treatment option in patients with T2DM, maintains glycaemic control over long-term follow up and is associated with less weight gain than MI. Copyright © 2007 John Wiley & Sons. [source] Use of the 70-Degree Diamond Burr in the Management of Complicated Frontal Sinus Disease,THE LARYNGOSCOPE, Issue 2 2004Rakesh K. Chandra MD Abstract Objectives/Hypothesis: Management of frontal sinus disease may require drill-out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches. Study Design: Retrospective review. Methods: The authors describe the use of a 70-degree diamond burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance. Results: The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill-out procedure, despite a pre-existing frontoethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow-up (mean period, 9.3 mo). Conclusion: Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70-degree diamond burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches. [source] The Long-Term Evaluation of Tracheostomy in the Management of Severe Obstructive Sleep Apnea,THE LARYNGOSCOPE, Issue 2 2003Gentry W. Thatcher MD Abstract Objective To determine the long-term success and morbidity of tracheostomies for patients with severe obstructive sleep apnea. Study Design A retrospective study of patients who have undergone tracheostomy for documented obstructive sleep apnea at Hennepin County Medical Center since 1979. Methods Retrospective chart review of all tracheostomy patients operated January 1, 1979, to June 30, 1999, were evaluated. Follow-up data from patient records, death certificates, and DMV. Results Seventy-nine patients (70 men and 9 women; age range, 25,70 y; mean age, 47 y) received tracheostomies at a regional sleep disorder center. Respiratory distress index ranged from 45 to 146 (mean value, 81). Tracheostomy eliminated obstructive sleep apnea in all cases. Follow-up ranged from 3 months to 20 years (mean period, 8.3 y). In all, 16 patients had decannulation (range, 2 mo to 13 y): 5 of the patients chose continuous positive airway pressure, 3 grew intolerant of their tracheostomy, 3 had obstructive sleep apnea fully resolve after uvulopalatopharyngoplasty, 3 unknown diagnosis for decannulation, 2 had significant weight loss. Morbidity seen within the first year was primarily limited to granulation tissue, infection, and stoma revision. Fourteen deaths were identified. Average age at time of death was 62 years. Five deaths were cardiopulmonary related, four were from cancer, two were from postoperative complications of unrelated surgery, and one was from aspiration. Tracheostomy-related mortality included one postoperative myocardial infarction and one tracheal-innominate fistula. Conclusion Severe obstructive sleep apnea and its comorbid conditions are effectively treated in the long term with tracheostomy. Initial management of more frequent complication is well tolerated. Significant morbidity and mortality are low. Chances of obstructive sleep apnea resolution allowing decannulation remain poor. [source] Usefulness of PCR Strategies For Early Diagnosis of Chagas' Disease Reactivation and Treatment Follow-Up in Heart TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2007M. Diez Heart transplantation (HTx) is a useful therapy for end-stage Chaga, cardiomyopathy; however, Chagas reactivation remains a mayor complication. Parasitological methods offer poor diagnostic sensitivity, and use of more sensitive tools such as the Polymerase chain reaction (PCR) is usually necessary. In the present study, reactivation incidence and PCR usefulness for early reactivation diagnosis, as well as for treatment response evaluation during follow-up, were analyzed using Strout parasite detection test, in 10 of 222 consecutive HTx patients suffering Chagas cardiomyopathy. PCR strategies targeted to minicircle sequences (kDNA, detection limit 1 parasite/ 10 mL blood) and miniexon genes (SL-DNA, 200 parasite/10 mL) were performed to compare parasite burdens between samples. No patients received prophylactic antiprotozoal therapy (benznidazole). Five patients (50%) exhibited clinical reactivation within a mean period of 71.6 days; positive Strout results were observed in most cases presenting clinical manifestations. kDNA-PCR was positive 38,85 days before reactivation, whereas SLDNA-PCR became positive only 7,21 days later, revealing post-HTx parasitic load enhancement present prior to clinical reactivation development. Reactivations were successfully treated with benznidazole and generated negative PCR results. Results observed in this study indicate the value of PCR testing for an early diagnosis of Chagas reactivation as well as for monitoring treatment efficacy. [source] ST Segment "Hump" during Exercise Testing and the Risk of Sudden Cardiac Death in Patients with Hypertrophic CardiomyopathyANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009Andreas P. Michaelides M.D., F.A.C.C., F.E.S.C. Background: The appearance of a discrete upward deflection of the ST segment termed "the ST hump sign" (STHS) during exercise testing has been associated with resting hypertension and exaggerated blood pressure response to exercise. Objective: We investigated the prevalence and clinical significance of this sign in a population of patients with hypertrophic cardiomyopathy. Methods: Eighty-one patients with hypertrophic cardiomyopathy (HCM) who underwent cardiopulmonary exercise testing were followed in a retrospective cohort study for a mean period of 5.3 years. Results: The appearance of the STHS at the peak of exercise testing was observed in 42 patients (52%), particularly in the inferior and the lateral leads. Patients with the STHS had higher fractional shortening and maximum left ventricular wall thickness and exhibited more frequently outflow tract gradient >30 mmHg at rest. Furthermore, the presence of STHS was a strong independent predictor of the risk of sudden cardiac death (SCD), as the latter occurred in eight of the patients with this sign (8/42, 19%) and in none of the patients without it (0/39, 0%) (P < 0.001). Conclusion: The appearance of a "hump" at the ST segment during exercise testing appears to be a risk factor for SCD in patients with HCM. However, further studies are necessary to validate this finding in larger populations and to elucidate the mechanism of the appearance of the "hump." [source] Evaluation of a 1-h exposure time to mechlorethamine in patients undergoing topical treatmentBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2002P. Foulc SummaryBackground Mechlorethamine is frequently used in the treatment of cutaneous lymphoma, but its application is limited in 30,80% of cases because of cutaneous intolerance. Reducing the concentration to avoid this side-effect has been only modestly successful. Objectives To investigate whether a shorter application period could reduce the frequency of intolerance. Methods In an open prospective study in 39 patients with cutaneous T-cell lymphoma or parapsoriasis, mechlorethamine was applied according to the usual practices of the participating physicians (number of weekly applications, treatment confined to lesions or performed over the entire body) and then washed off after 1 h in all cases. Results Cutaneous intolerance was observed in 19 of 39 patients (49%). Six of these patients showed allergic contact dermatitis to mechlorethamine after a mean period of 9·3 weeks, while the other 13 developed irritant contact dermatitis after a longer period. Cutaneous intolerance did not differ significantly according to the number of applications per week or the extent of body area treated. The therapeutic response rate was 69%, and no difference in therapeutic efficacy was noted between daily and intermittent applications. Conclusions Comparison with published studies showed no significant difference in the number of cases of cutaneous intolerance after short-term application, although their occurrence was delayed. Therapeutic response was decreased appreciably by short-term application as compared with results in the literature. [source] Relationships between ophthalmological and neuropaediatric findings in children adopted from Eastern EuropeACTA OPHTHALMOLOGICA, Issue 2 2010Marita Andersson Grönlund Abstract. Purpose:, This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe. Methods:, We studied 72 of 99 children, born during 1990,95 and adopted from Eastern Europe to western Sweden during 1993,97. The children (mean age 7.5 years, range 4.8,10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed. Results:, Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02). Conclusions:, In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe. [source] Discontinuous drug combination therapy in autoimmune ocular disordersACTA OPHTHALMOLOGICA, Issue 3 2009Jelka G. Orsoni Abstract. Purpose:, This study aimed to assess the effectiveness of a steroid-sparing immunosuppressive treatment (IST) protocol in the control of severe or steroid-resistant autoimmune ocular inflammatory diseases. Methods:, We carried out a prospective, non-randomized clinical study. Patients presenting with ocular inflammations that failed to respond adequately to steroids alone after monotherapy for a mean period of 9 ± 2 months (internal control) were offered the option to switch to a combined IST. The protocol consisted of different immunosuppressive drugs added in a stepladder sequence, where each drug (including the steroids) was administered discontinuously. Main outcome measures were control of inflammation, visual acuity and safety of treatment. Results:, A total of 76 subjects (121 affected eyes) enrolled in the IST protocol. Mean length of follow-up was 43 ± 15 months. Complete control of inflammation was achieved in 86% of patients. During the first year of IST, the rate of inflammatory recurrences/patient was 0.78 ± 1.13. This ratio diminished further during succeeding follow-up. Mean best corrected visual acuity improved from 0.31 logMAR to 0.24 logMAR (p < 0.001). Blood pressure and uric acid blood levels significantly altered for the worse in the study group. Conclusions:, Immunosuppressive treatment was effective in achieving inflammatory quiescence in a large majority of patients. The study also demonstrated the longterm safety of the protocol and its steroid-sparing effect. [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] | |||||||||||||||||||||||||||||||