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Selected AbstractsPregnancy complications associated with childhood anxiety disordersDEPRESSION AND ANXIETY, Issue 3 2004Dina R. Hirshfeld-Becker Ph.D. Abstract To determine whether perinatal complications predict childhood anxiety disorders independently of parental psychopathology, we systematically assessed pregnancy and delivery complications and psychopathology in a sample of children (mean age=6.8 years) at high risk for anxiety disorders whose parents had panic disorder with (n=138) or without (n=26) major depression, and in contrast groups of offspring of parents with major depression alone (n=47), or no mood or anxiety disorders (n=95; total N=306). Psychopathology in the children was assessed by structured diagnostic interviews (K-SADS), and pregnancy and delivery complications were assessed using the developmental history module of the DICA-P. Number of pregnancy complications predicted multiple childhood anxiety disorders independently of parental diagnosis (odds ratio=1.6 [1.4,2.0]). This effect was accounted for by heavy bleeding requiring bed-rest, hypertension, illness requiring medical attention, and serious family problems. Associations remained significant when lifetime child mood and disruptive behavior disorders were covaried. Results suggest that prenatal stressors may increase a child's risk for anxiety disorders beyond the risk conferred by parental psychopathology alone. Depression and Anxiety 19:152,162, 2004. © 2004 Wiley-Liss, Inc. [source] The epidemiology of diabetic limb sepsis: an African perspectiveDIABETIC MEDICINE, Issue 11 2002Z. G. Abbas Abstract We review the epidemiology of foot and hand sepsis in adult diabetes patients in Africa. Limb sepsis in these patients is associated with significant morbidity and mortality. The pathogenesis of diabetic foot infections in these patient populations appears to be similar to that for patients in industrialized countries ,ulcers and underlying peripheral neuropathy being the most important risk factors. Prevention of peripheral neuropathy through aggressive glycaemic control may be the most important primary control measure for foot infections. The tropical diabetic hand syndrome (TDHS) is being increasingly seen in diabetes patients in certain parts of Africa. The syndrome is acute, usually follows minor trauma to the hand, and is associated with a progressive synergistic form of gangrene. The major risk factors for TDHS are unknown but recent data suggest poor glycaemic control is associated with poor outcome. Treatment of TDHS requires aggressive surgery. Hence, preventive efforts for both foot and hand sepsis include aggressive glucose control, and education on hand and foot care and the importance of seeking medical attention promptly at the earliest onset of symptoms. Diabet. Med. 19, 895,899 (2002) [source] Time Trends in Incidence, Mortality, and Case-Fatality after First Episode of Status EpilepticusEPILEPSIA, Issue 8 2001Giancarlo Logroscino Summary: ,Purpose: Status epilepticus (SE) is a medical emergency associated with a high mortality. Clinical series have suggested that mortality after SE has decreased. No studies have systematically examined trends in incidence, mortality, and case fatality after SE in a well-defined population. Methods: All first episodes of SE receiving medical attention between January 1, 1935, and December 31, 1984, were ascertained through the Rochester Epidemiology Project Records-Linkage System and followed up until death or study termination (February 1, 1996). We calculated incidence rates in the 50-year period (1935,1984), while we considered mortality and case-fatality in the last 30-year period (1955,1984). Results: Incidence of SE increased over time to 18.1/100,000 (1975 through 1984). The increase was related to an increased incidence in the elderly and to the advent of myoclonic SE after cardiac arrest, a condition not seen in the early decades. In the last decade, ,16% of the incidence was due to myoclonic SE. The mortality rates increased from 3.6 per year in the decade 1955,1965 to 4.0/100,000 per year between 1975 and 1984. The 30-day case-fatality (CF) was unchanged, although a trend toward improvement was shown after excluding myoclonic SE. Conclusions: Incidence and mortality rates of SE have increased in the last 30 years. Case fatality remained the same. The increased incidence and mortality are due to the occurrence in the last decade of myoclonic SE after cardiac arrest. The mortality in the elderly was twice that of the youngest age group, across all study periods. Changes in the age and cause distribution of SE over time are responsible for the stable survivorship. There is improvement in survivorship in the last decade when myoclonic SE is excluded. [source] Candidate genes for panic disorder: insight from human and mouse genetic studiesGENES, BRAIN AND BEHAVIOR, Issue 2007M. Gratacňs Panic disorder is a major cause of medical attention with substantial social and health service cost. Based on pharmacological studies, research on its etiopathogenesis has been focused on the possible dysfunction of specific neurotransmitter systems. However, recent work has related the genes involved in development, synaptic plasticity and synaptic remodeling to anxiety disorders. This implies that learning processes and changes in perception, interpretation and behavioral responses to environmental stimuli are essential for development of complex anxiety responses secondary to the building of specific brain neural circuits and to adult plasticity. The focus of this review is on progress achieved in identifying genes that confer increased risk for panic disorder through genetic epidemiology and the use of genetically modified mouse models. The integration of human and animal studies targeting behavioral, systems-level, cellular and molecular levels will most probably help identify new molecules with potential impact on the pathogenetic aspects of the disease. [source] Huntington's disease with onset ages greater than 60 yearsGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2007Kunihiro Yoshida We examined five patients with late-onset Huntington's disease (HD), who developed chorea as an initial symptom at age 60 or later. The mean disease duration from the onset of chorea was approximately 8 years (range, 2,16 years). All carried expanded HD alleles with 39 or 40 CAG repeats. Cognitive or psychiatric decline was observed in four patients, the mean duration of the disease being approximately 10 years. One of them had been institutionalized in a nursing home undiagnosed for a long time. Late-onset HD patients with shorter repeat expansions may be overlooked in Japan. Non-disabling chorea, mild cognitive or psychiatric decline in such patients are sometimes unrecognized or misunderstood as aging-related phenomena, and do not come to medical attention. Considering the potential genetic risk to younger generations, however, genetic testing on such late-onset HD patients should be conducted with careful genetic counseling and psychological support for their family members. [source] Psychosocial factors involved in delayed consultation by patients with head and neck cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2005Olivier Rozniatowski DESS Abstract Background. In the north of France, a delay in primary consultation has been noted among patients with head and neck cancer. This group is often correlated with lower socioeconomic status and a lack of medical information. Therefore, the choice to seek consultation is often influenced by symptoms such as pain and change in the size of tumors in the neck. We studied this delay in seeking consultation, focusing on psychosocial variables such as professional and social background, the involvement of a spouse/partner, and the presence of anxiety and depression. Methods. Two rating scales were administered to 50 patients with large tumors (T3/T4) and 50 patients with small tumors (T1/T2), and the results were compared. These rating scales were as follows: (1) a 17-item questionnaire assessing sociodemographic data, presenting symptoms, factors generating the consultation, and reasons for delay; and (2) the Hospital Anxiety and Depression Scale (HADS). Results. Both groups were predominantly male and working-class. Significant differences were observed in time since symptom onset and in conscious delay in seeking medical attention. The group with large tumors was characterized by lower involvement of a spouse/partner, conscious delay before first consultation, greater social isolation, fewer medical visits, and lower HADS anxiety scores. The group with small tumors sought consultation sooner and was characterized by greater involvement of a spouse/partner, correlated with significant anxiety. Depression was not a factor influencing delay within either group. Conclusions. The interpersonal relationship with a spouse/partner seemed to be essential in the dynamics surrounding consultation. Anxiety, rather than socioeconomics status, was a discriminating factor in the delay in seeking consultation. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Un-promoted issues in inflammatory bowel disease: opportunities to optimize careINTERNAL MEDICINE JOURNAL, Issue 3 2010J. M. Andrews Abstract Inflammatory bowel diseases (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gut, which lead to significant morbidity and impaired quality of life (QoL) in sufferers, without generally affecting mortality. Despite CD and UC being chronic, life-long illnesses, most medical management is directed at acute flares of disease. Moreover, with more intensive medical therapy and the development of biological therapy, there is a risk that management will become even more narrowly focused on acute care, and be directed only at those with more severe disease, rather than encompassing all sufferers and addressing important non-acute issues. This imbalance of concentration of medical attention on ,high-end' care is in part driven by the need to perform and publish randomized clinical trials of newer therapies to obtain registration and licensing for these agents, which thus occupy a large proportion of the recent IBD treatment literature. This leads to less attention on relatively ,low-technology' issues including: (i) the psychosocial burden of chronic disease, QoL and specific psychological comorbidities; (ii) comorbidity with functional gastrointestinal disorders (FGIDs); (iii) maintenance therapy, monitoring and compliance; (iv) smoking (with regard to CD); (v) sexuality, fertility, family planning and pregnancy; and (vi) iron deficiency and anaemia. We propose these to be the ,Un-promoted Issues' in IBD and review the importance and treatment of each of these in the current management of IBD. [source] Decubitus ulcers: A review of the literatureINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2005Cheryl Bansal BA Decubitus ulcers are a worldwide health care concern affecting tens of thousands of patients and costing over a billion dollars a year. Susceptibility to pressure ulcers comes from a combination of external factors (pressure, friction, shear force, and moisture), and internal factors (e.g. fever, malnutrition, anaemia, and endothelial dysfunction). Often, enough damage is done to create the basis for a decubitus ulcer after as little as 2 h of immobility, a situation which may be difficult to avoid if the patient must undergo prolonged surgery or remain bedridden. Damage owing to pressure may also occur hours before the patient receives medical attention, especially if the patient falls or becomes immobilized owing to a vascular event. Several classification systems for decubitus ulcers have been described, based on where injury first occurs. The histologic progression of decubitus ulcers is a dynamic process involving several stages, each having characteristic histologic features. A team-focused approach integrating all aspects of care, including pressure relief, infection control, nutrition, and surgery, may improve healing rates. With accurate risk assessment and preventative care, we can hope to minimize complications and mortality owing to decubitus ulcers. [source] Conceptualization of mild cognitive impairment: a reviewINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2004Heather S. Davis Abstract Background Several factors have prompted renewed interest in the concept of declines in cognitive function that occur in association with aging, in particular the area between normal cognition and dementia. We review the changing conceptualization of what has come to be known as mild cognitive impairment (MCI) in an effort to identify recent developments and highlight areas of controversy. Methods Standard MEDLINE search for relevant English-language publications on mild cognitive impairment and its associated terms, supplemented by hand searches of pertinent reference lists. Results Many conditions cause cognitive impairment which does not meet current criteria for dementia. Within this heterogenous group, termed ,Cognitive Impairment, No Dementia' (CIND), there are disorders associated with an increased risk of progression to dementia. Still, the conceptualization of these latter disorders remains in flux, with variability around assumptions about aging, the relationship between impairment and disease, and how concomitant functional impairment is classified. Amongst patients with MCI, especially its amnestic form, many will progress to Alzheimer's disease (AD). In contrast with clinic-based studies, where progression is more uniform, population-based studies suggest that the MCI classification is unstable in that context. In addition to Amnestic Mild Cognitive Impairment (AMCI), other syndromes exist and can progress to dementia. For example, an identifiable group with vascular cognitive impairment without dementia shows a higher risk of progression to vascular dementia, Alzheimer's disease and mixed dementia. Conclusions Recent attempts to profile patients at an increased risk of dementia suggest that this can be done in skilled hands, especially in people whose symptoms prompt them to seek medical attention. Whether these people actually have early AD remains to be determined. The more narrowly defined MCI profiles need to be understood in a population context of CIND. Copyright © 2004 John Wiley & Sons, Ltd. [source] Development of sonic technology for the daily cleansing of the skinJOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2006Robert E Akridge PhD Summary Even though many skin cleansing products are commercially available, the cleansing of the skin is dependent upon the user's diligence, compliance, and technique, which often results in inconsistent cleansing. When the skin is inadequately or excessively cleansed, the skin becomes compromised, sometimes leading to acute or chronic conditions that may require medical attention. A sonic skincare brush was developed to enhance and provide consistent skin cleansing while preventing the skin from becoming compromised. Utilizing a technology previously used to cleanse the oral cavity, the sonic skincare brush is optimized to work with the skin's own elasticity providing rapid oscillatory flexing of the infundibular opening. By oscillating at sonic speed the net result is the inelastic comedones become loosened and detached from the infundibular wall and are then cleared from the acroinfundibulum. Although additional clinical research into the various applications of sonic skin care technology is needed, utilization of sonic technology is now available for effectively and consistently cleansing the skin. [source] Tuberculids as sentinel lesions of tuberculous epididymo-orchitisJOURNAL OF CUTANEOUS PATHOLOGY, Issue 11 2007Pratistadevi K. Ramdial Background:, Tuberculids are rarely associated with male genital tract tuberculosis (TB). Tuberculous epididymo-orchitis (TBEO) has been associated rarely with papulonecrotic tuberculid (PNT) but not with erythema induratum (EI) or the simultaneous occurrence of different tuberculids. Methods:, A retrospective assessment of tuberculids that occurred with underlying TBEO was carried out. Results:, Five patients, four with one and one with two skin biopsies, with clinical diagnoses of PNT (two), EI (one), impetigo (two) and calf ulcer (one), formed the study cohort. Histopathological evaluation confirmed PNT and EI in four and two skin biopsies, respectively. Two patients who returned for follow-up were commenced on anti-tuberculous therapy. All patients sought medical attention 3,34 months later for tender right-sided (two) and left-sided (three) testicular masses. Orchidectomy was undertaken following a poor clinical response to empirical treatment with trimethoprim sulfamethoxazole. Pathological examination of the testis and epididymis confirmed TBEO. The patients were initiated on anti-tuberculous therapy. There was dramatic healing of the skin lesions. Conclusion:, Tuberculids are a sentinel cutaneous manifestation of visceral TB and a valuable external audit of treatment compliance and response. Heightened recognition of and more rigorous genitourinary tract investigation are necessary to identify occult or asymptomatic TBEO as the underlying cause of tuberculids. [source] Anaphylactic Reactions on the Beach: A Cause for Concern?JOURNAL OF TRAVEL MEDICINE, Issue 2 2009Alexander D. Karatzanis MD Background The commonest causes of anaphylaxis include hymenoptera bites, high-risk food, exercise, and jellyfish bites and may often be encountered on the beach. Therefore, millions of visitors at popular touristic locations are exposed to increased risk of anaphylactic reactions every year. At least 35 cases of acute allergic reactions requiring medical attention took place on the beaches of Crete, Greece during the previous summer. Objective To evaluate the level of training of lifeguards working on the beaches of the island of Crete, Greece, with regard to emergency management of anaphylaxis as well as to assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction. Methods A questionnaire was prepared by the authors and administered to 50 lifeguards working on various beaches of Crete. Queries included the definition of anaphylaxis, proper medical treatment, and the existence or not and composition of an emergency kit with regard to the management of acute allergic reactions. Results Our series consisted of 50 lifeguards, 39 (78%) male and 11 female (22%). Although 41 (80%) lifeguards were aware of an acceptable definition of anaphylaxis, no one knew that epinephrine is the first-choice treatment, and 32 (60%) lifeguards replied that steroids should be used for emergency treatment. Additionally, no one possessed an emergency kit that would qualify for management of acute allergic reactions. Conclusions The beach should be considered as a high-risk place for the appearance of anaphylactic reactions. Lifeguards who would be the first trained personnel to encounter this condition should be sufficiently trained and equipped for emergency treatment. Our department is currently introducing a training program to local authorities for the proper training and equipping of lifeguards in the island of Crete. [source] Evaluation of Repatriation Parameters: Does Medical History Matter?JOURNAL OF TRAVEL MEDICINE, Issue 1 2009Sjoerd Greuters MD Background Aeromedical repatriation of patients is an expanding service due to the growing number of travelers worldwide. Of these repatriated patients, a small number require specialized transportation due to severe medical complications. We evaluated the medical in-flight records of Dutch patients with severe disease or polytrauma who were repatriated by air from 1998 to 2002 via one of the largest Dutch alarm centers. We questioned how this Dutch population of repatriated patients is demographically distributed and whether this population is a priori at high risk for acute medical complications that need specialized medical attention. Results Seventy-seven of 115 repatriated patients were 50 years and older, of which most were male (73%). Fifty patients had no significant medical history, whereas the remaining 65 patients suffered from comorbidities such as cardiovascular disease or cancer. In patients aged 18 to 49 years, one third of all patients were repatriated due to traumatic fractures. In the older age category, the main reasons for repatriation were cardiopulmonary incidents. There was an equal distribution in the primary medical reason for repatriation as defined by need for trauma/neurological support and ventilation or circulatory support. Of note, 82% of the 65 patients who traveled with a chronic disease condition were repatriated due to worsening of this particular condition. Conclusions The present study shows that an aeromedical repatriation service is frequently employed by travelers with a history of chronic disease who develop medical complications. The growing number of repatriated elderly patients and/or patients with preexisting comorbidities requires development of secure pretravel risk assessment and adaptation of the medical service level in foreign countries. [source] Clinical significance of RLSMOVEMENT DISORDERS, Issue S18 2007Wayne A. Hening MD Abstract While the restless legs syndrome (RLS) may have been known in antiquity, it has only recently come to medical attention. Individuals with RLS fall along a spectrum from mild, infrequent symptoms to those with severe daily life-impairing discomforts and sleep disruption. These problems can cause impaired mood, daytime fatigue, cognitive difficulties, and inability to participate in a variety of quiet activities. This leads to a general reduction in quality of life similar to other significant psychiatric and medical disorders. Recent studies suggest that RLS may be a risk factor for developing both psychiatric disorders (such as major depression and anxiety) and somatic diseases (such as hypertension and cardiovascular disease). In dialysis patients, RLS has been found to be a risk factor for mortality. Therefore, those with RLS who have clinically significant symptoms suffer increased morbidity and are at risk for impaired long-term medical outcomes. © 2007 Movement Disorder Society [source] Carpal tunnel syndrome among apprentice construction workers,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2002John C. Rosecrance PT Abstract Background In terms of lost-work time and restricted workdays, surgery, and rehabilitation, one of the most costly occupational musculoskeletal disorders is carpal tunnel syndrome (CTS). The purpose of this study was to determine the prevalence of CTS among apprentice construction workers. Methods This cross-sectional study included apprentices from four construction trades. Apprentices completed a self-administered questionnaire and received electrophysiologic studies assessing median nerve function across the carpal tunnel. A surveillance case definition for CTS was based on characteristic hand symptoms and the presence of median mononeuropathy across the carpal tunnel. Results Of the 1,325 eligible apprentices, 1,142 (86.2%) participated in the study. The prevalence of CTS among apprentices was 8.2%; sheet metal workers had the highest rate (9.2%). In operating engineers, the prevalence of CTS was significantly higher (OR,=,6.9; 95% CI,=,2.6,18.2) among the heavy equipment mechanics than the drivers of those vehicles. Body mass index, age, and self-reports of working overhead were associated with prevalent CTS. Less than 15% of the apprentices with CTS sought medical attention for their disorder. Conclusions Many construction workers begin developing CTS before or during their apprenticeship. Few apprentices seek medical attention for hand symptoms characteristic of CTS. The results of this study indicate a public health need for the implementation of prevention strategies for CTS in the construction industry. Am. J. Ind. Med. 42:107,116, 2002. © 2002 Wiley-Liss, Inc. [source] Magistrates' Attitudes to Domestic Violence and Sentencing OptionsTHE HOWARD JOURNAL OF CRIMINAL JUSTICE, Issue 4 2002Elizabeth Gilchrist This study explored the sentencing decisions made by magistrates for perpetrators of domestic violence versus perpetrators of stranger violence. Sixty,seven magistrates considered six vignettes involving violent incidents and suggested a sentence. More magistrates suggested prison for cases where the victim of the assault was a stranger rather than the perpetrator's partner, but this was not statistically significant. Significant differences in sentencing were found where the vignettes featured alcohol, or the necessity of medical attention. Magistrates' reasoning reflected the themes of denying, minimising, justifying and victim blaming. The article discusses the need for training to dispel myths about domestic violence. [source] ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Can an Educational Program Optimize PDE5i Therapy?THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2007A Study of Canadian Primary Care Practices ABSTRACT Introduction., The importance of patient instructions, designed to optimize therapy with phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction (ED), has recently been demonstrated. Aim., To evaluate the impact of an educational program for new sildenafil users against usual ED management in Canadian primary care practices. Methods., This multicenter, 6-month cluster randomized prospective study was conducted across Canada in general practitioners' offices where sites were randomized to receive a treatment optimization program (TOP) tool at visit 1 (TOP sites) or not to receive the TOP tool (non-TOP sites) while continuing with usual practice. Study participants were men seeking medical attention for ED and who were sildenafil naďve. The TOP tool consisted of a tear-off sheet, a brochure, and a video. Study drug was not provided to the patients. Sildenafil samples and prescriptions were dispensed as per usual care practices. Main Outcome Measures., The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used to determine treatment satisfaction at visit 2 (month 3) and visit 3 (month 6). Patient and physician satisfaction with the TOP tool was assessed using self-reported questionnaires. Results., The intent-to-treat (ITT) population consisted of 2,573 patients from 231 primary care sites. At visits 2 and 3, treatment satisfaction with sildenafil was high with almost 9 patients out of 10 satisfied with treatment. No significant statistical differences were observed in the EDITS scores between the TOP and the non-TOP groups at visits 2 and 3. More than 80% of the participants were satisfied or very satisfied with the video and the brochure. More than 8 out of 10 participating physicians (84%) would use the TOP tool in their current practice if available. Conclusions., TOP is a valuable and time-efficient ED management tool providing benefits to newly diagnosed ED patients and to their physicians. Brock G, Carrier S, Casey R, Tarride J-E, Elliott S, Dugré H, Rousseau C, D'Angelo P, and Defoy I. Can an educational program optimize PDE5i Therapy? A study of Canadian primary care practices. J Sex Med 2007;4:1404,1413. [source] Do Not Delay: Breast Cancer and Time, 1900,1970THE MILBANK QUARTERLY, Issue 3 2001Robert A. Aronowitz Until the 1960s, the central public health message about breast cancer was that women should not delay seeking medical attention for breast problems. Epidemiological, pathological, public health, and clinical writings, movies, and doctor-patient correspondence are analyzed in order to understand the durability and centrality of this "do not delay" message. Problematic assumptions about the natural history of cancer, the efficacy of surgery, and individual responsibility for disease contributed to the durability of the "do not delay" message. More important, the message catalyzed or sustained changes in the routines of ordinary women, general practitioners, surgeons, and pathologists, which led to the perception that the campaign against cancer was working. Thus a powerful set of reinforcing perceptions and behaviors maintained the centrality of the "do not delay" campaign until the era of mammography. [source] A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriageBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2005F. Blohm Objectives To study if misoprostol 400 ,g, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. Design Randomised, double blind placebo controlled study. Setting Sahlgrenska University Hospital, Göteborg, Sweden. Sample One hundred and twenty-six women seeking medical attention for early miscarriage. Method Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 ,g or placebo. Main outcome measures Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. Results Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20,2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08,1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups. Conclusions Treatment with 400 ,g misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not. [source] Cardiovascular risk factors correlate with prostate size in men with bladder outlet obstructionBJU INTERNATIONAL, Issue 1 2003L. Sandfeldt OBJECTIVE To study whether the risk profile for cardiovascular disease correlates with prostate size in elderly men seeking medical attention for lower urinary tract symptoms (LUTS), by assessing physiological, biochemical and personality traits. PATIENTS AND METHODS Fifty-two men (mean age 68 years, range 52,85) with bladder outlet obstruction, as verified by urodynamic testing, had their prostate size measured by transrectal ultrasonography. Their blood and urine was also examined, and their personality and heart rate variability tested. The measured variables were assessed statistically in relation to whether the prostate volume was smaller (22 men) or larger (30 men) than 50 mL. RESULTS Patients with a large prostate (mean 104 mL) had a higher mean arterial pressure (105 vs 95 mmHg, P < 0.01), and serum glucose (5.3 vs 4.8 mmol/L, P < 0.01) and serum cortisol (423 vs 362 nmol/L, P = 0.06) concentrations than those with a small gland (mean 31 mL). The personality test showed that they were also less assertive than the others (P < 0.03). The components of the heart rate variability indicated that men with a large prostate had increased sympathetic activity. CONCLUSION Men with LUTS caused by a very large prostate have more risk factors for cardiovascular disease than those with a smaller gland. [source] Management of neuro-ophthalmology cases in childrenACTA OPHTHALMOLOGICA, Issue 2009S MILAZZO Neuro-ophthalmological conditions in children must be analyzed carefully and some emergencies must be recognized. Clinical and practical cases are illustrated. On that basis the most important aspects of the field of neuro-ophthalmology are covered succinctly but sufficiently to enable the practitioner to determine an appropriate diagnosis and course of treatment. Rare and unusual diseases are included but those that are especially critical to the patient's vision or general health and life. Some specific clinical signs and symptoms need to be carefully evaluated as papilledema, papillary abnormalities, ptosis, diplopia or ocular motility abnormalities. Each clinical case deals with a symptom that leads the patient to seek medical attention or a sign that is demonstrated on physical examination. The proper diagnosis is frequently made with the imaging but must be repeated if necessary. Specific techniques in children are described including oculomotor and electrical testing, tomodensitometry and magnetic resonance imaging. Different treatment as medical surgical and neurosurgical are discussed. The physician evaluating neuro-ophtalmic patients needs to have a broad background of medical information. So the patient's workup is properly managed and therapeutic orientations can be done. [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] Healthcare service use in adolescents with non-specific musculoskeletal painACTA PAEDIATRICA, Issue 8 2010Stefano Masiero Abstract Aim:, To estimate occurrence of non-specific musculoskeletal pain in a wide population sample of Italian adolescents, and to investigate their use of healthcare services (seeking of medical attention, referral for diagnostic tests and treatment use). Methods:, We investigated 7542 high-school adolescents (aged between 12 and 16 years) by a structured questionnaire and consisting of personal data, presence of pain, health provider consulted, referral for diagnostic tests and compliance with the prescribed treatments. Results:, In 3399 (45.1%) reported musculoskeletal pain (the most affected sites being the spine and knees), 2525 (74.2%) of whom had sought medical attention. Of the 2525 subjects who had sought healthcare, 1061 (42.0%) had consulted more than one health provider, 2410 (95.4%) had been referred for diagnostic tests, and some form of treatment had been recommended for 2445 (96.8%), but only 1694 (69.2%) had complied with prescribed therapies. The most important factors linked to health seeking behaviour were pain intensity, pain lasting longer than 3 months, injury, interruption to or absence of physical activity and localization in the spine and knee. Conclusion:, Non-specific musculoskeletal pain is a frequent event in Italian adolescents and that a large number of these subjects consult a healthcare service. [source] Long-term behavioural outcomes of pre-school mild traumatic brain injuryCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2010A. McKinlay Abstract Background Mild traumatic brain injury (MTBI) is a leading cause of injury for children during their pre-school years. However, there is little information regarding the long-term outcomes of these injuries. Method We used fully prospective data from an epidemiological study of a birth cohort to examine behavioural effects associated with MTBI during the pre-school years. Cases of confirmed MTBI were divided into two groups, those that had received outpatient medical attention, and those that had been admitted to hospital for a brief period of observation (inpatient cases). The remainder of the cohort served as a reference control group. Results Mother/teacher ratings for behaviours associated with attention deficit/hyperactivity disorder and oppositional defiant/conduct disorder, obtained yearly from age 7 to 13, revealed evidence of deficits after inpatient MTBI (n = 21), relative to more minor outpatient injury MTBI (n = 55) and the reference control group (n = 852). For the inpatient group there was evidence of increasing deficits over years 7,13. Conclusions More severe pre-school MTBI may be associated with persistent negative effects in terms of psychosocial development. The vulnerability of pre-school children to MTBI signals a pressing need to identify high-risk cases that may benefit from monitoring and early intervention. [source] Clinical Immunology Review Series: An approach to the patient with allergy in childhoodCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2009R. Sporik Summary Allergic conditions are common, with asthma being the most common chronic illness in childhood in most developed countries. Some 80% of asthmatic children are sensitized to aeroallergens, usually indoor animal dander and house dust mite. Some 80% of asthmatics also have rhinitis. Rhinitis and eczema receive less medical attention than asthma, but they can cause long-term morbidity and have substantial direct and indirect economic costs. Food allergy and anaphylaxis are increasingly recognised and are usually easily diagnosed and managed. Clinicians can use in vivo and in vitro measurements of allergen-specific immunoglobulin E to better time reintroduction of implicated foods. Specific parenteral and sublingual immunotherapy is widely practiced internationally but is uncommon in the UK. It may alter the natural history of aeroallergen reactive diseases in the upper and lower airways. Specific oral tolerance induction represents the current cutting edge in clinical allergy research. It remands resource intensive at present and cannot be adopted into routine clinical practice at this time. [source] | ||||||||||||||||||||||||||||