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Appropriate Management (appropriate + management)
Terms modified by Appropriate Management Selected AbstractsAuditory neuropathy/dys-synchrony: Diagnosis and managementDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2003Charles I. Berlin Abstract Auditory brainstem responses (ABRs) and otoacoustic emissions (OAEs) are objective measures of auditory function, but are not hearing tests. Normal OAEs reflect normal cochlear outer hair cell function, and an ABR indicates a synchronous neural response. It is quite possible for a patient to have normal OAEs but absent or grossly abnormal ABR and a behavioral audiogram that is inconsistent with either test. These patients, who may constitute as much as 10% of the diagnosed deaf population, have auditory neuropathy/dys-synchrony (AN/AD). To diagnose AN/AD accurately, ABRs are obtained in response to condensation and rarefaction clicks to distinguish cochlear microphonics (CM) from neural responses. Appropriate management is confounded by variation among patients and changes in auditory function in some patients over time. Recommendations for management include visual language exposure through methods such as American Sign Language (ASL), Cued Speech, or baby signs, and closely following patients. MRDD Research Reviews 2003;9:225,231. © 2003 Wiley-Liss, Inc. [source] Acute Hepatitis Associated with Treatment of Peyronie's Disease with Potassium Para-Aminobenzoate (Potaba)THE JOURNAL OF SEXUAL MEDICINE, Issue 12 2008Joey Roy ABSTRACT Introduction., Potassium para-aminobenzoate is an agent used in the treatment of sclerotic diseases including Peyronie's disease of the penis. It has been reported that this medication may have been responsible for cases of acute liver injury. Aim., To inform clinicians of the possibility of an adverse drug event associated with the oral intake of potassium para-aminobenzoate by reporting an additional case and compiling information from previous reports. Methods., The affected patient's medical records were diligently reviewed; all available and relevant information pertaining to this adverse event is reported. Similar case reports were analyzed and compared, and relevant information was compiled in this report. Results., The patient enjoyed a full biochemical recovery from his hepatitis 4 months after discontinuation of potassium para-aminobenzoate. Conclusion., To date, the oral use of potassium para-aminobenzoate has been reported to be linked to acute liver injury in six individuals. Appropriate management of this adverse drug event is the immediate discontinuation of the offending drug and general patient support measures. Roy J, and Carrier S. Acute hepatitis associated with treatment of Peyronie's disease with potassium para-aminobenzoate (Potaba). J Sex Med **;**:**,**. [source] The evolving management of the third stage of labourBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2009AM Gülmezoglu The immediate postpartum period is a risky period because life-threatening events can occur unexpectedly, and lead to death if they are not managed promptly. Appropriate management of the third stage of labour can reduce severe postpartum haemorrhage and death. This commentary summarizes how various management techniques of third stage of labour evolved to date and the evidence base for current international recommendations. [source] Multiple Primary Acral Melanomas in African-Americans: A Case Series and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 1 2007ANGELA C. S. HUTCHESON MD BACKGROUND Although melanoma accounts for only 4% to 5% of all skin cancers in the United States, it causes most skin cancer,related deaths. We describe a unique group of African-American patients with multiple primary acral lentiginous melanomas (ALMs). OBJECTIVE The purpose of this study was to review the case histories and management of a cohort of patients in the Mohs practice of our dermatologic surgeon with multiple primary ALM. METHODS This is a case series of patients with multiple ALM identified by chart review from 2000 to 2005. A thorough review of the literature was performed. RESULTS Four patients, all African-American, were identified with multiple ALM. All patients were managed with excision or Mohs micrographic surgery utilizing permanent sections. None of the patients with ALM had melanomas at nonacral sites or other types of skin cancer. Several had acral melanosis. Information in the literature on patients with multiple primary acral melanomas was insufficient. CONCLUSION Patients with multiple acral melanomas have not, to our knowledge, been reported thus far. It can be extrapolated from current literature, however, that appropriate management of these patients, including staging work and surgical intervention, is to be determined by the individual characteristics of the melanoma and the patient's concomitant risk factors, if any. [source] Prevalence of and risk factors for extracranial internal carotid artery stenosis in Korean Type 2 diabetic patientsDIABETIC MEDICINE, Issue 12 2006J. H. Park Abstract Aims The objectives of this study were to evaluate the prevalence of and risk factors for extracranial internal carotid artery stenosis in Type 2 diabetic patients. Methods This study included 406 patients aged 40,79 years with Type 2 diabetes (male 55.4%, female 44.6%). Both carotid arteries of each patient were examined by carotid duplex scanning. The duplex ultrasound criteria based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) measurement method were used for the identification of carotid stenosis. Results Extracranial internal carotid artery stenosis , 40% by velocity criteria was detected in 5.2% of the patients. The prevalence of carotid stenosis increased with advancing age: 1.0% at 40,49 years of age, 5.0% at 50,59 years, 7.3% at 60,69 years and 9.5% at 70,79 years. The degree of stenosis was > 70% in 42.9% of patients with stenosis, Bilateral stenosis was detected in 14% of patients. Of the patients with , 40% carotid stenosis, 33% had a decreased ankle-brachial index, 38% had a previous history of stroke, and only one patient (5%) had a documented history of coronary artery disease. Multivariate analysis, including variables determined to be significantly different by univariate analysis between patients with or without , 40% stenosis, indicated that age, systolic blood pressure and high-density lipoprotein (HDL)-cholesterol (inverse correlation) were independent risk factors associated with carotid stenosis. Conclusions Carotid duplex scanning is a useful strategy in identifying carotid stenosis in older Type 2 diabetic patients with high systolic blood pressure, or low levels of HDL cholesterol. The early identification and subsequent appropriate management of carotid stenosis, particularly in this group of patients, may facilitate efforts to reduce the incidence of macrovascular complications. [source] Diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes: A study of 210 casesDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2003F.I.A.C., Raj K. Gupta M.D. Abstract The aim of this study was to evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes, which were analyzed in 210 cases. NAC in all the cases were performed by the conventional aspiration method and cytologic examination was done on site after staining smears with the Papanicolaou method. In addition, Diff-Quik-stained air-dried smears, Papanicolaou-stained fixed smears, and filter preparations from needle washings and hematoxylin-eosin-stained sections of cell blocks were studied. The NAC diagnosis was supported by examining cell blocks in 92/210 cases which showed a reliable histologic architecture; further support was also obtained with a tissue biopsy in 9/12 cases of inflammatory lesions, 7/7 cases with a suspicious diagnosis, 20/26 cases of melanomas, 15/15 cases of lymphomas, and/or a comparison with the primary tumor in other cases of metastatic tumors. Additionally, immunoperoxidase and/or histochemical stains were done. Twelve cases were diagnosed as inflammatory lesions and 88 cases were regarded as negative (normal cellular elements n = 40; reactive elements n = 48). In 58 cases a variety of metastatic tumors were diagnosed (melanoma n = 26; others n = 32) and in 15 cases a diagnosis of lymphoma was made. Seven cases were diagnosed as suspicious of malignancy and 30 cases were unsatisfactory due to scanty/acellular samples (despite 2,3 repeat samplings). However, in five of these malignant tumors were later found on a biopsy which was done due to a persistent and continued enlargement of lymph node(s). The sensitivity was 91.7%, specificity 98.2%, positive predictive value (PPV) 97.7.%, and negative predictive value (NPV) was 95.45%. Based on our study we feel that NAC as a first line of investigation is not only useful in the diagnosis of lesions in inguinal lymph nodes, but can also help in deciding on an appropriate management. Also, histologic architecture from cell blocks can be correlated with cytology and such material can be used for histochemical and immunomarker studies. Diagn. Cytopathol. 2003;28:175,180. © 2003 Wiley-Liss, Inc. [source] A sediment budget for a cultivated floodplain in tropical North Queensland, AustraliaEARTH SURFACE PROCESSES AND LANDFORMS, Issue 10 2007Fleur Visser Abstract Sugarcane is grown on the floodplains of northern Queensland adjacent to the Great Barrier Reef lagoon. Sediment and nutrient loss from these sugarcane areas is considered a potential threat to coastal and marine ecosystems. To enable sugarcane cultivation, farmers have structured the landscape into different elements, comprising fields, water furrows, ,headlands' and drains. In order to apply appropriate management of the landscape and reduce export of sediment, it is important to identify which of these elements act as sediment sources or sinks. In this study erosion and deposition rates were measured for the different landscape elements in a subcatchment of the Herbert River and used to create a sediment budget. Despite large uncertainties, the budget shows that the floodplain area is a net source of sediment. Estimated sediment export varies between 2 and 5 t ha,1 y,1. The relative importance of the landscape elements as sediment sources could also be determined. Plant cane is identified as the most important sediment source. Water furrows generate most sediment, but are a less important source of exported sediment due to their low connectivity. Headlands and minor drains act as sediment traps. Copyright © 2007 John Wiley & Sons, Ltd. [source] How can we preserve and restore species richness of pollinating insects on agricultural land?ECOGRAPHY, Issue 6 2008Markus Franzén During recent decades, concern about the loss of biodiversity on agricultural land has increased, and semi-natural grasslands have been highlighted as critical habitats. Temperate European agricultural landscapes require distinct and appropriate management to prevent further impoverishment of the flora and fauna. This is especially urgent for pollinating insects that provide important ecosystem services. Our aim was to examine how species richness of three important groups of pollinating insects; solitary bees, butterflies and burnet moths are related to different farm characteristics, and if there are any differences between these three groups. A further aim was to test if red-listed species are related to any farm characteristics. Species richness of solitary bees, butterflies and burnets was measured on all semi-natural grasslands at 16 farms in a forest-dominated area of 50 km2 in southern Sweden, using systematic transect walks in April to September 2003 (only butterflies and burnets) and 2005. Species richness of solitary bees and butterflies was intercorrelated, both before and after controlling for the area of semi-natural grassland. Species richness of solitary bees increased with the area of semi-natural grassland. After controlling for the effect of the area of semi-natural grassland species richness was strongly positively related with the density of the plant Knautia arvensis and negatively related with the proportion of grazed grassland. The results were similar for solitary bees and butterflies. The number of red-listed solitary bees was positively related to the proportion of meadows with late harvest (after mid-July) and decreased with increased farm isolation. The number of burnet species (all red-listed) was positively related to vegetation height, flower density and the proportion of meadows with late harvest on a farm. Areas with a high density of K. arvensis and with traditional hay-meadow with late harvest present, harbour most species. Promoting traditional hay-meadows, late extensive grazing and the herb K. arvensis, people managing agricultural biodiversity can encompass high species richness of pollinating insects and support red-listed species. Further, we suggest that the density of K. arvensis at a farm can be used as a biodiversity indicator, at least for pollinating insects. [source] Consequences of misdiagnosis of lymphomatoid papulosisEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2006S. LAUBE mrcp We report two patients with lymphomatoid papulosis (LyP), who were initially diagnosed as systemic T-cell lymphoma. The patients presented with recurrent self-healing cutaneous lesions and skin biopsies showed a lymphocytic infiltrate with malignant features. Clinico-pathological correlation of findings was not performed and results of staging investigations were misinterpreted. Consequently, both patients were unnecessarily treated with multi-agent chemotherapy, radiotherapy and stem cell/bone marrow transplants and sustained long-term adverse effects. The clinical and histological features of LyP are described and appropriate management discussed in detail. Factors leading to the unnecessary treatment of both patients are examined and several learning points highlighted such as the importance of a multidisciplinary approach. [source] Novel SDHD germ-line mutations in pheochromocytoma patientsEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2007C. Neumayer Abstract Background,SDHD germ-line mutations predispose to pheochromocytoma (PCC) and paraganglioma (PGL). Material and methods, The incidence and types of SDHD germ-line mutations are determined in 70 patients with apparently sporadic adrenal and extra-adrenal PCC. Results,SDHD sequence variants were identified in the germ line of five patients. Two of three novel mutations were in exon 1 and one in exon 3. One patient had a codon 1 missense mutation (M1K) and a concurrent 3-bp deletion in intron 1. Three of 10 family members had only the exon 1 mutation, whereas one had only the intron 1 mutation. The other exon 1 mutation resulted from a deletion of nucleotides 28,33 with a 12-bp in-frame insertion (c.28_33 del ins TAGGAGGCCCTA). This mutation generated a premature stop codon after codon 9 and was also present in the brother who had a bilateral PCC. The third patient with a carotid body tumour, with an abdominal and a thoracic PGL had a 12-bp deletion in exon 3 (codons 91,94, c.271_282 del). Her father carried the same mutation and had bilateral carotid body tumours. Two further patients, one with six PGL, carried a previously described H50R polymorphism, whose disease-specific relevance is currently unclear. The three patients with bona fide SDHD mutations were younger than those without germ-line mutations. Conclusion,SDHD germ-line mutations are rare in patients with PCC, but their identification is an important prerequisite for the clinical care and appropriate management of affected individuals and their families. [source] Alterations in electrolyte equilibrium in patients with acute leukemiaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2005Theodosios D. Filippatos Abstract:,Background and aim:,A wide array of disturbances in electrolyte equilibrium is commonly seen in patients with acute leukemia (AL). These abnormalities present a potential hazard in these patients, as that of enhancing the cardiotoxic effects of certain chemotherapeutic regimens. The literature dealing with AL-related electrolyte abnormalities and their interactions in leukemic patients was reviewed. Data synthesis:,Sources included MEDLINE and EMBASE. The search strategy was based on the combination of ,acute leukemia', ,electrolyte abnormalities', ,acid-base disorders', ,potassium', ,sodium', ,magnesium', ,calcium', and ,phosphorus'. References of retrieved articles were also screened. A decrease in serum potassium, mainly owing to lysozyme-induced tubular damage, appears to be one of the most frequent and potentially hazardous abnormalities. Other clinically significant metabolic perturbations include hyponatremia and hypercalcemia. Conclusion:,A broad spectrum of electrolyte abnormalities is encountered in the clinical setting of AL, which are related to the disease process per se and/or to the therapeutic interventions. Clinicians should be vigilant for early detection and appropriate management of these disorders before the initiation of chemotherapy regimens as well as during treatment. [source] A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task ForceEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2006A. Albanese chairman To review the literature on primary dystonia and dystonia plus and to provide evidence-based recommendations. Primary dystonia and dystonia plus are chronic and often disabling conditions with a widespread spectrum mainly in young people. Computerized MEDLINE and EMBASE literature reviews (1966,1967 February 2005) were conducted. The Cochrane Library was searched for relevant citations. Diagnosis and classification of dystonia are highly relevant for providing appropriate management and prognostic information, and genetic counselling. Expert observation is suggested. DYT-1 gene testing in conjunction with genetic counselling is recommended for patients with primary dystonia with onset before age 30 years and in those with an affected relative with early onset. Positive genetic testing for dystonia (e.g. DYT-1) is not sufficient to make diagnosis of dystonia. Individuals with myoclonus should be tested for the epsilon-sarcoglycan gene (DYT-11). A levodopa trial is warranted in every patient with early onset dystonia without an alternative diagnosis. Brain imaging is not routinely required when there is a confident diagnosis of primary dystonia in adult patients, whereas it is necessary in the paediatric population. Botulinum toxin (BoNT) type A (or type B if there is resistance to type A) can be regarded as first line treatment for primary cranial (excluding oromandibular) or cervical dystonia and can be effective in writing dystonia. Actual evidence is lacking on direct comparison of the clinical efficacy and safety of BoNT-A vs. BoNT-B. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for generalized or cervical dystonia, after medication or BoNT have failed to provide adequate improvement. Selective peripheral denervation is a safe procedure that is indicated exclusively in cervical dystonia. Intrathecal baclofen can be indicated in patients where secondary dystonia is combined with spasticity. The absolute and comparative efficacy and tolerability of drugs in dystonia, including anticholinergic and antidopaminergic drugs, is poorly documented and no evidence-based recommendations can be made to guide prescribing. [source] White pines, Ribes, and blister rust: integration and actionFOREST PATHOLOGY, Issue 3-4 2010R. S. Hunt Summary The preceding articles in this series review the history, biology and management of white pine blister rust in North America, Europe and eastern Asia. In this integration, we connect and discuss seven recurring themes important for understanding and managing epidemics of Cronartium ribicola in the white pines (five-needle pines in subgenus Strobus). Information and action priorities for research and management of the pathogen, telial and aecial hosts, and their interactions are listed in a detailed Appendix. Syntheses focused on genetics, plant disease, invasive species or forest management have provided alternative but knowledgeable lessons on the white pine blister rust pathosystem. Two critical issues for the conservation of white pines are to sustain ecosystems affected by blister rust and to maintain genetic diversity for adaptive traits such as disease resistance. Forest genetics includes tree improvement and molecular techniques for research; their application can increase rust resistance by artificial and natural selection. Silviculture augments genetics with methods to deploy and enhance resistance as well as to regenerate and tend white pine stands. Although cultivated or wild Ribes might serve as inoculum sources, silviculture and horticulture can reduce the risk of serious impacts from blister rust using genetics for breeding and epidemiology for hazard assessment and disease control. Climate change threatens to cause major alterations in temperature and precipitation regimes, resulting in maladapted conifers succumbing to various diseases and insect outbreaks. In contrast, many white pine species have broad ecological ranges and are tolerant of harsh environments,traits that permit successful establishment and growth over wide geographic and altitudinal zones. Given appropriate management, white pines could thrive as valuable commercial and ecologically important keystone species. In an uncertain environment, adaptive management provides a learning and participatory approach for sustaining resilient ecosystems. [source] COPD management: new and existing therapy optionsFUTURE PRESCRIBER, Issue 1 2010DRCOG Professor of Primary Care, David Price MA, MRCGP Early detection and appropriate management of chronic obstructive pulmonary disease (COPD) may help to reduce the high mortality and morbidity associated with this disease. New pharmacological treatments for COPD, along with the implementation of recommendations of the National Strategy for COPD due for publication later this year, will help to raise the standard of care and improve outcomes for COPD patients. In this article, Professor Price and Rhonda Siddall consider current COPD therapy and look at future treatment options for COPD. Copyright © 2010 John Wiley & Sons, Ltd. [source] Herbage mass and nutritive value of herbage of extensively managed temperate grasslands along a gradient of shrub encroachmentGRASS & FORAGE SCIENCE, Issue 3 2009S. Kesting Abstract Semi-natural grasslands often serve as important reserves of biodiversity. In Europe extensive grazing by livestock is considered an appropriate management to conserve biodiversity value and to limit shrub encroachment. However, little is known about the influence of shrubs on agronomic values. A gradient analysis of shrub-invaded temperate grasslands (from shrub-free to pioneer forest) in Germany was carried out to test the hypothesis that herbage mass and variables describing nutritive value of herbage decrease with increasing shrub encroachment. The herbage mass of dry matter (DM), variables describing the nutritive value of herbage, composition of the vegetation and mean of Ellenberg's indicator values were analysed with respect to the extent of shrubs. There was a reduction of herbage mass of DM from 3570 to 210 kg ha,1 with increasing shrub encroachment. Metabolizable energy concentration of herbage ranged from 8·9 to 10·2 MJ kg,1 DM and crude protein concentration from 72 to 171 g kg,1 DM, both measures being positively correlated with shrub occurrence. Increasing shrub occurrence was associated with a decrease in water-soluble carbohydrates concentration (from 151 to 31 g kg,1) and a reduction in the indicator ,forage value'. The results indicate a potentially large agronomic value for shrub-encroached temperate grasslands. [source] Diagnosis and Treatment of the Menstrual Migraine PatientHEADACHE, Issue 2008Stephen D. Silberstein MD Women presenting with recurrent disabling headache frequently have migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of migraine with or without aura. Many women who experience migraine in close association to their menstrual cycle may meet the diagnostic criteria for either menstrually related migraine (MRM), or pure menstrual migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short-term prophylaxis. Herein we review the difference between non-menstrual migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of migraine associated with hormonal fluctuations. [source] The effects of HCV infection and management on health-related quality of life,HEPATOLOGY, Issue 3 2007Zobair Younossi Infection with HCV leads to an array of symptoms that compromise health-related quality of life (HRQL). Chronic hepatitis C is treated primarily with pegylated interferon (peg-IFN) and an inosine 5, monophosphate dehydrogenase inhibitor, ribavirin (RBV), with the goal of achieving a sustained virologic response (SVR). SVR reduces the rate of hepatic fibrosis and other disease-related complications and, in turn, increases HRQL. Although combination therapy with peg-IFN and RBV produces SVRs in more than 50% of treated patients, it is associated with side effects that can reduce short-term HRQL, can lead to dose reductions and discontinuations, and may impair treatment response. Fatigue and depression are common symptoms of chronic HCV infection that may also be caused by IFN-based therapy. Hemolytic anemia and IFN-mediated bone marrow suppression are well-known consequences of IFN/RBV therapy, often resulting in dose reductions or discontinuations, and have the potential to affect SVR rates. Management of these symptoms is vital to successful outcomes and generally relies on therapy that is adjunctive to the primary treatment of the viral infection itself. Several new drugs with the potential to increase SVR rates without compromising HRQL are in development. Conclusion: The relationship of chronic HCV infection, treatment, and HRQL is complex. Successful treatment of chronic hepatitis C requires an understanding of the intricacies of this relationship and appropriate management of treatment-related symptoms. (HEPATOLOGY 2007;45:806,816.) [source] The expression of Wilms' tumour-1 and Ca125 in invasive micropapillary carcinoma of the breastHISTOPATHOLOGY, Issue 6 2007A H S Lee Aim:, Metastases from ovarian serous papillary carcinoma to the breast and primary invasive micropapillary carcinoma of the breast are histologically similar. The distinction is clinically important to ensure appropriate management. Wilms' tumour-1 (WT1) and Ca125 are frequently expressed in serous papillary carcinomas, and uncommonly in unselected mammary carcinomas. One previous study found Ca125 expression in 69% of invasive micropapillary carcinomas. The aim was to assess the frequency of expression of WT1 and Ca125 in invasive micropapillary carcinoma. Methods and results:, Twenty-five of 34 invasive micropapillary carcinomas showed no nuclear expression of WT1. The remaining nine tumours showed weak to moderate immunoreactivity in 1,10% of nuclei. Six of these nine tumours also contained ductal carcinoma in situ, which expressed WT1 in five of the six. Membranous or cytoplasmic expression of Ca125 was found in seven tumours. Conclusion:, Nuclear WT1 expression is present in a minority of invasive micropapillary carcinomas and, when present, expression is focal. The frequency of expression of Ca125 was similar to the results in unselected mammary carcinoma. Thus, these markers are useful members of the immunohistochemical panel for the distinction of mammary invasive micropapillary carcinoma from ovarian serous papillary carcinoma. [source] Using faecal elastase-1 to screen for chronic pancreatitis in patients admitted with acute pancreatitisHPB, Issue 3 2006R.C. Turner Abstract Background: Patients presenting with acute pancreatitis may have co-existing chronic pancreatitis, the accurate diagnosis of which would potentially guide appropriate management. Gold standard tests are often invasive, costly or time-consuming, but the faecal elastase-1 assay has been shown to be comparatively accurate for moderate and severe exocrine deficiency. This study aimed to evaluate fecal elastase-1 concentration [FE-1] against clinical criteria for chronicity in an acute setting. Patients and methods: [FE-1] was performed on patients admitted with acute onset of epigastric pain and a serum lipase at least three times the upper limit of normal. Clinical diagnosis of chronic pancreatitis was defined by the presence of specific clinical, pathological or radiological criteria. A [FE-1] value of <200 µg/g was similarly considered indicative of chronic exocrine insufficiency. Thus a 2×2 table comparing [FE-1] and clinical diagnosis was constructed. Results: After exclusion of liquid stool specimens, 105 stool specimens from 87 patients were suitable for [FE-1] determination. [FE-1] was evaluated against the clinical diagnosis of chronic pancreatitis, initially for the whole sample, and then after exclusion of cases of moderate and severe acute pancreatitis (Ranson score >2). The latter analysis, based on an exocrine insufficiency threshold of 200 µg/g, yielded a sensitivity of 79.5%, specificity of 98.0%, positive predictive value of 96.9% and negative predictive value of 86.0%. Conclusion: [FE-1] is an accurate screening tool for underlying chronic exocrine insufficiency when taken in the course of a hospital admission for mild acute pancreatitis. [source] Biological weapons preparedness: the role of physiciansINTERNAL MEDICINE JOURNAL, Issue 5-6 2003C. L. Cherry Abstract The real risk posed by biological weapons was demonstrated with the distribution of anthrax spores via the USA postal service in 2001. This review outlines the central roles of physicians in optimizing biopreparedness in Australia, including maintaining awareness of the risk, promptly recognizing an event, notifying appropriate authorities upon suspicion of an event, and instituting appropriate management. Management aspects covered include appropriate diagnostic tests, infection control procedures, and empirical therapy of agents considered possible biological weapons. The critical role of physicians as public health advocates working to prevent the use of biological weapons is also outlined. (Intern Med J 2003; 33: 242,253) [source] An MDE modeling framework for measurable goal-oriented requirementsINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 8 2010Fernando Molina It is a proved fact that the appropriate management of requirements is one of the most influential factors in the success of software development projects. With the advent of the model-driven engineering (MDE) development paradigm, the need for formal gathering mechanisms, which provide the necessary degree of nonambiguity and detail, has led to the proposal of a myriad of requirements metamodels. However, a great disparity exists, both in the concepts/relationships and in the underlying semantics involved in each metamodel. Moreover, most existing proposals lack backward (e.g., alignment with business goals) or forward (e.g., connection with validation methods) traceability. In view of this situation, this article proposes a "measurable requirements metamodel" that offers support to the elicitation of measurable requirements. This support is based on the explicit connection of goals, requirements, and measures, thus fostering a goal-driven measurable requirements engineering (RE) perspective. Additionally, since it is well known that metamodels only reflect the abstract syntax of the modeling language, the proposed metamodel also includes a notation (concrete syntax) which, for reasons of understandability, is based on the goal-oriented requirements language (GRL) notation. This notation is supported by a unified modeling language (UML) profile that facilitates its adoption by RE analysts in the context of any UML-based software engineering process. To support this proposal, an Eclipse tool has been developed. This tool permits the integration of measurable requirements as a driving force in the context of a given MDE development process. © 2010 Wiley Periodicals, Inc. [source] Clinical course linkage among different priapism subtypes: Dilemma in the management strategiesINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2008Shin-ichi Hisasue Objectives: Priapism is a rare condition whose management differs according to the etiology. We report the clinical course of three forms of priapism to assess the feasibility and safety of recent management strategies. Methods: The study included eight patients complaining of persistent erection for ,4 h who were treated in our institution between January 1996 and July 2007. Results: Overall, we categorized 12 cases of priapism in eight patients divided as follows: five cases of ischemic priapism (IP), three of stuttering priapism (SP), and four of non-ischemic priapism (NIP). Two of five IP patients needed a shunt procedure, which led to the subsequent erectile dysfunction. The other three were treated successfully with a corporal injection of sympathomimetic agents and subsequently suffered from SP. One of the three SP patients suffered from mimicked NIP with increased arterial blood flow during the initial treatment for IP. Four of the NIP patients including the mimicked one achieved complete detumescence, through arterial embolization in two and conservative management in two. Conclusions: Current management seems effective and safe in the short-term. However, the long-term outcome of the treatment for IP is still disappointing. Careful long-term observation is needed for an appropriate management. [source] Epidermoid cyst of the penis: A case report and review of the literatureINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2000Michihiro Suwa Abstract Penile cysts are uncommon. A case of a 7-year-old boy with an epidermoid cyst of the penis is reported. He had an asymptomatic, slowly growing soft mass in the frenulum of the penis. Excision of the mass was performed, and the diagnosis was epidermoid cyst of the penis. No recurrence has been noted within the year since excision. To our knowledge, there have been no previous reports of malignancy developing in cystic disease of the penis. In such cases, clinicians should attempt more appropriate management, involving either watchful observation or complete excision of the cyst, by considering the embryogenesis and nature of the disease. [source] Applied issues with predators and predation: editor's introductionJOURNAL OF APPLIED ECOLOGY, Issue 2 2002S. J. Ormerod Summary 1,The effects of predation are among the most pervasive in ecology. As parasitoids, parasites, grazers or top carnivores, predators have large influences on the distribution, density, dynamics and evolved traits of other organisms. Effects scale-up to influence community attributes such as species coexistence and ecosystems processes such as production or trophic cascades. 2,Increasingly, however, some of the largest predation issues fall clearly within the scope of applied ecology. They include instances where, due to their ecological attributes and trophic position: (i) predators are valuable to nature conservation, as biocontrol agents, as natural enemies, or as grazers used in rangeland or ecosystem management; (ii) natural or introduced predators are viewed negatively due to effects on conservation, agriculture, forestry, hunting or disease transmission; (iii) predators are affected by human activities such as resource exploitation, or from exposure to factors such as biomagnified pollutants and disturbance; (iv) predators are controversial because different groups view them as either desirable or undesirable. 3,In all these cases, ecologists have a pivotal rôle in facilitating appropriate management. For valued predators, this involves developing sufficient ecological understanding to optimize habitat, increase prey abundance or to reinforce, establish or reintroduce desirable species. For predators considered undesirable, management can involve direct control. In other cases, predation and its consequences can be mitigated by deterrent, exclusion, supplementary feeding, habitat management to favour prey, predator swamping, or by compensating losses financially. These latter strategies are often used where predators are themselves considered too valuable to remove or control. 4,This collection of seven papers illustrates many of these themes by examining contrasting aspects of the applied ecology of Eurasian lynx; by further probing the interaction between predatory birds and red grouse; by exploring the effects of weather on biocontrol; and by illustrating effects on plant species where grazing or seed predation play a dominant rôle. 5,A key lesson from these and other recent papers in the Journal of Applied Ecology is that the successful management of predators depends invariably on understanding adequately the exact ecological context in which predator,prey interactions take place and in which problems arise. With predator-related issues growing rather than diminishing, ecologists will need sufficient resources to maintain current research if they are to provide the understanding required to offer and evaluate sound management. [source] Local extent of old-growth woodland modifies epiphyte response to climate changeJOURNAL OF BIOGEOGRAPHY, Issue 2 2009Christopher J. Ellis Abstract Aim, To quantify the interaction between climate and woodland continuity in determining the bioclimatic response of lichen epiphytes. Location, Northern Britain (Scotland). Methods, Indicator-species analysis was used to pre-select lichen epiphytes along parallel gradients in climate and the extent of old-growth woodland. Nonparametric multiplicative regression was used to describe in a predictive model the individualistic response of selected species, which were projected based on climate-change scenarios and contrasting patterns of simulated woodland loss or gain. Species with a similar response were grouped using a novel application of cluster analysis to summarize the potentially huge number of projected outcomes. Projected patterns of occurrence under climate-change scenarios were examined for different levels of old-growth woodland extent. Results, Forty-two lichen species were statistically significant indicator species in oceanic woodlands, and old-growth indicators under suboptimal climatic conditions. Responses to climate-change scenarios were contrasting, with one group comprising species projected to increase in extent in response to climate warming, and other response groups projected to decrease in occurrence, possibly in response to shifting rainfall patterns. The occurrence of all response groups had a positive relationship with old-growth woodland extent. Main conclusions, An ,oceanic' biogeographical group of epiphytes identified using the baseline climatic and present-day woodland setting comprised species with a cyanobacterial photobiont or tropical phytogeographical affinities. However, within this group the individual species responses to climate-change scenarios were contrasting. Additionally, group responses may be poorly matched with simple ecological traits. However, the studied interaction between climate and habitat continuity suggests that the impact of climate change might be offset for certain lichen epiphytes by appropriate management of woodland resources, for example, expansion of native woodland around remnant old-growth stands. [source] Gingival involvement of oral lichen planus in a series of 700 patientsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2005Michele D. Mignogna Abstract Background: Oral lichen planus (OLP) is one of the most common oral mucosa disorders. OLP gingival involvement is very frequently observed, and it is characterized by wide variations in clinical appearance and symptoms, leading, in many cases, to misdiagnosis or undiagnosis. This can be potentially harmful since OLP patients require appropriate management in oral and periodontal care, together with an adequate systemic evaluation. Objective: In this paper, we have analysed the prevalence and clinical aspects of gingival lesions in our series of 700 patients affected by OLP. Furthermore, we have discussed the possible periodontal implications on the basis of the available literature. Patients and Methods: Data from 700 patients affected by OLP, clinically and histologically assessed, have been studied; the location and morphology of lesions, the symptoms and the progression of the disease have been considered, with particular attention given to gingival involvement. Results: Gingival lesions have been diagnosed in 48% of cases, usually associated with diffuse oral involvement. Only 7.4% of patients had OLP lesions confined to the gingiva. The morphology of lesions included all the forms originally described for OLP (reticular, papular, plaque, atrophic, erosive and bullous). The symptoms, if present, varied from mild discomfort to severe oral pain, with the general trend increasing from the keratotic to the erosive forms. The gingiva was involved in four out of 21 of our oral cancer cases, which developed from pre-existing OLP lesions. Conclusion: OLP is a very proteiform disorder; considering the high frequency of gingival involvement and its influence on oral health, it is our opinion that periodontologists should be involved in OLP management and should become familiar with its clinical aspects and related themes. [source] Adductor insertion avulsion syndrome with stress fracture of femoral shaft: MRI findingsJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2007MA Lawande SUMMARY Chronic vague hip pain may be caused by stress-related injury in the proximal or mid-femoral diaphysis. This has been described as an entity called adductor insertion avulsion syndrome, or thigh splints. In the appropriate clinical setting, the radiologist interpreting the magnetic resonance imaging must be aware of this condition as its imaging findings are subtle. The diagnosis will help the clinician plan the appropriate management. Magnetic resonance imaging can also depict the complications such as stress fracture. [source] Unilateral Neonatal Testicular TorsionJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2000Linda J. Juretschke MSN Testicular torsion in the neonatal period is an unusual finding. Because of the high morbidity associated with this condition, early recognition and appropriate management are imperative. Testicular torsion may be unilateral or bilateral and may occur prenatally or in the early postnatal period. Often, the nurse is the first health care provider to examine a newborn after birth and must be aware of the signs of this condition to minimize the risk of testicular loss. [source] A pure nongestational ovarian choriocarcinoma in a 10-year-old girl: Case report and literature reviewJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2009Bao Kong Abstract Nongestational ovarian choriocarcinoma (NGCO) is a rare form of malignancy, which is difficult to diagnose. We present a case of a 10-year-old girl diagnosed with pure nongestational ovarian choriocarcinoma. This patient responded well to conservative surgery and cisplatin-based regimen chemotherapy. Approximately 38 authenticated cases of NGCO have been reported in the English published work to date in the world. We report here the clinical features, differential diagnosis, appropriate management and outcome of our case, together with analysis of the reported cases in the published work. [source] Cervical varix with placenta previa totalisJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2007Yukiyo Kumazawa Abstract A cervical varix during pregnancy is a very rare complication. It can lead to hemorrhage and may result in significant morbidity. Furthermore, appropriate management has not yet been established. We present a case of a cervical varix with placenta previa totalis. A 30-year-old woman with placenta previa totalis also had a cervical varix without bleeding. At 32 weeks' gestation, massive hemorrhage from the cervical varix occurred. A vaginal pack controlled the bleeding, and a cesarean section was subsequently carried out because of uncontrollable uterine contractions. A 1655 g female infant was delivered; the estimated blood loss was 1814 mL. The cervical varix decreased dramatically in size. In conclusion, presented herein is a rare case of a cervical varix, which had a successful outcome. [source] | |||||||||||||||||||||||||||||||||||||