Questions and (some very tentative) answers about hospital ethics committees.
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Biomedical subjects
Publications and source records attributed to C Levine.
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The ribs are frequent sites of primary Ewing tumor accounting for about 10-12% of all cases. The lesions may be predominantly lytic or sclerotic or show a combination of bone destruction and secondary reactive changes. In some patients bony changes are subtle and are obscured initially by frequently associated large extrapleural masses or pleural fluid. These patients may present clinically with findings secondary to compression of mediastinal structures by the soft tissue masses. Computed tomography (CT) is of great value in the diagnosis of such difficult cases and better demonstrates the tumor extent and relationships than other available imaging modalities. CT is also of considerable help in determining the optimal time for en bloc tumor resection. Many tumors are initially considered non-resectable due to extensive involvement of the lung, the mediastinum, or the diaphragm. CT accurately documents tumor regression during preoperative courses of chemotherapy.
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Barium enema (BE) is usefull and safe in diagnosis of pediatric appendicitis, but pitfalls must be avoided. Reasons for false negative BE include failing to or inability to obtain good compression local views of the cecum and accepting a partially filled appendix as normal. In addition to right ovarian lesions in girls, there are less common causes of false positives, including mucocele, intussuscepted appendix, and recurrent inflammation of appendiceal stump. Non-filing of the appendix is not in itself abnormal. Abdominal ultrasound may be complementary, and increasingly is becoming the primary imaging modality for uncertain appendicitis.
This is a report of an atypical fibrous histiocytoma in the skull of an infant, who at the age of 3 months was noted to have a "lump" beneath the scalp in the right parietal region. It was about 2 cm in diameter, and the scalp was movable over it. Physical examination was otherwise normal. Radiographs showed erosion of the scalp deep on the palpable mass. At operation a neoplasm was found, which had destroyed the bone and invaded the adjacent temporal muscle and dura mater. The tumor was removed en bloc after the surrounding bone had been excised. Histological examination using light and electron microscopy revealed the tumor to be an atypical fibrous histiocytoma. Radiation therapy was not given. There has been no recurrence for 7 years.
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A 20-year-old Coloured woman presented on three occasions with recurrent right-sided spontaneous pneumothorax which proved to be associated with pulmonary histiocytosis X. After corticosteroid therapy there was no recurrence of pneumothorax or radiographic evidence of progressive disease during a 6-month follow-up period.
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By taking into account a respondent's role-taking standpoint, this study proposes that moral judgments coded at Kohlberg's conventional stages can be expected to vary depending upon (a) the identity of the protagonist implicated in the moral dilemma and (b) the nature of the issues raised by the moral dilemmas used. Different groups of respondents were asked to answer three versions of Kohlberg's moral judgment questionnaire. One version implicated strangers in the dilemmas used (fictitious-other questionnaire), while the other two versions implicated respondents' best friends or mothers (primary-other questionnaires). A comparison of these questionnaire treatments indicates that Stage 3 response rate significantly increases and Stage 4 response rate significantly decreases when respondents answer primary-other questionnaires. It is suggested that this finding casts doubt on the adequacy of the displacement view of moral stage acquisition. The displacement perspective argues that as more cognitively complex structures are acquired, earlier acquired structures are displaced. In contrast, the present study proposes that a "nondisplacement" view of stage acquisition is required in order to explain variation observed at Stage 3 when it may be assumed that a Stage 4 reasoning capability has been acquired.
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