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PubMedDate not supplied

Geometric properties and the predicted mechanical behavior of adult human clavicles.

An image processing system was used to examine histomorphometric properties of 15 adult male and female human clavicles. Variations in porosity, cross-sectional area, anatomic and principal moments of inertia were assessed at 2.5-5.0% increments along the length of the clavicles. The clavicle's biomechanical behavior (axial, flexural, and torsional rigidities and the critical force for buckling) was modeled from these data using beam theory. Over threefold variations in porosity and moments of inertia were found along the length of the s-shaped clavicle--the greatest porosity and moments of inertia were located in the variably shaped sternal and acromial thirds of the bone in contrast to the denser and smaller, more circulatory shaped central third of the bone. Clavicle orientation, as indicated by the direction of greatest resistance to bending (maximum principal moment of inertia), was found to rotate from a primarily cranio-caudal orientation at the sternum to a primarily anterior-posterior orientation at the acromion. Based on cross-sectional geometry, section moduli, and estimates of flexural and torsional rigidity, the clavicle was found to be weakest in the central third of its length. These data concur with the fracture location most commonly reported clinically. Analysis of Euler buckling predicted a minimum critical force for buckling during axial loading of approximately two to three body weights for an average adult. Thus, buckling, or a combination of axial loading and bending or torsional loading, must be considered as possible failure mechanisms for this commonly injured bone.

Acromion↗
PubMed1991

Discrepancies between patient report, clinical assessment, and urine analysis in psychiatric patients during inpatient admission.

Self-report and clinical assessment of substance use were compared with urine analysis results in 56 male patients consecutively admitted for inpatient psychiatric treatment. All subjects received DSM-III-R Axis I diagnosis and were classified into diagnostic groups. Urine samples were tested for cocaine, marijuana, opiates, phencyclidine (PCP), amphetamines, and barbiturates. Thirty-five of the 56 patients (62%) produced urine samples that were positive for at least 1 substance of abuse. Of this group, 15 patients (27% of total sample) denied substance use during the week prior to admission. In addition, the admitting physician did not identify intoxication in 23 of the 35 patients (66%) with positive urines. The admitting physician's assessment matched the patient's answers regarding recent substance use in 79 percent of the patients. This association was especially apparent with the 26 patients who denied recent substance use, all but one of whom received a drug-negative assessment from the admitting physician.

Humans↗
PubMed1995

[Prognosis of amyotrophic lateral sclerosis--clinical analysis].

We report the results of a study on the long-term outcome of amyotrophic lateral sclerosis (ALS). The clinical subjects were 81 ALS patients, 75 of whom required assisted ventilation, and 57 of whom have died. We found that the following factors were associated with a longer clinical course: (1) younger onset: (2) female sex: (3) left-sided predominance of amyotrophy: (4) slower development of bulbar symptoms.

Adult↗
PubMed1993

Guidelines for analysis and reporting of clinical trials in oncology.

When analyzing and reporting the results of clinical trials, investigators should follow a simple approach. The purpose of a trial is to estimate an effect or treatment difference, which if present would have clinical utility when treating new patients. Procedures or methods that do not facilitate precisely and impartially estimating and reporting the treatment effect are likely to mislead investigators. Most often in clinical trials, investigators are interested in estimates of risk ratios (specifically odds or hazard ratios) between the treatment groups or levels of a prognostic factor. These simple ideas suggest that the most useful results from clinical trials will be estimated risk ratios and their confidence limits. Especially in cancer, where disease progression, recurrence, and death are common events following treatment, estimates of risk difference are very relevant. Hypothesis tests and associated P-values, although often (or exclusively) reported, are of lesser utility because they do not fully summarize the data. These recommendations may be seen by some investigators to be contrary to accepted practice. It is true that they are somewhat contrary to common practice but their general acceptance is evident in many journals and presentations by clinical trial methodologists. Despite some disagreement among statisticians regarding the need for adjustment of analyses for imbalanced prognostic factors, it is helpful to see if treatment effects change after accounting for imbalances. When this occurs, it may be of clinical interest. Although we discourage analyses that exclude any patients who meet the eligibility criteria, some circumstances will require that this be done (e.g., when a patient refuses to participate after randomization). Investigators should report, and emphasize as primary, those analyses that include all eligible patients. It is our hope and belief that analysis and reporting of trial results along the guidelines suggested here will result in impartial and useful information for journal readers.

Clinical Trials as Topic↗
PubMed1998

Towards evidence based radiation oncology: improving the design, analysis, and reporting of clinical outcome studies in radiotherapy.

Although a substantial number of randomized clinical trials (RCTs) with a radiotherapy component have been conducted over time, it turns out that many of the trials have serious methodological flaws. What is even more frustrating is the circumstance that many RCTs, in radiotherapy as well as in other medical fields, are so heterogeneous in their reporting, that it is virtually impossible to judge their quality and thereby to judge the reliability of their conclusions. Recently, a new set of guidelines for reporting of RCTs has been proposed. These CONSORT (Consolidation of Standards for Reporting Trials) guidelines have now been accepted by a large number of medical journals. The present review presents the background for the CONSORT guidelines. Substantial research has been done on the methodological quality of RCTs reported in the literature and some of this will be reviewed here. Specific areas discussed include definition of endpoints, Type I and II errors, use of confidence intervals rather than P-values, randomization procedures, multiple significance tests, the intention-to-treat principle, and publication bias. Special concerns in relation to the reporting of radiotherapy RCTs are discussed as well. The conclusion is that we need to improve the quality of RCTs in terms of their design, conduct, analysis and reporting. As a step in that direction, a new set of guidelines for reports on treatment outcome in Radiotherapy and Oncology are presented. These guidelines meet the minimum criteria for reporting of RCTs as stated in the CONSORT guidelines.

Clinical Trials as Topic↗
PubMed2001

Reporting on methods of subgroup analysis in clinical trials: a survey of four scientific journals.

Results of subgroup analysis (SA) reported in randomized clinical trials (RCT) cannot be adequately interpreted without information about the methods used in the study design and the data analysis. Our aim was to show how often inaccurate or incomplete reports occur. First, we selected eight methodological aspects of SA on the basis of their importance to a reader in determining the confidence that should be placed in the author's conclusions regarding such analysis. Then, we reviewed the current practice of reporting these methodological aspects of SA in clinical trials in four leading journals, i.e., the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, and the American Journal of Public Health. Eight consecutive reports from each journal published after July 1, 1998 were included. Of the 32 trials surveyed, 17 (53%) had at least one SA. Overall, the proportion of RCT reporting a particular methodological aspect ranged from 23 to 94%. Information on whether the SA preceded/followed the analysis was reported in only 7 (41%) of the studies. Of the total possible number of items to be reported, NEJM, JAMA, Lancet and AJPH clearly mentioned 59, 67, 58 and 72%, respectively. We conclude that current reporting of SA in RCT is incomplete and inaccurate. The results of such SA may have harmful effects on treatment recommendations if accepted without judicious scrutiny. We recommend that editors improve the reporting of SA in RCT by giving authors a list of the important items to be reported.

Data Interpretation, Statistical↗
PubMed1994

Epilepsy: case report and analysis of clinical management problems.

Epilepsy is a major cause of morbidity and accounted for up to 40% of psychiatric outpatient attendances in the experience of the author in Transkei, South Africa. In many cases clinical diagnosis and management were easy. In this paper, the author analyses the clinical management problems presented by seven patients between January 1986 and May 1989. A detailed case report is presented to illustrate difficulties in management. It is suggested that ethosuximide might be effective in the control of probable partial seizure disorders. Underlying electrophysiological considerations are discussed. It is noted, however, that it may not be easy to differentiate between partial or generalised seizure disorders on clinical grounds.

Adolescent↗
PubMed2004

Vardenafil (Levitra) for erectile dysfunction: a systematic review and meta-analysis of clinical trial reports.

Trials of the efficacy and safety of vardenafil in the treatment of male erectile dysfunction (ED) were meta-analysed. All available databases were searched (January 1, 2001-November 30, 2003). Trials were eligible if they included men with ED, compared vardenafil with placebo, were randomized, were at least of 12 weeks duration, and assessed clinically relevant outcomes. Two reviewers independently evaluated study quality and extracted data in a standardized fashion. Nine trials (6809 men) met the inclusion criteria. In results pooled from seven fixed-dose trials, vardenafil increases the Erectile Function domain of the International Index of Erectile Function questionnaire by 6.18 units (weighted mean difference (WMD)). Vardenafil also increases the percentage of erections firm enough to allow vaginal penetration (WMD: 26) and the percentage of sexual attempts that were successful per participant (WMD: 29.8). The percentage of men agreeing with the statement that 'the treatment they have been taking over the past 4 weeks improved their erections', is also in favour of vardenafil (relative risk (RR): 3). These efficacy variables appeared greater at higher doses, although there are no significant differences between 10 and 20 mg dose. The same results were extracted for the two flexible 'as needed' dosing trials. Discontinuations are greater at the vardenafil groups compared to placebo (RR: 2.25). Specific adverse events with vardenafil included flushing, dyspepsia, headache, and rhinitis. Vardenafil was not significantly associated with serious cardiovascular events or death. Vardenafil, in all treatment regimens, shows to possess superior efficacy to placebo in the treatment of patients with erectile dysfunction. More data is needed on patients' subgroups.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

A clinical case report: interface analysis of a successful well-functioning transmandibular implant from a cadaver mandible.

Transmandibular implants (TMI) are indicated both for functional reconstruction of the severely atrophic mandible and when routine augmentation is unpredictable. This study investigates the interface of bone around a TMI, retrieved from the cadaver. The TMI had successfully functioned for 7 years. The mandible was immersed in 10% formaldehyde and sectioned into nine appropriate pieces. Samples were embedded in polymethylmethacrylate, and cut around the transosseous posts and cortical screws in both vertical and horizontal sections. Samples were analyzed at 400 MHz (nominal lateral resolution, 2.5 microm) using a UH3 Scanning Acoustic Microscope (Olympus, Tokyo, Japan). The middle of implant specimens 1-4 were cut to 50 microm, and stained by toluidine blue for light microscopy. Dental X-rays showed no bone resorption around any implant. On a 2-mm lateral scan, almost uniform interface space was seen between bone and implant surface in cortical screws. There are wider spaces around the transmandibular posts in the superior area. Histology revealed the small area of direct contact. There is bone marrow space in the interface, with no significant fibrous tissue. We interpret these results at the interface to be because of adaptation for stress distribution.

Adaptation, Physiological↗
PubMed2003

Abutment positioning in a cantilevered shortened dental arch: a clinical report and static analysis.

This article describes the extension of a shortened dental arch with a cantilever fixed partial denture in a patient who refused to be treated with an implant-supported and retained prosthesis. Orthodontic movement of the distal abutment to enlarge the interabutment span was performed before the final restoration. The mechanical advantage of the enlarged span in a cantilever fixed partial denture is analyzed, discussed, and demonstrated by 2-dimensional static analysis.

Biomechanical Phenomena↗
PubMed1979

Neurotoxicity of halogenated hydroxyquinolines: clinical analysis of cases reported outside Japan.

An analysis is presented of 220 cases of possible neurotoxic reactions to halogenated hydroxyquinolines reported from outside Japan. In 80 cases insufficient information was available for adequate comment and in 29 a relationship to the administration of clioquinol could be excluded. Of the remainder, a relationship to clioquinol was considered probable in 42 and possible in 69 cases. In six of the probable cases the neurological disturbance consisted of an acute reversible encephalopathy usually related to the ingestion of a high dose of clioquinol over a short period. The most common manifestation, observed in 15 further cases, was isolated optic atrophy. This was most frequently found in children, many of whom had received clioquinol as treatment for acrodermatitis enteropathica. In the remaining cases, a combination of myelopathy, visual disturbance, and peripheral neuropathy was the most common manifestation. Isolated myelopathy or peripheral neuropathy, or these manifestations occurring together, were infrequent. The onset of all manifestations (except toxic encephalopathy) was usually subacute, with subsequent partial recovery. Older subjects tended to display more side effects. The full syndrome of subacute myelo-optic neuropathy was more frequent in women, but they tended to have taken greater quantities of the drug.

Adolescent↗
PubMed1987

[Occupational contact dermatitis: analysis of clinical case reports, 1972-1985].

The hospital records of 105 subjects with professional dermatitis, admitted at the Institute of Occupational Health of Verona between 1972 and 1985, were reviewed. Work sectors, chemicals, sites of dermatitis, latency and age of onset were evaluated. Contact allergic dermatitis were 80% while irritative ones were 10%. Metal-, construction- and tannery workers were more frequently involved. The most common causes were salts of heavy metals. The authors discuss results and remark the need of standardization in diagnostic procedures.

Adult↗
PubMed1989

[Tonsillolith: clinical picture and mineralogic analysis].

We report the clinical appearance and mechanism of origin of a tonsillolith 7 g in weight, found in a 77-year-old patient and simulating a tumour of the oropharynx. Mineral analysis showed the main ingredients to be CaO and P2O5. Only trace amounts of SiO2, MgO, Na2O and K2O were found.

Aged↗