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PubMed1998

International consensus recommendations. Summary statement and additional suggested guidelines. European Consensus Conference, November 1991. American College of Chest Physicians consensus statement of 1995. International Consensus Statement, 1997.

Since the NIH Consensus Conference in 1986, the developments in the field of prevention and treatment of venous thromboembolism were mainly characterized by a more specific and extended use of new prophylactic agents such as low-molecular-weight heparins as well as the perception that out-patients may be at risk for thromboembolic complications, too. Therefore, in 1991 and 1995, consensus conferences were held in Europe and North America in order to analyze the risk constellation of various patient populations and to give recommendations for primary prophylaxis and treatment of thromboembolic complications. The most recent, the 1997 International Consensus Recommendations are also discussed.

Anticoagulants↗
PubMed1998

International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection. Ghent International Working Group on Mother-to-Child Transmission of HIV.

BACKGROUND: An understanding of the risk and timing of mother-to-child transmission of HIV-1 in the postnatal period is important for the development of public-health strategies. We aimed to estimate the rate and timing of late postnatal transmission of HIV-1. METHODS: We did an international multicentre pooled analysis of individual data from prospective cohort studies of children followed-up from birth born to HIV-1-infected mothers. We enrolled all uninfected children confirmed by HIV-1-DNA PCR, HIV-1 serology, or both. Late postnatal transmission was taken to have occurred if a child later became infected. We calculated duration of follow-up for non-infected children from the time of negative diagnosis to the date of the last laboratory follow-up, or for infected children to the mid-point between the date of last negative and first positive results. We stratified the analysis for breastfeeding. FINDINGS: Less than 5% of the 2807 children in four studies from industrialised countries (USA, Switzerland, France, and Europe) were breastfed and no HIV-1 infection was diagnosed. By contrast, late postnatal transmission occurred in 49 (5%) of 902 children in four cohorts from developing countries, in which breastfeeding was the norm (Rwanda [Butare and Kigali], Ivory Coast, Kenya), with an overall estimated risk of 3.2 per 100 child-years of breastfeeding follow-up (95% CI 3.1-3.8), with similar estimates in individual studies (p=0.10). Exact information on timing of infection and duration of breastfeeding was available for 20 of the 49 children with late postnatal transmission. We took transmission to have occurred midway between last negative and first positive HIV-1 tests. If breastfeeding had stopped at age 4 months transmission would have occurred in no infants, and in three if it had stopped at 6 months. INTERPRETATION: Risk of late postnatal transmission is consistently shown to be substantial for breastfed children born to HIV-1-positive mothers. This risk should be balanced against the effect of early weaning on infant mortality and morbidity and maternal fertility.

Blotting, Western↗
PubMed1993

Toward an international consensus on temporomandibular joint surgery. Report of the Second International Consensus Meeting, April 1992, Buenos Aires, Argentina.

This consensus statement reflects the current status of temporomandibular joint surgery in the international community of oral and maxillofacial surgeons in the early 1990s. It is not the end, and it is not the beginning; it is a step forward in the treatment of patients with temporomandibular disorders. It is hoped that this statement will encourage member organizations, and individual members to pursue the issues raised by the proposed criteria. Also there should be continuing debate on the findings presented and on future developments, as well as efforts to teach others the skills the specialty has acquired.

Humans↗
PubMed1997

Assessment of International Psychogeriatrics: the Journal of the International Psychogeriatric Association.

In 1996, new editorial management took over International Psychogeriatrics (IP), only a year after the frequency of its publication increased from semiannual to quarterly. At the request of the editorial board, an assessment of the journal was conducted by comparing it to other journals in the field of geriatrics and, specifically, geriatric psychiatry. The evaluation included both a modified citation analysis and a review of journal content. The study was undertaken in order to identify the position the journal has within its discipline. Further, it was to identify the journal's strengths and weaknesses with the overall goal of recommending changes to IP's current content and format. IP ranked seventh of 15 journals in terms of impact factor. It is primarily oriented towards the publication of original research, and features fewer longer articles than others in the field. Adding a wider variety of content may increase the overall interest in the journal. However, these changes must be weighed against the goals of the journal and its reputation as a source of original research in the field of geriatrics.

Aged↗
PubMed1999

Stage-modified international prognostic index effectively predicts clinical outcome of localized primary gastric diffuse large B-cell lymphoma. International Extranodal Lymphoma Study Group (IELSG)

BACKGROUND: The definition of prognostic parameters in early stages of gastric lymphoma is still controversial. The aim of this retrospective analysis was to assess the value of the stage-modified international prognostic index (IPI) in predicting the outcome of a large, consecutive series of patients with PGL of diffuse large B-cell histology (DLCL). PATIENTS AND METHODS: Three hundred twelve consecutive, newly-diagnosed, patients with localized PGL (stages I-IIE according to the 'Lugano staging system for GI lymphomas') referred from April 1972 to December 1997 to eight Italian and one Swiss centers were reviewed and their outcomes updated to June 1998. One hundred three patients were treated with single-modality therapy, while two hundred four received combined-modality treatment, most of which included surgery and short-term chemotherapy. RESULTS: After a median follow-up of 66 months (range 0.6-300 months), 195 (64%) were alive in first continuous complete remission (CCR). The five-year estimates of overall survival (OS) and event-free survival (EFS) were 75% and 67%, respectively. OS and EFS varied according to IPI, from, respectively, 90% and 82% for patients with 0-1 risk factors, to 40% and 35% for patients with > or = 3 risk factors (P = 0.00001). Cox regression analysis showed that IPI was the strongest predictor of survival. CONCLUSIONS: This study shows that stage-modified IPI is an effective predictive model in patients with primary DLCL of the stomach, enabling identification of patients with significantly different outcomes.

Adolescent↗
PubMed2006

Enhanced memory performance on an internal-internal source monitoring test following acute psychosocial stress.

Research on the effect of acute stress and high levels of glucocorticoids on memory has largely focused on memory tasks involving the medial temporal lobe (e.g., declarative memory). Less is known, however, about the effects of stress and glucocorticoids on more strategic memory processes regulated by the prefrontal cortex (e.g., source monitoring). In the current study, the authors investigated whether exposure to acute psychosocial stress would result in altered source monitoring performance relative to the performance of a nonstressed control group. To this end, the authors assigned nonsmoking, healthy, young men to either a stress (n = 22) or a control (n = 18) condition, after which the men were given an internal source monitoring test. Results show that relative to control participants, stressed participants made fewer source monitoring errors. This study suggests that stress may have differential effects on memory, depending on whether the memory test is regulated by the prefrontal cortex or the medial temporal lobe.

Adult↗
PubMed1985

A new device for internal fixation of thoracolumbar and lumbar spine fractures: the 'fixateur interne'.

A new system of operative fixation of thoracolumbar and lumbar spine fractures is presented: the 'fixateur interne' (F.I.). From a posterior approach long Schanz screws are inserted through the pedicles into the body of the two vertebrae just adjacent to the lesion and connected by th threaded F.I. rods. By tightening the nuts the Schanz screws are fixed in all directions. The advantages of the F.I. system are: excellent reposition by the long lever-arm of the Schanz screws, immobilization of only two segments and therefore good mobility of the residual spine, stability against flexion forces better than is obtained with Harrington distraction rods, additional rotational stability, and fixation in lordosis or kyphosis as is desired. The F.I. does not act as a four point bending system like all other dorsal spine instrumentation systems, but provides stability in flexion by itself. Therefore it can be Used independently of the condition of all ligaments (including the anterior longitudinal ligament) and of the posterior wall of the fractured vertebrae, and there is no need to fix more than the two immediately adjacent vertebrae, thus avoiding the often painful and cumbersome iatrogenic loss of lumbar lordosis and of mobility and permitting early mobilization of the patient. Experience with the first 45 patients is very promising.

Bone Screws↗
PubMed2000

Growth hormone deficiency and replacement in elderly hypopituitary adults. KIMS Study Group and the KIMS International Board. Pharmacia and Upjohn International Metabolic Database.

OBJECTIVE: Although elderly hypopituitary adults demonstrate an increase in total and central fat compared with age-matched controls and are distinguishable from control subjects in terms of growth hormone (GH) responsiveness on dynamic testing, there are few data available on response to GH replacement. The objective of this study was to compare the baseline characteristics and longitudinal response to GH replacement in patients aged > 65 years with that observed in younger patients enrolled in KIMS (Pharmacia and Upjohn International Metabolic Database). KIMS is a physician-managed, open, long-term surveillance study of adult GH-deficient patients receiving GH replacement. Patients were entered and data provided by interested physicians. PATIENTS: Baseline characteristics were studied in 109 patients (66 males) aged > 65 years commencing GH replacement at time of entry into KIMS and the effects of GH replacement on blood pressure, lipids and quality of life in 64 patients who had completed at least 6 months of GH replacement. Data were compared with baseline data on 863 patients aged < 65 years with adult onset GH deficiency, who had not received GH for at least 6 months prior to entry into KIMS, 220 of whom went on to complete > 6 months GH therapy in KIMS. RESULTS: Blood pressure, cholesterol and LDL cholesterol were positively correlated with age, particularly in females, and older patients had a predictably higher prevalence of diabetes mellitus and history of hypertension. The frequency of previous fractures was increased in females but not in males aged > 65 years. Body mass index, waist/hip ratio and quality of life (AGHDA score) was similar in both groups prior to commencement of GH therapy. GH replacement doses were similar in younger and older patients and the percentage of patients with serum IGF-I of > 2SD above the age-related normal mean was not significantly different between the groups (< 65 years, 20%; > 65 years, 11%). After 6 months of GH replacement significant improvements were evident in waist circumference, waist/hip ratio, diastolic blood pressure, total and LDL cholesterol and AGHDA score in patients aged < 65 years. Similar significant reductions in total and LDL cholesterol were evident in patients > 65 years. In addition, male patients aged > 65 years demonstrated significant reductions in diastolic blood pressure and AGHDA score but no change in waist circumference whereas females aged > 65 years demonstrated a trend to reduction in waist circumference and AGHDA score. CONCLUSIONS: These data, derived from the largest series of GH-treated hypopituitary patients published to date, confirm similar baseline characteristics and positive benefit from GH replacement in older compared with younger hypopituitary patients particularly in relation to quality of life.

Aged↗
PubMed1995

The BEST Working Party of the International Society of Blood Transfusion: an international effort to improve the quality of blood components.

BACKGROUND: The Biomedical Excellence for Safer Transfusion (BEST) Working Party of the International Society of Blood Transfusion was formed with the aim of improving the quality and safety of blood components. An outline of the aims, working methodology, and results after the first 4 years of activity of the BEST Working Party is presented. RESULTS: Seven studies have been performed, evaluating techniques for counting residual white cells in white cell-reduced red cells, platelet quality control, and cellular harvests in blood components prepared with different methods. Areas of possible interest in the near future include stem cells, platelet crossmatching, and virus inactivation of blood components. An important BEST feature is the sharing of information gathered through collections of large sets of data from routine settings, so as to produce a reliable picture of the "real world." CONCLUSION: Such information could prove useful to those in charge of developing recommendations and guidelines.

Blood Component Transfusion↗
PubMed2000

International integrative primary care outcomes study (IIPCOS-2): an international research project of homeopathy in primary care.

OBJECTIVE: The primary objective is to evaluate the effectiveness of homeopathic treatment compared to conventional treatment for respiratory and ear complaints commonly seen in the primary care setting: runny nose, sore throat, ear pain, sinus pain, and cough. METHOD: This study is an international, multi-center, prospective, outcomes study on the effectiveness of homeopathic treatment compared to conventional treatment. The participating investigators will be divided into three groups: * Homeopathic treatment; * Homeopathic or conventional treatment according to the patient's preference, either randomized or non-randomized; * Conventional treatment. A total of 2400 patients will be recruited. Consecutive patients, age one month or older, presenting with one of the five chief complaints, and onset of symptoms less than seven days will be included into the study. Prior to enrolment into the trial each patient must provide written informed consent. Patient outcome will be measured using the Integrative Medicine Outcomes Scale (IMOS) at 7-, 14- and 28-d telephone follow-up. In addition, covariate data related to the following will be collected: patient demographics and medical history, patient preference for treatment and willingness to be randomized, health-related quality of life, primary treatment and adjunctive therapies prescribed, adverse events, type and length of consultation, follow-up recommendation, patient compliance, patient satisfaction with treatment, and patient willingness to choose therapy and health care provider again. The main outcome criterion will be the response rate according to the IMOS after 14 days of treatment. RESULTS: Preliminary interim results will be presented. CONCLUSIONS: Lessons learned from the study will be discussed.

Ear Diseases↗
PubMed2001

Temporomandibular joint internal derangement type III: relationship to magnetic resonance imaging findings of internal derangement and osteoarthrosis. An intraindividual approach.

The purpose of this study was to investigate whether in patients with a clinical unilateral temporomandibular joint (TMJ)-related finding of internal derangement type (ID)-III (disk displacement without reduction) in combination with TMJ-related pain, the intraindividual variable of 'unilateral TMJ ID-III pain' may be linked to subject-related magnetic resonance (MR) imaging findings of TMJ ID, and TMJ osteoarthrosis (OA). The study comprised 48 consecutive TMJ pain patients, who were assigned a clinical unilateral TMJ pain side-related diagnosis of ID-III. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ ID and/or OA. Comparison of the TMJ side-related data showed a significant relationship between the clinical finding of TMJ ID-III pain and the MR imaging diagnoses of TMJ ID (P=0.000) and TMJ ID type (P=0.000). There was no correlation between the clinical finding of TMJ ID-III pain and the MR imaging diagnosis of TMJ OA (P=0.217), nor between the MR imaging diagnosis of TMJ OA and that of TMJ ID (P=0.350). Regarding the diagnostic subgroups of TMJ ID, a significant relationship was found between the presence of TMJ OA and the MR imaging diagnoses of TMJ ID type(P=0.002). Use of the Kappa statistical test indicated a fair diagnostic agreement between the presence of TMJ ID-III pain and the MR imaging diagnosis of disk displacement without reduction (DDNR) (K=0.42). The results suggest that TMJ ID-III pain is related to TMJ-related MR imaging diagnoses of ID. Further, the data confirm the biological concept of 'DDNR and OA' as an underlying mechanism in the etiology of TMJ-related pain and dysfunction.

Adolescent↗
PubMed2001

Anatomical variations in the internal jugular veins of cancer patients affecting central venous access. Anatomical variation of the internal jugular vein.

PURPOSE: Establishing a reliable central venous access is an important procedure in clinical haematology and oncology. The purpose of this study was to determine how anatomical variations in the internal jugular vein (IJV) and its position in relation to the common carotid artery (CCA) in cancer patients affects external landmark puncture. PATIENTS AND METHODS: In 113 patients with haematological or oncological diseases we examined sonographically potential target regions for placement of a central catheter via the IJV. RESULTS: 36% of our patients showed anatomical variations in the IJV and surrounding tissue. CONCLUSIONS: External landmark puncture may be difficult in a considerable number of patients since the IJV might not be situated in the presumed location anteriorly or laterally to the CCA, or a normal lumen may not be present in approximately 1/3 of cancer patients. This study supports the use of ultrasound-guided techniques for central venous catheters particularly in haematological and oncological patients.

Adult↗
PubMed2002

[Psychiatric examination of accused for the "United Nations International Tribunal for the prosecution of persons responsible for serious violations of International Humanitarian Law committed in the territory of the former Yugoslavia" (ICTY)].

Psychiatric examination of accused for the International Tribunal is a new and challenging task for expert medical witness and forensic psychiatry. After a brief description of a case report relevant aspects of psychiatric evaluation of persons responsible for war crimes are outlined and possible implications for forensic research are discussed.

Adult↗
PubMed1998

Rarity of surgical complications after postchemotherapy nephrectomy for nephroblastoma. Experience of the International Society of Paediatric Oncology-Trial and Study "SIOP-9". International Society of Paediatric Oncology Nephroblastoma Trial and Study Committee.

The aim of the study was to assess rates and types of nephrectomy-related complications in children nephrectomized for nephroblastoma after preoperative chemotherapy. Records of 598 Wilms' tumour patients registered in the International Society of Paediatric Oncology Trial & Study No. 9 (SIOP-9), and pretreated correctly according to the protocol with vincristine + actinomycin D +/- epirubicine or adriamycin prior to nephrectomy, were retrospectively reviewed. Forty-nine patients (8%), who suffered from 54 complications, were identified. Most frequent events were small-bowel occlusions (3.7%) and tumour ruptures (2.8%). Other complications were registered in 2.0% of cases. The low rate of nephrectomy complications and no deaths related to registered ones, are another argument for preoperative chemotherapy in Wilms' tumour patients.

Adolescent↗
PubMed2006

Relationship between nocturnal penile tumescence parameters, International Index of Erectile Function symptom scores and sildenafil responses1This paper was presented at the 6th Congress of the International Society of Sexual and Impotence Research, Buenos Aires, Argentina, 17-21 October 2004.

OBJECTIVE: To evaluate the correlation between International Index of Erectile Function (IIEF) questionnaire scores, nocturnal penile tumescence parameters and sildenafil response in patients with erectile dysfunction using a minimal investigations approach. MATERIAL AND METHODS: A total of 97 patients without any risk factors for erectile dysfunction were included. After completing the IIEF questionnaire, nocturnal penile tumescence monitoring was performed in all patients for 1 or 2 nights. Subsequently, sildenafil was given at a dosage of 50 or 100 mg according to the response. The relationship between nocturnal penile tumescence results, the severity of erectile dysfunction according to the IIEF questionnaire and sildenafil response was evaluated using Pearson's chi2 test. RESULTS: Based on the questionnaire scores, 25 patients (25.8%) had mild, 44 (45.4%) had moderate and 28 (28.8%) had severe erectile dysfunction. Forty-four patients (45.4%) had normal and 53 (54.6%) had abnormal parameters after nocturnal penile tumescence recording. The sildenafil response was positive in 63 patients (64.9%) who were given 50 mg and in 26 (26.8%) who were given 100 mg. However, eight patients (8.2%) did not respond to sildenafil. While the severity of erectile dysfunction according to IIEF scores and the sildenafil response did not show any correlations with nocturnal penile tumescence results, there was a statistically significant relationship between sildenafil response and the severity of erectile dysfunction. CONCLUSION: Changing concepts in the evaluation of ED have resulted in the use of effective therapeutic applications consistent with the degree of symptoms of patients without the waste of time caused by performing expensive, invasive, ineffective and time-consuming diagnostic tests.

Adult↗
PubMed2004

Identifying the concepts contained in outcome measures of clinical trials on four internal disorders using the International Classification of Functioning, Disability and Health as a reference.

OBJECTIVES: To systematically identify and compare the concepts contained in outcome measures of clinical trials on chronic ischaemic heart disease, diabetes mellitus, obesity, and obstructive pulmonary disease, including asthma using the International Classification of Functioning, Disability and Health (ICF) as a reference. METHODS: Randomized controlled trials between 1993 and 2003 were located in MEDLINE and selected according predefined criteria. The outcome measures were extracted and the concepts contained in the outcome measures were linked to the ICF. RESULTS: 166 trials on chronic ischaemic heart disease, 227 trials on diabetes mellitus, 428 trials on obesity, and 253 trials on obstructive pulmonary disease were included. Ten different health status questionnaires (fulfilling the inclusion criteria) were extracted in chronic ischaemic heart disease, 19 in diabetes mellitus, 47 in obesity, and 39 in obstructive pulmonary disease. Across conditions at least 75% (range 75-92%) of the extracted concepts could be linked to the ICF. In diabetes mellitus and obesity the most used ICF categories were general metabolic functions (b540), in obstructive pulmonary disease respiration functions (b440) and in chronic ischaemic heart disease heart functions (b410). CONCLUSION: In all 4 health conditions the majority of studies were drug trials focusing on clinically relevant parameters and not on functioning. The ICF provides a useful reference to identify and quantify the concepts contained in outcome assessment used in clinical trials.

Activities of Daily Living↗
PubMed1997

Preliminary findings of the international typing study on Clostridium difficile. International Clostridium Difficile Study Group.

Preliminary results of the International Typing Study on Clostridium difficile indicate that there is excellent correlation between the phenotypic methods reliant on cell surface antigens for typing strains and that a larger number of phenotypes and genotypes of C. difficile exists than was previously appreciated by each group of investigators acting independently. Evidence has also emerged that some of the types described by each method are common to all typing methods, indicating that strains of the same type are found in hospitals in the United Kingdom, Belgium, the United States, and Australia.

Bacterial Typing Techniques↗
PubMed2005

NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study.

AIMS: Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents. METHODS AND RESULTS: Differences in NT-proBNP levels among 1256 patients with and without acute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P<0.001), and levels of NT-proBNP correlated with HF symptom severity (P=0.008). An optimal strategy to identify acute HF was to use age-related cut-points of 450, 900, and 1800 pg/mL for ages <50, 50-75, and >75, which yielded 90% sensitivity and 84% specificity for acute HF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to exclude acute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2-8.1, P<0.001]. CONCLUSION: In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.

Acute Disease↗