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At least 55 records · Page 3Linked to original sources
PubMed1997

[A case of superficial siderosis of the central nervous system with bilateral vestibular dysfunction].

A 58-year-old woman developed slowly progressive hearing loss, anosmia, and unsteady gait. She had neither repeated episode of headache nor a past history of neurosurgical operation or head injury. Neurological examination revealed anosmia, moderate degree of sensorineural hearing loss. She showed loss of caloric response bilaterally. No nystagmus was found. Romberg sign was present. No cerebellar ataxia was noted in the finger-to-nose or the heel-to-knee test. No adiadochokinesis was noted. Deep tendon reflexes were increased in both upper and lower extremities. Sensation was intact. She showed disturbance of the righting reflex in the tilt-table examination. CSF were under normal pressure, xanthochromic with siderophages. CSF total protein and ferritin level were elevated. T2-weighted image (TE4000/TR100) of high field strength magnetic resonance imaging (MRI) showed marginal hypointensity of the brain stem, the Sylvian fissures, the tips of temporal lobes, anterior cerebellar surfaces and the entire spinal cord. Angiography of the cerebral vessels and spinal arteries failed to identify the source of bleeding. It seemed likely that she had lost bilateral vestibular and auditory functions caused by hemosidelin deposition to her eighth nerves which are often affected by this disorder. Her disturbance of gait and station was apparently similar to cerebellar ataxic gait, however, she did not have limb ataxia. The electronystagmogram revealed marked degree of vestibular dysfunction (VOR) and relative sparing of cerebellar function (OKN). Her disturbance of the righting reflex in the tilt-table examination and the characteristic feature of her Romberg sign with directional preponderance also indicate that the bilateral loss of vestibular functions, i.e., vestibular ataxia caused her dysequilibrium syndrome. It is our impression that vestibular ataxia might precede cerebellar ataxia commonly reported so far.

Brain↗
PubMed1995

[Autonomic failure as the cause of vertigo and syncope].

BACKGROUND: Vertigo and syncope often occur during orthostatic conditions. A possible cause is asympathicotonic dysregulation with a fall of blood pressure and no increase in heart rate. After the exclusion of secondary disturbances of autonomic innervation. g. in diabetes mellitus, and pharmacological side effects, e.g. tricyclic antidepressants, primary reasons must be considered. We present 2 cases of primary autonomic failure. PATIENTS: Patient 1 had Parkinson-syndrome, impaired bladder function and orthostatic dysregulation with a maximal drop of blood pressure to 60/40 mm Hg. Patient 2 showed orthostatic dysregulation with a minimal blood pressure of 70/30 mm Hg without further symptoms, in a tilt table examination catecholamines were measured during orthostatic conditions. Patient 1 had normal, and patient 2 very low resting catecholamine plasma levels. Neither patient reacted with a rise of plasma catecholamines when tilted to an upright position. These findings are diagnostic of multiple system atrophy (MSA) in patient 1 and pure autonomic failure (PAF) in patient 2. DISCUSSION: In PAP only dysautonomic symptoms are found. It has a favourable prognosis. MSA consists of an autonomic dysregulation in combination with parkinsonism, cerebellary and bulbar symptoms, prognosis quo ad vitam is poor. Diagnosis is often established by a tilt table examination and radiology findings, and is often late. Treatment of both diseases consists of pharmacological, e.g. fludrocortisone, vasopressin analogues and ergotamine tartrate as well as non-pharmacological blood pressure stabilizing measures.

Adult↗
PubMed1993

Physicians' practice patterns in pediatric electrodiagnosis.

The medical literature contains contradictory reports and recommendations regarding pediatric patients' pain and distress during electrodiagnosis. We surveyed 117 pediatric neurologists and physiatrists regarding their practice patterns in pediatric electrodiagnosis; 84 (72%) responded, of whom 44 (52%) regularly perform electrodiagnosis on children (mean = 85 per year, representing 3,667 examinations per year). Respondents reported extreme behavioral distress (eg, screaming, flailing, requiring additional restraint, or attempting to leave the examination table) in 35% of examinations, most often among 2- to 6-year-olds. Pain medications are never prescribed by 45%, occasionally by 48%, and always by 2%; general anesthesia is never administered by 75%, occasionally by 21%. Only 32% reported that any psychological intervention is routinely offered to enhance child coping. Wide variability was found in physicians' preferences about parental presence, order of examinations, demonstration of procedures, and other aspects of electrodiagnosis.

Adolescent↗
PubMed1997

[Microbial contamination of small animal ambulatory veterinary clinics and waiting rooms].

Air and contact indicator microflora was monitored for a year during 17 outpatients' examinations at indicated sites of the balance loading area, examination tables and manipulation tables in an outpatients' consulting room partitioned into two sections (I, II) and in two waiting rooms (I, II) of an internal clinic of the Faculty of Veterinary Medicine at Brno. The consulting room and both waiting rooms were after reconstruction. Ambience monitoring by a sedimentation method demonstrated the lower microbial contamination of waiting room II and outpatients' consulting room II, which were reserved for vaccination of healthy animals. The ambience in waiting room I and outpatients' consulting room I, where diseased animals were examined, showed the higher values microbial contamination. The indicators of microbial contamination under observation involved total microbial counts on meat-peptone agar (MPA), counts of hemolytic (H+) and nonhemolytic (H+) micrococci on blood agar with 10% NaCl, counts of lactose positive (L+) and lactose negative (L-) microbes on Endo agar and of molds and other microbes on Czapek-Dox agar. Frequent occurrence of representatives of the genus Aspergillus and Penicillium out of 42 genera and species of identified molds was indicated in the ambience of the waiting rooms and outpatients' consulting rooms. Examination of the indicated sites of the balance loading area in waiting room I and of examination and manipulation tables in outpatients' consulting rooms by smear and impress methods demonstrated the lowest contamination on the surface of examination tables. Microbial contamination of the balance loading area was however highest, and the identified values indicate a risk of the permanent contact of animal patients with the increased microbe concentrations during their weighing. The balance location in the waiting room is not convenient under the present schedule of cleaning and cleansing. In the Discussion section, an overall decrease in the ambience microbial contamination in waiting rooms and outpatients' consulting room under observation in building no. 9 after reconstruction is shown in comparison with the results of preceding monitoring of the waiting room and outpatients' consulting room in building no. 6 under provisional conditions.

Animals↗
PubMed1977

Factors influencing the assessment of the pseudomonacidal activity of disinfectants by a quantitative suspension test. II. The post-disinfection recovery of surviving organisms.

Bacteria which have been treated by a disinfectant may be partially damaged so that they will be able to survive and to multiply only if all environmental factors are kept as optimal as possible. Otherwise no growth at all is obtained and the disinfectant solution will be wrongly considered as active. Therefore the technique of the post-medication recovery of surviving microorganisms is a matter of great importance. Since our aim is to elaborate a quantitative test, the counting technique using pour or streak plates is investigated here. In contrast to the results of viable counts of normally cultivated P. aeruginosa (Tables 1 and 2), the colony counts of phenol-treated bacteria gain higher figures when the spread plate method is used instead of the pour plate technique (Table 3). - Out of nine solid media examined (Table 4), four culture media are considered to be superior to the others (Table 5). They are Davis Agar, the Nutrient Agar of the German pharmacopoeia, the Nutrient Agar proposed by the APHA, and Tryptone Soy bean peptone Agar. Further investigation on the influence of the recovery medium is needed since there is stated that significant differences are obtained when three preparations of the same formulation are compared (Table 6). Finally the author observed that the volume of the culture medium affects the survival rate (Table 8). The recovery of disinfectant-treated bacteria is found to be very complex; further research on this domain should be encouraged.

Bacteriological Techniques↗
PubMedDate not supplied

Pruritus: a practical approach.

Pruritus is usually caused by a primary disorder of the skin, but can also be caused by a systemic disease (Table 1). Some dermatologic conditions that cause pruritus can be inconspicuous or nonspecific (Table 2), while others are usually apparent on physical examination (Table 3). Classification of pruritus as localized (Fig. 1) vs. generalized (Fig. 3) can be helpful in arriving at a correct diagnosis. The history and physical examination are the most important diagnostic tools, though laboratory testing for systemic disease may be necessary. In refractory cases, one should consider occult systemic disease (such as malignancy), psychiatric disease (especially depression), and HIV infection. Subsequent referral to a dermatologist may be indicted. When treatment of the underlying cause of pruritus is not possible, antihistamines and topical agents (menthol, phenol, and/or pramoxine) can be helpful.

Anal Canal↗
PubMed2004

[Image examination of postoperative evaluation for the cochlear implanted electrode].

OBJECTIVE: To evaluate the image feature of the X-ray plain film, the spiral computed tomography (CT) scans and three dimension reconstruction of inner ear with implanted electrode. METHODS: Eighteen patients of cochlear implant (MEDEL Combi 40+) recipients were involved in this study. The implanted electrode of all patients were examined on the fifth to seventh postoperative day, by the use of X-ray plain film with either anteroposterior transorbital projection (nine cases) or lateral position with coronal 60 degrees away from the examine table (nine cases). Three of the cochlear implant recipients were examined by the way of spiral CT scans with axial 1 mm image slices. The data of the CT scans was transferred to workstation for three-dimensioned reconstruction (direct volume rendering) of the inner ear. RESULTS: The X-ray plain film from both of anteroposterior projection and lateral with coronal 60 degrees projection provide satisfactory image of implanted electrode including the shape and the position in the temporal bone. The insertion depth of the electrode can be evaluated indirectly. In contrast, the images from CT scans with 3D reconstruction of the inner ear demonstrate more accurately the shape, the position, and the insertion depth of the electrode. Moreover, each of the electrode pairs can be identified clearly. CONCLUSIONS: X-ray plain film can meet the routine needs of postoperative evaluation of the implanted electrode with several kinds of head position of projection. But CT scans with 3D reconstruction of inner ear provide more accurate image of the spacial relationship of the electrode in the cochlear canal with direct demonstration of electrode insertion depth in the cochlea.

Adolescent↗
PubMed1991

A test for knee posterolateral rotatory instability.

A test for knee posterolateral instability, which is a modification of the standard posterolateral rotatory instability test, is described. In this test, the patient lies supine on the examination table with hips and knees flexed to 90 degrees. The examiner grasps both feet and attempts to maximally externally rotate them. A positive test is indicated by (1) excessive external rotation of the affected tibia, which is easily recognized since the feet act as pointers and amplify the external rotation, and (2) a slight posterior sag of the affected tibial tubercle, which is more subtle but still a very recognizable sign.

Humans↗
PubMed1975

The koala (Phascolarctos cinereus)! past, present and future.

The koala (Phascolarctos cinereus) (from the Greek phascolarctos meaning leather pouch and bear, cinereus ashen grey in colour) is Australia's most admired native animal but very little scientific reference material is available on this unique animal. The demands of the fur trade during the latter half of the last century and up to the 1920's almost exterminated the koala and this tragic episode from the past is briefly recounted. Koalas are nocturnal and arboreal. Details of appearance, distribution, breeding, diet, water intake, volatile eucalypt oil detoxication and handling are briefly described, while information concerning intravenous injections, anaesthetic agents antibiotic therapy and fluid therapy are given. As an aid to veterinarians presented with koalas to examine, tables are presented for physiological, haematological and biochemical values. Pathological conditions found on post mortem examination are summarised, while disease conditions such as anaemia, keratoconjuctivitis, toxoplasmosis, cryptococcocis, reproductive disorders, miscellaneous conditions and internal and external parasites are mentioned. Finally, the future of the koala is discussed. Diminishing habitat, depletion of food supplies, bushfires, the threat of disease, coupled with a paucity of relevant scientific information, create an uncertain future for the koala. A plea is made to totally protect and expand the very few remaining known koala breeding areas especially in Victoria, and for veterinarians to become involved in conservation programs and wildlife research in order that the future of the koala in common with all other native species may be assured.

Anemia↗
PubMedDate not supplied

The prone hip extension test: a method of measuring hip flexion deformity.

The "prone hip extension test" is described as a simple, convenient, and reliable method of measuring hip flexion contracture. The test may be performed on a padded examining table or bed, it is applicable to the spastic patient, and as the patient is examined prone, it provides a method of flattening the lumbar spine under visual control to avoid obtaining either a falsely high or low value. It, therefore, circumvents the problems commonly associated with the traditional "Thomas Test".

Child↗
PubMed2000

[Complaints against radiologists in Italy].

INTRODUCTION: Legal claims against radiologists are a relevant phenomenon also in our country and represent an increasing risk for a radiologist's professional activity. MATERIAL AND METHODS: We reviewed the 1993-1998 insurance claims against Italian radiologists. We found 259 claims subdivided by type into: 1) misdiagnosis; 2) complications of the examination; 3) missed referral for further examinations/treatment; 4) (non)ionizing radiation treatment; 5) slip-and-fall injuries; 6) miscellaneous cases. All claims were reviewed anonymously. RESULTS AND DISCUSSION: Most of the 259 malpractice claims were filed late after the event, which makes the actual incidence of the phenomenon difficult to evaluate. Nevertheless the incidence of malpractice claims can be estimated at 32 per thousand people a year, meaning that an Italian radiologist's risk of being sued by a patient at least once in his/her professional life exceeds 1. Alleged misdiagnosis was the most frequent claim category. Missed bone abnormalities of any type, including fractures, dislocations, malignant lesions and other nonspecific conditions accounted for 52.9% of cases. Missed abnormalities on breast and chest examinations accounted for 17.5% and 15.3%, respectively. Within this claim category, missed breast lesions exhibited the most increasing trend. Alleged complications from radiological examinations accounted for 20% of cases and mostly involved i.v. contrast agent administration, interventional procedures and barium enema. Slip-and-fall injuries, where the patients falls off the examination table, slips on the floor, bumps into a piece of equipment and so on, accounted for 7% of cases. Missed referral to further examinations accounted for 1.5% only. Finally, radiologists were frequently sued as one of many defendants, together with medical/surgical doctors, in case of patient's death, in 20% of all cases. CONCLUSIONS: Italian radiologists currently run the same risk of being sued for malpractice as their American colleagues. Strict compliance with radiological standards is recommended to try to decrease the risk and to obviate litigation.

Diagnostic Errors↗
PubMed1985

Minicomputer-based system for obstetric ultrasound analysis, with multi-user and networking capability.

A computer-assisted approach to the dating of gestation and the evaluation of fetal growth by ultrasonography that relies on a computer-based information management system of a general hospital is described. The system processes, stores, retrieves, and compares ultrasound data, and a report can be generated by the ultrasonographer while the patient is still on the examining table. A major feature is that the system can be accessed by any authorized user from any terminal within the hospital where obstetric ultrasound examinations are performed and from off-site physicians' offices. The large memory capacity, the networking among several data bases, and the statistical manipulation capabilities of the system make it ideal for clinical research.

Computers↗
PubMed1977

[Seamen and dental health. Studies of tooth status among naval staff and merchant seamen. A review].

Dental health among Norwegian seamen, based on clinical examinations (Table 2) and interviews have been studied. Interview findings from eight ships in overseas trade indicated that the occupational conditions of seafarers caused irregular use of dental services (Table 3) and poor dental health compared with that of the general population. In an epidemiological survey comprising 431 Norwegian seamen in overseas trade, these indications were supported (Table 1 and Table 2). Approximately every fifth of the male seafarers aged 20 years or more had visited the dentist annually during the last five years. In a subsample of 212 subjects who were examined both clinically and radiographically, the number of decayed teeth averaged 6.1. It is concluded that regular dental check-up as well as delivery of dental services should be provided through the established health centers for seamen.

Adult↗
PubMed1999

[Ambulatory cardiac phase II rehabilitation--"the Cologne model"--including 3-year-outcome after termination of rehabilitation].

From January 1992 until December 1994 the Cologne model of ambulant cardiac rehabilitation (ACR) in the greater area of Cologne, Germany, was performed and is still in progress. In Germany until 1992 the cardiac rehabilitation was exclusively performed stationary. The objective of the "Cologne model" was to evaluate, whether the transfer of the stationary cardiac rehabilitation programs into the ambulatory setting is achievable without deficits in efficiency, safety and overall quality. The results obtained are intended to serve for standardization and quality control of future ambulatory cardiac rehabilitation programs in Germany. From 1992 to 1994 108 patients (94 men, 14 women; 52.3 +/- 8.0 years old) with coronary artery disease (CAD) which were compatible with the criteria of the "Cologne model" (Table 1) participated in the 4-week ACR. The indications for inclusion into the ACR were in 74 cases a myocardial infarction (MI), in 34 cases CAD without MI, but with PTCA/stent-procedure (Table 3). Seven patients discontinued the ACR prematurely, 2 patients because of cardiovascular reasons. Reasons for the preference of the ambulatory over a stationary cardiac rehabilitation program were in 40.6% of the patients refusal of "hospital ambience", in 43.6% familiar or in 12.9% professional reasons. During the 4-week ACR patients participated in a mean of 72.9 +/- 6.7 hours of therapy (Table 4). As a result of the ACR exercise tolerance increased highly significantly (**) from 116.4 +/- 28.8 to 129.9 +/- 34.6 watt). This improvement was maintained at the 1- and 3-year control (128.7 +/- 35.8**) examinations (Tables 5 and 7). One year after ACR 77% of the patients stated to be physically active in ambulatory heart groups (AHG) (27.6%) or on their own (49.4%). Three years after ACR the rate of regularly physically active patients still was 59.2%. Furthermore, as a result of ACR the dietary behavior was changed significantly. There was a reduction in the consumption of lipids by 20.8%, saturated fatty acids by 30.7% and of cholesterol by 30.5%. The plasma concentrations of cholesterol decreased from 231 +/- 49.8 to 213.2 +/- 35.9 mg%**. Six (and 12) months after ACR they increased again to 225.6 +/- 39.4 mg%. Three years after ACR the mean cholesterol level was 219.1 +/- 39.3 mg%. In the high risk group (cholesterol at the initial visit > 220 mg%) cholesterol levels were reduced from 266 +/- 44 to 232 +/- 31.9 mg%**. Six and 12 months after ACR they were 239.7 +/- 35.8 mg% and 245.8 +/- 32.6 mg%, respectively, (Tables 6 and 7) and still significantly lower than before ACR, though only 19% of the patients were treated with lipid lowering agents. Three years after ACR cholesterol were 234.6 +/- 37.7 mg%** in the high-risk group. 34.2% of the patients received lipid lowering agents. Mean body weight remained unaltered over the 3-year period. Smoking behavior was not altered significantly during the 4-week ACR. However, before the cardiovascular event 67.3% of the patients had smoked cigarettes. At the beginning and at the end of ACR 20.8% of the patients still smoked. During the ACR the number of smoked cigarettes was reduced significantly from 32.4 +/- 15.2 to 6.9 +/- 5.2 cigarettes per day. One year after ACR 23% of the patients were smokers, 3 years after ACR the percentage of smokers increased to 30.3%. Before ACR 73.3% of the patients were still working. During the first 6 months after ACR 68.2% returned to work and the percentage increased to 73% in the following 6 months. The results demonstrate that it is achievable to transfer the contents of the established stationary cardiac rehabilitation programs into the ambulatory setting without loss of efficiency, safety and overall quality. It is further confirmed, that it is necessary to continuously evaluate the results of the cardiac rehabilitation program on a long-term basis. (ABSTRACT TRUNCATED)

Adult↗
PubMedDate not supplied

[MR-angiography with contrast bolus vs digital angiography in peripheral arterial occlusive disease of the legs].

PURPOSE: Aim of our study was to compare MR Angiography and Digital Angiography in the diagnosis of peripheral vascular occlusive disease. MATERIAL AND METHODS: Forty-five patients underwent both MRA and DSA examination of the peripheral arterial district. We employed a 1.5 Tesla MRI unit using 3D FSPGR T1-w sequence on coronal scan plane (TR=5.2 ms; TE=1.5 ms; slice=1.5/3 mm; FOV=48 cm; matrix 384x512; TA=16/24 s), before and after automatic iv injection of Gd-DTPA BMA (0.15/0.3 mmol/kg) with a flow rate of 2 ml/s. We evaluated the vascular district from renal to medio-distal tibial arteries. The acquisition of this arterial district required a semi-automatic movement of the examination table. Qualitative and quantitative analyses were carried out according to MIP reconstructions. DSA evaluation, considered as the gold standard, was performed by trans-femoral access using a 4-5F catheter. RESULTS: The MRA examination detected 246 steno-occlusive lesions while 285 were identified with DSA. No statistically significant differences were found among the various degrees of stenotic lesions detected by the two METHODS. The MRA examination had specificity and sensitivity values of: 100% and 84,8% for the iliac axes; 98,9% and 94,3% for the femoral district; 100% and 84,9% for the popliteal district; 97% and 89% for tibial vessels. CONCLUSIONS: MRA showed a high diagnostic accuracy close to that of DSA. On the basis of our short experience we believe that MRA will be a useful method in the detection of various degrees of peripheral artery occlusive diseases reserving DSA for the therapeutical step.

Aged↗