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PubMed2005

Do 40% of patients resected for barrett esophagus with high-grade dysplasia have unsuspected adenocarcinoma?

Results of studies conducted in the last 2 decades suggest that the detection of high-grade dysplasia in patients with Barrett esophagus is the harbinger of a synchronous adenocarcinoma, which remains undetected even by rigorous biopsy protocols but is discovered during resection of the esophagus. The reported prevalence of synchronous carcinomas ranges from 0% to 75%. Other researchers maintain that appropriate surveillance programs can be used to detect carcinomas at a curable stage and to prevent unnecessary esophagectomies. Both logistical difficulties and potential methodological pitfalls have plagued many studies designed to investigate this issue. A large multicenter study that would stratify participants for hitherto unexplored variables (eg, age, gender, and ethnic background) may be required before the 40% occult cancer prevalence can be either confirmed or refuted. However, the large scale needed for such a study to provide reliable data and new developments in endoscopic imaging (eg, magnification endoscopy and optical coherence tomography) and endoscopic therapy (eg, mucosectomy) are likely to make such a study both ethically unacceptable and logistically and financially unfeasible. Future research should utilize the combination of new endoscopic technologies with the continuing search for validated biomarkers that help predict the biological behavior of Barrett epithelium in individual patients, with a particular focus on the possible development of preneoplastic and neoplastic lesions. Pathologists who chose to shift their focus from the traditional morphological investigation of dysplasia to the search for usable biomarkers can position themselves at the center of innovative research projects that could radically modify the management of patients with Barrett esophagus.

Adenocarcinoma↗
PubMed1998

Value orientation of the Copper Inuit.

Primary health services in the Canadian Arctic are predominantly provided by nurses whose cultural backgrounds differ from that of their clientele. As in other areas, this diversity can result in misunderstanding and conflict between the health care providers and their clients. Greater understanding of the client culture is necessary in order to identify areas in which conflict exists and to plan culturally appropriate health programs and initiatives. This study defines and describes the value orientation profile of some Copper Inuit living in the hamlet of Coppermine (Kugluktuk), Northwest Territories. Data were collected through interviews, using a modification of the Kluckhohn value orientation questionnaire. Data analysis using t-test analysis of the overall value orientations indicated a distinct value orientation profile.

Adult↗
PubMed1994

A new respiratory monitor that enables accurate measurement of work of breathing: a validation study.

BACKGROUND: Computerized, yet portable, bedside pulmonary monitors that can measure work of breathing (WOB) are now commercially available; however, none accurately measures WOB. The purpose of this study was to evaluate new software designed to measure WOB by means of the Campbell diagram and to test the agreement between a monitor (Model CP-100, Bicore, Irvine CA) programmed with the new software and the conventional method of measuring WOB. MATERIALS & METHODS: Using a lung model of our own devising, we compared WOB measurements between the monitor and conventional laboratory equipment. Inspiratory flow-rate, tidal volume (VT), and resistance of the model were adjusted to produce WOB ranging from 0.80 to 3.25 J/L. Regression analysis and calculation of bias and precision were performed for these data. RESULTS: For total, elastic, and resistive WOB, the two methods of measurement correlated strongly and positively. For all values of WOB, the correlation coefficients (r) and coefficients of determination (r2) were close to 0.99 (p < 0.0001); bias was minimal (-0.05 J/L) and precision acceptable (0.06 J/L). CONCLUSION: Data from a lung model reveal that a respiratory monitor programmed with appropriate software can accurately measure total, elastic, and resistive WOB. The monitor may eventually prove useful for clinically assessing WOB, which then can be used to adjust the ventilator to optimize respiratory muscle loads.

Equipment Design↗
PubMedDate not supplied

Social work in the health field.

Health care delivery systems are under careful and systematic scrutiny. Particular concerns are the availability and access of health care to those in the lower and middle income groups and the escalating costs of health care which until quite recently have exceeded annual inflationary rates of increase. Efforts in social work in the health field have reflected these developments. Programmatic trends in health and social work now emphasize ambulatory care and are reflected in the concept of primary care medicine. Deinstitutionalization as a preferred program for patients is under review with particular emphas -is on providing adequate supportive services to maintain patients in a home care environment. Social work is a major discipline contributing to these programs through appropriate interventive measures. Moreover, the role of the social worker, because of involvement with front line community activities, is particularly suited to make a substantial contribution to this trend.

Ambulatory Care↗
PubMed1999

Guidelines for development and application of aquatic animal health regulations and control programs. AVMA Aquaculture and Seafood Advisory Committee.

The creation of sound health regulations or disease control programs for any animal species is a complex endeavor. When the diverse stakeholder interests related to aquaculture are considered, this endeavor becomes daunting. The AVMA Aquaculture and Seafood Advisory Committee designed the following guidelines as a tool to assist aquatic animal health professionals who discuss potential regulations or control programs with government and industry entities. The guide focuses on determining whether a regulation or program is appropriate and, if so, developing a suitable and effective aquatic animal health plan. The Aquaculture and Seafood Advisory Committee was established in 1992 as an ad hoc committee of the AVMA Executive Board. The committee is composed of 9 veterinarians with diverse interests in aquaculture and seafood, and one non-veterinarian who represents the aquaculture industry. Participants from the USDA/APHIS and FDA serve as consultants to the Committee.

Animals↗
PubMed1999

Dog bite injuries in children: a preliminary survey.

Dog bite injuries in children are a preventable health problem. To characterize this type of injury, we have undertaken to define demographic criteria and patterns of injury inflicted by dogs in our pediatric population. A retrospective chart review was conducted of pediatric patients with dog bite injuries admitted to a Level I pediatric trauma center from January 1986 through June 1998. Patient demographics, canine characteristics, and hospital patient data were collected and analyzed using the Excel program and appropriate statistical methodology. There were 67 patient records reviewed. Thirty-eight (57%) of the patients were male, and 29 (43%) were female. There were 43 (64%) white children, 22 (33%) African-American children, and 2 (3%) Hispanic children. The average age of the children was 6.2 +/- 4.2 years, with an average weight of 23.3 +/- 13.7 kg. More than half the attacks occurred in the afternoon and 55 per cent of these attacks were documented as "unprovoked" attacks. Thirty-one (46%) of these attacks involved family pets, and 30 (45%) dogs were known to the attacked child. The head and neck was involved in greater than 67 per cent of these injuries. Pit bulls caused 25 per cent of the bite injuries. Large dogs were responsible for 88 per cent of the attacks. Forty-four (66%) patients required operative intervention. Twenty-eight of these patients had multiple anatomical areas injured. There were 44 procedures involving the head and neck, 21 involving extremities, and 6 involving other areas of the body. All patients 5 years of age and under had head and neck injuries. Dog bite injuries requiring admission occur more in male children. Caucasian and African American children were the majority of children affected. The children under 5 years of age suffered the most devastating injuries. More than half of these attacks were not provoked. More than two-thirds of the injuries to these children involved the head and neck. We conclude that effective prevention strategies must stress careful supervision of young children and the family or neighbor's dog, a scenario that may easily lead to complacency and set the stage for a severe injury.

Adolescent↗
PubMed1999

Types of persistent dysplasia in congenital dislocation of the hip.

This article reports five types of persistent bony dysplasia in patients with congenital dislocation of the hip (CDH), suggests the pathogeneses, and discusses the treatment options. We consider the five types to be (1) maldirected acetabulum, (2) capacious acetabulum, (3) false acetabulum, (4) lateralized acetabulum, and (5) femoral deformity. The maldirected acetabulum persists when the acetabulum continues to face forward and laterally. The capacious acetabulum arises from joint instability; capsular laxity permits the proximal femur to slide within the acetabulum. The false acetabulum results from an ectopic fibrocartilaginous cavity in the pelvis created by the subluxated or dislocated femoral head.44 The lateralized acetabulum occurs with ossification of the cotyloid cavity from longstanding lateral subluxation or dislocation or premature closure of the triradiate cartilage. Femoral deformities include valgus and anteversion of the femoral neck, capital femoral physeal growth arrest, discrepancy between the greater trochanter and the femoral head, and femoral head asphericity. After clinical and radiographic evaluation, we believe that an understanding of the pathogeneses and types of dysplasia will facilitate appropriate treatment programs. Treatments consist of acetabular redirection, acetabular reconstruction, femoral osteotomies, and salvage procedures.

Acetabulum↗
PubMed2000

[Somatisizing patients. Concrete recommendations for a stepwise therapy in general practice].

Patients with physical symptoms but no detectable organic substrate often present a challenge for the family doctor. The therapeutic approach discussed herein focuses on the development of a psychosomatic model of the problem. In this step-by-step approach, the patient's subjective understanding of, and attitude towards, his illness and its treatment are established, alternative psychosomatic models of disease based on a consideration of psychophysiological interactions are worked out jointly with the patient, and, finally, thought is given to the current complaints within the context of the patient's personality and life situation. The basis for successful treatment is an empathic and sound doctor-patient relationship based on trust that gives the patient the feeling that he and his problem are being taken seriously. The prerequisite for the use of such a program is appropriate training in basic psychosomatic care.

Aged↗
PubMed2000

Surgical treatment of pectus excavatum.

In conclusion, the following points are reemphasized: 1) The abnormal (either depressed or protruding) cartilages should always be resected. This resection, especially in pectus excavatum abnormalities, should not be overdone because the highest point that the chest wall and sternum can be elevated to with these types of operations is only the level of the most anterior rib and the thickness of the sternum itself. 2) Marlex mesh is an ideal material to support the sternum in its corrected position. It is strong and holds well until the chest wall solidifies. Also, it is resistant to infection and it may be left in place permanently. The application of different metallic splints, rods, and so on, as well as costal allografts, was found to be absolutely unnecessary. 3) Intercostal strips detached from the sternum may be left in place. Also, the surgeon should not waste time in performing a meticulous "classic" subperichondrial resection of the cartilages and ribs but should just leave enough perichondrium and periosteum behind to ensure the regeneration of the ribs. For the same reason, a segment of the most lateral portion of the cartilage should be left in continuity with the ribs. 4) It is strongly recommended that in excavatum anomalies, one of the pleural cavities should be deliberately opened and wide communication established between the pleural and the retrosternal space; the entire operative area should be drained for a day or two using an intracostal water-sealed catheter. This will make the use of any other subcutaneous or mediastinal drainage devices unnecessary and will ensure appropriate drainage of blood or serum. It is also recommended that the resection of the cartilages should be done on the left side first, where inadvertent entering of the pleura is less likely because of the backing of the pericardium. If it happens, drainage of the right hemithorax is not necessary. Carinatum anomalies are handled with subcutaneous drainage. 5) To confirm appropriate results, the chest should be carefully inspected after closure of the skin, and flaws, if they exist, should be corrected right then. Also, surgical repair of all pectus anomalies, especially excavatum deformities, should be supplemented in due time with an appropriate exercise program. Swimming and weight lifting are especially useful. 6) We found that the age limit imposed on small children by some authors is unnecessary, and as a matter of fact it is preferable to operate on children at an early age, around 2 years, because of commonly existing psychologic problems at a later age. The author advises restraint in operating on individuals past the teenage years unless the deformity is physiologically restricting. 7) The jury is still out regarding procedures using limited exposure and that do not use transverse sternotomy to correct the depressed or elevated sternal axis. 8) The usage of cosmetic procedures, or in other words, operations that do not correct the anomaly of the bony chest wall but use various implants as camouflage, should be restricted to cases of moderate excavatum anomalies in late teenage patients and to adults without cardiorespiratory symptoms.

Funnel Chest↗
PubMed2000

Hospital arrival time after onset of different types of stroke in greater Taipei.

BACKGROUND AND PURPOSE: The effectiveness of stroke treatment is highly dependent on the post-onset time of treatment. Recent reports have established the importance of aggressive medical or surgical intervention in the hyperacute stage. In order to design an appropriate treatment program for acute stroke patients, we studied the arrival time after onset of different types of stroke at a tertiary medical center serving the greater Taipei area. METHODS: This was a prospective study of acute stroke patients admitted to the emergency department (ED) during a 1-year period (1997). There were 842 patients with accurate records of hospital arrival time who were either directly or indirectly admitted to the ED during the study period. Each stroke patient had a diagnosis of either cerebral infarction (CI), cerebral hemorrhage (CH), subarachnoid hemorrhage (SAH), or transient ischemic attack (TIA). CI was further divided into five subtypes: large artery atherothrombosis, lacunae, cardioembolism, other specific causes, and undetermined cause. The arrival time after stroke onset was stratified into seven different time intervals: 0 to 3, 3 to 6, 6 to 12, and 12 to 24 hours, and 1 to 3, 3 to 7, and more than 7 days. RESULTS: Stroke patients who came directly to the ED arrived much sooner after onset than those who came via an indirect route (80.5% vs 36.5% in the first 24 hours). Of the 617 patients in the direct group, the percentage of patients arriving at the ED within 3 hours after onset was significantly greater among CH (66.2%), SAH (68.4%), and TIA (57.9%) patients than among CI (27.4%) patients. The percentage of CI patients who arrived early (0 to 3 hours) was significantly higher in those with cardioembolism (56.3%) than in those with large artery atherothrombosis (24.5%), lacunae (15.3%), other specific causes (13.6%), or undetermined cause (23.2%). CONCLUSIONS: These results show that direct transportation to the ED after stroke onset resulted in shorter treatment delay; hospital arrival time varied significantly among the different types of stroke and subtypes of CI. Patients with hemorrhagic stroke (CH and SAH) and cardioembolism were sent to the ED with the shortest delay. These results may be useful in strategic planning for stroke management.

Humans↗
PubMed2000

Acquired immunodeficiency syndrome wasting, functional performance, and quality of life.

Unintentional loss of weight and lean body mass (wasting) is a major cause of morbidity and mortality in patients with acquired immunodeficiency syndrome (AIDS). Patients with AIDS wasting (AW) often experience reductions in lean body mass, muscle strength, and the ability to perform functions of daily living. Dependence on assistance with activities of daily living may be associated with a lower quality of life (QOL) and higher risk of mortality. These factors suggest that slowing or reversing the loss of lean body mass in AW can improve well-being. Nutritional support or appetite stimulants in the absence of exercise therapy or growth hormone supplementation can increase fat without improving body composition, whereas appropriate exercise programs, androgen therapy, and recombinant human growth hormone (rhGH) therapy may increase lean body mass in patients with AW. Resistance exercise programs can increase muscle strength and lean body mass. In addition, both resistance and endurance (aerobic) exercise augment endogenous growth hormone levels, decrease depression, enhance self-esteem, and may improve immune response. Randomized, double-blind trials have shown that rhGH therapy increases total body weight, lean body mass, exercise capacity, and QOL. In summary, interventions that improve exercise capacity and functional performance may enhance QOL in patients with AW and may reduce mortality in this group.

Activities of Daily Living↗
PubMedDate not supplied

Neonatal tetanus in the southeast of Turkey: risk factors, and clinical and prognostic aspects. Review of 73 cases, 1990-1999.

Although neonatal tetanus (NT) can be prevented by immunization of expectant mothers and by good hygiene and asepsis during delivery, it is still a common cause of neonatal mortality in developing countries. The objective of this study was to determine indicators in NT. We reviewed the clinical records of 73 neonates admitted to the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, Turkey, with the diagnosis of NT. Delivery had occurred at home by untrained traditional birth attendants in all cases. None of the mothers had immunization with tetanus toxoid during pregnancy. The median age of infants at presentation was 7.3 days and the mean age at onset of symptoms was 5.6 +/- 2.8 days. The overall mortality was found to be 52 percent. Mortality was significantly associated with an incubation period of 4.3 days or less and fever. The incidence of NT in Turkey is on the decline due to widespread tetanus toxoid use in pregnant women, but in some regions, especially in the so-called rural poor areas, there is still risk of preventable diseases. Hygienic deliveries and immunization of pregnant women are very important for the prevention of NT deaths, and universal prenatal care, including education programs on appropriate perinatal and cord care, can significantly reduce NT incidence and mortality in developing countries.

Equipment Contamination↗
PubMed2000

Cancer screening behaviors among Korean-American women.

The goals of this study were to evaluate breast and cervical cancer screening tests and to examine the correlates of cancer screening behaviors. A cross-sectional face-to-face survey of 438 Korean-American women residing in Maryland was conducted. About 50% of women age 18 and older had had a Pap smear and 46.6% of these women age 40 and older had had a mammogram in the past 2 years. In multiple logistic regression analyses, the strongest correlate of screening behaviors was having a regular medical checkup. Age and acculturation were found to be important correlates of cancer screening tests: Women less than 50 years of age were more likely to have cancer screening tests than those 50 years and older. English language proficiency was associated with having a mammogram and the proportion of life spent in the United States was associated with having a Pap smear. Employment interacted with marital status for a Pap smear, with those married and unemployed being less likely to have a Pap smear than women who were both married and employed. For strategies to increase cancer-screening tests among Korean-American women, we need to aim at developing culturally appropriate educational programs about cancer for less acculturated and recent immigrants.

Adult↗
PubMed2001

Update on chemotherapy for advanced colorectal cancer.

Efforts to improve the length and quality of life, as well as to expand treatment options, for patients with metastatic colorectal cancer have only recently become more successful. With maximization of dose and schedule schemes for fluoropyrimidine therapy, new drugs such as irinotecan (CPT-11, Camptosar) and oxaliplatin have also become part of the standard therapy for patients. Combination chemotherapy has been established to have superior response rates and progression-free survival and--in some instances, for fluorouracil and irinotecan combinations--improved overall survival compared to fluorouracil alone. There is still much to be learned about the optimal management of patients with colorectal cancer, including the role of second- and third-line chemotherapy in the overall survival outcome, and the role of salvage therapy in patients with limited metastatic disease. Most importantly, the development of a biological marker of prognosis and response should help to select appropriate chemotherapy programs for patients on a rational and individual basis, not only in the setting of metastatic disease, but also in the adjuvant population.

Colorectal Neoplasms↗
PubMed2000

TERIMA-2: national extension of thrombolytic treatment with recombinant streptokinase in acute myocardial infarct in Cuba.

AIM: The extension of recombinant streptokinase (rSK) use in Cuba and to evaluate its effect on in-hospital mortality of patients with acute myocardial infarct (AMI). METHODS: A phase IV clinical study was performed in 52 hospitals from the 14 Cuban provinces. Patients (any age) with ST segment elevation or bundle branch block were included if they came less than 12 h after the onset of AMI symptoms, without contraindications for thrombolytic therapy. They received 1.5 x 10(6) IU of rSK (Heberkinasa, Heberbiotec, Havana) intravenously, during one hour. Endpoints were death due to cardiac (pump failure, wall rupture, arrhythmia) or any cause and cardiovascular events at hospital release. RESULTS: The study included 2,923 patients, 22-98 years-old, 74.4% men, which represented 37.2% of the total AMI patients attended at the participating hospitals from November 1992 to May 1995. Aspirin was given to 92.5% and betablockers to 65.3%. AMI was confirmed in 93.5% of the patients. The mean symptoms--rSK infusion time interval was 5.25 h (22.3% of the patients treated within the first 3 h). 302 patients died, 80.1% of them due to cardiac causes, 12 attributed to rSK treatment, and 16 to non-cardiac causes. This 10.4% mortality represents a 4% absolute and a 28.3% relative reduction (179 lives saved per year) as compared to a survey made before rSK treatment was introduced. In a logistic regression analysis, mortality was favored by age, symptoms--infusion time. Killip class, and not having taken aspirin or betablockers. Feminine gender was close to the limit of significance. The more frequent adverse events were arrhythmias and hypotension during infusion. Major bleeding occurred in 27 patients (9 strokes). CONCLUSION: Local recombinant-DNA biotechnology can influence on a major health problem with favorable cost/ and risk/benefit balances, not possible in a developing country with an imported drug. The further extension of this treatment in the country is feasible and recommended, monitored through an appropriate pharmacosurveillance program.

Adult↗
PubMed2001

Classifiers and social control in wheelchair rugby.

The purpose of this study was to examine the features of wheelchair rugby classifiers in order to maintain social control in wheelchair rugby. The examination centered on the theme-resources used by classifiers to maintain the authority of International Wheelchair Rugby Federation (IWRF). Data were collected using participant observation methodology at national and international wheelchair rugby championships and a survey of the 14 IWRF authorized classifiers. The results of this study identified five essential features of IWRF classifiers. In particular, they need to have a background in medicine or physical therapy. In addition, IWRF classifiers use their medical and sporting knowledge and experience to control the wheelchair rugby classification process and to maintain fairness of competition. The results of this study may help to train Taiwanese professionals with medical or sporting backgrounds to become international classifiers and also to develop appropriate training programs for national classifiers.

Classification↗
PubMed2001

[Eradication, elimination of congenital rubella syndrome].

The strategies of World health Organisation for elimination of congenital rubella syndrome were presented. The ways of prevention of congenital rubella syndrome by appropriate immunization programs were discussed. The concomitant adverse effects and risks were presented. On the basis of epidemiology of rubella in Poland the authors propose the adjusted vaccination policy.

Child↗
PubMed2001

Polyposis syndromes: pediatric implications.

The diagnosis of a polyposis syndrome, such as juvenile polyposis, Peutz-Jeghers syndrome, and familial adenomatous polyposis, requires knowledge of the site, number, and histologic type of the polyps and an appreciation of relevant family history. Children and adolescents with polyposis syndromes are faced with not only the immediate complications of the polyps, such as intussusception or bleeding, but also the extraintestinal manifestations and the long-term risk for malignancy. This article reviews the diagnosis, clinical management, surveillance, and surgical options for children with polyposis syndromes and discusses genetics and appropriate screening programs.

Adenomatous Polyposis Coli↗