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At least 739 records · Page 41Linked to original sources
PubMed2001

Operative treatment of interdigital neuroma. A long-term follow-up study.

BACKGROUND: The literature regarding the outcome of surgical treatment of interdigital neuroma is incomplete. The purpose of this study was to assess the demographics associated with the presentation of an interdigital neuroma as well as the long-term clinical results of operative resection by a single surgeon. METHODS: A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified eighty-two patients who had been treated operatively for a primary, persistently painful interdigital neuroma more than three years previously. Of these eighty-two patients, sixty-six (seventy-one feet, seventy-four neuromas) returned at an average of 5.8 years for a follow-up evaluation, which included a review of the interval history since the surgery, a physical examination, a radiographic evaluation, and an assessment of the patient's satisfaction with the result of the surgery. RESULTS: Overall satisfaction was rated as excellent or good by fifty-six (85%) of the sixty-six patients. Forty-six (65%) of the seventy-one feet were pain-free at the time of final follow-up. The patients who had had either bilateral neuroma excision or excisions of adjacent neuromas in the same foot in a staged fashion had a slightly lower level of satisfaction, but this difference was not significant. While major activity restrictions following surgery were uncommon, mild or major shoe-wear restrictions were noted by forty-six of the sixty-six patients. Although there was subjective numbness in thirty-six of the seventy-one feet, the pattern of numbness was quite variable and it was bothersome in only four feet. CONCLUSION: With careful preoperative evaluation and patient selection, resection of a symptomatic interdigital neuroma through a dorsal approach can result in a high percentage of successful results more than five years following the procedure.

Adolescent↗
PubMed2001

[Intramedullary spinal cord metastasis of lung adenocarcinoma causing Brown-Séquard Syndrome].

A 36-year-old woman admitted to our hospital because of numbness in the left limbs and weakness in the right arm, and was subsequently given a diagnosis of intramedullary spinal cord metastases from lung cancer. The patient had lung adenocarcinoma with metastases to the brain, spine and lymph nodes. Occipital craniotomy, radiation therapy and chemotherapy were performed on the lesions in the year following June 1994. In June 1995, however, she complained of numbness in the left limbs and weakness in the right arm. Compatible with her neurological manifestation, MRI demonstrated tumors in the right side of the cord at the spinal level of C3-4 and C7-Th1, both of which were of high density in T2-enhanced conditions with enhancement by gadolinium-diethylenetriamine pentaacetic acid. No invasion from spinal metastasis was detected by CT, scintigraphy or MRI. We therefore diagnosed her manifestation as Brown-Séquard syndrome caused by intramedullary spinal cord metastatic tumors of lung adenocarcinoma. In order to avoid paraplegia and dysfunction of the bladder and bowel, radiation therapy of the cord lesions with total dose of 44 Gy was performed. Her neurologic manifestation was improved, restoring her quality of life, as the tumor size estimated by MRI decreased. Four months later, however, she died of lung adenocarcinoma that developed accompanied with severe peritonitis carcinomatosa and multiple metastases.

Adenocarcinoma↗
PubMed2001

The course of post-traumatic stress disorder after the Oklahoma City bombing.

Oklahoma City bombing survivors (N = 182) were studied 6 months post-bombing and reassessed approximately 1 year later (N = 141) to determine the longitudinal course of post-traumatic stress disorder (PTSD) and other psychiatric disorders. The Diagnostic Interview Schedule assessed lifetime, current, predisaster, and post-bombing psychiatric diagnoses at both assessment points. One-third of the Oklahoma City bombing survivors had PTSD at index, and similar rates were diagnosed at follow-up. More recovery from depression was apparent than from PTSD. No delayed onset PTSD was observed, and all PTSD was chronic. Avoidance and numbing symptoms were dominant in defining the development of PTSD. Early onset and chronicity of PTSD indicate need for prompt and long-term intervention after disasters. Focus on avoidance and numbing symptoms may aid in identification of individuals needing intervention and monitoring the course of PTSD.

Female↗
PubMed2002

[Successful treatment of advanced recurent breast cancer using DMpC therapy as maintenance therapy].

A 65-year-old female who underwent radical mastectomy on 28 April 1988 felt swelling and numbness of her left lower jaw. As a result of bone biopsy and scintigraphy, multiple bone metastasis was diagnosed. After 6 cycles of CMF therapy, the swelling and numbness of the left lower jaw were reduced, but atelectasis of the left lung upper lobe appeared. After 10 cycles of paclitaxel therapy, atelectasis and bone metastasis were reduced. Daily oral chemoendocrine combination therapy, DMpC therapy (5'-DFUR 800 mg/day + CPA 100 mg/day + MPA 800 mg/day) was continued for 12 months. No recurrent signs and serious side effects were observed during DMpC therapy.

Aged↗
PubMed2002

[Posttraumatic stress disorder in victims of sexual assault--related to depression or physical symptoms].

UNLABELLED: To clarify the clinical characteristics of mental disorders in sexual assault victims, we investigated the victims focusing on PTSD, depression, physical symptoms, and their relationships. SUBJECTS: Participants were 46 treatment-seeking female victims of sexual assault who consulted four hospitals, one clinic and one psychological services center, between February 2000 and April 2001. The mean +/- SD age of the participants was 28.0 +/- 8.9 years, the mean +/- SD period from the traumatic event was 94.5 +/- 88.0 months. PTSD was diagnosed and evaluated using a structured interview (Clinician-Administered PTSD Scale for DSM-IV: CAPS). Depressive symptoms were assessed using Self-rating Depression Scales (SDS). Physical symptoms were assessed using the Physical symptom scale developed by the authors. RESULTS: Thirty-two participants (69.6%) met the criteria for PTSD in their current diagnosis, and 41 (89.1%) had the disorder at some point during their lives. SDS score and Physical symptom scale score of the PTSD group were significantly higher than those scores of the non-PTSD group. The SDS score correlated with the Avoidant-numbing score. The Physical symptoms scale score correlated with the Intrusion score and Hyperarousal score. We think that the PTSD group had the co-existing depression secondary to PTSD. Although previous studies have discussed the relationship between physical symptoms and Hyperarousal symptoms, this study suggested that physical symptoms were related to Intrusion symptoms as much as Hyperarousal symptoms. We found 2 patterns when PTSD patients reported physical symptoms related to Intrusion symptoms. The patterns were caused (1) by physiological reactivity on exposure to internal or external cues that symbolize an aspect of the traumatic event, and caused (2) by somatic reenactment symptoms. CONCLUSION: We discuss the importance for clinicians to distinguish Intrusion symptoms from physical symptoms as well as Avoidant-numbing symptoms from depressive symptoms on PTSD diagnosis. Because sexual assault victims have difficulty in talking about the traumatic experience, clinicians should pay attention to these findings in developing therapeutic plans for the victims.

Adolescent↗
PubMedDate not supplied

Nocturnal penile tumescence and rigidity testing in bicycling patrol officers.

A health assessment study was conducted in response to complaints of groin numbness in a bicycling police unit. Seventeen male cyclists were compared with 5 nonbiking men. The cyclists rode an average of 5.4 hours per day, and 91% indicated they experienced groin numbness on occasion. Each man wore the RigiScan Plus Rigidity Assessment System for one normal sleep session. Pressure measurements were also taken between the cyclist and the bicycle saddle. The percentage of sleep sessions that recorded an erectile event was significantly lower in the cyclists than it was in noncyclists (cyclists 27.1%; noncyclists 42.8%; P =.008). This duration percentage is negatively correlated with average hours a day that cyclists rode their bikes (r = -.41; P =.05), the number of days a week they rode (r = -.55; P =.009), and the average pressure exerted on the nose of the bike saddle (r = -.39; P =.08). The other measures of erectile quality (tumescence activity units [TAUs] and rigidity activity units [RAUs] of both the base and tip of the penis) were lower in the cyclists, but did not reach statistical significance. The number of hours cyclists rode during the day of RigiScan Plus assessment was negatively correlated with penis tip RAU (r = -.41; P =.04), and tip TAU (r = -.45; P =.04). These data suggest that prolonged bicycle riding may have negative effects on nocturnal erectile function and indicate a need for innovative bicycle saddle designs.

Adult↗
PubMed2002

[Rosai-Dorfman disease accompanying hypertrophic cranial pachymeningitis with an early symptom of right peripheral facial palsy].

We experienced a rare case of sinus histiocytosis with massive lymphoadenopathy (Rosai-Dorfman disease) accompanying hypertrophic cranial pachymeningitis. The patient is a 64-year-old woman with an early symptom of rt. peripheral facial palsy. She had a 4-month history of headache with a 5-week history of numbness in the rt. supraorbital nerve area, and lost her weight by 10 kg in 2 months. She developed rt. trochlea nerve palsy and numbness in the lt. mandibular nerve area. Laboratory findings showed that ALP, LDH and CRP were higher than normal. Of CT, MRI and MRA, the images of her head were normal. However, the Gd-enhanced MRI only showed a diffuse pachymeningeal enhancement. After about 3 months from the onset of rt. peripheral facial palsy, she died of DIC of unknown etiology. As a result of examinations in anatomical pathology, she was diagnosed as having sinus histiocytosis with massive lymphoadenopathy (Rosai-Dorfman disease). There were a large number of histiocytes on the pachymeninx. These findings suggest that hypertrophic cranial pachymeningitis caused multiple cranial neuropathy. We emphasize that use of Gd-enhanced MRI in the early stage is important for diagnosis.

Facial Paralysis↗
PubMed2002

[Giant, invasive sacral schwannoma extending to the 4th lumbar spine].

In this report, we describe a case with giant sacral schwannoma, which invasively extended to the 4th lumbar spine and to the surrounding sacral and iliac bone. A 26-year-old female was admitted to our hospital because of numbness and transient weakness of the right leg, and dysuria. Radiological examinations revealed that a giant sacral tumor, associated with multiple cystic formations, had invasively extended to the 4th lumbar spine, sacrum, and iliac bone. She underwent partial removal of the tumor, followed by irradiation. Pathological diagnosis was schwannoma. Subsequently, she underwent a second operation because of tumor regrowth 15 months later, and the tumor was totally removed. Numbness of the right leg resolved after surgery. No tumor recurrence has been noted during 5-year follow-up period. Previously, only 5 cases have been reported of invasive sacral schwannoma extending to the lumbar spine. Our experience in this rare case strongly suggests that aggressive resection should be aimed to improve long-term outcome.

Adult↗
PubMed2003

[2 cases of paresthetic meralgia of the femoral cutaneous nerve].

We report two cases of meralgia paresthetica. The first patient was 35-year-old pregnant woman who reported dull pain on the front and side of her thigh presenting at 6 weeks gestation. The symptoms disappeared in 1 week with conservative treatment and no other symptoms developed. The second patient was a 56-year-old woman, obese, who reported intense, burning pain with numbness and occasional bouts of piercing pain. The symptoms were resistant to treatment with non-steroidal antiinflamatory drugs or mild opiates, but were relieved by injection of local anesthetics and corticosteroids. Meralgia paresthetica is mononeuropathy that affects the lateral femoral cutaneous nerve. It can occur during pregnancy or in other contexts. The most common cause is entrapment of the nerve at the anterior superior iliac spine or during its passage through the inguinal ligament. The most common symptom is numbness at the front of the thigh, although burning, formication, tingling, or other forms of paresthesia may also be present. The condition is usually self-limiting, although uncomfortable. Diagnosis is based on careful neurological examination. Conservative treatment is preferred and is based on limiting periods of standing and avoidance of tight clothing. Oral analgesics can be prescribed if necessary and weight loss is required for obese patients. Surgical ablation of the nerve is a last resort.

Female↗
PubMed2002

[A patient of sensorimotor neuropathy with small cell lung carcinoma and anti-GM1 antibody].

We reported a 62-year-old woman had sensorimotor neuropathy with small cell lung carcinoma (SCLC) and anti-GM1 antibody. She was admitted with several months history of progressive numbness, walking disturbance and anorexia. Neurologic examination revealed severe numbness and deep sensory disturbance of extremities and body, and mild weakness of distal extremities. Deep tendon reflexes were absent. Her limbs were ataxic. Nerve conduction studies showed no sensory evoked responses. CSF protein was elevated. Sural nerve biopsy revealed severe loss of myelinated fibers and perivascular mononuclear cells surrounding the perineurial vessel. Vasculitic neuropathy was diagnosed, and prednisolone was started, with no benefit. In the clinical course, she developed cough attacks and was found the lymphnode swelling in the mediastinum and supraclavicular fossa, which was diagnosed SCLC. Although anti-Hu antibody were not detected, anti-GM1 antibody was positive. She was treated with intravenous immunoglobulin, with transient improvement. The rare case of the paraneoplastic peripheral neuropathy with SCLC and anti-GM1 antibody was reported.

Autoantibodies↗
PubMed2003

The long-term results of surgical treatment for spinal stenosis in the elderly.

PURPOSE: To evaluate the surgical results of spinal stenosis in the elderly and to investigate which factors may contribute to a poor outcome. METHODS: This is a retrospective study of 68 patients aged 60 and above who had decompression laminectomy for lumbar spinal stenosis between 1989 and 1991. They were evaluated at an average of eight years after surgery. The mean age at surgery was 68 years. Twenty-eight had co-existing illnesses. Twenty-one had concomitant degenerative spondylolisthesis. Thirty-two (47%) had decompression laminectomy performed at one level. Eleven (16%) had arthrodesis. Seven had spinal instrumentation, of which six were Hartshill rectangles. Functional result was graded using modified Paine classification. Multivariate analysis with logistic and linear regression was used to determine predictors of poorer outcomes. FINDINGS: There were 68% excellent and good, 22% fair and 10% poor results. Back pain was relieved in 91% of the patients. Leg pain was relieved in 76% of the patients. Numbness was relieved in 87% of the patients. Five patients had re-operations. Multivariate analysis revealed that age, sex, co-morbidity score, number of levels decompressed, and degenerative spondylolisthesis did not predict worse outcomes. However, Hartshill rectangle instrumentation and pre-operative leg numbness predicted less favourable results. CONCLUSIONS: The surgical results of spinal stenosis in the elderly are favourable and comparable to those reported for the general population at an eight-year follow-up.

Aged↗
PubMed1992

[A case of sarcoid polyradiculopathy with nerve roots swelling demonstrated by myelography].

A 62-year-old woman was admitted to our hospital because of tingling numbness in the trunk and upper extremities. She was well until 18 days earlier, when she began to feel tingling numbness on the ulnar side of the left arm. During the next two weeks it spread gradually over the trunk and ulnar side of the bilateral arms. She had also progressive difficulty in taking hold of objects. On neurological examination she was alert and cooperative with normal articulation. The neck was supple. The cranial nerves were intact. Superficial sensation was bilaterally hypesthetic in the distribution from the 7th cervical through 12th thoracic segments. Mild weakness was distally noted in the upper extremities. Deep tendon reflexes were reduced or absent without laterality. Plantar responses were bilaterally flexor. Coordination and gait were normal. Routine laboratory examinations including blood counts, blood chemistries and urinalysis were unremarkable. Serum angiotensin converting enzyme (ACE) was slightly elevated. A lumbar puncture yielded clear, colorless cerebrospinal fluid (CSF) containing 22 white cells/mm3 and protein of 106 mg/dl. Conventional nerve conduction studies were normal. F-wave conduction studies revealed elevated F-ratios for the upper and lower extremities. Studies of short-latency somatosensory evoked potential showed mild prolongation of N13 recorded after stimulation of the right median nerve. An X-ray film of the spine was unremarkable except for mild narrowing of the C5-6 intervertebral disk space. Postcontrast magnetic resonance imaging of the spine with gadolinium-DTPA was unrevealing as well as a precontrast study. A myelogram disclosed enlarged lateral filling defects corresponding to cervical nerve roots from C6 through C8 bilaterally.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗
PubMed1992

Clinical investigation of potency and onset of different lidocaine sprays for topical anesthesia in dentistry.

The clinical effects of three lidocaine-containing solutions with and without frigen (freon-113) as a propellant, after different waiting periods, and with different dosages applied were investigated in 130 outpatients who were undergoing dental treatment in the maxilla under local anesthesia. They were divided randomly into five groups (A through E): (A) Xylocaine spray with frigen, two applications (20 mg lidocaine); (B) Xylestesin spray with frigen, two applications (14 mg lidocaine); (C) Xylestesin spray with frigen, three applications (21 mg lidocaine); (D) Xylestesin pump spray without frigen, two applications (14 mg lidocaine); and (E) no topical anesthesia. They were further divided into 12 subgroups to evaluate waiting periods between the application of the topical anesthesia and the injection (1, 2, or 3 minutes). Patients assessed the pain of the injection, intensity of numbness, and intensity of the taste on a visual analog scale; they also assessed the pain of the injection compared to former injections. Pain during injection was reduced by topical application of lidocaine. A waiting period of 2 minutes proved to be sufficient and can be justified to avoid impatience and increased numbness in patients. However, a 3-minute waiting period may be appropriate for sensitive patients. An increase in the dosage failed to show better analgesia. The pump spray without frigen proved to be effective.

Aerosols↗
PubMed1992

[Wallenberg's syndrome due to vertebral artery dissection following minimal neck injury--report of two cases].

We described two cases of the lateral medullary syndrome (Wallenberg's syndrome) due to vertebral artery dissection following minimal neck injuries. The first case was a 45-year-old man, who hit his head and often rotated his head because of posterior neck discomfort. Two years after the injury, he suffered from sudden sharp neck pain, nausea, and vertigo, which was followed by left hand numbness and difficulty in walking due to the right lateral medullary syndrome. Angiography showed right vertebral artery dissection at the fourth segment. The second case, a 48-year-old man, suffered from neck pain immediately after he hyperextended his neck for painting a wall. Within several hours, he experienced left hand numbness and difficulty in walking due to the lateral medullary syndrome. Angiography showed a saccular aneurysm and dissection of the right vertebral artery at the fourth segment. In both cases, minor traumas were thought to be the causes of vertebral artery dissection. We surveyed previously reported 84 cases (men: 50, women: 34) of the vertebral artery dissection due to minor traumas. Seventy per cent of patients were in their third or fourth decade of life. The main causes of trauma preceding the dissection were neck manipulation especially chiropractics (52%). The third segment was most vulnerable. Delay in onset following neck trauma could be more than a week, but in most cases the delay was less than 24 hours. Cervical rotation and extension were thought to precipitate dissection.

Aortic Dissection↗
PubMed2003

Compartment syndrome.

Compartment syndrome is a limb-threatening and occasionally life-threatening injury. It occurs whenever the tissue pressure (referred to as interstitial pressure) within a closed anatomic space is greater than the perfusion pressure. Untreated, compartment syndrome leads to tissue necrosis, permanent functional impairment and, if severe in large compartments, renal failure and death. Compartment syndrome can occur within any muscle group located in a compartment. It is most common following an event that severely damages a muscle, like a crushing or twisting injury. Mechanisms of injury that involve circumferential burns, ischemia and tourniquets can cause compartment syndrome. Motorcyclists who suffer lower-extermity injuries in accidents are a high-risk group. A tough membrane referred to as a fascia covers muscle groups, forming a compartment for the muscle. In normal circumstances, this arrangement allows the muscle to function more efficiently, but if the muscle is injured in any way, the fascia limits the amount of swelling that can occur. This in turn restricts the flow of blood through the affected region. The first compromised function within the compartment is the flow of lymph and venous blood. If there are sensory nerves running through the compartment, they will not function correctly, causing the numbness, tingling and, later, the pain associated with compartment syndrome. With more swelling, arterial flow is compromised, pain worsens and motor function is impaired. An artificial way of producing a compartment syndrome is to place a cast or splint around a damaged extermity, compressing it. This is a way emergency personnel can compromise an injury and cause long-term consequences for the patient. Recovery is achieved by surgically opening the compartment involved (a fasciotomy) and releasing the pressure. The muscle at first will swell outside the compartment, but then it recovers, swelling is reduced and normal function can be recovered. Prehospital treatment of extremity injuries that will prevent or limit compartment syndrome is immobilization, elevation and cooling. Recognition of the syndrome later in its course, as in this case, requires the EMT to remove the patient to an appropriate emergency department. Prehospital providers need to recognize that many mechanisms of injury can produce this syndrome, even those that seem relatively minor. All injured patients should be educated to seek care should the symptoms of numbness, deep pain and coolness to the distal extremity occur. This case involved a patient who, from a relatively minor mechanism of trauma, experienced an internal disruption of the muscle group controlling the thumb (thenar mass). The early swelling in the thenar compartment resulted in the patient experiencing a tingling sensation in his left thumb. In many cases, such an injury would be referred to as a "stinger" (a temporary neurological deficit due to a sudden and excessive stimulation of a neurologic plexus or junction). But this patient had more swelling in the compartment, resulting in a lack of circulation manifested by a cool extremity, poor capillary refill and decreased pulse oximetry. Luckily, this officer recognized the need for medical evaluation of what appeared to be a minor injury and was returned to duty with no permanent impairment.

Compartment Syndromes↗
PubMed2003

A pilot study of hand and arm musculoskeletal disorders in dental hygiene students.

PURPOSE: This study was designed to determine the relationship between musculoskeletal disorder symptoms and vibration in dental hygiene students as a pilot for a larger scale study. METHODS: A custom-designed questionnaire was distributed to three intact student groups: those accepted for admission, those at the end of the first year, and graduating students at the end of the second year. Data were analyzed using tabular and multivariate analysis. Students increased their use of ultrasonic instruments from 0.2 to 2.8 to 7.3 hours per week over the three years. Dental hygiene students with symptoms of numbness in the upper extremities used ultrasonic scalers a mean of 8.2 hours per week compared to 2.8 hours of use by students with no upper extremity numbness. These students also used manual instruments 10.1 hours and 4.8 hours per week, respectively. RESULTS: Logistic regression revealed a significant association between hours of use of ultrasonics and upper extremity numbness/tingling, with an odds ratio of 1.10 for each increased hour of use (95% CI 1.01-1.19; chi-square = 4.9). A similar result was found for manual instrument use. CONCLUSION: Results indicate that musculoskeletal disorder symptoms may increase with the use of ultrasonic and/or manual instruments.

Adult↗
PubMed2004

Spectrum of dentofacial deformities: a retrospective survey.

INTRODUCTION: This retrospective study investigates the spectrum of dentofacial deformities, demographic profile, management and surgical outcomes of orthognathic patients treated in the University Hospital in Malaysia. MATERIALS AND METHODS: Over a period of 10 years (1989 to 1999), 34 patients with dentofacial deformities who had orthognathic surgery were reviewed; patients with cleft lip and palate or syndromes were excluded. RESULTS: The mean age (range, 17 to 35 years) of the patients was 24.3 years and the ratio of female to male was 2.4:1. The predominant ethnic group was Chinese, with females (47.1%) forming the largest group. The main reason for seeking surgery was aesthetic improvement (41%). The majority of the patients had skeletal class III pattern (91%) and bilateral sagittal split osteotomy was the most common surgery done (82%). Postoperative complications were mainly paraesthesia/numbness (56%) and infection (15%). In long-term review, 2 (6%) patients had persistent numbness of the inferior alveolar nerve. CONCLUSION: The findings suggest that the majority of the patients are young adult female students with skeletal class III pattern and treated for mandibular prognathism. The complication of persistent numbness and higher rate of postoperative infection indicate that longterm reviews and good antibiotic prophylaxis/therapy are necessary.

Adolescent↗
PubMed1992

Right submammarian thoracotomy in female patients with atrial septal defects and anomalous pulmonary venous connections. Comparison between the transpectoral and subpectoral approaches.

A right submammarian incision with anterior thoracotomy was performed in 89 female patients to repair simple and complex forms of atrial septal defects. Patients' ages ranged from 8 to 38 years (mean 21.5 years). Seventy-seven had secundum-type atrial septal defects, one had the primum type, and 11 had an associated partial anomalous pulmonary venous connection. The patients were divided into two groups: 57 patients in group A, in whom, after a breast flap was elevated, a transpectoral approach was used to enter the chest; 32 patients in group B, in whom the pectoral muscle was not divided and a subpectoral approach was used. Aortic cannulation was accomplished without difficulty in all 89 patients. There were no early or late deaths in either group. Follow-up ranged from 24 to 108 months (mean 63.7 months) and included 86 patients, who were free of symptoms. In group A, however, among 54 patients examined, the volume of the right breast and pectoral muscle was smaller than the left in four patients (7.4%), and 21 (38.8%) had persistent right periareolar numbness. In 32 patients evaluated in group B, no difference was noted in the size of the breasts, and persistent numbness was present in four patients (12.5%). In summary, atrial septal defects or anomalous pulmonary venous connections can be safely repaired through a right submammarian thoracotomy in female patients. The subpectoral approach offers better results because breast asymmetry and paresthesias are significantly less prevalent (p less than 0.01).

Adolescent↗