[Iatrogenic pathology on admission of aged persons to the hospital. A prospective study].
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Aged↗
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[Immunoreactive insulin and C-peptide in glucose tolerance disturbances in the relatives of diabetes mellitus patients].
The content of immunoreactive insulin (IRI) and of immunoreactive C-peptide (IRCP) was determined in the relatives of patients with juvenile diabetes mellitus and in healthy persons during the oral glucose tolerance test (GTT). The IRCP content was higher than the IRI content. The IRI and IRCP curves were identical in persons with normal and doubtful GTT results; these curves differed from those in patients with latent and manifest diabetes which were torpid in character. The coefficient of molar IRCP/IRI proportion differed in persons with pathological GTT results as compared with the normal.
Adolescent↗
[EEG evaluation of patients undergoing extracorporeal circulation under analgesic and electrohypoalgesia with auricular acupuncture].
Electroencephalograms recorded 12 hours before and 12 hours after heart surgery in ECC and moderate hypothermia (30 degrees) are evaluated. Two groups of patients were studied: - the first group was composed of those undergoing analgesic anaesthesia; - the second group of those undergoing electroencephalograms by means of auricular acupuncture. In the first group the postoperative EEG was dominated by long "theta" and "delta" waves characteristic of the deep sedation of analgesic anaesthesia. In the second the EEG displayed a "theta" rhythm interspersed with trains of "alpha" waves, similar to that of a tired, but alert person. The pathological traces with signs of diffused, hemispheric or cerebral distress, do not bear any relationship to the type of anaesthesia, but to the type of disease, which had increased the probability of thrombo-embolic, and/or ischaemic risk.
Acupuncture Therapy↗
[L-transformation of mycobacteria in the light of current epidemiological situation of tuberculosis in the world].
To determine a role of L-forms of Mycobacterium tuberculosis in the development of a recurrent tuberculous process in persons with residual pulmonary tuberculous changes, a total of 2,412 persons registered at a dispensary as those included into Groups VIIA and VIIB who were found to have a significant tuberculosis infection pool. The tuberculosis pathogen was detected in 214 (9%) examinees in the bacterial and L forms. A further follow-up of the persons whose pathological material had shown the L form which are prone to reverse indicated that the isolation of unstable mycobacterial L forms is an important predictive sign showing the high potential hazard of tuberculous process reactivation.
Adult↗
Pitch perception in patients with a multi-channel cochlear implant using various pulses width.
Cochlear implants have been designed to partially restore hearing to those people who are totally deaf. Multi-channel cochlear implants offer the opportunity to evoke acoustic perceptions like loudness and pitch, elicited by a controllable pattern of electric stimulation by means of electrodes placed in different places along the cochlear length. In this study, two psychophysical experiments were conducted with 4 patients, 1 prelingually and 3 postlingually-deafened, implanted with the multi-channel cochlear prosthesis Nucleus 22. Experiments were carried out to study the effect of varying the width of the electric biphasic pulsatile stimuli on the discriminative abilities of the pitch perception. The tests involved place pitch ranking and pulse rate discrimination. Place pitch ranking was studied by determining the just noticeable difference in pitch pairs (jnd-pp), defined as the pair of nearest electrodes which elicit different pitch perception. Pulse rate discrimination was studied by determining the just noticeable difference in pulse rate (jnd-pr) defined as the minimal difference in stimulus repetition rate over a given electrode, which elicits different pitch perceptions. Both experiments were conducted using pulses of 400, 200, 100 and 50 microseconds/phase. The results indicated that in spite of the differences in pathologies and personal histories, both jnd-pp and jnd-pr decrease by diminishing the pulse width. Speech perceptual data, measured for various pulse widths, validates the usefulness of decreased pulse width which yields favorable results in the psychophysical tests.
Acoustic Stimulation↗
[Light scattering study of the cornea in contact lens patients. In vivo studies using confocal slit scanning microscopy].
For the first time, we present measurements of the scattered light intensity of the human cornea to determine the functional state of the corneal endothelium. In 94 contact lens wearers endothelial alterations were measured by means of a newly developed confocal slit scanning video microscope and correlated with photometrically recorded stromal scattered light intensity. Our control group consisted of 26 persons without corneal pathology. It was shown that in persons wearing contact lenses the endothelial cell density was significantly below that of the control group and endothelial cell polymegatism (coefficient of variability of cell size) was significantly greater. Further, in contact lens wearers the level of scattered light intensity was significantly higher than in the control group, and the difference increased with the wearing time. In addition, the variation of the endothelial cell size correlated with the increased scattered light within the stroma, only a low correlation was found between the endothelial cell density and the scattered light intensity, however. From our results it can be assumed that a corneal endothelium with marked polymegatism has a reduced hydration function. Thus, decreased endothelial function can be determined very early and non-invasively by measuring the corneal scattered light intensity. In addition, the scattered light intensity gives topographical information about corneal swelling.
Adult↗
[The unwanted father: psychodynamic aspects of the relationship after separation and divorce].
Although the importance of the father for the development of the child is well known and although an increased presence of the father in the family system is often demanded, processes of active shutting out the father occur. The deterioration of relation between father and child is not seen as a result of pathological male personality, but rather as a result of family or couple system. The special situation for counsellors of such cases is discussed.
Adolescent↗
[Toxoplasmosis in families. I. Detection of T. gondii invasion and serological appraisal].
Toxoplasmosis was studied in 102 families, in which index-cases manifested the fully symptomatic course of the acquired lymphnodular toxoplasmosis, confirmed by presence of IgM and IgG class antibodies (ELISA, Vidas, BioMerieux). The index-cases (group A) provided a rational index of the acquired invasion or its late sequele in other families members. The studies were performed in 388 persons, originating from Wielkopolska region, including 102 patients of a group A and 286 of families members of group B (167 children and 221 adults). In group A patients (including 49 children and 53 adults) immunoserological studies detected IgM class antibodies in 68.7% of cases and IgG class antibodies in 94.1% patients. In 286 family members (group B), presence of IgM class antibodies was found in 12.2% and IgG class antibodies was found in 55.2% studied persons; clinical pathology was noted in 46 patients (16.3%) including 3 pregnant women. The obtained results point to the need of complex evaluation of family environments based on analysis of serological tests (including estimation of IgM and IgG class antibodies) and accompanied by clinical analysis of studied children and adults.
Adolescent↗
Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program.
BACKGROUND: Increasing incidence and mortality rates from cutaneous melanoma are a major public health concern. As part of a national effort to enhance early detection of melanoma/skin cancer, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples provision of skin cancer information to the general public with almost 750,000 free skin cancer examinations (1985-1994). OBJECTIVE: To begin to evaluate the impact of this effort, we determined the final pathology diagnosis of persons attending the 1992-1994 programs who had a suspected melanoma at the time of examination. METHODS: We directly contacted all such persons by telephone or mail and received pathology reports from those who had a subsequent biopsy. RESULTS: We contacted 96% of the 4458 persons with such lesions among the 282,555 screenings in the 1992-1994 programs. We obtained a final diagnosis for 72%, and the positive predictive value for melanoma was 17%. Three hundred seventy-one melanomas were found in 364 persons. More than 98% had localized disease. More than 90% of the confirmed melanomas with known histology were in situ or "thin" lesions (< or = 1.50 mm thick). The median thickness of all melanomas was 0.30 mm. The 8.3% of AAD cases with advanced melanoma (metastatic disease, regional disease, or lesions > or = 1.51 mm) is a lower proportion than that reported by the 1990 Surveillance, Epidemiology and End Result Registry. The rate of thickest lesions (> or = 4 mm) and late-stage melanomas among all participants was 2.83 per 100,000 population. Of persons with a confirmed melanoma, 39% indicated (before their examination) that without the free program, they would not have considered having a physician examine their skin. CONCLUSION: The 1992-1994 free AAD programs disseminated broad skin cancer educational messages, enabled thousands to obtain a free expert skin cancer examination, and found mostly thin, localized stage 1 melanomas (usually associated with a high projected 5-year survival rate). Because biases impose possible limitations, future studies with long-term follow-up and formal control groups should determine the impact of early detection programs on melanoma mortality.
Adult↗
Morbidity assessment in urinary schistosomiasis infection through ultrasonography and measurement of eosinophil cationic protein (ECP) in urine.
In a Schistosoma haematobium-endemic village in western Madagascar we evaluated ultrasonography and Eosinophil Cationic Protein (ECP) in urine as means to detect the associated urinary tract pathology. 192 individuals were matched according to age and sex, and grouped into infected persons with bladder and, if present, kidney pathology (n = 96); infected persons without pathology (n = 48) and noninfected persons without pathology (n = 48). The median urinary egg count was significantly higher in individuals with ultrasonographically detectable urinary tract pathology (115 eggs/10 ml urine) than in infected persons without (45 eggs/10 ml of urine). At 136 ng/ml, the median ECP level was significantly higher in the 144 infected individuals than in the 48 noninfected persons (0.35 ng/ml). Egg excretion correlated positively with ECP level. The median ECP level was significantly higher in the group with ultrasonographically detectable urinary tract pathology than in the group without (183 ng/ml vs. 67 ng/ml). The results suggest that minor degrees of pathology, particularly at an early stage of infection with S. haematobium, might be overlooked by ultrasonography despite the presence of marked inflammation, as indicated by markedly increased urinary ECP levels in infected individuals without ultrasonographically detectable urinary tract pathology. ECP may therefore provide important information on the evolution of S. haematobium-associated urinary tract morbidity.
Adolescent↗
Personality traits and psychological factors in voice pathology: a foundation for future research.
It has been argued that personality, emotions, and psychological problems contribute to or are primary causes of voice disorders and that voice disorders in turn create psychological problems and personality effects. This article (a) briefly reviews the literature surrounding the role of psychological and personality processes in individuals with functional dysphonia (FD), vocal nodules (VN), and spasmodic dysphonia (SD); (b) provides an overview of recent concepts in personality and trait structure; and (c) summarizes the fundamental tenets of a theoretical synthesis proposed by Roy and Bless (2000) to explain the dispositional bases of FD and VN. This theory links FD and VN to the signal sensitivities and behavioral response biases of neurotic introverts and neurotic extraverts, respectively. In a companion article, the merits of the Roy and Bless theory are evaluated.
Humans↗
[The psychological meaning of abnormal behavior in mental retardation].
The aim of the article is to encourage psychiatrists to follow the psychopathological approach to mental retardation. According to the author's opinion it is impossible to explain mental retardation only by using neurological and genetic categories. Mental retardation belongs to the group of psychological disorders like the psychoses and the neuroses. This disorder is characterized by pathological organisation of personality, that inhibits the development of the cognitive functions. The author presents the conditions of life in social care homes (where the basic needs concerning dignity, love and freedom are absent) as an example of the factors pathologizing the personality. She explains the psychological meaning of some abnormal behaviours by persons with mental retardation living in such conditions.
Aggression↗
[Benign uterine pathology in premenopause and transvaginal sonohysterography: personal experience].
BACKGROUND: In this study we report our experience about hysterosonography and its use for the diagnosis of benign uterine pathology in premenopausal women referred to our Hospital. METHODS: From May to October 2000, 58 patients underwent transvaginal sonohysterography. They referred to our Ultrasonography Center because of sterility, intermenstrual bleedings, menometrorrhagias or anomalous endometrial echopatterns which had been found by basal transvaginal ultrasound examination. All patients were in fertile age and were examined during the follicular phase of the ovarian cycle. The hysterosonographic examination consisted in introducing 20 cc of a physiological solution by catheter with inflating balloon for hysterosalpingography and assessment of the uterine cavity was possible thanks to the acoustic window created by the fluid which gradually distended the cavity itself. We considered as failures of the techniques those cases in which the profile of endometrial cavity was not clearly visualized. RESULTS: Sonohysterography was performable in 52 of the 58 patients. The failure of examination in 3 cases was due to inadequate distention of the uterine cavity, in 2 cases to cervical stenosis and in 1 case to the reflux of the contrast medium. Diagnosis effected with sonohysterography revealed 3 uterus bicornis, 16 endometrial polyps and 9 submucosal myomas. No ultrasound anomalies were found in 23 patients. All the women underwent a subsequent hysteroscopy which confirmed our ultrasound diagnosis. CONCLUSIONS: Our study shows that sonohysterography allows to obtain a precise diagnosis of benign uterine pathology, which generally basal transvaginal ultrasonography can only suspect. The applicability of positive and negative predictive values, of the sensitivity and specificity is limited by the small number of cases included in the study. The role of sonohysterography is more difficult to define when compared to hysteroscopy. The conclusion is drawn that this new method offers an important aid for gynecological diagnosis of benign pathology.
Adult↗
Psychosurgery and personality disorders.
Defining personality and its pathological variants is a hazardous enterprise. The personality concept refers to the global coherence of functioning of a person as a whole and can be divided into two components, temperament and character. Personality disorders will be discussed according to the DSM III-R (1987) (The Diagnostic and Statistical Manual of Mental Disorders) the most recent psychiatric taxonomy of the American Psychiatric Association. The interaction between psychosurgery and personality is multiple. It will be stated that the mere presence of a personality disorder in a patient should never be an indication for psychosurgery. It may sometimes even act as a contraindication. Psychosurgery can produce changes in some basic psychic dysfunctions and although there is no universally accepted understanding of how it works, some hypothetical neurobiological foundations will be discussed.
Humans↗
Coadministration of calcium antagonists and ACE inhibitors--is a skeptic convinced?: a personal view.
The pathological chain of events that stretches from the earliest atheromatous lesion to end-stage myocardial failure and death is amenable to attack in many places. It may well prove that a multifaceted intervention offers the best therapeutic option. Two important cardiovascular therapies, the calcium entry blockers and ACE inhibitors, may offer more than their effects on vascular tone and remodeling. Both have actions on the basic process of atheroma. Individually, or more challengingly in combination, they may strike at the basic pathogenesis of atherosclerosis yet still provide their more general beneficial effect on vasomotor tone. Whilst clinical data are yet scant, there is a plausible biological basis for their coprescription.
Angiotensin-Converting Enzyme Inhibitors↗
Videothoracoscopic approach to primary mediastinal pathology.
STUDY OBJECTIVES: Personal results and validity of videothoracoscopic (VTS) approach to primary mediastinal diseases are analyzed. DESIGN: Retrospective review of personal experience. SETTING: Department of Surgery, San Giuseppe Hospital, University of Milano, Italy. PATIENTS: From September 1991 to January 1999, of a personal series of 1,653 VTS procedures, 118 regarded primary mediastinal diseases. In 47 cases, diagnostic videothoracoscopy was performed to obtain large biopsy specimens or to carry out accurate staging; in 71 cases, full resection was anticipated. INTERVENTIONS: The patient, intubated with a double-lumen Carlen's tube and in the lateral decubitus position, underwent videothoracoscopy. Two ports and a small anterior utility thoracotomy were completed. Thorough exploration of the mediastinum and, if possible, complete resection of the lesion were accomplished. MEASUREMENTS AND RESULTS: Videothoracoscopy yielded adequate diagnosis or staging in all patients operated on for diagnostic purposes. Of 71 patients operated on with resective intent, 66 had complete thoracoscopic resection (22 stage-I thymomas, 4 thymic cysts, 21 myasthenia gravis associated with thymic hyperplasia, 19 miscellaneous tumors). Conversion was required in five cases, mostly for invasion of mediastinal structures. Complications included the following: one patient developed intraoperative bleeding controlled endoscopically, two patients experienced postoperative bleeding requiring re-thoracoscopy, and one patient had postoperative pneumonia requiring assisted ventilation. One recurrence of malignant thymoma occurred 4 years postoperatively. CONCLUSIONS: Videothoracoscopy can attain a leading role in obtaining large samples in lymphatic mediastinal diseases. Dysembriomas, schwannomas, simple cysts, and similar lesions can benefit from VTS removal. Total thymectomy for myasthenia gravis associated with thymic hyperplasia can be performed thoracoscopically. Further data and more extensive experience are needed.
Biopsy↗
[The cardiovascular risk-profile of persons with normal, borderline disturbed and certain pathological glucose tolerance in dependence on the body-weight (author's transl)].
For a group of 218 persons with normal, borderline disturbed and certain pathological glucose tolerance (age and sex matched controls) the following risk factors were determined: - overweight (Broca-index greater than 1.1) - hypertension (WHO-criterions) - hypertriglyceridaemia (from 200 mg/dl) - hypercholesterolaemia (from 260 mg/dl) and - hyperuricaemia (from 6,5 mg/dl (male) respectively 6,0 mg/dl (female). These risk factors were compared in dependence on the bodyweight in each case. There were average values of 1.68 associated risk factors for normal persons, 2.55 for borderline diabetics and 2.72 for newly discovered but not yet treated diabetics. With growing bodyweight the part of hypertensions increases, with borderline diabetics stronger than with normal persons but weaker than with diabetics. The behaviour of the hypertriglyceridaemia frequency is the same. The frequency of hyperuricaemias surpasses with borderline diabetics those for normal persons and diabetics. The frequency of hyperuricaemia does not show the strong proportionality to the bodyweight with disturbed glucose tolerance as with normal persons. The average value of cardiovascular risk factors increases greater with low degree of glucose intolerance than with clearly disturbed glucose tolerance.
Body Weight↗
Historic autopsies. I. the post-mortein examination of Daniel McNaughton.
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Autopsy↗