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At least 1,063 records · Page 59Linked to original sources
PubMed1996

Psychodynamics and psychiatric diagnoses of pseudoseizure subjects.

OBJECTIVE: The goal of this study was to determine current and lifetime rates of DSM-III-R disorders in patients with pseudoseizures and to ascertain whether trauma is associated with the occurrence of pseudoseizures. METHODS: Adult pseudoseizure patients (N = 45) were interviewed regarding seizure course and life events, and they were given the Structured Clinical Interview for DSM-III-R--Patient Version, the Structured Clinical Interview for DSM-III-R Dissociative Disorders, the Dissociative Experiences Scale, and the Personality Diagnostic Questionnaire--Revised. The pseudoseizures were diagnosed in a tertiary-care video-EEG facility. Most of the subjects (78%) were female, and the mean age of the overall patient group was 37.5 years (SD = 9.7). RESULTS: The mean duration of the subjects' seizure history was 8.3 years (SD = 8.0). Common current psychiatric diagnoses included somatoform disorders (89%), dissociative disorders (91%), affective disorders (64%), personality disorders (62%), posttraumatic stress disorder (PTSD) (49%), and other anxiety disorders (47%). The lifetime occurrence of nonseizure conversion disorders was 82%. The mean Dissociative Experiences Scale score was 20.2 (SD = 18.2). Trauma was reported by 84% of the subjects: sexual abuse by 67%, physical abuse by 67%, and other traumas by 73%. CONCLUSIONS: Pseudoseizure subjects have high rates of the psychiatric disorders found in traumatized groups; they closely resemble patients with dissociative disorders. Reclassification of conversion seizures with the dissociative disorders should be considered. Pseudoseizures often appear to express distress related to abuse reports. Clinicians should screen pseudoseizure patients for adult and childhood trauma, dissociative disorders, depression, and PTSD.

Adolescent↗
PubMed2001

Changes in mental health and service use after termination of SSI benefits.

OBJECTIVE: Supplemental Security Income (SSI) benefits for a substance abuse disability were terminated by federal legislation as of January 1, 1997. This study examined the changes in mental health and in the use of mental health services two years after the legislation was implemented among individuals who had been receiving benefits under this classification. METHODS: From a random sample of 400 SSI beneficiaries in Los Angeles, 253 were interviewed at the time the legislation took effect and again at 12-month, 18-month, and 24-month follow-ups. The study subjects were characterized by income source after the legislation and by probable mental health diagnosis. Their use of mental health services was also measured. RESULTS: The mental health status of the participants remained unchanged between baseline and 24-month follow-up. The proportion who reported any use of mental health services decreased, primarily among those who continued receiving SSI benefits under a different classification. Among those who lost SSI benefits, emergency department visits and hospitalizations did not increase, and rates of outpatient visits remained the same. CONCLUSIONS: Contrary to expectations, the mental health status of individuals who had been receiving SSI benefits for a substance abuse disability did not worsen after the benefits were terminated. Local safety nets and reclassification under another disability may have mitigated the effects of the policy change. The results of this study underscore the need for longitudinal data to inform policy decisions.

Adult↗
PubMed1996

Carcinoma of the anterior commissure of the larynx: II. Proposal of a new staging system.

On the basis of embryology and clinical experience, we have defined here an anterior commissure (AC) subsite of the human larynx and have addressed the issue as to whether the degree of involvement of this subsite is related to the outcome of glottic cancer, in terms of local control within 5 years of therapy. Retrospective analysis of 534 patients included 1) classification of patients according to the TNM, 2) actuarial evaluation of the outcome, 3) reclassification of patients according to the involvement of the AC subsite, and 4) reevaluation of the outcome according to this latter classification. The results showed that the outcome was not well correlated with TNM classification, whereas patients with progressively heavier involvement of the AC subsite had a progressively worse outcome. On the basis of these data, we suggest that TNM classification of cancer involving the AC be implemented by and AC classification, in order to better forecast the prognosis and design specific conservative surgery.

Adult↗
PubMed1993

Categorical and programming changes in special education services.

Special education students (N = 654) were studied to determine what proportion had a categorical or programming change and what factors (child, school, and home) were associated with change. The study included all students with disabilities from preschool through secondary school in a tricounty rural district. Data were gathered through a record review and parent survey. Change was found to be more common than is generally perceived: 38.2% of the students had a classification change (21.9% by termination and 16.3% by reclassification). Rates of change varied significantly among classifications and the student's initial classification, grade level, and comorbidity were significantly predictive of change in classification.

Achievement↗
PubMed1980

Discriminant analysis of personality and body-image factors of females differing in percent body fat.

The purpose of the study was to determine whether individuals with high percent body fat can be distinguished on the basis of personality and body-image from those possessing lower levels of body fat. 65 female college students were administered the 16 Personality Factor Questionnaire and the Secord and Jourard Body-cathexis Scale. Measurement of height, weight, and skin folds at the triceps and illiac crest were also taken. On the basis of percent body fat two groups of 20 females each (high and low percent body fat) were identified. From discriminant analyses one personality factor and six body-image items were identified which distinguished between groups. Reclassification of the subjects, based upon derived discriminant functions, resulted in 60.0% of the subjects being correctly reclassified from personality data and 100% of the subjects correctly reclassified from body-image data. Body-image appears to be an important factor that can distinguish between individuals possessing high and low levels of body fat.

Body Height↗
PubMed1975

Subpopulations of lymphocytes: a review.

Human lymphocytes comprise a heterologous population of cells which can be sub-divided on functional criteria or on the basis of surface membrane markers. Although it is widely accepted that human lymphocytes are broadly divisible into thymus dependent (T) and thymus independent (B) cells, recent evidence suggests that at least in humans this distinction may not be as clear cut as previously thought. An assessment of the relative numbers of T and B cells in human peripheral blood and lymphoid tissues can be made utilizing these marker systems. This has led to a reclassification of human lymphoid diseases according to the T and B cell concept, which might be of value in characterising the immunological status in health and disease, and may allow a more rational approach to the therapy of immune deficiency states and lymphoid malignancies.

Agammaglobulinemia↗
PubMed1990

Echographic tissue characterization in diffuse parenchymal liver disease: correlation of image structure with histology.

Seventy livers were examined in vitro using a computerized ultrasound B-mode data acquisition and analysis system. For tissue characterization, statistical parameters from pattern recognition algorithms describing image brightness and image structure were used. Reference classification based on histopathology as well as on chemical/morphometrical analysis led to the diagnostic classes of normal, fatty liver, fibrosis/cirrhosis and fatty fibrosis/cirrhosis. Comparing the two reference methods for ultrasound tissue characterization, reclassification based on chemical/morphometrical analysis resulted in a significant increase in diagnostic accuracy. The strong correlations between statistical ultrasound image parameters and morphometrical features reflect the relevance of our statistical approach to ultrasound tissue characterization.

Fatty Liver↗
PubMedDate not supplied

Prolapse of the laryngeal ventricle.

Many varied lesions may protrude into the laryngeal lumen from between the true and false vocal cords. These protrusions can be precisely diagnosed only by biopsy. Prolapse of the laryngeal ventricle is one of these lesions; it is a distinct clinicopathologic entity, a primary lesion unrelated to other laryngeal or systemic disease. Eversion of the ventricle (or saccule) is a similar protrusion that is secondary to pulsion or traction by an associated laryngeal lesion. Other lesions that may produce similar clinical findings and gross appearance include benign tumors, cysts, and, rarely, squamous cell carcinoma. Biopsy is therefore mandatory to plan rational treatment. A review of 26 patients who had been diagnosed as having prolapse resulted in the reclassification of 20 cases of prolapse and six cases of eversion. Prolapse is possibly unrelated etiologically to cough, or chronic laryngeal or respiratory tract infection. The histopathologic data suggest further that prolapse is a result of fatty infiltration, edema, and inflammation of the periventricular tissue above the ventricle, which cause the tissue to enlarge and protrude into the laryngeal lumen from between the true and false vocal cords.

Aged↗
PubMedDate not supplied

Using in vitro prediction models instead of the rabbit eye irritation test to classify and label new chemicals: a post hoc data analysis of the international EC/HO validation study.

The international validation study on alternative methods to replace the Draize rabbit eye irritation test, funded by the European Commission (EC) and the British Home Office (HO), took place during 1992-1994, and the results were published in 1995. The results of this EC/HO study are analysed by employing discriminant analysis, taking into account the classification of the in vivo data into eye irritation classes A (risk of serious damage to eyes), B (irritating to eyes) and NI (non-irritant). A data set for 59 test items was analysed, together with three subsets: surfactants, water-soluble chemicals, and water-insoluble chemicals. The new statistical methods of feature selection and estimation of the discriminant functions classification error were used. Normal distributed random numbers were added to the mean values of each in vitro endpoint, depending on the observed standard deviations. Thereafter, the reclassification error of the random observations was estimated by applying the fixed function of the mean values. Moreover, the leaving-one-out cross-classification method was applied to this random data set. Subsequently, random data were generated r times (for example, r = 1000) for a feature combination. Eighteen features were investigated in nine in vitro test systems to predict the effects of a chemical in the rabbit eye. 72.5% of the chemicals in the undivided sample were correctly classified when applying the in vitro endpoints lgNRU of the neutral red uptake test and lgBCOPo5 of the bovine opacity and permeability test. The accuracy increased to 80.9% when six in vitro features were used, and the sample was subdivided. The subset of surfactants was correctly classified in more than 90% of cases, which is an excellent performance.

Animal Testing Alternatives↗
PubMedDate not supplied

Classic versus sequential diagnostic support for chronic nonspecific respiratory diseases.

The authors discuss two approaches to assisted medical diagnosis of chronic nonspecific respiratory diseases, Bayes-Fisher linear discrimination and a decision tree based on the linear discriminant functions of the individual nodes. Only the two most discriminative variables obtained for differentiation of groups at individual nodes are used for the node subclassification. They are the four linguistic variables cough, character of dyspnea, physical examination of the chest, and x-ray examination of the chest obtained by conversion of discrete features. No laboratory finding is used. The tree classifier simulates a physician's thought process. Results with multigroup linear discrimination on the same four variables for both a reclassification and a cross-validation technique were comparable to the tree-scheme outcomes. The tree classifier lends itself to simple graphic presentation, the patient being created as a point in the plane of the two most discriminative variables without the need for mathematical formulas and posterior probabilities. The classification errors that appear in the chronic bronchitis group can be easily corrected using an additional variable, smoking index.

Algorithms↗
PubMed1996

Patient characteristics, MRI examination, and dopaminergic drug response in clinical possible Parkinson's disease.

Patients with parkinsonism can be classified as clinical definite, probable, possible, or unlikely Parkinson's disease (PD). Possible PD includes patients with PD according to conventional diagnostic criteria and with at least a moderate response to dopamine agonists. However, these patients have clinical features that may reduce the probability for idiopathic PD. The objective of this study was to clinically characterize patients with possible disease in a prevalence study of PD and to indicate the frequency of idiopathic PD in this group of patients. The diagnostic re-evaluation was based on detailed MRI examinations and investigations of dopaminergic drug response after several years of treatment. In a community-based prevalence study in Norway, comprising 245 PD patients, we found 36 patients (15%) with clinical possible PD. The patients with possible disease had significant and clinically important differences in demographic and disease characteristics compared to patients with definite and probable PD. Possible PD patients were older at disease onset, more disabled, and had more neurobehavioral disorders. MRI examinations of 14 of the 36 patients with possible PD in the prevalence study revealed significant group effects compared to an age-matched control group, with reduced pars compacta width and increased cortical atrophy. In individual patients, signal attenuation consistent with vascular lesions of the basal ganglia contributed to diagnostic reclassification. Dopaminergic drug withdrawal revealed no response in 4 of 12 examined patients. Two of the remaining eight patients had a clear short-duration drug response. Six patients had only a varying degree of long-duration response. The re-evaluation of diagnosis indicates that probably less than half of the patients with clinical possible PD have idiopathic disease. Patients with atypical features and diagnosed as possible PD should thus be excluded from studies with a presumed high specificity for idiopathic PD.

Aged↗
PubMed2005

Imaging gastrointestinal stromal tumors.

BACKGROUND: Because of the recent reclassification of mesenchymal tumors, which was based on a better understanding of the genetics and immunophenotype of gastrointestinal stromal tumors (GISTs), only a limited number of studies have described the radiologic appearance of GISTs. METHODS: This study reviews the imaging characteristics of GISTs, with an emphasis on differentiating benign and malignant tumors using positron emission tomography (PET), computed tomography (CT), and magnetic resonance imaging (MRI). We reviewed the data from 53 cases of GISTs treated at our institute. The imaging studies from these cases, which were recorded at our institute from January 1998 through June 2003, included PET, CT, and MRI. RESULTS: Of the 53 GIST cases, stomach and small bowel tumors accounted for 80% of the tumors. Malignant lesions were larger and more heterogeneous, had ulcerations, and were PET positive. Peritoneal and liver metastases were most common. CONCLUSIONS: PET, CT, and MRI appear to be useful in differentiating nonmetastasizing from malignant GISTs.

Adult↗
PubMed1995

Subacute care, Medicare benefits, and nursing home behavior.

Two policy changes in 1988, one administrative and one legislative, allowed greater Medicare coverage of subacute care in skilled nursing facilities (SNFs). The Medicare Catastrophic Coverage Act (MCCA) of 1988, in conjunction with an administrative directive, or transmittal, from the Health Care Financing Administration (HCFA), changed the Medicare SNF benefit structure substantially. In this study, we specified a simultaneous equation system to explain the effects of the benefit changes on Medicare use. The results suggest that the two policy changes increased Medicare use in Pennsylvania SNFs substantially; however, the increase was associated with facility and case mix characteristics, which suggest that the increase was largely attributable to reclassification of current patients from other payer categories, Medicaid and self-pay, rather than new admissions. The effects of the MCCA and the HCFA transmittal on increased Medicare use were unanticipated and have important implications for the way in which subacute care is defined and financed in future benefit discussions.

Aged↗
PubMed2006

Unsupervised analysis uncovers changes in histopathologic diagnosis in supervised genomic studies.

Human gastrointestinal stromal tumors (GIST) have recently emerged as a distinct mesenchymal tumor type that has a unique phenotype characterized by a gain of function mutations in c-kit. In contrast, leiomyosarcomas (LMS) of the gastrointestinal tract or retroperitoneum, which were previously classified together with GISTs as gastrointestinal sarcomas, have much less frequent mutations of c-kit. We performed microarray analyses to gain a comprehensive understanding of the difference between the two types of soft-tissue sarcomas at the level of gene expression. Microarray experiments were performed on 30 GISTs and 30 LMSs that were collected at the time of surgical resection. These tumors were categorized based on the histopathologic diagnosis recorded in our institutional database. Prior to our search for genes that are differentially expressed between these two types of cancers, we first carried out an unsupervised analysis using multidimensional scaling (MDS) to determine whether the two groups have marked overall differences in gene expression. Initially, the MDS did not reveal a good separation between the two groups. We then re-reviewed the histopathology of these tumors and realized that some of the cases included in our study were acquired 10 years ago when the diagnosis of gastrointestinal sarcoma was made according to histopathologic criteria alone without immunohistochemistry for c-kit. An experienced pathologist reviewed all of the specimens and this revealed that a number of the GIST cases were classified as LMS in the clinical database. Correction of the histopathologic diagnosis and relabeling of the samples resulted in a much more pronounced separation of GIST and LMS in the MDS analysis. This study underscores the need to re-review histopathology as reclassification occurs. While updating the clinical database may be desired, this is usually impractical. For molecular studies that use archival samples, it is critical to have the archival samples re-reviewed by a pathologist. Further, unsupervised analysis often proves to be a critical quality control step in identifying structural problems that may exist. Finally, MDS analysis further supports that GIST is a distinct type of sarcoma.

Biomarkers, Tumor↗
PubMed1997

Occupational and Environmental Determinants for Benign Thyroid Disease and Follicular Thyroid Cancer.

Occupational and environmental determinants of benign thyroid disease and follicular thyroid cancer were evaluated in a series of cases in 1977-1987. Of the cases initially diagnosed as follicular thyroid cancer, only 31 remained after a reclassification, whereas 44 were found to be benign thyroid disease. Both series were compared with 387 randomly selected population controls. Occupational solvent exposure was strongly associated with benign thyroid disease (odds ratio, OR, 2.8; 95% confidence interval, 95% CI, 0.9-9.0 for women and OR 18.9; 95% CI 2.2-161 for men). Eight of the nine men found to have benign disease had been exposed to solvents, and six of them to trichloroethylene. For both types of cases, a private well at the birth address increased the risk, OR 2.0; 95% CI 0.9-4.0 and OR 3.0; 95% CI 1.2-7.2, respectively, whereas the risk was lower for those living in coastal areas. Less fish and shellfish in the diet increased the risk for malignant thyroid disease only. Although based on small numbers, the study indicates etiologic roles of occupational and environmental factors for both conditions studied. The influences of occupation and diet differ, however, for the two outcomes.

Journal Article↗
PubMed1998

Technical-regulatory aspects of antiseptics and disinfectants in Italy.

The authors analyze Italian laws, in light of changes introduced with Legislative Act n. 178/91, which regulate products with antiseptic and disinfectant action. A new reclassification of medicinal, cosmetic and health products is considered and proposed. Particular attention is given to marketing criteria adopted by various producers with regard to the form of product presentation.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Mortality from pleural mesothelioma in Rio de Janeiro, Brazil, 1979-2000: estimation from death certificates, hospital records, and histopathologic assessments.

To obtain information about the occurrence of pleural mesothelioma on a population basis in Brazil, mortality related to pleural tumors in the State of Rio de Janeiro during 1979-2000 was examined. Death certificates with pleural tumors as the main cause of death and hospital records were analyzed, together with histopathologic material, which was reevaluated. Of 217 death certificates coded as pleural tumors, 34.1% were considered wrongly coded. Results after reclassification were: definite mesothelioma = 45 cases; probable = 7; possible = 31; inconclusive = 65; other tumors = 11. Thus, the number of mesotheliomas in Rio de Janeiro in 1979-2000 is estimated to have been 83. The analysis also suggests a problem with mortality codification in the State.

Asbestos↗
PubMed2005

From Hodgkin disease to Hodgkin lymphoma: biologic insights and therapeutic potential.

Reclassification of Hodgkin disease as Hodgkin lymphoma (HL) represents a milestone in the lymphoma field, awarding recent insights in the molecular biology of Hodgkin and Reed-Sternberg (H-RS) cells and their environment. This review summarizes antiapoptotic and proproliferative pathways involved in the pathogenesis of this disease with the ultimate goal of translating laboratory knowledge into clinical decision making. The focus is on potential targets and novel drugs, which are discussed in the context of the complex biology of HL. Considering that HL patients are more likely to die from acute and late treatment-related toxicities than from HL itself, the introduction of targeted, biologically based therapies for HL patients with palliative and eventually curative intention might be justified.

Antineoplastic Agents↗