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PubMed1992

[Visual agnosia evolving to optic aphasia--a case study].

The underlying mechanism of visual agnosia and optic aphasia has not been fully elucidated, although a number of hypotheses have been proposed. Besides, the difference between these two conditions has been a matter of debate. We report here the result of neuropsychological evaluation in a case of associative visual agnosia evolving to optic aphasia. A 64-year-old right-handed patient was found to be disoriented and confused after undergoing the operation of gastrectomy. CT scan revealed a large infarction in the territory of left posterior cerebral artery. Since 3 weeks after onset, neuropsychological investigations were carried out during 5 months. He was alert and co-operative. Right homonymous hemianopia with macular sparing was noted, but his visual acuity was normal. There was neither a global deterioration of intellectual capacities nor aphasia. Most striking finding was his difficulty in identifying common objects and colours along with a profound alexia. Prosopagnosia was absent. Visual naming both for objects and line drawings was severely impaired. He was unable to describe or demonstrate the use of the objects which could not be named. Pointing to objects named by the examiner was also severely impaired. Although tactile naming was also impaired, both of auditory naming for environmental sounds and naming objects in response to verbal descriptions were preserved. While he was not able to copy the objects skillfully, matching of identical objects and matching objects to line drawings were normal. Clumsiness of coping was thought to be due to his constructional apraxia and visuomotor ataxia. Therefore, his deficit in visual domain was considered to be associative visual agnosia.(ABSTRACT TRUNCATED AT 250 WORDS)

Agnosia↗
PubMed1992

Multifrequency EPR investigations into the origin of the S2-state signal at g = 4 of the O2-evolving complex.

The low-temperature S2-state EPR signal at g = 4 from the oxygen-evolving complex (OEC) of spinach Photosystem-II-enriched membranes is examined at three frequencies, 4 GHz (S-band), 9 GHz (X-band) and 16 GHz (P-band). While no hyperfine structure is observed at 4 GHz, the signal shows little narrowing and may mask underlying hyperfine structure. At 16 GHz, the signal shows g-anisotropy and a shift in g-components. The middle Kramers doublet of a near rhombic S = 5/2 system is found to be the only possible origin consistent with the frequency dependence of the signal. Computer simulations incorporating underlying hyperfine structure from an Mn monomer or dimer are employed to characterize the system. The low zero field splitting (ZFS) of D = 0.43 cm-1 and near rhombicity of E/D = 0.25 lead to the observed X-band g value of 4.1. Treatment with F- or NH3, which compete with Cl- for a binding site, increases the ZFS and rhombicity of the signal. These results indicate that the origin of the OEC signal at g = 4 is either an Mn(II) monomer or a coupled Mn multimer. The likelihood of a multimer is favored over that of a monomer.

Electron Spin Resonance Spectroscopy↗
PubMed1992

Sutured laparoscopic cholecystojejunostomy evolved in an animal model.

In a series of acute and chronic experiments conducted in young pigs during a 2-year period, we have evolved a quick knotting technique to start and end a suture line and developed a curved 'Endoski' needle to improve needle passage through the tissues. These have been employed in the construction of cholecystojejunal anastomoses using a semi-closed technique with a single layer (deep seromuscular) of continuous polyglactin sutures. In chronic experiments in pigs, patent well healed bilioenteric anastomoses, which conveyed bile satisfactorily after ligation of the common bile duct, distal to the cystic duct, were achieved. A virtual absence of adhesions in these animals was noted.

Anastomosis, Surgical↗
PubMed2003

Alterations of cardiac innervation in evolving myocardial infarction and transplanted hearts. An anatomo-clinical reappraisal.

BACKGROUND: Debate regarding the alterations of the cardiac innervation in an evolving myocardial infarction and transplanted hearts is still raging and most studies are based on radionuclide uptake of neurotransmitters or on the evaluation of the cardiorespiratory reflex. METHODS: The present investigation, upon human autoptic specimens of 57 infarcts and 8 cardiac transplants, was carried out with traditional neuropathology and modern molecular biology techniques. The specimens were selected for the identification of neurons, nerve fibers and their sheaths. RESULTS: First of all, these techniques confirmed the gross difference in the vulnerability of infarcted myocytes if compared with the local innervation, the metabolism of which is infinitely less oxygen-dependent than that of working myocardium (approximate quantitation below). Delicate technicalities of the traditional silver impregnation for nerves usually yield a large incidence of artifacts. Thereby, only perfect results (20% of cases), corroborated by parallel nerve sheath immunostaining (70% of cases), were retained and documented herein. In the meantime, acidosis and free radicals increase, while catabolite accumulation supervenes. These three factors threaten myocardial viability. Thereby, nervelets can be seen to survive the hyperacute phase of ischemia, but may be in part damaged by the successive granulocytic-macrophage inflammation enzyme lysis of the infarcted muscle. The delayed and incomplete anatomical neural damage is confirmed by the observation of preserved nerve sheaths and neural filaments surviving in postinfarction scars, almost devoid of myocardiocytes. CONCLUSIONS: The rich sympatho-vagal cardiac network might further provide alternative bypasses for post-infarct reinnervation. The functional implications of this process remain unclear.

Adrenergic Fibers↗
PubMed1992

Child sexual abuse and forensic psychiatry: evolving and controversial issues.

Child sexual abuse has received growing attention in recent years, and the topic continues to spark controversy among mental health and legal professionals as well as in the popular media. This paper will review the concept of child sexual abuse, cover relevant definitions, address the clinician's role, and then will address the principal evolving and controversial areas. These areas include psychic damages, false allegations, improper investigatory techniques, use of anatomical dolls, admissibility of expert testimony, hearsay testimony, and the competency of minors to testify.

Adolescent↗
PubMed2004

The evolving management of blunt hepatic trauma in a rural setting.

Over the past decade, a nonoperative approach toward the management of blunt hepatic trauma has become prevalent at most major urban trauma centers. To determine the applicability of the nonoperative approach in a rural setting, a 10-year retrospective review was conducted at a level I rural university-based trauma center. The Census Bureau defines ruralized areas to provide a better separation of urban and rural territory and population. A ruralized area is composed of one or more places and the adjacent surrounding territory that together have a maximum of 50,000 persons. West Virginia University is classified as a rural academic medical center and is situated in Morgantown, whose permanent population does not exceed 35,000. All patients with documented blunt hepatic trauma between July 1990 and June 2000 were identified and reviewed. To evaluate evolving trends, the patients were divided into two groups: group A (July 1, 1990-June 30, 1995) and group B (July 1, 1995-June 30, 2000). There were 236 patients with documented blunt hepatic trauma identified between July 1, 1990, and June 30, 2000). Overall, 70 per cent of patients were managed conservatively. When comparing the two groups, statistical significance was obtained in mean hospital length of stay (LOS) [19.8 days A vs. 9.1 days B (P < 0.0001)]; mean intensive care unit (ICU) days [15.2 days A vs. 5.3 days B (P < 0.0001)], blood transfusion [10 units A vs. 4.2 units B (P < 0.0016)], number of patients requiring surgery [52 (46%) A vs. 37 (30%) B (P < 0.022)]. There was only one death associated with nonoperative management. We have shown a definite trend toward nonoperative management of blunt hepatic trauma in a rural setting over the past decade. More than 70 per cent of our liver injury patients over the past 5 years have been managed nonoperatively, with statistically significant reductions in hospital LOS, ICU LOS, and transfusion requirements. We have found a definite trend over the past decade toward nonoperative management of blunt hepatic trauma in a rural setting. The rural setting with a delay in transport time to level I trauma center also did not significantly affect the outcome of the patients with nonoperative management of liver injuries. Approximately 78 per cent of our liver injury patients over the past 5 years have been managed nonoperatively and are associated with statistically significant reductions in hospital and ICU LOS and transfusion requirements.

Adolescent↗
PubMed2004

Effect of inhaled corticosteroids on markers of pulmonary inflammation and lung maturation in preterm infants with evolving chronic lung disease.

BACKGROUND: Chronic lung disease (CLD) is one of the most severely disabling conditions of extremely low-birth-weight infants. Systemic corticosteroids are effective but cause many adverse effects. Targeted therapy with inhaled corticosteroids may be an effective and less toxic alternative. STUDY OBJECTIVE: To evaluate the additive effect of inhaled corticosteroids on markers of lung inflammation in infants receiving a 7-day course of systemic steroids. METHODS: Preterm neonates weighing 1 kg or less and aged 12 to 28 days who were prescribed a 7-day course of systemic corticosteroids for evolving CLD were studied prospectively and randomized to receive either a tapering 4-week course of beclomethasone metered-dose inhaler (MDI) (n = 5) or placebo MDI (n = 6). Primary outcome variables were the levels of pro- and anti-inflammatory cytokines, IL-8, TNF-alpha, IL-1alpha, and sIL-2R. RESULTS: This study was terminated early following literature reports of the adverse neurodevelopmental effects of dexamethasone. Measurements of respiratory and serum IL-8, IL-1alpha and TNF-alpha were similar between the study group taking inhaled and systemic corticosteroids and the study group taking systemic steroids alone. No differences were found between the two groups in relation to dynamic compliance or resistance. CONCLUSIONS: The addition of inhaled corticosteroids to a 7-day systemic course of corticosteroids did not alter cytokine response or improve pulmonary function.

Administration, Inhalation↗
PubMed2004

Registries are evolving to meet needs of chronically ill patients.

Registries for chronic disease management have been around for years. But as disease registries are adopted more widely, their definitions and functions are evolving--accompanied by a better understanding of how to manage a population of patients with chronic diseases--according to a new report.

Chronic Disease↗
PubMed2004

Problems and solutions with integrating terminologies into evolving knowledge bases.

We have merged two established anatomical terminologies with an evolving ontology of biological structure: the Foundational Model of Anatomy. We describe the problems we have encountered and the solutions we have developed. We believe that both the problems and solutions generalize to the integration of any legacy terminology with a disciplined ontology within the same domain.

Anatomy↗
PubMed2004

Surgery in the elderly: the evolving role of palliative care in general surgical practice.

Palliative care will continue to be an evolving part of general surgical practices, especially with an expanding elderly population. The challenge to a surgeon remains, namely, understanding when palliation is a better alternative to aggressive therapeutic measures. The transition from curative intervention to palliative care is aided by honest communication between physician and patient and respect for dying with dignity. An intimate understanding of the multidimensional nature of palliative care will enable a surgeon to provide appropriate care for a terminal patient.

Aged↗
PubMed2004

Evolving transforaminal endoscopic microdecompression for herniated lumbar discs and spinal stenosis.

The objective of this chapter was to demonstrate evolving transforaminal endoscopic microdecompression for herniated lumbar discs and spinal stenosis, and to become accomplished with endoscopic micro spinal instruments and laser application. Since 1993, 2000 patients with 3421 herniated lumbar discs were diagnosed with symptomatic lumbar single and multiple herniated intervertebral discs. Progressive series of different diameters endoscopic-assisted tubular retractors, with appropriate-sized dilators and more aggressive saw-toothed trephines, and laser were used to perform transforaminal endoscopic micro-decompression, in addition to the posterior-lateral foraminoscope and endoscopic-assisted spinal operating systems. No postoperative mortalities occurred, and the morbidity rate was less than 1%, in the 2000 patients. For a single level, 94% of the patients had good or excellent results; 6% had some residual symptoms although improved overall. Transforaminal endoscopic laser microdecompression can effectively decompress herniated lumbar discs and spinal stenosis, when foraminoplasty is performed, which provides a safe and effective modality to achieve results in effective spinal decompression, preserves spinal motion, and creates a channel for spinal arthroplasty.

Aged↗
PubMed2005

Successful treatment with peginterferon and ribavirin in a patient with acute hepatitis C evolving into chronicity.

Acute hepatitis C has a high frequency of chronic evolution, which may progress to cirrhosis and hepatocellular carcinoma. However, only a small proportion of acute hepatitis C patients are incidentally identified and then treated. Controversial issues regarding treatment of acute hepatitis C include optimal time of treatment initiation, best treatment regimen and appropriate duration of treatment. We report a symptomatic acute hepatitis C patient in the late acute phase evolving into chronicity successfully treated by peginterferon and ribavirin combination therapy for 6 months at late acute phase, with sustained virologic response for up to 18 months. Our findings indicate that combination peginterferon and ribavirin therapy may be as effective in treating acute hepatitis C as it is in chronic hepatitis C.

Acute Disease↗
PubMed2005

Evolving strategy and results of spinal cord protection in type I and II thoracoabdominal aortic aneurysm repair.

PURPOSE: We report our strategy and results of spinal cord protection in Crawford I and II thoracoabdominal aortic replacement. : METHODS: Retrospective analysis of 43 elective operations. Before 1994, we reconstructed segmental arteries during a single period of blood flow interruption in 11 of 12 patients, using distal aortic perfusion and evoked spinal cord potential (ESCP) monitoring. Deep hypothermia was used in one. Since 1994, we used multi-segmental sequential repair, in which T8-L1 arteries were sequentially reconstructed irrespective of evoked potential change, in 20 of 31 patients. In the remaining 11, deep hypothermia was used. Cerebrospinal fluid drainage (CSFD) was introduced in 1996 (n=26), and continuous infusion of naloxone in 1999 (n=17). RESULTS: In patients undergoing distal aortic perfusion without multi-segmental sequential repair, six spinal cord injuries including two deaths occurred. Change in evoked potentials was observed in nine of 10 monitored patients. With multi-segmental sequential repair, only one spinal cord injury occurred, and three of 11 monitored patients showed evoked potential change. With deep hypothermia, no spinal cord injury occurred. Multivariate analysis identified operation without multi-segmental sequential repair as a risk factor for spinal cord injury (p=0.008). CONCLUSION: Evolving strategy resulted in an improved outcome. Both multi-segmental sequential repair and deep hypothermia were more effective than our previous technique.

Adult↗
PubMed2005

Components separation technique and laparoscopic approach: a review of two evolving strategies for ventral hernia repair.

When faced with large ventral hernias, surgeons frequently must choose between higher incidence of recurrence after primary repair and higher incidence of wound complications after repair with mesh. The aim of this study is to compare early outcomes between laparoscopic repair (LR) and components separation technique (CST), two evolving strategies for the management of large ventral hernias. We reviewed 42 consecutive patients who underwent CST and 45 consecutive patients who underwent LR of ventral hernia defects of at least 12 cm2. Demographics, hernia characteristics, and short-term outcomes were compared between groups. Patients in the LR group were younger (53 +/- 2 vs 68 +/- 2 years, P < 0.0001), had greater body mass index (34 +/- 2 vs 29 +/- 1 kg/m2, P = 0.02), and had larger hernia defects (318 +/- 49 vs 101 +/- 16 cm2, P < 0.0001) than patients in the CST group. The LR resulted in shorter length of hospital stay (4.9 +/- 0.9 vs 9.6 +/- 1.8 days, P < 0.0001), lower incidence of ileus (7% vs 48%, P < 0.0001), and lower incidence of wound complications (2% vs 33%, P < 0.001) than the CST. Both techniques resulted in similar operative times, transfusion requirements, and mortality. Recurrences occurred in 7 per cent of patients at mean follow-up of 16 months in the CST group and 0 per cent at mean follow-up of 9 months after LR. The LR may have a short-term advantage over the CST in terms of incidence of ileus, wound complications, and hospital stay. Because of their unique advantage over traditional hernia repairs, both techniques may play a significant role in the future treatment of large ventral hernias. Adequate training will be essential for the safe and effective implementation of these techniques within the surgical community.

Aged↗
PubMed2005

Complications of otitis media: an evolving state.

The advent of antibiotics in the 1930s and 1940s has led to a decline in the incidence of otitis media complications. However, otitis media and its complications are continuing to evolve owing to the emergence of antibiotic resistance and the introduction of pneumococcal vaccines. Modern high-resolution computed tomographic scans have allowed for earlier diagnosis when signs and symptoms are present, but a high index of suspicion must be maintained because the clinical presentation may be quite subtle. The intent of this article is to discuss the intracranial and extracranial complications of acute and chronic otitis media. The clinical presentation, work-up, and management of the individual complications are presented.

Acute Disease↗
PubMed2005

Evolving management of pediatric urinary tract infection.

UTI is a common problem in the pediatric population with significant long-term morbidity. Fecal-urinary migration is the most common route of infection, and E. coli is the most common organism. Methods of urine collection and interpretation of urinalysis must be considered when guiding therapy, and treatment is age and severity specific. VUR is an extremely common finding in febrile urinary tract infections. The algorithm of treatment is evolving with the advent of highly successful, minimally invasive therapy.

Anti-Bacterial Agents↗
PubMed2004

From genes to decisions: evolving views of genotype-based management in MEN 2.

Diagnosis and management of MEN 2 has evolved considerably since the identification of the underlying disease mutations in the RETproto-oncogene. Presymptomatic detection and prophylactic surgical intervention are now the accepted standard of care. The strong correlation of disease phenotype and mutation genotype has already also allowed us to develop mutation-guided management strategies to optimize time ot intervention and schedule follow-up and management. As our understanding of the depth of these correlations increases we look forward to better refining our management regimes to fit both the best care requirements and the quality of life needs of the MEN 2 patient.

Decision Making↗
PubMed2005

[Resolution of carotenoid isomers in Lycium barbarum L. by heuristic evolving latent projection].

Lycium barbarum L., a kind of traditional Chinese herb, is found to have bioactivities such as anticancer, antioxidant, hypoglycemic and immunological activities. In both in vitro and in vivo studies, the carotenoids were found to be a class of the effective compounds. The carotenlysoids in Lycium barbarum L. were separated by high perforance liquid chromatography with diode array detection (HPLC-DAD). Seven peaks were obtained by HPLC on a C18 column with acetonitrile-methylene chloride (60:40, v/v) as mobile phase at a flow-rate of 1.0 mL/min. Most of the peaks that had been validated as single peaks in the 2-dimensional chromatography were found to be overlapping peaks. The overlapping chromatographic peaks were resolved by chemometric method--Heuristic Evolving Latent Projection (HELP) based on 3-dimensional data. As an example, the chromatogram and UV spectra of 4 isomers were obtained by resolving an overlapping peak. These results showed that the combination of chemometric methods and modern analytical instruments provides an effective method for the analysis of complex systems such as isomers.

Carotenoids↗