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PubMed2003

Is this woman perimenopausal?

CONTEXT: Perimenopause is a time of transition for women at midlife. Women want to know whether they are starting this change and physicians need to know the accuracy of a clinical examination in identifying perimenopausal women. These women should be counseled about alleviating climacteric symptoms, using contraception, and preventing diseases such as osteoporosis. OBJECTIVE: To systematically review the accuracy of self-assessment, symptoms, signs, and laboratory tests in diagnosing women in perimenopause. DATA SOURCES: English-language articles that presented data relevant to diagnosis of perimenopause were identified in a MEDLINE search from 1966 to 2001. References of these articles and other publications also were reviewed. STUDY SELECTION: Cross-sectional or longitudinal studies of women aged 40 years or older that used the definition of perimenopause as 3 to 11 months of amenorrhea or irregular periods, included a premenopausal control group, and reported a clinical examination finding. Of 1246 articles identified, 16 studies were included in the analysis. DATA EXTRACTION: Two authors independently reviewed articles for quality (L.A.B. and C.M.S.). Discrepancies were resolved by a third author (K.N.). DATA SYNTHESIS: The prior probability of perimenopause is directly related to a woman's age. After considering age, the following yielded the greatest positive likelihood ratios (LRs+): self assessment of going through the transition (LR+ range, 1.53-2.13), symptoms of hot flashes (LR+ range, 2.15-4.06), night sweats (LR+ 1.90; 95% confidence interval [CI], 1.63-2.21), vaginal dryness (LR+ range, 1.48-3.79), high follicle-stimulating hormone levels (LR+ 3.06; 95% CI, 2.06-4.54), and low inhibin B levels (LR+ 2.05; 95% CI, 0.96-4.39). Self-assessment of perimenopausal status had the smallest negative LR (range, 0.18-0.36). CONCLUSIONS: No one symptom or test is accurate enough by itself to rule in or rule out perimenopause. Clinicians should diagnose perimenopause based on menstrual history and age without relying on laboratory test results.

Adult↗
PubMed1977

Group differences in the structure of illness.

The paper reports an attempt to study in a naturalistic and quantitative fasion the features of illness episodes. Such episodes, as perceived and reported by lay persons, constitute a basic datum in ethnomedicine. Yet, they have rarely been the object of systematic research for theoretical and methodological reasons. The paper discusses ways in which illness episodes have significance in ethnomedicine and in health services research generally, and describes a method which can be used in field situations to study them. The content, internal structure and organization which illness episodes have are given attention by analysing and measuring the components of illness in a panel of adult females who reside in the highland state of Chiapas in Southeastern Mexico. Comparisons are undertaken in the two most dissimilar subgroupings of the region. Some commonalities and group differences in the duration of symptoms and in the way symptoms interrelate are described. An interpretation of these differences is offered, with principal emphasis given to the social circumstances and to the (cultural) meanings of illness in the two groups. The procedure employed, which is consistent with the way in which vital signs are recorded in the hospital, lends itself to field studies of the way symptoms and signs of disease unfold in the individual across time. The idea of a language of illness, which is introduced and developed in the paper, is used to draw emphasis to the communicative and symbolic features of illness.

Disease↗
PubMed1980

Conceptual representation of patient data bases.

Design of a computer-based assistant for patient data bases is discussed. A conceptual model for such an assistant, which can represent signs, symptoms, lab data, and radiological and morphological findings is described. The query language, interpretive reports, summary findings, and related issues in providing intelligent consultation are discussed. The role of such assistants in the context of a decision-making environment--human or automated--is emphasized.

Cholestasis↗
PubMed1976

[Iatrogenic myoclonic encephalopathies caused by bismuth salts].

Since the beginning of 1974, we have studied 17 cases of iatrogenic encephalopathy due to the ingestion of bismuth taken for the treatment of chronic digestive disorders. More than 100 similar cases have been reported in France within the same period. The clinical picture is remarkably consistent: there is a relatively long prodromal phase with difficulties in gait and writing, followed by a phase characterised by four signs, namely a severe confusional syndrome, myoclonus, astasia-abasia and sisorders of language. In our cases, after withdrawal of bismuth, recovery invariably began within 2 to 3 weeks but fatal cases have been described. All our patients had taken, for periods of between 3 weeks and 20 years, bismuth subnitrate. The levels of bismuth in the blood and urine in these patients were between 10 and 100 times as great as those in patients who had taken the same treatment without ill effect. The exact mechanism by which bismuth causes this complication, described only recently, is totally unknown.

Adult↗
PubMed2006

Aphasic status epilepticus with periodic lateralized epileptiform discharges in a bilingual patient as a presenting sign of "AIDS-toxoplasmosis complex".

We describe an HIV-infected, bilingual patient presenting with Wernicke's aphasia due to partial status epilepticus with periodic lateralized epileptiform discharges, as the first sign of AIDS-toxoplasmosis complex. The localization of the native and secondary language centers in the brain and the possible role of recurrent seizures in the fluctuating course of Wernicke's aphasia in this patient are discussed. The clinical course of this patient supports the belief that a second language area for a second language learned in the later stages of life is located in an area different from that for the native language but still in close proximity to it.

AIDS-Related Opportunistic Infections↗
PubMed2003

Inductive reasoning and the understanding of intention in schizophrenia.

BACKGROUND: The study explored the relationship between the understanding of intention in veiled speech acts and the ability to reason inductively. METHODS: A total of 39 people with DSM-IV-defined schizophrenia with no behavioural signs and 44 healthy participants performed the Hinting Task, a measure of pragmatic language in which the speaker's intention must be inferred, and a measure of inductive reasoning (Aha! Sentences) in which the meaning of ambiguous nonsocial sentences had to be inferred. The participants also completed measures of general intellectual ability, immediate memory for narrative and social problem-solving ability. RESULTS: A substantial correlation was found between performance on the inductive reasoning task and the Hinting Task in the sample of people with schizophrenia. The same relationship was not seen in the normal control sample. The robust relationship between these two measures in this sample survived when the roles of immediate memory for narrative and intellectual ability were controlled for. Furthermore, the relationship was distinctly more compelling for the patients who were currently ill compared to those in remission. CONCLUSION: These data suggest that people with schizophrenia use a different strategy to infer the meaning behind pragmatic language than that used by normally functioning adults. It is suggested that a reliance on different, possibly less specialised, skills in this group to perform this simple social inference task underlies their deficient performance on this and other measures of social inference. The fact that the relationship between the tasks in patients in remission is not as robust implies that the use of specialised skills to perform social inference tasks may be compromised most significantly during acute phases.

Journal Article↗
PubMed2003

Familiar words capture the attention of 11-month-olds in less than 250 ms.

The capacity of human infants to discriminate contrasting speech sounds specializes to the native language by the end of the first year of life, when the first signs of word recognition have also been found, using behavioural measures. The extent of voluntary attentional involvement in such word recognition has not been explored, however, nor do we know what its neural time-course may be. Here we demonstrate that 11-month-old children shift their attention automatically to familiar words within 250 ms of presentation onset by measuring event-related potentials elicited by familiar and unfamiliar words. A significant modulation of the first negative peak (N200), known to index implicit change detection in adults, was induced by word familiarity in the infants.

Acoustic Stimulation↗
PubMed2001

A new syndrome with craniofacial and skeletal dysmorphisms and developmental delay.

We report a 16-year-old boy with multiple craniofacial and skeletal dysmorphic features including brachycephaly, acrocephaly, hypertelorism, wide palpebral fissures, broad nose, anteverted nares, broad columella, long and smooth philtrum, thin upper lip, macrostomia, carp-like mouth, micrognathia, low-set and posteriorly angulated ears with small and abnormal pinnae, a low posterior hairline, a short neck, hypoplastic and widely-spaced nipples, multiple severe pterygia, an umbilical hernia, metatarsus varus, low implantation of the halluces, and delayed motor and language development. An MRI of the head showed bilateral frontal pachygyria but no sign of heterotopia. The unique features of our patient suggest that he represents a new syndrome.

Abnormalities, Multiple↗
PubMed2004

Oxaliplatin-associated neuropathy: a review.

OBJECTIVE: To review the incidence, mechanism, signs, symptoms, and management of oxaliplatin-induced neurotoxicity. DATA SOURCES: English-language publications from the MEDLINE database (1995-August 2004), published articles, and meeting abstracts were reviewed. STUDY SELECTION AND DATA EXTRACTION: Relevant data were extracted from published reports and abstracts on studies and case reports of humans with cancer who received oxaliplatin chemotherapy and in vitro studies of oxaliplatin neurotoxicity. DATA SYNTHESIS: Neurotoxicity is a common adverse effect of oxaliplatin that usually presents as peripheral neuropathy. There are 2 forms of oxaliplatin-induced neurotoxicity: acute and chronic. The acute form occurs in >90% of patients and may begin during the infusion or within hours of completion, is usually self-limited, and may be exacerbated by exposure to cold. Chronic neuropathy is cumulative and is most commonly seen in patients who have received total doses > or =540 mg/m2. Although it is a sensory neuropathy, the intensity can increase to the point that it impairs physical functions, such as holding objects and writing. Preventive measures include administration of calcium and magnesium solutions, gabapentin, carbamazepine, amifostine, and glutathione. Treatment measures include calcium and magnesium solutions, gabapentin, and alpha-lipoic acid. CONCLUSIONS: Peripheral neuropathy is seen in the majority of patients who receive oxaliplatin. The acute form is usually transient and self-limited; however, the chronic form can be dose-limiting. Calcium and magnesium solutions are an effective and convenient means of treating and reducing the severity of neuropathic symptoms. Additional studies, including controlled trials, are needed to determine the best way to prevent and treat this complication.

Antineoplastic Agents↗
PubMed2006

Stump appendicitis: a comprehensive review of literature.

Appendectomy for appendicitis is one of the most common procedures performed in the United States. Residual tissue left after an initial appendectomy risks the development of stump appendicitis. A comprehensive review of the English-language literature revealed 36 reported cases of stump appendicitis. Typically, patients present with signs and symptoms similar to acute appendicitis; however, due to prior surgery, the diagnosis is difficult and the rate of appendiceal stump perforation is extremely high. Herein, we present a case of a 32-year-old female presenting with right lower quadrant pain, nausea, and fever 5 months after laparoscopic appendectomy. Upon surgery, an appendiceal stump was discovered.

Adult↗
PubMedDate not supplied

[An introductive approach to linguistics (author's transl)].

The author proposes an information on the semiological approach to language starting from the systemic perspective (later to be said structuralist) which has been introduced by the Saussure. A group of notions can be delineated, which are distributed in binomial oppositions: language and verb, synchronia and diachronia, meaning and signified (which define the linguistic sign, which arbitrary character is being discussed) and other oppositions. The descriptive study of linguistic units of the chain concerns phonetics and phonology. The regulations for constructing a coherent message concern grammar (or syntax), where the traditional, normative approach is in opposition with actual research, descriptive and structural: distributionnal grammar, transforming, categorial, functional. The application of new linguistic methods to human sciences is very promising and opens the way of an interesting meditation on human condition.

Linguistics↗
PubMed1999

[Cochlear implantation in children. The first Danish results].

The aim of this study is to review indication, technique and results of cochlear implant (CI) treatment with Nucleus CI-multi-electrode of the first ten children operated in Denmark (five children with congenital deafness and five with acquired prelingual deafness due to meningitis). In the literature, the importance of early referral and operation at the age 2-3 (4) years for congenital deafness and as soon as possible on suspicion of acquired deafness (meningitis) is stressed. A short survey of our indications, technique and rehabilitation is presented. The results of treatment after 11-44 months' use of CI are that one child has language almost matching age, four use words and short sentences accompanied by support signing, three have sound reaction and say single words without sentence building, but of these two children have only used CI for a very short time and are improving. Two meningitis sequelae cases had cochlear ossification, which made the implantation difficult. Both patients had to be operated, and one of them is not using the processor.

Age Factors↗
PubMed1983

[Importance of auditory "screening" in the school and preschool environment in relation to language disorders].

Having recalled the acoustics spectrum of the human voice and different types of deafness, the author describes alarm signs of various hearing disorders. Bearing in mind the importance of early detection of deafness for optimal speech development, special emphasis is put on the necessity of mass hearing screening in kindergarten and nursing school. However, the diagnosis may be delayed in less severe deafness; medium hearing loss between 35 to 65 dB being scarcely detected before age 5! In this respect teacher's and school health professional's particular attention should bring the child to a specialised diagnostic and therapeutic center where medical or surgical audioprosthetic treatments could be performed before developmental retardation occurs. Two case records are presented.

Audiometry↗
PubMed2007

Do transposed-letter similarity effects occur at a morpheme level? Evidence for morpho-orthographic decomposition.

When does morphological decomposition occur in visual word recognition? An increasing body of evidence suggests the presence of early morphological processing. The present work investigates this issue via an orthographic similarity manipulation. Three masked priming lexical decision experiments were conducted to examine the transposed-letter similarity effect (e.g., jugde facilitates JUDGE more than the control jupbe) in polymorphemic and monomorphemic words. If morphological decomposition occurs at early stages of visual word recognition, we would expect an interaction with transposed-letter effects. Experiment 1 was carried out in Basque, which is an agglutinative language. The nonword primes were created by transposing two letters that either crossed the morphological boundaries of suffixes or did not. Results showed a transposed-letter effect for non-affixed words, whereas there were no signs of a transposed-letter effect across morpheme boundaries for affixed words. In Experiment 2, this issue was revisited in a non-agglutinative language (Spanish), with prefixed and suffixed word pairs. Again, results showed a significant transposed-letter effect for non-affixed words, whereas there were no signs of a transposed-letter effect across morpheme boundaries for affixed words (both prefixed words and suffixed words). Experiment 3 replicated the previous findings, and also revealed that, for polymorphemic words, transposed-letter priming effects occurred for within-morpheme transpositions. Taken together, these findings support the view that morphological decomposition operates at an early stage of visual word recognition.

Adult↗
PubMed1977

The sequelae of group B beta-hemolytic streptococcal meningitis in early infancy.

The group B beta-hemolytic streptococcus is responsible for an escalating frequency of neonatal meningitis. Of the 18 consecutive cases we report in this study, the mortality was 17%. Among the 15 survivors, there were two children with extensive neurological and psychological impairment. There were no major differences between the survivors and controls in tests of hearing and language function, social skills, and psychological testing. There was a greater number of minor neurological signs among the study group. The mortality and morbidity of group B beta-hemolytic streptococcal meningitis is apparently substantially less than that of all other types of neonatal bacterial meningitis.

Bender-Gestalt Test↗
PubMed2004

Phonological memory as a predictor of language comprehension in Down syndrome: a five-year follow-up study.

BACKGROUND: This study reports the language and memory progress over five years of 30 adolescents and young adults with Down syndrome, and investigates the relationship of earlier phonological memory abilities to later language development. METHODS: Tests of nonverbal ability, receptive vocabulary, grammar comprehension, digit span and nonword repetition were administered at two points in time. RESULTS: For the sample as a whole, there were significant gains in nonverbal ability, receptive vocabulary and grammar comprehension, but no increases in phonological memory measured by nonword repetition or digit span. However, there were considerable individual differences in progress which, in part, were related to chronological age. Phonological memory improved in many younger participants but there were signs of decline in some older ones. Partial correlations between earlier nonword repetition scores and later language scores, controlling for nonverbal ability and earlier language scores, indicated a significant role for phonological memory in the acquisition of vocabulary knowledge. There was similar evidence of a role for phonological memory in grammar comprehension, but only for younger participants. Earlier receptive vocabulary also predicted later nonword repetition scores, particularly for participants with higher levels of vocabulary knowledge. CONCLUSION: Relationships among the processes involved in language and memory development in Down syndrome may be similar to those established for typical development.

Adolescent↗
PubMed2002

Testing testimony: toxicology and the law of evidence in early nineteenth-century England.

This essay's principle objective is to examine how, when confronted with a case of possible criminal poisoning, early nineteenth-century English toxicologists sought to generate and to represent their evidence in the courtroom. Its contention is that in both these activities toxicologists were inextricably engaged in a complex communicative exercise. On the one hand, they distanced themselves from the instabilities of language, styling themselves as testifiers to fact alone. But at the same time, they saw themselves as deeply implicated in the difficulties of forging a coherent signifying system out of a disparate collection of signs that in themselves bore no intrinsic meaning. The analysis has three main components: first, two suggest why criminal poisoning featured so prominently in the burgeoning legal literature on evidence which provided the framework for expert testimony in English courts; next, to show that the scientific evidence offered by toxicologists in poisoning cases can be usefully understood as a form of (unstable) language; and finally, to suggest that this recourse to signs informed the toxicologist's encounter with another type of courtroom expert-the legal advocate-who was equally (though differently) interested in manipulating signs in order to construct (and deconstruct) legally sanctioned proof.

England↗