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Isolated acalculia due to left parietal lesion.

OBJECTIVE: To clarify the characteristics and the localization of isolated calculation disturbances due to left parietal lesions. DESIGN: Case series. SETTING: Tertiary care hospital. PATIENTS AND OTHER PARTICIPANTS: Three referred patients with isolated calculation disturbances due to stroke in the left parietal region. Sixteen volunteers for age and education constituted the control group. OUTCOME MEASURES: Neuropsychological tests, including a battery of tests for acalculia and the Wechsler Adult Intelligence Scale, and magnetic resonance imaging were performed. RESULTS: Three patients made calculation errors in the process where a number of steps were carried out simultaneously. The patients showed no aphasic components in number operations. They understood the basic processes of calculation. They showed little difficulty in the retrieval of table values. The patients had no impairment in aligning arithmetic problems or in assigning and maintaining place-holding values. They did not show any deficit of immediate memory for calculation problems. Overlapping lesions were located along the left intraparietal sulcus. CONCLUSION: The area lying along the left intraparietal sulcus is critical for isolated parietal acalculia. The profile of isolated acalculia suggests that it results from the disruption of the working memory for calculation.

Brain Diseases↗

An automated medical record system for a skilled nursing facility.

This paper reports on the development of an on-line automated medical record system suitable for nursing homes. The software was written in standard MUMPS (Massachusetts General Hospital Utilities Multi-Programming System) and is easy for the first-time user to operate. The data managed by the system may be divided into four major components, including text tables, the hierarchical problem dictionary, the patient admission data, and the care plan data. The system met all of the project's objectives and has been enthusiastically received by the nursing home staff.

Medical Records↗

Allogenic grafting of vascularized bone segments under immunosuppression. Clinical results in the transplantation of femoral diaphyses.

Trauma surgery lack, substitute, for the reconstruction of large defects of the long bones. Encouraged by the promising results of bone allotransplantation in animal models, we successfully performed vascularized bone transplantation in humans. Vascularized femoral diaphyses were allogenically transplanted into three patients suffering from chondrosarcoma or post-traumatic osteomyelitis with postoperative immunosuppression. The bone segments were harvested from multi-organ donors and perfused with UW solution. After back-table preparation, the grafts were transplanted into the defect zone. Interlocking devices were used in these operations. Vascular anastomoses were performed in end-to-side technique. The early clinical course of the patients was not free of anatomical, technical, or immunological complications. However, all patients are currently free of malignancy and infection. They are also free of pain and full weight bearing. We conclude that allogenic grafting of vascularized bone segments has the potential to become an alternative for the replacement of large bone defects.

Adult↗

Toxicity tests on ciliates--a short review.

A variety of methods has been proposed to study the toxicity of chemicals or polluted waters on ciliates as representative test organisms of the microfauna of aquatic ecosystems. These methods are based on morphological, ultrastructural, ethological, or metabolic criteria. The techniques proposed are mostly species dependent and so are their applications and restrictions. In view of a future standardization of protozoan toxicity tests a selection has been made by the authors on the basis of the applicability of the tests for routine analysis. The methods withheld are briefly described and comments are made on their advantages and limitations. The equipment involved, the operational complexity, and the accuracy of the results and their interpretation are listed in a synoptic table.

Animals↗

Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head.

Pancreaticoduodenectomy is often avoided in patients with portal or superior mesenteric venous involvement due to the perception that venous resection is complex, morbid, and carries a poor long-term survival. Our recent experience using state-of-the-art imaging and strict resection criteria show that venous reconstruction increases operative time, transfusion requirements, intensive care unit stay, and total hospital length of stay, but has no significant impact on operative morbidity rates, mortality rates, or the incidence of positive histologic margins. Kalpan-Meier life table analysis shows similar survival curves when compared to a contemporary cohort of patients who do not undergo venous reconstruction.

Adenocarcinoma↗

Survival of resin-bonded porcelain veneer crowns placed with and without metal reinforcement.

OBJECTIVES: The purpose of this retrospective case study of dental records was to compare the long-term failure rates and modes for resin-bonded sintered feldspathic porcelain veneer crowns (RBPVCs) either containing or without metal substructure reinforcement. METHODS: Two prosthodontists placed 62 RBPVCs fabricated with, and 167 without, metal reinforcement in 143 older adolescent and adult patients treated in a private practice. Clinical judgement determined the type of crown design placed. Preparation margins were generally finished on enamel, and all crowns occluded with opposing teeth. Observations included the patients, operators, crown designs and failure modes. Chi-square or Fisher's exact tests and life table survival statistics were used to evaluate the findings (alpha = 0.05). RESULTS: Over five years, failures occurred in 14.5% of RBPVCs fabricated with, and in 18.6% without, metal reinforcement. Cumulative survival estimates were 74.3 +/- 8.5(Standard Error)% and 72.9 +/- 4.8(SE)%, respectively (P = 0.96). Mandibular posterior crowns comprised 27.1% of the placements, but 47.5% of the failures. Bulk fracture of porcelain occurred in 7.0% of the crowns, all without metal reinforcement. Minor porcelain fractures and debonding were less frequent in both types of crowns. Persistent pulpitis occurred in 3.5% of all teeth. CONCLUSIONS: There was a significant risk of failure for sintered porcelain RBPVCs placed as posterior restorations. Although metal reinforcement was able to reduce the risk of bulk fracture of porcelain, other causes of failure were less affected.

Adolescent↗

Recovery of PET from packaging plastics mixtures by wet shaking table.

Recycling requires the separation of materials appearing in a mass of wastes of heterogeneous composition and characteristics, into single, almost pure, component/material flows. The separation of materials (e.g., some types of plastics) with similar physical properties (e.g., specific gravity) is often accomplished by human sorting. This is the case of the separation of packaging plastics in municipal solid wastes (MSW). The low cost of virgin plastics and low value of recycled plastics necessitate the utilization of low cost techniques and processes in the recycling of packaging plastics. An experimental study was conducted to evaluate the feasibility of production of a PET product, cleaned from PVC and PS, using a wet shaking table. The wet shaking table is an environmentally friendly process, widely used to separate minerals, which has low capital and operational costs. Some operational variables of the equipment, as well as different feed characteristics, were considered. The results show that the separation of these plastics is feasible although, similarly to the mineral field, in somewhat complex flow sheets.

Plastics↗

Vena caval involvement with renal tumors: surgical considerations.

We reviewed the experience at the University of Virginia over the past 10 years with renal tumors involving the inferior vena cava. There were 107 patients with renal tumors, 41 with invasion of the renal vein and 18 with involvement of the inferior vena cava. The groups with and without vena caval tumors were compared, and the operative approach is described. Although the rate of complications was higher in operations on the vena cava, none were fatal and no patient required chronic dialysis. Life-table analysis revealed that patients with involvement of the inferior vena cava survived longer than those with incomplete resection. Because extraction of these tumors can be accomplished with acceptable morbidity and mortality, because complete resection confers a survival advantage, and because chemotherapy and radiation are ineffective, we recommend aggressive workup and resection of renal tumors involving the inferior vena cava.

Adult↗

Autotransfusion decreases blood usage following cardiac surgery -- a prospective randomized trial.

INTRODUCTION: 10% of blood issued by the National Blood Service (220,000) is utilised in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We tested the efficacy of autotransfusion of washed postoperative mediastinal fluid in a prospective randomized trial. PATIENTS AND METHODS: 166 patients undergoing coronary artery bypass grafting (CABG), valve or CABG + valve procedures were randomized into three groups. The indication for transfusion was a postoperative haemoglobin (Hb) < 10 g/l or a packed cell volume (PCV) < 30. When applicable, group A patients received washed post-operative drainage fluid. Group B all received blood processed from the cardiopulmonary bypass (CPB) circuit following separation from CPB and if appropriate washed post-operative drainage fluid. Group C were controls. Groups were compared using analysis of variance. RESULTS: There was no significant difference in age, sex, type of operation, CPB time and preoperative Hb and PCV between the groups. Blood requirements were as shown. [table - see text] Twelve patients in group A and 10 in group B did not require a homologous transfusion following processing of the mediastinal drainage fluid. CONCLUSION: Autotransfusion of washed postoperative mediastinal fluid can decrease the amount of homologous blood transfused following cardiac surgery. There was no demonstrable benefit in processing blood from the CPB circuit as well as mediastinal drainage fluid.

Adult↗

Speculum lumbar extraforaminal microdiscectomy.

BACKGROUND CONTEXT: Public interest, monetary pressures and improving diagnostic techniques have placed an increasing emphasis on minimalism in lumbar disc excision. Current techniques include microlumbar discectomy and minimally invasive spinal surgery. Both are good techniques but may be painful, require a hospital stay and/or are not widely used because of difficulty acquiring the necessary skills. The author therefore developed a less invasive microscopic technique that may be performed on a consistent outpatient basis with easily acquired skills. PURPOSE: The purpose of this study was to describe a variant of minimally invasive lumbar disc excision, while assessing the effects on a small group of patients. STUDY DESIGN: The treatment protocol was a prospective community hospital-based case study designed to evaluate a less invasive method of excising herniated lumbar discs residing in the canal, foraminal or far lateral space. PATIENT SAMPLE: This study is comprised of 50 patients with all anatomic forms of lumbar disc herniations, inside or outside the canal, at all levels except the lumbosacral joint. OUTCOME MEASURES: Clinical results were measured by return to work time, the criteria of MacNab and by Prolo et al.'s economic and functional criteria. METHODS: Selection criteria included adult patients with intractable low back and leg pain, plus an imaging study revealing a lumbar disc herniation consistent with the patient's clinical presentation. Mean patient age was 48 years. The male:female ratio was approximately 2:1. All patients failed at least 3 weeks of conservative therapy. Herniations occurred from the L2-3 space through L4-5, with 30 herniations being within and 20 outside the spinal canal. Both contained and extruded/sequestered herniations were treated. Excluded from the study were patients with herniations inside the spinal canal at the L5-S1 level. Surgical approach was by microscopic speculum transforaminal route for discs residing both within and outside the lumbar canal. RESULTS: The initial 50 consecutive patients had successful technical operations performed on an outpatient basis by this less invasive technique. By the criteria of MacNab (Table 3), 84% (42 of 50) had an excellent or good result, returning to work at a mean time of 3.5 weeks. Per Prolo et al.'s economic scale, 72% were disabled at levels I and II before surgery. Postoperatively, 92% had improved to levels IV and V. Similarly, on his functional scale, 94% functioned at levels I and II before surgery, whereas 88% achieved levels IV and V after surgery. Eighty percent required no pain medications 1 week after surgery. The only complication was an L3 minor nerve root injury as it exited the L3-4 foramen. CONCLUSION: The author has described a minimally invasive technique for excising herniated discs that is applicable to all types of lumbar herniations, except for those residing in the canal at L5-S1. Clinical outcomes are comparable to those of other forms of discectomy.

Diskectomy↗

Information extraction for enhanced access to disease outbreak reports.

Document search is generally based on individual terms in the document. However, for collections within limited domains it is possible to provide more powerful access tools. This paper describes a system designed for collections of reports of infectious disease outbreaks. The system, Proteus-BIO, automatically creates a table of outbreaks, with each table entry linked to the document describing that outbreak; this makes it possible to use database operations such as selection and sorting to find relevant documents. Proteus-BIO consists of a Web crawler which gathers relevant documents; an information extraction engine which converts the individual outbreak events to a tabular database; and a database browser which provides access to the events and, through them, to the documents. The information extraction engine uses sets of patterns and word classes to extract the information about each event. Preparing these patterns and word classes has been a time-consuming manual operation in the past, but automated discovery tools now make this task significantly easier. A small study comparing the effectiveness of the tabular index with conventional Web search tools demonstrated that users can find substantially more documents in a given time period with Proteus-BIO.

Abstracting and Indexing↗

Validation of bone mass and body composition measurements in small subjects with pencil beam dual energy X-ray absorptiometry.

OBJECTIVE: To validate the most widely reported dual energy X-ray absorptiometry (DXA) technique for the measurement of bone mass and body composition in human infants with a piglet model. METHODS: Duplicate scans were obtained in 13 piglets (1950g to 21100g) using a whole body densitometer (Hologic QDR 2000 plus, Hologic Inc., Waltham, MA) operated in the pencil-beam mode on a two platform (aluminum platform overlying a foam table pad) system. DXA measurements that included total weight, bone mineral content, fat and lean mass were compared with carcass weight and chemical analysis for ash and calcium content, fat and lean mass. RESULTS: Measurements from duplicate DXA scans were nearly perfectly correlated (r = 0.98 to 1.00). DXA measurements were strongly predictive of scale weight and chemical composition for all piglets (adjusted r(2) = 0.93 to 1.00, intraclass reliability coefficients = 0.943 to 0.999, p < 0.001 for all comparisons) although DXA bone mineral content consistently underestimated carcass ash and calcium content. Measured values from heavier piglets were not significantly different from values predicted from the lighter piglets' data. Slopes from regression based on lighter versus heavier piglets were not significantly different except for the bone mineral content with carcass ash or calcium content. CONCLUSION: Our study validated the use of pencil beam DXA and its ability to determine relative changes in bone mass and body composition measurements over a much greater range of body weight than previous reports although its use as a direct indicator of nutrient requirement may be limited.

Absorptiometry, Photon↗

Prospective evaluation of hemostatic techniques for liver injuries.

The methods of hemostasis used for liver injuries were evaluated prospectively in 637 patients treated at Detroit General Hospital during a 5-year period. Variables evaluated included severity of injury, presence or absence of bleeding, and methods of hemostasis, The liver injury was either not bleeding or was controlled by temporary pack compression during laparotomy in 325 patients: none of these patients, including the 284 in whom no hemostatic procedure was used, rebled postoperatively. Active bleeding at laparotomy was directly related to the severity of liver injury, and required some hemostatic procedure in 312 patients. The methods of hemostasis were liver sutures (244 patients), nonanatomic resection (30 patients), anatomic resection (21 patients), hepatic artery ligation (nine patients), hepatotomy with intraparenchymal vascular control (five patients), and temporary internal pack with later re-operation (three patients). Rebleeding occurred in eight of the 243 patients who survived (seven after liver sutures and one after nonanatomic resection) and four required re-operation for control of bleeding. Sixty-nine patients with active bleeding died. Death on the table in 38 patients was related primarily to uncontrolled bleeding from liver and major vessel injury. Postoperative rebleeding from the liver occurred in 14 of 31 patients who died after surgery: following initial control by liver sutures (seven patients); anatomic resection (four patients); and hepatic artery ligation (three patients). There was no apparent relationship between any hemostatic procedure and the subsequent appearance of the hepatic ischemia or parahepatic abscess. Based on this experience, the merits and detriments of individual hemostatic procedures are presented.

Hemorrhage↗

Estimation of hospital emergency room data using OTC pharmaceutical sales and least mean square filters.

BACKGROUND: Surveillance of Over-the-Counter pharmaceutical (OTC) sales as a potential early indicator of developing public health conditions, in particular in cases of interest to Bioterrorism, has been suggested in the literature. The data streams of interest are quite non-stationary and we address this problem from the viewpoint of linear adaptive filter theory: the clinical data is the primary channel which is to be estimated from the OTC data that form the reference channels. METHOD: The OTC data are grouped into a few categories and we estimate the clinical data using each individual category, as well as using a multichannel filter that encompasses all the OTC categories. The estimation (in the least mean square sense) is performed using an FIR (Finite Impulse Response) filter and the normalized LMS algorithm. RESULTS: We show all estimation results and present a table of effectiveness of each OTC category, as well as the effectiveness of the combined filtering operation. Individual group results clearly show the effectiveness of each particular group in estimating the clinical hospital data and serve as a guide as to which groups have sustained correlations with the clinical data. CONCLUSION: Our results indicate that Multichannel adaptive FIR least squares filtering is a viable means of estimating public health conditions from OTC sales, and provide quantitative measures of time dependent correlations between the clinical data and the OTC data channels.

Adolescent↗

Lymphatic Filariasis (Elephantiasis) Elimination: A public health success and development opportunity.

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis, launched following World Health Assembly Resolution 50.29 (WHA 50.29), has been facilitated in its progress by new research findings, drug donations, the availability of diagnostic tools, disability management strategies to help those already suffering and the development of partnerships. The strategy recommended by the World Health Organization of annual treatment with a two-drug combination has proved safe. DISCUSSION: Using different approaches in several countries the elimination of lymphatic filariasis (LF) has been demonstrated to be feasible during earlier decades. These successes have been largely overlooked. However, the programme progress since 2000 has been remarkable - upscaling rapidly from 2 million treatments in 2000 to approximately 60 million in 2002. Around 34 countries had active programmes at the end of 2002. It is anticipated that there will be further expansion - but this will be dependent on additional resources becoming available. The programme also provides significant opportunities for other disease control programmes to deliver public health benefits on a large scale. Few public health programmes have upscaled so rapidly and so cost-effectively (<$0.03/treatment in some Asian settings) - one country treating 9-10 million people in a day (Sri Lanka). The LF programme is arguably the most effective pro-poor public health programme currently operating which is based on country commitment and partnerships supported by a global programme and alliance. Tables are provided to summarize programme characteristics, the benefits of LF elimination, opportunities for integration with other programmes and relevance to the Millennium Development Goals. SUMMARY: Lymphatic filariasis elimination is an "easy-to-do" inexpensive health intervention that provides considerable "beyond filariasis" benefits, exemplifies partnership and is easily evaluated. The success in global health action documented in this paper requires and deserves further support to bring to fruition elimination of lymphatic filariasis as a public health problem and health benefits to poor people. A future free of lymphatic filariasis will reduce poverty and bring better health to poor people, prevent disability, strengthen health systems and build partnerships.

Journal Article↗

Hand transplantation.

The surgical techniques necessary to perform hand transplantation have been available for at least 25 years. In this article, the authors provide a review of hand transplantation, including its history, preoperative evaluation, and case reports. Data on transplant preparation, operation data, immunosuppression, rejection, immunologic assessment, and functional assessment are presented in easy-to-use table format.

Adult↗

[The role of computer methods in the diagnosis of mono- and multifactorial traumatic compression of the brain].

A scheme of differential diagnosis of mono- and multifactor compression of the brain was formed on the grounds of 18 most frequently encountered signs of the injury. The work is based on 693 cases which were verified on operation. The results were checked on a large independent selection. Accuracy of recognition was 87.5%. The Table suggested by the authors may prove valuable in emergency situations when the patients are admitted in a serious condition, in impetuous development of the compression syndrome, and when there is lack of time for carrying out instrumental examination.

Adult↗

The impact of vein patch angioplasty on long-term surgical outcome after carotid endarterectomy. A prospective follow-up study with serial duplex scanning.

In 304 patients the natural history of 339 endarterectomized and 269 nonoperated internal carotid arteries was examined by means of ultrasonic Duplex scanning over a period of 60 months. In 172 cases the operated artery was closed primarily and venous patching was performed in 167 endarterectomies. By life-table analysis the rate of significant recurrent stenosis (more than 50% diameter reduction) during the first year was respectively 3.4% for male and 4.3% for female patched arteries. For primarily closed vessels these numbers were respectively 14.5% for male and 24.4% for female arteries. More than 1 year after surgery, no significant difference between the 4 groups was demonstrated and the mean annual rate of recurrent stenosis amounted to 1.7%. For the nonoperated arteries, no significant difference between the first and the remaining 4 years of follow-up could be demonstrated. For these vessels the mean annual rate of progression to stenosis greater than 50% diameter reduction was 11.2%.

Arteriosclerosis↗