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8042495 | Necrotizing effect of phenol on normal tissues and on tumors. A study on postoperative and cadaver specimens. | We investigated the necrotizing effect of a 75% alcoholic solution of phenol on normal tissue harvested during surgery (muscles, fatty or connective tissue) or post mortem (peripheral nerves, arteries, epidermal tissue, joint and epiphyseal cartilage) and on tumor tissue (60 samples freshly harvested from patients suffering from bone tumors). The necrotizing effect was measured by determining the thickness of the cell layers demonstrating nuclear pyknosis or necrosis after 2 min of phenolization in a light microscope by ocular measurements in microns. No effect could be seen in epidermal tissue and in cartilage, whereas all other normal tissues exhibited necrotic zones between 40 and 500 microns. In all the tumors except those with chondromatous tissue, necrotic zones between 40 and 1000 microns were found. No difference in extension of the necrotic zone was seen between specimens from benign and malignant tumors and tumor-simulating processes. Phenolization cannot be recommended for the treatment of chondromatous tumors. |
8042494 | Talectomy for osteoporotic and neuropathic feet. 7 cases followed for 2-3 years. | I modified a technique of talectomy reported previously for osteoporotic cases. A larger medial malleolar fragment is displaced laterally to prevent the bone from being splintered during fixation. 2 Hawkins Group III fracture-dislocations of the talus and 4 equinovarus feet were successfully treated by this technique. |
8042493 | The social and economic consequences of finger amputations. | 120 patients with amputation of at least 1 of the 4 ulnar fingers were admitted to hospital. In none was replantation considered to be possible because of serious damage to the soft tissues and bone. 12 (3-18) years after the accident 80 percent of the patients assessed their condition as good or fair, even those with proximal amputation or loss of 2 or 3 fingers. Our observations do not support replantation when only one of the second-to-fifth fingers have been amputated. |
8042492 | Sacral and non-spinal tumors presenting as backache. A retrospective study of 17 patients. | Among 1302 cases reported to our tumor registry, 78 presented with backache as primary symptom. 17 of these had non-spinal tumors, 7 pelvic, 6 sacral, 3 femoral, and 1 costal. There were long delays in making the correct diagnosis; some patients even had had spinal surgery. The mistakes were the classic ones: poor history, poor physical examination, poor radiological work-up. Analysis of these 17 cases suggests that standard spinal radiographs should include an AP pelvis film and a lateral sacral projection. Patients with persistent radiating pain and normal radiographs should have a Tc-99 scan. The correct diagnosis would have been made in all the cases if this protocol had been followed. |
8042491 | Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases. | 32 consecutive patients suffering from chronic shoulder pain for more than 6 months after a single, nondislocating shoulder trauma were examined clinically and by special radiographs, dynamic sonography, MRI and arthroscopy. Typical complaints were pain during loading, especially during over the head activities. Symptoms of a "dead arm" and instability were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive signs of apprehension and impingement, but only 4 had clinical signs of shoulder instability. Diagnostic evaluation identified labral tears, partial and total rotator cuff lesions with subacromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction, arthroscopic labral resection and open subacromial decompression. In conclusion, patients with chronic posttraumatic shoulder pain have intraarticular injuries, especially tears of the glenoid labrum. History, clinical findings, radiography and sonography are seldom diagnostic. MRI is valuable, particularly for identification of labral pathology, but arthroscopy appears necessary for a preoperative assessment. |
8042490 | Maturation of the distracted callus. Sonographic observations in rabbits applied to patients. | We measured the corticalization of lengthened callus in rabbits and humans with ultrasonography. In rabbits, the echo reflection value was correlated with the strength of the callus; when this value exceeded 70 percent of that of the normal cortex, the callus strength was equal to that of the normal tibia. Clinically, the lengtheners in 8 patients were removed when the echo value exceeded 70 percent, regardless of attained lengthening. Neither fracture nor collapse of the callus ensued. The time required from the end of the lengthening process until the echo reflection value reached 70 percent was correlated with the patients' age. |
8042489 | Periosteal stripping in achondroplastic children. Little effect on limb length in 10 cases. | We present a prospective study of the results of periosteal stripping and division in 10 achondroplastic children. A single limb (femur and tibia) was operated on and the change in actual length of each bone and the percentage change in growth compared to that of the non-operated limb was measured by scanogram. The mean absolute increase in growth was small, measuring 3 mm for the femur and 2 mm for the tibia. There was no measurable growth difference after 18 months. This method of increasing limb length in achondroplastic children prior to definitive and extensive lengthening procedures is not recommended. |
8042488 | Back pain and arthralgia before and after lengthening. 75 patients questioned after 6 (1-11) years. | We performed 100 lengthenings of the lower extremities in 85 patients from 1980 to 1991, using three different surgical techniques. 6 (1-11) years after lengthening 75 of these patients with a preoperative leg length inequality of 6 (3-14) cm were clinically and radiographically assessed, and replied to a questionnaire on pre- and postoperative complaints of low back pain and pain from the joints of the lower extremities. Patients 15 years of age or younger at surgery had few complaints. Before lengthening, 18 patients suffered from severe low back pain compared with 6 at follow-up. Complaints from the joints of the lower extremities were less common and the effect of lengthening on these symptoms was minor. The ability to work, walk and to perform recreational activities was improved. 60 patients were satisfied with the result of the lengthening. |
8042487 | Osseointegration of titanium implants in the tibia. Electron microscopy of biopsies from 4 patients. | We studied the ultrastructure of bone tissue around implants of pure titanium inserted into the tibia in 4 patients with arthrosis or rheumatoid arthritis. Three main appearances of the interface were noted. First, a close contact between titanium and calcified bone with living osteocytes inside the newly-formed bone was observed in all samples. Secondly, a close contact was also seen between the implant and osteoid, the newly formed collagenous matrix being either uncalcified or calcifying. Thirdly, a loose extracellular matrix with fibrillar and nonfibrillar materials was sometimes observed between bone mineral and implant. There was no inflammatory reaction at the interface. We concluded that the titanium implants were osseointegrated, but the calcification of the bone tissue was not complete even after 20 months. However, mineralization of osteoid and living bone cells revealed the presence of an active tissue. |
8042486 | Survival of the Townley knee. 360 cases with 8 (0.1-15) years' follow-up. | We evaluated 360 Townley arthroplasties in 167 OA and in 193 RA knees, performed between 1978-1986. 35 revisions were performed during the follow-up time. The main reasons for revision were aseptic loosening (18 knees), instability (6 knees), and infection (5 knees). The durability of different prosthesis components and of different tibial trays in relation to loosening were analyzed separately. The probability of the prosthesis remaining in situ was 94 percent after 5 years and 89 percent after 10 years. The success rate at 10 years was not significantly higher in arthrosis (94 percent) than in rheumatoid arthritis (85 percent). The other patient-related factors, age, sex, weight, did not influence the results. Comparing the different prosthesis components and the different designs of the tibial tray, we found no differences in success rates. |
8042485 | Kotz modular femur and tibia replacement. 28 tumor cases followed for 3 (1-8) years. | In the period 1984-1991, 33 lower limb reconstructions were performed with an uncemented Kotz modular femur tibia reconstruction (KMFTR) prosthesis after resection of 32 malignant bone tumors and 1 benign giant cell tumors. Tumor localization was proximal femur in 12, distal femur in 17, and proximal tibia in 4. The mean age of the patients was 38 years. 28 patients with a minimum follow-up of 1 year were studied after 3 (1-8) years. 7 patients were reoperated because of complications. Good or excellent results were obtained in 6 of the 10 proximal and 13 of the 14 distal femur reconstructions. In 2 of the 4 patients undergoing combined distal femur and proximal tibia resection, a deep infection developed, and above-knee amputation was performed. One local recurrence occurred after proximal femur resection. |
8042484 | Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2-7) years. | We report the outcome of 71 consecutive posterolateral lumbar fusions without spinal instrumentation. The indication for the operation was spondylolysis-olisthesis, degenerative disc disease/facet joint arthrosis, or pain after prior laminectomy. Concerning pain relief, 29/43 patients with spondylolysis-olisthesis were classified as good. The corresponding figures in the group with degenerative disc disease and/or facet joint arthrosis were 8/16 patients and in the group with pain post-laminectomy, 6/12 patients. No surgical complications were noted. In the total material 54 patients had a solid fusion, as defined by radiographic osseous trabecular bridging at all intended levels. One-level fusions tended to heal solidly in a higher frequency than two-level fusions. For the spondylolysis-olisthesis group, healed fusion correlated with a good clinical result. Such a correlation could not be verified for the other diagnostic groups. We conclude that non-instrumented posterolateral lumbar fusion is a valid method for treating low-grade spondylolysis-olisthesis, especially when the aim is to fuse a single level. Improved patient selection methods are required in fusion for degenerative disc disease and pain after laminectomy. |
8042483 | Decreased broadband ultrasound attenuation of the calcaneus in women with fragility fracture. 85 Colles' and hip fracture cases versus 77 normal women. | The broadband ultrasound attenuation (BUA) of the right calcaneus was measured in 49 women with Colles' fracture, in 36 women with hip fracture, and in 77 normal women. All were postmenopausal, and the fractures were all of fragility type. BUA correlated with age only in the normals. BUA distinguished between the fracture cases with sensitivities of 97 percent and 70 percent and specificities of 72 percent and 92 percent at 61 dB/MHz and 51 dB/MHz, respectively. The women with hip fracture had lower BUA than those with Colles' fracture. For screening purposes, BUA below 51 dB/MHz may arouse suspicion of a fracture risk, notably if other factors such as a tendency to fall, dietary and other habits, inactive lifestyles and early menopause are present. |
8042482 | The neuronal regulation of fracture healing. Effects of sciatic nerve resection in rat tibia. | The effect of sciatic nerve resection on tibial fracture healing was studied in rats 25 days post-trauma. To prevent differences in loading between sham-operated and nerve-resected animals the fractured limbs were cast-immobilized. On radiograms 8 of 11 fractures in the sham-operated animals showed very little callus formation in contrast to only 1 of 8 fractures in the group with nerve resection. Measured by single-photon absorptiometry, animals with sciatic nerve resection had a higher bone mineral content than the sham-operated animals. However, the mechanical strength in three-point cantilever bending was not better in the nerve-resected rats, implying a defective organization of the large callus. These results suggest neural regulation plays a role in the type of fracture healing, primary or secondary, and in the amount and quality of the callus. |
8042481 | Radiographic prediction of failure after fixation of cervical hip fracture. | During 1984-1985, 410 patients with cervical hip fracture were randomized between 2 methods of internal fixation--a single nail (Rydell) or 2 LIH hook pins (LIH). The patients were followed-up prospectively for at least 2 years. Radiographs were taken after 1 week, 1, 3, 6, 12, and 24 months. The radiographs of the 295 patients alive 2 years postoperatively were examined by one of the authors. The sliding and the diversion of the pins and the nail in the anteroposterior projection and the diversion in the lateral projection were measured. In the failure group (non-union, late segmental collapse), the greatest sliding was noted within 1 month postoperatively and the diversion increased up to 3 months. Significant differences between the failure and the non-failure groups could be seen even after 1 week. We also found that the degree of sliding of the LIH pins and the Rydell nail 1 month postoperatively is comparable to the scintigraphic pattern 2 weeks postoperatively in predicting failure after internal fixation of cervical hip fractures. |
8042480 | Prospective comparison of hip fracture treatment. 856 cases followed for 4 months in The Netherlands and Sweden. | In a prospective multicenter study 1115 hip fracture patients were registered in Rotterdam (The Netherlands), Sundsvall and Lund (Sweden). The patients had similar background parameters with a mean age of 78 years, about half of them living alone and just above 80 percent coming from independent living. For cervical fracture, hemiarthroplasty was the predominating treatment in Rotterdam (n 169), whereas osteosynthesis was used in Sundsvall (screws n 135) and Lund (hook-pins n 148). The mean (median) hospitalization time was 32 (20) days in Rotterdam, 16 (12) days in Sundsvall, and 17 (10) days in Lund. Discharge to independent living varied from 53 percent in Lund to 72 percent in Sundsvall. Functional outcome (walking ability and ADL capacity) was at 4 months similar in all groups, but at 2 weeks was lower in Rotterdam. Mortality at 2 weeks/1 month/4 months was in Rotterdam 4/9/20, in Sundsvall 2/4/13, and in Lund 0/3/10 percent. Trochanteric fractures were treated by screwplate in Rotterdam (n 146) and Lund (n 78), and by Ender nails in Sundsvall (n 117). The mean (median) hospitalization time was in Rotterdam 39 (29) days, in Sundsvall 24 (15) days and in Lund 19 (11) days. Discharge to independent living varied from 41 percent in Lund to 57 percent in Sundsvall. Functional outcome was similar between the groups. Mortality at 2 weeks/1 month/4 months was in Rotterdam 2/6/14, in Sundsvall 6/12/19 and in Lund 12/12/18 percent. Thus, our study has shown that it is possible to perform a prospective multicenter study involving different European countries.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042479 | Extracellular matrix metalloproteinases around loose total hip prostheses. | We have explored the tissue localization of extracellular matrix metalloproteinases MMP-1 (fibroblast collagenase), MMP-2 (72-kDa gelatinase/Type IV collagenase), MMP-3 (stromelysin), MMP-8 (polymorphonuclear leukocyte collagenase) and MMP-9 (92-kDa gelatinase/Type IV collagenase) in the tissues around loose hip prostheses. The findings were compared with those in synovial tissues obtained from patients with a fractured femoral neck. MMP-type specific antisera were applied in the sensitive avidin-biotin-peroxidase complex methods. MMP-1 was found in monocyte/macrophages, fibroblasts, and vascular endothelial cells in both interface tissues between bone and acetabular components and the pseudocapsular tissues obtained from loosening of hip prostheses. In these tissues, MMP-8 was occasionally found, but only in polymorphonuclear leukocytes. Cells showing immunoreactivity to 72- and 92-kDa gelatinase/Type IV collagenase, MMP-2 and MMP-9, respectively, and stromelysin, MMP-3, were abundant in both interface and pseudocapsular tissues in loose hip prostheses. In contrast, in hip fractures, immunoreactivity to MMP-1, 2, 3, and 9 was weak and only observed in synovial tissues. Immunoreactivity to MMP-8 was confined to polymorphonuclear leukocytes attached to the synovial membrane or in the infiltrate around blood vessels in the subsynovial connective tissues. The finding of MMP-1, 2, 3, and 9 in the tissues around loose hip prostheses suggests that they play a role in the weakening of connective tissues, and this leads to loosening. |
8042478 | Quantitative bone scanning after asymptomatic Charnley arthroplasty. | To establish the normal pattern of postoperative tracer uptake we performed 73 99mtechnetium methylene diphosphonate scans following primary Charnley hip replacements for arthrosis in 68 patients without clinical, hematological and radiographic complications. The patients were divided into 7 subgroups according to the period, 6-24 months, between surgery and scan. There were 10-12 patients in each subgroup. A high-resolution gamma camera with a large field of view was used. Ratios of uptake in each of 10 peri-prosthetic zones to normal bone were calculated. Femoral uptake was found to decrease in linear fashion from 6 to 12 months after surgery. Thereafter the uptake remained unaltered at levels nearly twice the normal ones in the greater trochanter and nearly 1.5 times in the lesser trochanter, returning to almost normal levels in other zones. Acetabular uptake remained elevated throughout. |
8042477 | Morsellized allografts for fixation of the hip prosthesis femoral component. A mechanical and histological study in the goat. | To simulate femoral intramedullary bone stock loss in revision surgery of failed total hip arthroplasties, a method was developed using impacted trabecular bone grafts. In 14 goats a cemented total hip arthroplasty was performed, fixating the stem within a circumferential construction of bone allografts. After 6 or 12 weeks, 4 goats were used for mechanical tests and 3 for histology. The stability of the stems was determined in a loading experiment with roentgen-stereophotogrammetric analysis; loads of up to 1.44 times body weight were used. One aseptic loosening was seen with gross movements. In the other cases the most important movements were axial rotations (max. 0.24 degrees under 800 N) and axial translations (max. 0.16 mm under 800 N). After unloading some elastic recovery occurred. There were no differences between the 6 and 12-week groups. Histologically, revascularization and remodeling of the grafts were evident. Bone apposition and bone resorption of the grafts resulted in a mixture of graft and new bone. There was more new bone formation in the 12-week group, but the process was not yet completed. The use of impacted trabecular bone grafts in cases of severe intramedullary bone stock loss seems to be a promising revision technique. |
8042476 | Fixation of cementless acetabular cups. A radiographic 4-8-year study of 102 porous-coated components. | We studied fixation changes over time in 113 porous-coated Howmedica (PCA) cementless acetabular cups inserted in 90 patients 1984-1988. The mean follow-up was 5 years. Radiographic fixation was classified as stable, fibrous-stable, or unstable. 9 cups, 3 in neutral position and 6 vertical, were revised. At follow-up, 40/75 neutral cups were stable versus 7/27 vertical cups. Most stable cups and two thirds of the unstable cups were clinically good. After the first 2 years, 28/75 neutral cups and 10/27 vertical cups changed their fixation; 12 had improved fixation and 26 had a worse one. |
8042475 | Reproducible radiographs of acetabular prostheses. A method assessed in 35 patients. | 35 patients with a smooth, threaded acetabular Mecron type prosthesis were examined with the aid of a table top with wiremarkers and a fixed 30-degree wedge to allow for reproducible positioning. Under fluoroscopic control, pelvic and spot films were made. The inter- and intraobserver variability of anteversion and inclination angle measurements of the prostheses had a standard deviation of less than 1 degree. The method can be applied to other acetabular prostheses as well. |
8042474 | Two-year outcome of hydroxyapatite-coated prostheses. Two femoral prostheses retrieved at autopsy. | We performed a histological study of the bone-implant interface on 2 human femurs implanted with a hydroxyapatite-coated self-locking stem for 2 years. Extensive bone formation with no intervening fibrous tissue was noted around the entire circumference of the 2 prostheses. The newly-formed bone had 2 morphotypes: an alveolar disposition with a continuous contact between bone and hydroxyapatite, and a digitiform one where distinct bony trabeculae were in contact with the ceramic coating or with the bone marrow. Partial or even total resorption of the hydroxyapatite coating was clearly identified, these areas showing bone in contact with the metal. |
8042473 | Bone formation in coralline hydroxyapatite. Effects of pore size studied in rabbits. | We analyzed osseous reactions in the rabbit femoral condyle to coralline hydroxyapatite bone substitutes of various pore sizes by radiology and histology. The results were compared to bone repair of empty cavities and to integration of allografts. Spontaneous bone repair of the empty cavities took approximately 12 weeks, while integration of the cryopreserved allografts occurred after 9 weeks. However, no signs of new bone formation were found with the 200 microns pore size hydroxyapatite. In contrast, there was substantial production of bone within the 500 microns pore size implants at 12 and 26 weeks. Our results indicate that the pore size of the coralline hydroxyapatite influenced the development of bone in the implants in the cancellous bone bed of the rabbit femoral condyle. The results also show that spontaneous bone repair should be taken into consideration when the integration of implants is evaluated. |
8042472 | Ineffective hip rotation with Pavlik harness. Prospective study of 35 infant dislocations. | 35 hips in 31 infants diagnosed as unstable were treated with a Pavlik harness and followed by weekly clinical and monthly ultrasound evaluation to determine eventual stability. 26 hips became stable within 3 months, and 9 dislocations required reduction with hip spica placement; 1 of these subsequently required open reduction. Of the 7 infants with 9 hips that failed, 2 children had a late onset of treatment, 2 children had problems with brace fit or family acceptance, and 3 other children had no problem with use of the orthosis. Internal rotation of a degree not possible with the Pavlik harness was required to reduce 4 of these 9 hips. The Pavlik harness is ineffective in some patients because of the need for internal rotation. |
8042471 | The impact of intra-uterine factors on neonatal hip instability. An analysis of 1,059,479 children in Norway. | The records of the Medical Birth Registry of Norway from 1970 through 1988 contain information on maternal health, course of delivery and health of 1,059,479 newborns. The overall prevalence at birth of neonatal hip instability (NHI) was 0.9 percent: 0.6 percent in boys and 1.4 percent in girls. In breech presentation, the rate was 4.4 percent. In vaginally delivered children, the rate was only marginally higher compared to those delivered by cesarean section. In children with a birthweight less than 2,500 g, the rate was 0.3 percent. In vertex presentation, the duration of pregnancy had no influence in boys whilst, in breech presentation, the prevalence increased up to the 39th week of gestation. In girls, the NHI rate increased with the duration of gestation, particularly in breech presentation. In first-born children, these patterns were even more obvious. The data are consistent with a hypothesis that intra-uterine mechanical factors, in combination with hormonal factors, are of importance rather than the actual trauma of vaginal delivery. |
8042468 | Immediate post partum thrombosis of the veins of the round ligament imitating an irreducible inguinal hernia. | Following delivery, our patient presented acutely with a painful swelling in the groin. Diagnosis could only be established by exploration. Thrombosed veins of the round ligament were found on histology of the swelling. Exploration was necessary to rule out an acute inguinal hernia. |
8042469 | Ultrasound in abruptio placentae praecox of the second twin. 'Boomerang phenomenon'. | The diagnosis of abruptio placentae praecox of the second twin is usually difficult. The clinical symptoms may not be evident. The appearance of the new (third) hypoechogenic space, on ultrasound scan, was in our case the only diagnostic clue. It proved to be blood from the abrupted edge of twin B's placenta penetrating the dividing septum. Its characteristic ultrasound image brought forward the idea and namegiving 'boomerang phenomenon' and indeed, it could return like a boomerang as the intrauterine fetal demise, if ignored. This picture could mislead to the conclusion of being the leakage of amniotic fluid or the amniotic sack of the 'vanishing fetus' in primarily triplet pregnancy. The potentially ominous prognosis of abruptio placentae praecox warrants strict supervision of pregnancies with this phenomenon. |
8042467 | Pregnancy and spontaneous delivery 13 months after heart transplantation. | This case report is about a 23-year-old female patient who underwent heart transplantation because of dilatative cardiomyopathy. Four months after transplantation she conceived. Thirteen months postoperatively, the patient had spontaneous vaginal delivery and gave birth to a child in good physical condition. |
8042465 | Is differentiation of benign and malignant cystic adnexal masses possible by evaluation of cysts fluids with respect to color, cytology, steroid hormones, and tumor markers? | Differentiation of benign and malignant cystic adnexal masses by analysis of cyst fluid was investigated. Eighty-one cystic adnexal lesions of 80 patients were punctured intraoperatively or after surgical removal. Color of the cyst fluid, cytology, concentrations of steroid hormones (estradiol, progesterone, testosterone), and tumor markers (CEA, CA 125, CA 15-3) were correlated to histology. Color of cyst fluid was not reliable in the differential diagnosis of cystic adnexal masses. Cytology missed four out of seven malignant tumors. One mucinous cystadenoma was cytologically suspicious for malignancy. The combination of negative cytology, low tumor marker levels, and estradiol levels higher than 1000 pg/ml may support the diagnosis of a 'functional' cyst. Elevated CEA levels may be suspicious for all mucinous and malignant lesions. Analysis of cyst fluid could not accurately discriminate between benign or malignant tumors. |
8042466 | The U-elevator. A new manipulator for gynecologic laparoscopy. | A new uterine elevator/manipulator for gynecologic laparoscopy is described. The instrument is a u-formed tube with a cone for insertion into the uterus via the vagina. In the other end is a handle with a canal for instillation of fluid (dye). After insertion the handle is placed at the pubic area and the operation can be performed with the patient placed at a normal position on her back. The elevator can be handled by the surgeon without moving his hands outside the sterile area. No assistant is necessary. The u-form of the instrument allows the uterus to be moved in all directions facilitating the laparoscopic view and operation. At a study of 97 laparoscopies no difficulties concerning the insertion and use were found. The instrument was easy to handle and pertubation was possible in most cases. The U-elevator is found to be a good alternative to the existing elevators. |
8042464 | Microcurettage sampling of the endometrium for histopathological examination--simpler but not safe? Comparison of endometrial histopathology in samples obtained by a disposable mechanical curette and by traditional curettage. | The routine use of dilatation and curettage (D&C) is questioned as a standard procedure for endometrial sampling. Instruments have been developed in order to simplify the procedure. The aim of the present study was to estimate the sensitivity to detect malignancy/premalignancy by histological examination of endometrial samples obtained by microcurettage using a disposable plastic curette, Gynoscann. The histological examination of the combined microcurettage and D&C material was defined as the true diagnosis. All patients undergoing diagnostic D&C at the two participating hospitals were included in the study. The endometrial samples were evaluated at the Department of Pathology as part of their routine work. The microcurettage samples were re-examined independently by two pathologists (observer 1 and observer 2) who did not have access to the rest of the tissue material nor the diagnosis given previously. A total of 902 patients were enrolled in the study. Endometrial cancer was found in four women below 50 years of age. None of these were detected by histological examination of the Gynoscann obtained sample. Among women aged 50 and above, samples from 16 women turned out to have endometrial cancer. The microcurettage samples were correctly classified as malignant/premalignant by observer 1 in 13 cases and by observer 2 in 14 cases. We conclude that diagnostic D&C among women 50 years and below cannot be replaced by histological examination of Gynoscann samples without the risk of overlooking significant pathology. |
8042463 | Abortion ethics--women's post abortion assessments. | Induced abortion is often discussed in terms of ethics. The aim of the present report is to describe the abortion ethics as it was expressed by women undergoing a legal abortion. Moral considerations expressed during semistructured interviews by 128 women two weeks after a first trimester abortion in Stockholm 1987-90 are reported. The women had faced a choice between abortion and parenthood. At the time of the abortion many of them were living under conditions that meant they were unable to offer a child the security they regarded as a child's right. The conflict the women spontaneously described as their main moral dilemma was not a conflict between the woman and the fetus, but a conflict between several close relationships, also concerning the prospective father. The ethics that the women applied to the problems of abortion was founded on a long-term responsibility to care for persons in their relationships. The women interviewed had three levels of moral reasoning simultaneously present. 1. A theoretical level--most of all concerning other women--a liberal view of rights: abortion should be a freely obtainable option. 2. A theoretical level--above all, concerning themselves--a restrictive deontological view: the extinction of life is morally wrong and should be avoided. 3. A practical level--when the problem was a reality: a consequentialist ethics of care. According to this ethics of care it was important that the abortion could be performed as early as possible during pregnancy. |
8042462 | Evaluation of vaginal and perineal area during the use of external sanitary protection throughout the menstrual cycle. | A clinical study evaluated potential external genital effects associated with the use of sanitary protection. The subjects used either a pad with traditional cellulose absorbent core or one containing cellulose and absorbent gelling material. Assessments included objective (transepidermal water loss, vaginal pH) and semi-quantitative subjective--methods (skin irritation grading, gynaecological inspection). No statistical or clinical significant differences for any of the parameters evaluated between the groups using the two pads, or compared to the non-pad control period, were found. The parameters used to study the effects on the genital area of an external sanitary product appear appropriate. No significant changes were observed for either of the two pads during daily use for two menstrual cycles. |
8042461 | Pulsatile gonadotropin releasing hormone (GnRH)--treatment for hypothalamic amenorrhoea causing infertility. | Thirty women with hypothalamic amenorrhoea and infertility were treated with pulsatile GnRH s.c. without monitoring with estradiol and ultrasonography. Ovulation rate per patient was 93%. Ovulation rate per cycle was 90%. Pregnancy rate per ovulatory cycle 30%. Miscarriage rate 18.5%. 23 children were born including one set of twins. No serious side effects were recorded. |
8042460 | Who uses Norplant. A study from Finland. | Although Norplant implantable contraceptives were introduced first in Finland, their use has been infrequent. The objective of this study was to investigate what kind of women use Norplant in Finland, who suggested its use, and from what source women get their information on Norplant. A questionnaire was mailed to all women having had Norplant inserted one to two years before the study initiation (June 1992) in seven family-planning clinics in the Helsinki city area (n = 262). After one reminder, the response rate was 82%. Most of the users were 25-34 years old, and many of them had had a previous abortion. Half of the women were still considering a (subsequent) child. All the women had used some birth control method before Norplant and reported several problems with it. Women reported that they themselves had chosen Norplant, but physicians and nursing staff in the family-planning clinic were their most important information sources. Most women considered that they had received sufficient information before insertion regarding both the good and bad aspects of the method. Women with previous abortions are a special users' group for Norplant, even though most users are in no way exceptional women. |
8042459 | Routine revision of uterine scar after prior cesarean section. | Up until the early seventies fear of uterine rupture led to the widespread practice of 'once a section, always a section'. Nowadays, there is a consistent trend toward vaginal birth after a prior cesarean delivery, making early detection of uterine scar dehiscence at delivery important. However, the need for routine transcervical revision of the uterine scar following vaginal delivery is controversial in the medical literature. The present study reviewed 467 women who underwent vaginal delivery following a previous cesarean section. In 414 patients the scar was examined transcervically, and not one case of dehiscence of the scar was detected. The patients included four with twin pregnancies, and four with breech presentations (two underwent external cephalic version). Intrauterine pressure was monitored in 17 cases; Prostaglandin E2 vaginal tablets were used in 46 patients, and in 14 cases labor was augmented by Pitocin. Our results suggest that routine revision of a uterine scar at the time of a subsequent vaginal delivery is usually unnecessary. |
8042458 | 'To bathe or not to bathe' during the first stage of labor. | Does a warm tub bath relieve labor pain? How is it experienced by the parturient? prospective randomised trial. labor ward of a teaching hospital with a uniform active labor management. one hundred and ten nulliparous low risk women, at term, in true spontaneous labor. Fifty-four women had a bath, 56 women served as controls. labor pain (assessed by means of a visual analogue scale) and post partum patients' bathing experience (by means of a self-made questionnaire). The study group and the control group were comparable with respect to maternal age, weight, length, duration of gestation, cervical status and labor pain sensation before randomisation. Absolute values of labor pain were not statistically different between the two groups, yet this latter progressed differently: in the bathing group the initial pain sensation (V.A.S.) was 6.8, and this remained stable during the first 25 minutes (V.A.S. = 6.7) and then rose to 8.2 after a mean of 53 minutes. In the control group, labor pain rose progressively from 6.3 to 7.3 after 25 min and to 8.7 after a mean of 52 min (p < 0.01, Student t-test). There was no difference in the use of epidural analgesia. There were no differences in labor duration nor in the frequencies of either operative deliveries or neonatal complications. Eighty percent of the bathers experienced soothing of the pain and all but one reported body relaxation. Ninety percent wanted to bathe again during a next labor. Bathing provided no objective pain relief. It had, however, a temporal pain stabilizing effect possibly mediated through the improved ability to relax in between contractions. No side effects were found. It gives great satisfaction to users. Bathing, in conjunction with other forms of analgesia, is recommended. |
8042457 | Falling population incidence of eclampsia. A case-control study of short term outcome. | Eclampsia remains a serious complication of pregnancy and childbirth and factors related to morbidity require continued evaluation. Retrospective case-control study on the incidence and outcome of eclampsia. A defined total island population over 20 years. All centrally collected birth registration returns in Iceland for the years 1972-1991 were reviewed to identify women with the diagnosis of eclampsia, selecting women delivering immediately before and after the eclamptic case as controls. Information from all places where women had delivered was obtained to ensure that no case was missed. Maternity records were reviewed to verify the diagnosis and obtain maternal and neonatal data. Forty women had eclampsia (0.046% of deliveries). The incidence diminished between the decades 1972-81 and 1982-91 (p < 0.05), as did the incidence of eclamptic convulsions before delivery. Eclamptic women were more often primiparous, younger and delivered earlier than controls. Preterm delivery and a low ponderal index were more common among offspring of the eclamptic mothers and the male/female ratio was lower. The incidence of eclampsia in the population is falling. Common features related to the condition were confirmed. Severe maternal illness is rare, but the babies often appear growth-retarded and are delivered preterm. |
8042456 | Uro-genital microbial colonization and threatening preterm delivery. | To examine whether there is a relationship between the uro-genital microbial colonization and threatening preterm delivery. The microflora in the urine and endocervix was studied in 43 women with preterm labor, 45 women with preterm premature rupture of the membranes (PPROM) and 80 normal pregnant women at 26-34 weeks of gestation. Amniotic fluid was examined in 20 of the patients with preterm labor. Data were analyzed by Fisher's exact test (two-tailed). The microflora in the urine was not significantly different in patients with preterm labor, PPROM and normal pregnant women. Compared with normal pregnant women, patients with preterm labor had significantly lower prevalences of corynebacteria (p < 0.05) and coagulase-negative staphylococci (p < 0.01) in the cervix, while patients with PPROM had significantly lower prevalences of lactobacilli (p < 0.05) and coagulase-negative staphylococci (p < 0.05) in the cervix. Positive amniotic fluid cultures were detected in three of the 20 patients with preterm labor who underwent transabdominal amniocentesis. Evidence of ascending colonization was found in two of these cases. The microbial colonization of the urine was not associated with threatening preterm delivery. Reduced prevalences of lactobacilli, corynebacteria and coagulase-negative staphylococci in the cervix were associated with threatening preterm delivery. |
8042455 | Plasma copper, zinc and magnesium levels in patients with premenstrual tension syndrome. | We measured plasma Cu. Zn and Mg levels in 40 women suffering from premenstrual tension syndrome (PMTS) and in 20 control subjects by atomic absorption spectrophotometer. Mean plasma Cu, Zn and Mg levels, the Zn/Cu ratio were 80.2 +/- 6.00 micrograms/dl, 112.6 +/- 8.35 micrograms/dl, 0.70 +/- 0.18 mmol/l, and 1.40 +/- 0.10 in the PMTS group; and 77.0 +/- 4.50 micrograms/dl, 117.4 +/- 9.50 micrograms/dl, 0.87 +/- 0.10 mmol/l, and 1.51 +/- 0.05 in the control group respectively. The mean Mg level and the Zn/Cu ratio were significantly lower in PMTS patients than in the control group. Plasma Mg and Zn levels were diminished significantly during the luteal phase compared to the follicular phase in PMTS group. Mg deficiency may play a role in the etiology of PMTS. |
8042452 | Peroneal muscular atrophy with Poland syndrome. | A 22-year-old male college student had a syndactyly between the second and third fingers of his left hand, which was congenitally small in size. His left pectoralis muscles were absent. He first walked at the age of 12 months, but soon developed difficulties in walking due to weakness of the legs. Atrophy and weakness of the legs aggravated gradually. He was diagnosed as having peroneal muscular atrophy and Poland syndrome, an association of which has not been reported before. A small number of similar cases of peroneal muscular atrophy with various skeletal abnormalities in the literature suggest that the association is not incidental, but of clinical significance. |
8042451 | Severe axonal polyneuropathy with onset in the postpartum period. | We report two patients who presented severe polyneuropathy in the postpartum period. Electrophysiological studies evidenced an axonal process which was associated with proximal demyelination in the second patient. In both cases, a peripheral nerve biopsy showed severe axonal Wallerian-like degeneration and no feature of demyelination. The first patient had a dramatic loss of myelinated fibres, and severe disability persisted for several months. These two patients are different from cases of acute or chronic inflammatory demyelinating polyradiculoneuropathy previously reported in relation with pregnancy. |
8042450 | Progressive ataxia in Swedish children: a re-evaluation study. | The results of follow-up of 76 children with progressive ataxia first reported in 1988 are described with special reference to type of potential underlying metabolic diseases. In 70% of cases the clinical follow-up did not lead to reconsideration of diagnoses. Six of 23 biochemically and morphologically re-examined children got a new and definite diagnosis: 1 myoclonic encephalopathy with ragged red fibres, 2 carbohydrate-deficient glycoprotein syndrome, 1 neuroborreliosis, 1 Hallervorden-Spatz disease and 1 leucodystrophy. Different clinical groups are discussed. |
8042449 | Surgical intervention and heparin-anticoagulation improve prognosis of rhinogenic/otogenic and posttraumatic meningitis. | It is still controversial, whether early surgical removal of infectious material and heparin-anticoagulation to reduce vascular complications will improve outcome in acute meningitis. In the present pilot-study 40 patients with acute or delayed post-traumatic or oto-/rhinogenic purulent bacterial meningitis were analysed for neurological outcome by using the Glasgow outcome score (GOS) and the Tuthill functional score; patients were treated either by early surgical revision of the septic focus (Group 1, within 6 days, n = 15), late surgery (Group 2, later than 6 days, n = 19), or no surgery at all (Group 3, n = 6). All patients, independent of surgical approach, received therapeutic heparin-anticoagulation. Patient groups were otherwise comparable for antibiotic treatment, osmotherapy, microbiology, CSF-findings, CT-scans and prognostic factors. Outcome according to GOS was superior in Group 1 compared with Groups 2/3 (non-significant). Although there was no significant difference on admission in the Tuthill functional score, Group 1 achieved a superior final outcome of 96 points compared with Groups 2 and 3, who gained 72 points (p < 0.01). In addition, Group 1 patients had significantly less intracranial complications (8/15 patients versus 21/25 patients in Groups 2/3, p < 0.01) and were dependent upon respirator treatment for fewer days (10.2 days) than Groups 2/3 (12.5 days, non-significant). In 31 patients CSF-leakage was identified: among these, 17 patients had CSF-leakage, which had not been anticipated by clinical/neuroradiological examinations and revealed only by surgery. The overall mortality in this study population was very low (2.5%), therefore, therapeutic heparin seems to represent an additional favorable treatment measure.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042448 | Guillain-Barré syndrome in Cantabria, Spain. An epidemiological and clinical study. | Seventy-one patients with Guillain-Barré syndrome (GBS) were retrospectively selected from within a defined area (Cantabria) in northern Spain, from 1975 to 1988. Excluding two non-resident cases, epidemiological analysis was based on 69 cases. The annual incidence rates were stable during the 14-year period of study with an average incidence of 0.95 (age-adjusted, 0.86) cases per 100,000 population. No significant difference was found for sex, urban or rural residence and there was no significant seasonal clustering. Antecedent event were recorded in 57% of patients, the most frequent events being upper respiratory infection and gastroenteritis. No association between use of gangliosides and the syndrome was found. Eight patients had variant syndromes including Fisher's syndrome (2 cases), and axonal (4 cases) and sensory (2 cases) GBS. Recurrences occurred in 3 cases. Excluding nine patients with incomplete follow-up and two with Fisher's syndrome, clinical analysis was based on 60 cases. Patients were divided into three groups as a function of their peak weakness. Significant features of the severe group were a requirement for ventilation, presence of bulbar palsy or dysautonomia and a longer duration of the plateau phase. However, it was not possible at an early stage of the clinical course to predict future motor deficit. Four (6.7%) patients belonging to the severe group died during the acute phase of the disease. No specific treatment for GBS was given. Outcome was assessed by means of serial examination up to 24 months after the onset of symptoms using a functional scale. At 3, 6 and 24 months 70%, 46% and 12% of patients, respectively, had a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS) |
8042447 | Acute intracerebral haemorrhage: circadian and circannual patterns of onset. | Hypothesis of the circannual and circadian variation in onset of intracerebral haemorrhage (CH) was verified, by means of single cosinor method and chi-square test for goodness of fit, in 161 consecutive patients (94 men and 67 women) admitted into the Institute of Neurosurgery of Ferrara Hospital, Italy, over 9 years. The majority of CH occurred in the morning between 06.00 AM and 12.00 noon (36.7% of cases, p < 0.001); when considering the specific anatomical sites, typical supratentorial haemorrhages showed a similar pattern (37.4%, p = 0.01). A similar morning behavior was found when considering subgroups by sex (men 36.2%, women 37.3%), age > or = 60 years (42.5%), no presence of hypertension (39.7%), no presence of diabetes mellitus (33.3%) and non-smokers (30.4%). The results by cosinor analysis yielded a circadian rhythmicity both for total sample and, for the men's subgroup, with a morning peak at 11.44 and 11.25, respectively. For women, however, spectral analysis found a significant ultradian cycle, having a period of 12 h (p = 0.01). A circannual periodicity, with a prevalent peak in February, was found for total sample and males subgroups, too. The results of this study confirm that intracerebral haemorrhages present a characteristic circadian and circannual pattern in onset. |
8042446 | Mechanisms of tizanidine action on spasticity. | This investigation estimated the mechanisms of tizanidine action on spasticity using a battery of neurophysiological methods. Thirty patients with old post-stroke spastic hemiparesis took part in the investigation. They were treated with tizanidine-mean daily dose 15.8 +/- 5.6 mg for a mean of 23.3 +/- 4.8 days. A questionnaire for assessment of subjective improvement after treatment used a 5-point scale. For standardization of the neurological examination 5-point scales were used to assess muscle tone, muscle force and tendon reflexes. A battery of neurophysiological methods was used to analyze different mechanisms of spasticity: for alpha motoneuron excitability--the F wave parameters; for presynaptic inhibition--the ratio of H reflex amplitudes before and after vibration of the achilles tendon (Hvibr/Hmax); for common interneuron activity--the flexor reflex parameters. Our results revealed that tizanidine reduces spastically increased muscle tone, but has no influence on muscle force, tendon reflexes, Babinski sign and ankle clonus. Tizanidine is supposed to act by increasing the presynaptic inhibition and decreasing of alpha motoneuron excitability. When spasticity has decreased presynaptic inhibition and increased motoneuron excitability, it is better to treat with tizanidine. |
8042445 | Recovery of the hypothalamic-pituitary-adrenal axis from suppression by short-term, high-dose intravenous prednisolone therapy in patients with MS. | We have studied the recovery of the hypothalamic-pituitary-adrenal (HPA) axis from inhibition by short-term, intravenous high-dose, corticosteroid therapy (IVHDCT) without subsequent oral replacement therapy in 10 patients with relapsing-remitting or progressive multiple sclerosis (MS) using the human corticotrophin-releasing hormone (hCRH) test. There was significant HPA suppression with profoundly decreased basal and peak plasma ACTH and cortisol levels 24 h after cessation of therapy. However, at 48 h the pituitary response was greatly enhanced with peak ACTH concentrations rising by more than 100% over baseline values in 7 of 10 patients. Basal and stimulated ACTH concentrations returned to pre-treatment levels at 120 h. Basal and stimulated plasma cortisol levels remained subnormal in 6 patients 120 h after IVHDCT. We conclude that IVHDCT without oral replacement therapy in MS patients is endocrinologically safe. |
8042444 | Reduced expression of erythrocyte complement receptor (C3bR) in MS. | The study was carried out in patients with MS (n-121) and in control group (n-519). On the basis of haemagglutination intensity and results of radioimmunoassay three phenotypes of complement receptor were classified: high HH, medium HL, and low LL. Considerable differences were observed in the distribution of these phenotypes between controls and MS in whom the low phenotype was more frequent. Family studies suggest that reduced expression of the complement receptor on the erythrocytes depends in MS on the disease process in the first place, and not on genetic factors. |
8042443 | Clozapine in the treatment of tremor in Parkinson's disease. | Tremor at rest is a classic symptom of Parkinson's disease that causes significant disability and distress for the patient and is generally only weakly responsive to conventional treatment, like anticholinergic and dopaminergic medication. This study describes the treatment with Clozapine in patients with Parkinson's disease, who despite optimal antiparkinson medical therapy still have a major disabling tremor at rest. Clozapine is an "atypical" neuroleptic agent, producing fewer extra pyramidal side effects common to conventional antipsychotic drugs. Clozapine, however, has as its most serious complication agranulocytosis, and hence all patients taking Clozapine must undergo blood tests at least several times a month. Under these frequent blood monitoring conditions, in this study Clozapine produced a substantial alleviation of parkinsonian tremor in 17 of 23 patients (73%). The beneficial response was reached with a relative low dose of Clozapine (18 mg./day), while previous antiparkinson medication was kept unchanged. The improvement of tremor at rest was noticeable generally within 2 weeks of beginning Clozapine therapy. No tolerance to the antitremor efficacy of Clozapine was seen during study-period of at least 6 months. Leucopenia developed in one patient, other major adverse events were hypersalivation and day-time drowsiness. These findings confirm the substantial antitremor efficacy of Clozapine in Parkinson's disease. |
8042442 | Old-onset Parkinson's disease compared with young-onset disease: clinical differences and similarities. | Of 261 patients with clinically diagnosed Parkinson's disease (PD), whose age at the onset was 58.2 +/- 11.3, 46 patients with the onset age above 70 (the mean for the whole group + 1SD) were compared to 44 patients with onset age below 47 (the mean for the whole group - 1 SD). Old-onset PD patient were more susceptible to develop psychotic complications of levodopa treatment. More often had they tremor both as presenting and dominant symptom of their disease. Among young-onset PD bradykinesia was more often the dominant clinical feature, and susceptibility to levodopa induced dyskinesia was higher. In 9 cases of young-onset PD (20.5% of this group) paraesthesia was a presenting symptom, compared to only 1 patient (2%) in the group of old-onset PD. |
8042441 | Could seborrhoeic dermatitis be implicated in the pathogenesis of parkinsonism? | The spouses of a group of aged sufferers have been demonstrated to have multifarious differences relevant to parkinsonism from matched controls, which were difficult to explain by selective mating, learned or reactive behaviour. Could parkinsonism be transmissible? The frequency of inflammation and scaling on head or neck was greater (P = 0.05) in these spouses (19 available) than in controls (36), the best discriminating site of inflammation being scalp (P = 0.02). Both seborrhoeic dermatitis and overt, or pre-clinical, parkinsonism occurred in sufferers and spouses: to presume they are not causally related is to accept multiple entities. In favour of seborrhoeic dermatitis being causal for parkinsonism, rather than vice versa, is the involvement of a known organism, Pityrosporum ovale, in the dermatitis, and that the evidence of parkinsonism in the spouses indicated that they were only part way down the path towards the clinical condition. |
8042440 | Clinical diagnosis of Parkinson's disease. Proposal of diagnostic subgroups classified at different levels of confidence. | The objective of this paper is to evaluate the accuracy of conventional diagnostic criteria for Parkinson's disease and give an overview of alternative causes to parkinsonian syndromes. We also propose a new approach to the clinical diagnosis of Parkinson's disease, which may improve the diagnostic accuracy. The available information on autopsy findings in patients clinically diagnosed as Parkinson's disease shows that 20 to 30% of these patients do not have the typical neuropathological features with Lewy bodies and cell loss in the substantia nigra. The use of selected additional clinical criteria improves the diagnostic accuracy, however, at the cost of rejecting a rather large group of patients with idiopathic disease verified by autopsy. Based on this fact and a review of the literature on parkinsonian syndromes that may be confused with idiopathic Parkinson's disease, we propose criteria for diagnostic subgroups of the disease classified at different levels of confidence. The suggested diagnostic subgroups are clinical definite, probable and possible Parkinson's disease with a decreasing level of specificity and an increasing level of sensitivity in the different patient categories. The clinical features given special importance in this classification includes presence of resting tremor, asymmetrical disease, response to dopamine agonism and presence of atypical clinical features like dementia and clinical autonomic failure at onset and pyramidal or cerebellar signs at examination. In addition, a history indicating possible etiology for another parkinsonian syndrome will exclude the diagnosis. |
8042434 | Oncocytic neuroendocrine carcinoma of the pancreas. Report of a case with needle aspiration cytology, immunocytochemistry and electron microscopy. | Needle aspirate of a histologically, immunochemically and ultrastructurally confirmed oncocytic neuroendocrine carcinoma of the pancreas revealed single and loosely clustered polygonal cells with abundant, granular, defined cytoplasm and oval, hyperchromatic nuclei. |
8042433 | Cytologic diagnosis of extrapulmonary Pneumocystis carinii infection in pleural and ascitic fluid. Report of a case in a patient with the acquired immunodeficiency syndrome. | We present a case of an extrapulmonary Pneumocystis carinii infection in a human immunodeficiency virus-positive patient undergoing prophylactic treatment with pentamidine. The diagnosis was established in pleural and ascitic fluid, and the patient died before starting specific systemic treatment. We discuss the cytologic differences between pulmonary and extrapulmonary infections and the importance of careful screening for this pathogen in immunosuppressed patients. |
8042432 | Metastatic squamous cell carcinoma of the tonsil presenting as multiple cystic neck masses. Report of a case with fine needle aspiration findings. | A case of squamous cell carcinoma with multiple cystic metastases to the neck is reported. The tumor originally presented as a tender left neck mass clinically misdiagnosed as an abscess secondary to infected dental caries. Subsequently, multiple cervical neck cysts developed, and fine needle aspiration (FNA) of two of them demonstrated metastatic squamous cell carcinoma. A tonsillar primary was found. Metastatic squamous carcinoma of the tonsil often presents as a solitary neck cyst that may be confused with a benign lesion. On FNA the lesion must be distinguished from branchial cleft cyst and Warthin's tumor with squamous metaplasia. |
8042431 | Primary pulmonary lymphoma. Report of a case diagnosed by fine needle aspiration cytology. | A case of primary pulmonary lymphoma, small lymphocytic type, with plasmacytoid differentiation (lymphoplasmacytic lymphoma) and IgM gammopathy, was diagnosed by fine needle aspiration of the lung. It was further substantiated by pleural fluid cytology, biochemical and immunologic parameters, and the clinical picture. This case is documented for its rarity along with a review of literature on the diagnosis of low grade small lymphocytic lymphomas. |
8042430 | Bronchoalveolar lavage in a girl with Gaucher's disease. A case report. | A case of Gaucher's disease with pulmonary involvement occurred. Numerous Gaucher cells were seen in bronchoalveolar lavage (BAL) fluid on two occasions in a girl with Gaucher's disease and respiratory symptoms. The Gaucher cells resembled macrophages with eccentric, small, oval nuclei but were distinguished by their abundant cytoplasm with the characteristic "rumpled tissue paper" appearance. The Gaucher cells were in a cellular background composed mainly of macrophages. These cells stained strongly positive with periodic acid-Schiff stain. Electron microscopy revealed numerous intracytoplasmic, elongated, membrane-bound lysosomes containing the characteristic twisted tubular structures. Severe pulmonary involvement is seen infrequently in all types of Gaucher's disease, and it is especially rare in the adult and juvenile forms (types I and III). To our knowledge, Gaucher cells have never been found before in BAL fluid. This case shows that BAL can be a useful adjunct in diagnosing and following the progression of pulmonary involvement in patients with Gaucher's disease. |
8042429 | Fine needle aspiration cytology of chondroblastoma and chondromyxoid fibroma. A report of two cases. | The fine needle aspiration cytology in two cases of chondroblastoma and chondromyxoid fibroma are described. The diagnosis of chondroblastoma was made on a recurrent tumor of which the histopathology was known, whereas chondromyxoid fibroma was diagnosed initially on fine needle aspiration cytology. The radiologic appearances and differential diagnoses of these chondroid neoplasms are discussed. |
8042428 | Fine needle aspiration cytology of acrometastasis. A report of two cases. | We describe two cases of adenocarcinoma metastatic to the fingers diagnosed by fine needle aspiration (FNA). In one case pain in the finger lesion was the presenting symptom of bronchogenic carcinoma, and the cytologic examination led to discovery of the primary neoplasm. In the second case, FNA of the finger lesion helped document the presence of extensive osseous metastasis from a primary adenocarcinoma of the gastroesophageal junction. These cases illustrate the usefulness of FNA biopsy in distinguishing acrometastasis from other, more common, nonneoplastic, destructive lesions, which it can mimic clinically. |
8042427 | Unusual immunocytochemical and ultrastructural features of synovial fluid cells in multicentric reticulohistiocytosis. A case report. | We present the first report in which cells in synovial fluid from a patient with multicentric reticulohistiocytosis (MRH) were studied by immunocytochemistry for correlation with routine light and electron microscopy. MRH cells stained predominantly for lymphocyte-related surface antigens and not for the monocyte marker LEU M3 (CD14). These findings suggest a lymphocytic origin of MRH cells and not a histiocytic origin, as previously suggested. In addition, large numbers of membrane-bound, electron-dense, secretory-type granules were found ultrastructurally in the cytoplasm of these cells. |
8042426 | Cutaneous endometriosis as a diagnostic pitfall of fine needle aspiration biopsy. A report of three cases. | We describe the cytologic features of three cases of cutaneous endometriosis in young women (average age, 27 years); two cases presented as lower abdominal nodules associated with a previous cesarean section scar. The third case presented as a 5 x 4-cm inguinal mass. The smears were generally cellular, consisting of epithelial and stromal fragments. Epithelial cells showed large, hyperchromatic nuclei and moderate amounts of cytoplasm, with considerable nuclear overlapping. The stromal aggregates also showed crowded, overlapping nuclei and scant, admixed, hemosiderin-laden macrophages. These features, combined with isolated cells in the background, made differentiation from metastatic carcinoma extremely difficult. Cutaneous endometriosis can present a diagnostic pitfall on fine needle aspiration, especially in the absence of a previous history of abdominal surgery or established diagnosis of endometriosis. |
8042425 | Testicular embryonal rhabdomyosarcoma diagnosed by fine needle aspiration cytology. A report of two cases. | During a 12-year period, 1980-1992, two cases of testicular embryonal rhabdomyosarcoma were diagnosed by fine needle aspiration cytology at the Shiraz University Hospitals. The smears revealed various types of cells including spindle cells, strap cells, rhabdomyoblasts, round cells and tadpole cells with a high nuclear/cytoplasmic ratio. Cross-striations were noticed in the cytoplasm at higher magnification under oil immersion. The cytologic diagnoses of embryonal rhabdomyosarcomas were confirmed on histologic sections. |
8042424 | Leiomyosarcoma of the kidney. Report of a case diagnosed by fine needle aspiration cytology and electron microscopy. | A 41-year-old man presented with a large abdominal tumor that yielded, in the fine needle aspiration biopsy, dyshesive, pleomorphic malignant cells. Electron microscopy of the aspirated material revealed nonepithelial cells showing intracytoplasmic bundles of microfilaments with vague focal densities and micropinocytotic vesicles along the cell membrane, suggesting a malignant leiomyosarcoma, which was confirmed by microscopic examination of the resected right kidney. The patient died four months after surgery from widespread metastases. |
8042423 | Retroperitoneal endodermal sinus tumor. Report of a case with an abnormal cervicovaginal smear. | An unusual case of an endodermal sinus tumor arising in the retroperitoneum and invading the fallopian tube is reported. The patient presented with malignant cells mimicking adenocarcinoma in the cervicovaginal smear. The differential diagnoses of such cells in cervicovaginal cytology are discussed. The cytohistologic, immunohistochemical and ultrastructural findings of the tumor are correlated. |
8042422 | Unsuspected metastatic renal cell carcinoma diagnosed by fine needle aspiration biopsy. A report of four cases with immunocytochemical contributions. | Fine needle aspiration biopsy (FNAB) is currently considered a valid procedure in the diagnosis of various primary and metastatic neoplasms. It is also known that computed tomography (CT)-guided percutaneous FNAB of the kidney is very useful in diagnosing primary renal cell carcinoma (RCC) and has a high accuracy rate. Nonetheless, its usage in the detection of unsuspected metastatic RCC has been described rarely. Below we report four unusual cases of metastatic RCC discovered by FNAB. The patients presented with subcutaneous, pulmonary, adrenal and flank masses with no previous history of RCC. Immunocytochemical (ICC) stains, including cytokeratin, epithelial membrane antigen, vimentin and fat stain, were obtained on two cases and were very helpful in establishing the diagnosis. We suggest that cytopathologists consider metastatic RCC a possibility when evaluating patients with tumors of unknown origin and that FNAB can be useful in diagnosing unsuspected metastatic RCC, especially when assisted by ICC and fat stain. |
8042421 | Relationship of cytomorphology to spirometric findings in cigarette smokers. | The objective of the study was to determine the relationship between sputum cytomorphology and pulmonary function. A cross-sectional correlation analysis of results from pulmonary function testing and eight cytomorphologic indices of inflammation and metaplasia was conducted in 143 smokers registered in a residential smoking-cessation program. Stepwise multiple regression analysis revealed that after adjusting for age and smoking history, lower levels of pulmonary function were related significantly to higher levels of macrophage pigmentation, neutrophils and metaplasia. Higher levels of macrophages were associated with higher levels of pulmonary function. The overall regression coefficient, 0.35, was highly significant (F[5,136] = 14.84, P = .0001). Categorical analyses revealed that smokers with high counts of neutrophils, macrophage pigmentation, columnar cells, spirals and metaplasia were two to three times more likely to have abnormal pulmonary function than were those with low counts. From these results we conclude that elevations in certain cytologic indices are associated with abnormal lung function. These findings may reflect the pathophysiology of obstructive lung disease. Longitudinal studies are required to determine whether cytomorphologic parameters can identify individuals at risk for functional deterioration at a stage amenable to intervention. |
8042420 | Cytologic examination and carcinoembryonic antigen assay of fine needle aspirates of bone tumors. | A prospective study of 28 consecutive fine needle aspirates of bone was conducted comparing the sensitivities of cytologic diagnosis with carcinoembryonic antigen (CEA) content to determine if the CEA assay could enhance the sensitivity of cytologic diagnosis of carcinoma metastatic to bone. Aspirates obtained radiologically or at surgery underwent cytologic examination and CEA assay. Cytologic examination was performed on Papanicolaou-stained smears and/or cell blocks. CEA was measured with an enzyme immunoassay; 5 ng/mL was used as the cutoff. Twenty-one were malignant and seven benign. The sensitivities of cytology and CEA were 85% and 47.6%, respectively, and the specificities, 100%. Mean CEA and sensitivity were highest for adenocarcinoma of lung (361.5 ng/mL, 77%), lowest for carcinoma of breast and negative for lymphoma, myeloma and benign aspirates. High CEA was useful in (1) suggesting adenocarcinoma of lung in patients with an unknown primary, (2) suggesting a new primary lung adenocarcinoma in a patient with previous transitional cell carcinoma of bladder, and (3) discriminating lung adenocarcinoma from adenocarcinomas of kidney, thyroid, prostate or endometrium. |
8042419 | Immunocytochemical characterization of isolated human type II pneumocytes. | The expression of surface antigens on human type II pneumocytes is unknown but may be important in diagnostic cytology of bronchoalveolar lavage specimens. Thus, the immunocytochemical reactivity of isolated human type II pneumocytes was determined using a panel of commercially available monoclonal antibodies (MAbs). Type II pneumocytes were isolated from fresh human lung tissue obtained from surgical specimens (four non-smokers, six heavy smokers) after enzymatic digestion with dispase and subsequent discontinuous metrizamide gradient centrifugation. MAbs OKIa; EMA; OKT9; BMA 130a, b and c; EP4; TAG 72; HEA 125; and Leu M1 were studied using the peroxidase-antiperoxidase adhesive slide assay method. In all cases, type II pneumocytes reacted positively with OKIa, BMA 130a, BMA 130b, EMA, EP4, TAG 72 and HEA 125 and negatively with OKT9, BMA 130c and Leu M1. The percentage of positively reacting type II pneumocytes was 90 for OKIa, HEA 125 and EP4; 80 for EMA; 50 for TAG 72 and BMA 130a; and 5 for BMA 130b. Human type II pneumocytes share the expression of several antigens with epithelial tumor cells. This limits the usefulness of these markers with respect to differentiating between reactive type II pneumocytes and malignant cells. |
8042418 | Poster color application for cytologic smear identification. | A new method of marking cytologic smears was devised using commercially available poster color. Dots made with poster color proved to be more readily visible than those made with conventional ink. |
8042417 | Management of suboptimal cytologic smears. Persistent inflammatory smears. | In this study, cytologic smears from 161 women presenting with persistent inflammation were reviewed and the cytologic diagnoses compared with the colposcopic and biopsy findings. When colposcopy was performed and information was available for evaluation (102 cases), 62.7% (64 cases) had abnormal colposcopic findings requiring treatment. The similar figure for biopsy was 76.2% (64 of 84 cases). Of significance was the proportion of major advanced abnormalities requiring immediate treatment. Colposcopy and biopsy, respectively, revealed 7.9% and 19.1% of cases with high grade squamous intraepithelial lesions (CIN 2) or worse. These striking data reinforce the importance of recommending colposcopy as a means of managing persistent inflammation in cytologic smears. |
8042416 | AgNOR counts as a discriminator of lesions of the endocervix. | Recently the argyrophil for staining proteins associated with nucleolar organizing regions (AgNORs) has been applied widely in cytohistopathology in various malignancies. Nucleolar organizer region-associated proteins (NORs) are located on the short arm of chromosomes 13, 14, 15, 21 and 22. We applied the technique to 78 cytologic smears from the endocervix stained with the Papanicolaou technique. These included 36 normal endocervical cases, 17 reactive endocervical cases, 19 dysplastic endocervical cases and 6 endocervical adenocarcinoma cases. Statistically significant differences were found between AgNOR counts from normal endocervical smears and smears of endocervical gland dysplasia (P < .001), between normal endocervical smears and smears of endocervical adenocarcinoma (P < .001), between reactive endocervical smears and smears of endocervical gland dysplasia (P < .001) and between reactive endocervical smears and endocervical adenocarcinoma (P < .005). The AgNOR technique appears useful as an adjunct in the diagnosis of endocervical lesions. |
8042415 | Age-related changes in the size of thyrocyte nuclei in aspirates from nontoxic nodular goiter. | It is believed that the size of thyrocyte nuclei correlates with the age of the patient in both normal thyroid tissue and nodular goiter. Therefore, we examined karyometric parameters in aspirates obtained from 38 patients ranging from 18 to 79 years (48.8 +/- 15.2, mean +/- SD). Routine cytologic evaluation revealed nodular goiters in all the patients. Subsequently, the same smears were analyzed with a computer system for karyometric measurements. The mean volume, intersection area and perimeter of nuclei of thyrocytes from nodular goiters correlated positively with age. The results suggest that the age of the patient should be considered when interpreting thyrocyte nuclear size during cytologic examination. |
8042414 | Fine needle aspiration biopsy of pediatric orbital tumors. An immunocytochemical study. | Specific antibodies against neuron-specific enolase, leukocyte common antigen and desmin were assessed for their usefulness in the cytodiagnosis of 23 cases of pediatric orbital round cell tumors (10 cases of orbital recurrence of retinoblastoma, 11 cases of embryonal rhabdomyosarcoma and 2 cases of inflammatory pseudotumor). Alcohol-fixed, Papanicolaou-stained smears were decolorized and stained with monoclonal antisera using the peroxidase-antiperoxidase procedure. Twenty of 23 aspirates were positively immunostained with antisera against leukocyte common antigen, desmin and neuron-specific enolase. Eight of 10 cases of clinically diagnosed orbital recurrence of retinoblastoma showed strong monotypic staining with anti-neuron-specific enolase antiserum. More than 50% of tumor cells in 9/11 cases of embryonal rhabdomyosarcoma were also immunopositive with this antiserum. Desmin positivity was seen in 10/11 cases of embryonal rhabdomyosarcoma, whereas immunopositivity with leukocyte common antigen was detected in both cases of inflammatory pseudotumor. These results indicate that the use of a panel of monoclonal antibodies on aspirate smears is imperative for establishing the diagnosis and classification of pediatric round cell orbital tumors. |
8042413 | Asbestos content of bronchoalveolar lavage fluid. A comparison of light and scanning electron microscopic analysis. | We studied the asbestos content of bronchoalveolar lavage fluid (BALF) from 9 patients with asbestosis, 17 asbestos exposed but without asbestosis, 15 with idiopathic pulmonary fibrosis (IPF) and 9 nonexposed volunteers. The cellular lavage pellet was digested and filtered for asbestos body (AB) quantification by light microscopy (LM) and analysis of numbers and types of uncoated fibers (UF) by scanning electron microscopy (SEM) and energy dispersive x-ray analysis. BALF of asbestosis patients had significantly higher AB content than that of the combined IPF and volunteer groups. The UF content as determined by SEM was similar in all four groups. Commercial amphiboles (amosite or crocidolite) were identified more frequently in BALF from patients with asbestosis than from the other groups. ABs were detected by SEM only in highly exposed individuals. We conclude that the findings of > 1 AB per 10(6) cells or 1 AB/mL BALF by LM and of ABs or commercial amphibole fibers by SEM are indicative of considerable exposure to asbestos in the majority of cases. |
8042412 | The alcohol-fixed Diff-Quik stain. A novel rapid stain for the immediate interpretation of fine needle aspiration specimens. | A rapid alcohol-fixed Diff-Quik stain is described. The technique takes less than five minutes and results in excellent cytologic detail, comparable to that with Papanicolaou stain, as well as superb stromal definition. The stain should be very useful to pathologists and cytotechnologists for immediate interpretation of fine needle aspiration specimens. |
8042411 | Cytology requisition log-in with a minimum of keyboard entry. | Virtually every cytology laboratory invests considerable staff time in the entry or log-in of specimens into a laboratory information system. In many cases these systems are not optimized for rapid entry of the data. We describe a combination of two techniques (fastkey/macros and bar code) that has enabled us to reduce the number of keystrokes required for cytologic smear accessioning and to improve the overall efficiency of the requisition entry process by 25%. Similar techniques could be used with a wide variety of information systems. |
8042410 | [Expression of myogenic differentiation program in cultured normal postmitotic mononucleated myoblasts and the aberrant differentiation in rhabdomyosarcoma cells]. | Development of primary cultured chicken myogenic cells were studied using living cell micro-morphoanalysis, muscle specific protein immunofluorescent double staining, image projection analysis and 3H-TdR incorporation autoradiography methods. Changes in single, normal newborn myoblasts from the time of their last mitosis until 22 hr old were followed. All +/- 4 hr myoblasts were desmin+ and most were positive for alpha-actinin, zeugmatin, troponin-I (TnI), alpha-actin. titin, nebulin and myosin heavy chain (MHC). There was no obligatory temporal or spatial sequence in the order of the appearance of the major myofibrillar proteins. Nascent sister myoblasts assumed an exceptionally elongated bipolar morphology that is as singular to mononucleated postmitotic myoblasts as is their capacity to transcribe myofibrillar genes. The assembly of non-striated myofibrils (NSMFs) was evident in all 6-8 hr cells and was initiated in the absence of myomesin and C-protein. Myomesin first appeared along NSMFs in 10-14 hr old cells. C-protein was only found localized to transverse doublets bisecting 1.6 microns wide A-bands of assembled sarcomeres. Each newly assembled sarcomere presented the same invariant distribution of proteins that is found in adult sarcomeres. There is a lag of 16 or more hours between the first appearance of most of the major myofibrillar proteins and their assembly into NSMFs and the first appearance of striated myofibrils (SMFs). The observations indicated that the majority of normal myoblasts up-regulate the synthesis of myofibrillar proteins prior to, not after, fusion. In brief, new-born +/- 4 hr myoblasts expressed their differentiation program in the process as (1) withdrawal from the cell cycle: (2) initiation of synthesis and accumulation of desmin and 7 early myofibrillar proteins: (3) cellular elongation and assembly of NSMFs and SMFs: (4) acquisition of a fusion-competent sarcolemma. The expression of this cell autonomous myogenic differentiation program is distorted or blocked in rhabdomyosarcoma RD cells. The majority of RD cells expressed desmin (50-90%): among these desmin+ cells, 10-20% incorporated 3H-TdR. In addition, 60-78% of the mitotic cells were desmin+. Most desmin+ cells were myofibrillar protein negative. Only a small number of tumor cells (5-10%) expressed MHC, titin, alpha-actinin and s-alpha-actin. 3H-TdR positive nuclei were observed in these myofibrillar protein+ cells: 11-12% in titin+ or nebulin+ cells and 4% in MHC+ cells. But none of the mitotic cells were myofibrillar protein+.(ABSTRACT TRUNCATED AT 400 WORDS) |
8042409 | [Effect of indomethacin on H+ transportation of pig gastric H+/K(+)-ATPase]. | As a noncompetitive inhibitor of pig gastric H+/K(+)-ATPase, indomethacin inhibited the H+ transportation function of the enzyme, leading to not only the obvious dissipation of H+/K(+)-ATPase-generated H+ gradients, but also the decreasing of the H+ gradient formation ability of the enzyme. 4% of indomethacin was able to penetrate into the lipid bilayer of H+/K(+)-ATPase vesicles at 0.15 mg/ml protein concentration, which showed an influence of indomethacin to the membrane. Indomethacin reduced the membrane fluidity of H+/K(+)-ATPase vesicles significantly. It also damaged the conformation of membrane protein extraordinarily, which was evidenced by decreasing the intrinsic fluorescence of H+/K(+)-ATPase. From the results, we suggest that the effect of indomethacin on H+/K(+)-ATPase is taken place by its inhibition on H+/K(+)-ATPase protein, as well as by its influence on the membrane lipid bilayer of H+/K(+)-ATPase vesicles. |
8042408 | [Nuclear reconstitution around purified HeLa chromosomes in a cell-free system from Xenopus eggs]. | Activated Xenopus egg extracts are capable of reconstituting nucleus around the added DNA or chromatin. To understand better the nuclear reconstitution process and the structure of the assembled nucleus, we have developed a cell-free system using activated Xenopus egg extracts and metaphase chromosomes of HeLa cells. We demonstrate that the extracts are efficient promoting the decondensation of the metaphase chromosomes and the nuclear reconstitution around the chromosomes, and that the nuclear reconstitution is a precise process. The reassembled nucleus possesses a typical nuclear envelope, pore complexes, nuclear lamina, nuclear matrix, chromatin, etc., as shown by electron microscopy, embedment and embedment-free electron microscopy, and immunofluorescence method. We also found that the annulate lamellae directly take part in nuclear envelope and pore complex reconstitution by fusing with the double membrane, having reassembled on the surface of chromatin/chromosomes. |
8042407 | [Studies on mechanism about ATP inhibited the proliferation of MGC-803 cells]. | This experiment was to study the mechanism of ATP anticancer effects. By using flow cytometry, Scrape-Loading and dye transfer (SLDT), dot hybridization methods, changes of cell cycle phase distribution, gap junctional intercellular communication (GJIC), and oncogene expression were observed in human stomach mucous glandular carcinoma (MGC-803) cells treated with ATP (0.23 mg/ml). It was found that ATP inhibited the proliferation and arrested cell cycle in S phase. The ATP-treated MGC-803 cells increased in GJIC, and decreased in expression of c-Ha-ras oncogene. These results indicated that the inhibition of proliferation and increased GJIC was closely correlated with the reduction of c-Ha-ras oncogene expression. |
8042406 | [Study on the influence of enzymatic digestion upon tumor-infiltrating lymphocytes]. | To get a long-term culture of tumor-infiltrating lymphocytes (TILs) is very difficult. The authors have investigated some suitable enzymes, their digestive conditions such as time and temperature, which may influence the viability and cytotoxicity of TILs. The results showed that collagenase II and IV could keep viability of TILs much longer than those treated with trypsin or hyaluronidase. The digestion with collagenase II or IV at 4 degrees C for 24 hours was much less damage to viability of TILs than those treated at 37 degrees C for one hour. The TILs, which digested at 4 degrees C for 24 hours, still had cytotoxicity against autologous tumor cells as long as sixty to seventy-five days. |
8042402 | [Regional cerebral blood flow as dependent on the nature of the occlusive lesion of the branches of the aortic arch]. | A 133Xe radionuclide investigation was employed for examination of regional cerebral circulation with 5% carbogen mixture loading in patients with occlusions of the aortic arch major arteries. It was established that a positive response to carbogen mixture inhalation indicates a compensated cerebral circulation irrespective of the arterial lesion type and number. The negative vascular response is associated with uni- or bilateral reduction of the regional cerebral circulation depending on the type and severity of the arterial involvement. |
8042401 | [Aneurysms of the cerebral vessels and pneumococcal infection]. | Two cases of cerebral aneurysm rupture with repeat subarachnoidal haemorrhage are reported in patients with pneumococcal infection confirmed bacteriologically. It is concluded that in pathogenesis of the aneurysmal rupture in pneumococcal infection a significant role is played not only by pneumococcal tropism to the meninges, but also by affection of the endothelium and cerebral vascular membranes, hemostasis defects, arterial hypertension as manifestations of a general adaptation syndrome. |
8042399 | [The concept of including psychiatry in insurance medicine]. | Arguments for restructuring of psychiatric service on the principles of medical insurance are given. Because mental disorders are characterized by chronic development and high disability rate, the necessity of mixed budget-insurance financing of psychiatry is grounded. Obligatory state insurance must be conducted for all mentally ill persons. However, only a certain part of outpatient care and the treatment period in hospital are to be insured, while the remaining part of outpatient visits or hospital stay will be financed from the budget. The method of calculation of the incurred number of the doctor's visits and the length of hospital stay during the year is discussed. |
8042398 | [The socioeconomic problems of a mental health service]. | The state and prospects of the development of mental health service are discussed. Special attention is drawn to the economic aspects of mental health service and financial problems, in particular. The principles of creation and utilization of financial resources for psychiatric facilities in conditions of medical insurance are given. Social and economic aspects of mental diseases and their cost for the society are considered. The conclusion is made on the priority of psychiatric care programmes among other programmes of health care, that must be solved on the state level. |
8042397 | [Visual evoked potentials and functional asymmetry in children with with different degrees of intellectual retardation]. | Visual evoked potentials (VEP) to flash and patterned visual stimuli have been recorded from occipital and central brain regions in 7-8-year-old boys with normal intellect (20 cases), with mental retardation (15 cases) and with oligophrenia of a debile degree (27 cases). A significant elongation of late-component latency has been revealed in motor brain areas VEP in oligophrenia group compared to normal subjects. A negative correlation between P190 component latency of motor area VEP to patterned visual stimulus and general and non-verbal intellectual indices has been stated in full right-handed subjects with intellectual deficiency. Such a relation was absent in right-handed patients with left dominant eye. |
8042396 | [EEG maturation and hemispheric functional asymmetry in 5- to 7-year-old children with general speech retardation]. | EEG and a hand-eye functional asymmetry (FAS) profile have been compared in children with general speech retardation (GSR, 45 cases) and in normal children (45 cases) aged 5-7 years. The least EEG deviations have been noted in healthy full right-handed cases. Some delay in EEG maturation as well as existence of pathologic activity foci mostly in associative cortical brain areas have been noted in healthy non-right-handed and in GSR children. The most pronounced EEG disturbances have been observed in GSR children, 40% of whom were ambidextrous, left-handed and cross-lateralized children. The percentage of non-right-handed cases in the healthy group was less and decreased up to the age of 7 years. Prenatal, perinatal and 1st year postnatal pathology have been revealed in 86.6% of children in GSR group (in comparison to 11.1% in normal control group). Such pathology is suggested to be the reason of dysontogenesis and probably to be involved in brain electrical activity maturation, in FAS profile and in speech development. |
8042395 | [An epidemiological method for studying the effect of elevated background radiation on the neuropsychic health of children]. | The children living in 4 regions of Russia contaminated as a result of the Chernobyl catastrophe were investigated. The control group consisted of the children of 2 regions which did not undergo this influence. The investigations were made 1-3 years after the catastrophe took place. An increase of etiologically non-clear asthenic-vegetative disorders was determined in the regions of radiation contamination. They were observed mainly among the children who had light residual organic cerebral deficiency. The authors cannot exclude the impact of the psychogenic factors. |
8042394 | [Panic anxious-depressive states in children and adolescents who have experienced natural disasters and catastrophes]. | 744 children and adolescents at the age of 1-17 years who underwent disasters (earthquakes) and catastrophes were observed. In 216 cases anxious-depressive conditions of different duration were revealed. These disorders were divided into 3 groups: the neurosis of fear (42.1%), phobia-like states of the type "panic disorders" (31.0%) and mixed somatogenic and psychogenic disorders of "panic type" (26.9%). The least favorable prognosis was noted in the 3d group. The questions of drug therapy and psychotherapy of every type of these disorders are discussed. |
8042393 | [The complex clinico-electrophysiological assessment of the motor disorders in patients in the early period of recovery from an ischemic stroke]. | A neurophysiological analysis of motor affections has been made in post-apoplectic patients during early convalescence. Altogether 26 patients aged 45-68 were examined on week 3-4 since ischemic hemispheric apoplexy. Magnetic stimulation of cerebral cortex motor zones, measurements of M-response and evoked skin sympathetic potential. Mild or moderate motor dysfunctions were characterized by reduced amplitude of the M-response and prolonged central pyramid conduction on the affected side. Severe paresis is associated with no M-response to magnetic stimulation of the cortex on the affected side. Pathogenetic mechanisms of the above disorders and their implications for treatment and rehabilitation are discussed. |
8042392 | [The catamnesis of patients with protracted forms of trichotillomania starting in childhood and adolescence]. | Sequelae of severe trichotillomania initiating in childhood and adolescence were studied in 26 patients aged 21-32. A mean prospective follow-up lasted for 13 years. Thirteen patients were qualified as healthy. In the rest trichotillomania remained the main symptom of the illness, in 9 patients the progressive disease became the basis for secondary psychopathies, pathocharacterological personality of deficiency type. The following factors reliably affecting the prognosis were revealed: residual-organic origin of trichotillomania, intensity, generalization and polymorphism of the habit, persistence of the syndrome development, severity of vegetative component, late therapy start. |
8042391 | [The clinical and neurophysiological aspects of Rett's syndrome]. | 36 children with Rett's syndrome were examined in respect to the illness stage and psychopathologic trends. It is supposed that relationship of EEG abnormalities to clinical stages reflects gradual involvement of different brain structures in the pathological process. Possibility of temporary interruptions in the disease progression is demonstrated. |
8042390 | [The premorbid characteristics of schizophrenia in adolescent and young patients with overevaluation tendencies]. | The author studied premorbid traits of personality in 42 patients with juvenile schizophrenia. The age-scale of the overvalued bents was determined with reference to a premorbid type of personality, the patients' age at the onset of schizophrenia and the appearance of the initial positive and negative schizophrenic symptoms. |
8042389 | [The epidemiological characteristics of schizophrenia with an onset in adolescence]. | A comparative clinical-epidemiological study was made in groups of schizophrenics with onset in adolescence hospitalized for the first time at the Regional Tomsk Mental Hospital in 1948-1951 (period I), in 1958-1961 (period II), in 1968-1971 (period III) and in 1978-1981 (period IV). A primary hospitalization rate in patients with adolescent schizophrenia has been stable for the last 30 years. In general population of schizophrenics hospitalized for the first time, a reliable proportional reduction of adolescent schizophrenics from the first till consequent periods (from 31.1% till 17.7%) was observed. Group I patients show reliable differences by severity of psychopathological disorders and lower level of socio-occupational adaptation in comparison with the other groups. According to 6-year follow-up data, clinical and socio-occupational characteristics of the patients show more frequent dissociation between clinical and social levels of adaptation which in half of the cases is manifested by low level of socio-occupational adaptation. |
8042388 | [Depersonalization as a developmental disorder of self-consciousness]. | The comparison of psychopathological and age characteristics of depersonalization was made for 114 schizophrenic patients. It has been concluded that depersonalization syndrome may be viewed as a developmental or dysontogenetic disorder of self-consciousness. In the majority of the cases depersonalization arises in adolescence which is the most critical period in the development of self-consciousness. Typical psychopathological features of depersonalization correspond to typical features of puberty identity crisis. |
8042387 | [The possibilities for prevention and rehabilitation at different stages in treating mentally ill children and adolescents]. | The results of rehabilitational and psychological correction of mentally ill children and adolescents in hospital, inpatient-outpatient and outpatient conditions and of the follow-up are presented. The problem of prevention and rehabilitation is reviewed in general. Some considerations on further perfection of the aid to mentally ill children are suggested. |
8042386 | [The prognosis of multiple sclerosis: computed tomographic comparisons]. | The authors analyze the data obtained at clinical and computed tomography (CT) examinations of 56 patients suffering from multiple sclerosis. The diagnosis was established by G. Schumacher's clinical criteria. Neurologic status of the patients was assessed according to J. E. Kurtzke. A clinical and CT evaluation demonstrates significant correlations between cerebral atrophy and motor insufficiency. Two variants of the disease course are recognized: 1) malignant with emergence of brain atrophy seen at CT as early as the disease year 1; 2) benign with appearance of CT evidence of cerebral atrophy later than the disease year 5. Working ability in variant 2 is recorded for longer periods. |
8042385 | [The clinico-angiographic manifestations of vascular spasm in the acute period of an aneurysm rupture]. | The clinical picture was compared to angiographic findings on the spasm in 85 patients in acute period of an aneurysmal rupture in the absence of the intracranial hematoma. Spasm-induced ischemia was responsible for cerebral dysfunction and neurological symptoms. Days 5-13 since the aneurysmal rupture can be viewed as a functionally significant spasm interval. To prevent repeat hemorrhages and brain ischemia, aneurysmal intervention should be conducted on early hours and days of the disease, before or during a less severe vascular spasm. |
8042384 | [The effect of pentoxifylline and nicergoline on the systemic and cerebral hemodynamics and on the blood rheological properties in patients with an ischemic stroke and atherosclerotic lesions of the major cerebral arteries]. | Pentoxifylline versus nicergoline therapy has been studied in 56 patients with atherosclerosis of major cerebral arteries who had ischemic apoplexy. Pentoxifylline enhances circulation primarily in the stenotic vessels, while nicergoline in the intact cerebral arteries. The former is more potent in inducing antiaggregation inhibiting spontaneous platelet and red cell aggregation and reducing blood viscosity. The results of the study suggest better response in case of pentoxifylline treatment of patients with hypo- and eukinetic circulation, while in nicergoline treatment hyperkinetic hemodynamics patients benefit more in view of the drug cardiodepressive activity. |
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