High-frequency (10-MHz) sonography demonstrated a cervical mass or lymphadenopathy, or both, during postoperative follow-up of 52 patients who had undergone surgery for thyroid cancer. Percutaneous biopsy with ultrasonographic (US) guidance was performed in all 52 masses, 44 of which were nonpalpable. Malignant cells were obtained in 29 biopsies, and the results of 20 biopsies were negative, yielding benign lymphocytes only. Results in three biopsies were nondiagnostic due to hypocellular specimens. Therefore, 94% of biopsy results (49) of 52) were confidently assigned as either positive (56%) or negative (38%) for malignancy. There were no complications. High-frequency sonography can demonstrate clinically occult thyroid bed tumor recurrence and lymph node metastases. US-guided biopsy is an accurate and safe technique to confirm or exclude malignancy in patients at high risk of recurrence of thyroid cancer. 相似文献
AIMS: The aim of the study was to examine trends in adolescent depression and anxiety symptoms from 1997 to 2006, using four time-points (1997, 2000, 2003, and 2006), and adolescent mental health service use in the same period, using three time-points (1997, 2000, and 2006). METHODS: Four cross-sectional population-based samples of 14- and 15-year-old students, attending the compulsory 9th and 10th grades of the Icelandic secondary school system, completed questionnaires relating to mental health. In total, 21,245 students participated in the four studies. RESULTS: Anxiety symptoms increased significantly for both boys and girls, throughout the period from 1997 to 2006. Depressive symptoms increased significantly for girls, while there were no significant changes in depression among boys. During the same time period, the proportion of adolescents who visited healthcare specialists, i.e. psychiatrists, psychologists and social workers, increased significantly. The results revealed that regular visits (six times or more during 1 year) to psychiatrists and psychologists increased significantly over the same period among girls but not among boys. CONCLUSIONS: The findings show that symptoms of depression and anxiety have increased among adolescents in Iceland. Future work would benefit from further research into the trends in risk and protective factors associated with these outcomes. The findings call particular attention to the increasing risk for depression and anxiety symptoms among girls. 相似文献
A prospective trial was undertaken to evaluate the efficacy of stimulated
in-vitro fertilization (SIVF) and stimulated intrauterine insemination
(SIUI) in couples with unexplained and mild male factor infertility. In
all, 80 couples were allocated to treatment with SIVF or SIUI, both
treatments following the same protocol [clomiphene citrate and follicle
stimulating hormone (FSH) injection], except that higher doses of FSH were
used in the SIVF treatment cycles. Initially, 41 couples were allocated to
and started treatment with SIVF but eight cases were eventually converted
to SIUI because of under-response. Similarly, although 39 couples were
initially allocated to SIUI treatment, five of these converted to SIVF
because of over-response. The treatment cycles that were converted either
to SIUI or to SIVF were not considered as treatment failures but as
treatment changes and so were included in the analyses. Of the final 38
SIVF cycles, four were cancelled (dysfunctional response), failed
fertilization occurred in five cycles and 29 subjects reached embryo
transfer. There were two biochemical pregnancies [positive human chorionic
gonadotrophin (HCG) only], two clinical abortions and seven live births. Of
the final 42 SIUI cycles, only two were cancelled, insemination being
performed in the remaining 40 cases. The result was one clinical abortion,
three ectopics and eight live births. The proportion of cycles with
positive HCG was identical (28.9% per cycle treated for SIVF and 28.6% for
SIUI) and the livebirth rates were also not different (18.4% per cycle
treated for SIVF and 19.0% for SIUI). The cost per maternity of SIUI was
approximately half that of SIVF (Pounds Sterling 1923 versus Pounds
Sterling 4611) and so we conclude that, as SIUI had an efficacy that was
not significantly different from SIVF (using similar protocols) but was
more cost-effective, it must be considered the more appropriate form of
management for the treatment of unexplained and mild male factor
infertility. Indeed, it is hard to justify the routine use of IVF, as a
first approach, in unexplained infertility.
相似文献
Numerous agencies have developed clinical practice guidelines for the management of postmenopausal osteoporosis. The study
objective was to conduct a systematic assessment of the quality of osteoporosis guidelines produced since 1998. 相似文献
Twelve women with established lactation of 4–8 weeks duration were given a low-dose progestogen-only contraceptive, ethynodiol diacetate 0.5 mg (Femulen) daily. On the seventh and eighth day of the study, prior to the mother's taking the pill, a blood sample was taken from her and from the infant. Further blood samples were collected from the mother 4 and 12 hours later. Breast milk samples were collected at every feed on day 7 and day 8.
Ethynodiol diacetate is rapidly metabolised in humans, changing into the metabolite norethisterone which is found in both blood and milk. Hence, norethisterone concentrations were estimated.
On day 7 and day 8, four hours after ingestion of the pill, the median norethisterone maternal plasma concentration was 1.60 ng/ml and it fell to a median level of 0.30 ng/ml prior to the next dose of the pill. At this time the median infant concentration was 0.10 ng/ml but the maximum observed level was 0.50 ng/ml.
In the breast milk the norethisterone concentration appears to peak at around 4–8 hours following the ingestion of the pill. The maximum observed concentration in breast milk was 0.84 ng/ml. The amount of norethisterone ingested by the infant averaged 0.02% (6.65 μg) of the dose of ethynodiol diacetate ingested by the mother. The maximum observed on any one day was 0.07% (27.52 μg).
The above results indicate that the amount of progestogen ingested by the infant from its mother's milk is small and is unlikely to pose a risk to the infant. 相似文献
Little is known about the efficacy and the factors affecting the outcome of
fine needle aspiration biopsy of the testis for sperm retrieval in
azoospermic men with defective spermatogenesis. A prospective study was
designed to compare the efficacy of needle and open (window) testicular
biopsies for testicular epididymal sperm extraction (TESE) in 35
consecutive men with azoospermia due to defective spermatogenesis
undergoing testicular biopsy for intracytoplasmic injection of oocytes.
Each of the consecutive 35 patients underwent TESE using a 19 gauge
butterfly needle followed by a window (1-1.5 cm-sized incision) testicular
biopsy in the same procedure. The extraction of spermatozoa into culture
medium was compared with the assessment of testicular biopsies by
histology, the mode of biopsy (needle or open biopsy) and the amount of
tissue retrieved by either method. Testicular spermatozoa were retrieved in
22 (63%) who had an open testicular biopsy compared with five (14%)
patients who had multiple needle biopsies, respectively; the difference was
statistically significant. Open testicular biopsy retrieves more testicular
tissue than needle biopsy. Needle testicular biopsy retrieved testicular
spermatozoa in 50% of those with hypospermatogenesis, 10% with focal
spermatogenesis and in no patients with maturation arrest or Sertoli
cell-only pattern. In contrast, sperm retrieval was successful in 100%, 90%
and 66% of those with respective histologies using open testicular biopsy.
Other than bruising, for which they required no analgesia, none of the
patients suffered any obvious complications associated with traditional
testicular biopsy. We conclude that open testicular biopsy is more
effective than needle biopsy for the retrieval of testicular spermatozoa in
azoospermic men with defective spermatogenesis. The difference observed may
be related to the amount of testicular tissue retrieved and to the
influence of testicular histology.
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Purpose: To review and characterise biomechanical approaches for the measurement of spasticity as one component of the upper motor neurone syndrome. Method: Systematic literature searches based on defined constructs and a four-step review process of approaches used or described to measure spasticity, its association with function or associated phenomena. Most approaches were limited to individual joints and therefore, to reflect this trend, references were grouped according to which body joint(s) were investigated or whether it addressed a functional activity. For each joint, references were further sub-divided into the types of measurement method described. Results: A database of 335 references was established for the review process. The knee, ankle and elbow joints were the most popular, perhaps reflecting the assumption that they are mono-planar in movement and therefore simpler to assess. Seven measurement methods were identified: five involving passive movement (manual, controlled displacement, controlled torque, gravitational and tendon tap) and two involving active movement (voluntary and functional). Generally, the equipment described was in an experimental stage and there was a lack of information on system properties, such as accuracy or reliability. Patient testing was either by cohort or case studies. The review also conveyed the myriad of interpretations of the concept of spasticity. Conclusions: Though biomechanical approaches provide quantitative data, the review highlighted several limitations that have prevented them being established as an appropriate method for clinical application to measure spasticity. 相似文献
Seven children with significant idiopathic short stature (SISS) whose heights were significantly below the third percentile (SD score for height —2.5 to —3.5) and who had normal levels of growth hormone (GH) were treated with growth hormone releasing hormone (GH-RH) in a dose of 30 /μg/kg/day. Therapy was discontinued if patients failed to increase their rates of growth by more than 2.0 cm/year over their pre-therapy growth rate. Treatment was discontinued in two of the patients after 12 months but was continued in the other five for 24 months. These data demonstrate that some patients with SISS grow well during the first 2 years of treatment with GH-RH. 相似文献