Recommendations from a multi-study evaluation of proposed criteria for staging reproductive aging.

In 2001, the Stages of Reproductive Aging Workshop (STRAW) proposed bleeding and endocrine criteria for defining the early and late menopausal transition stages. Based on expert consensus, STRAW recommended a shorter interval of amenorrhea than the commonly used 90-day amenorrhea criteria for late transition and a >7-day change in cycle length for early transition. The ReSTAGE collaboration used prospective menstrual calendar data from four cohorts (TREMIN, Melbourne Women's Midlife Health Project, Seattle Midlife Women's Health Study, and Study of Women's Health Across the Nation) to quantitatively evaluate STRAW's recommendations. This empirical assessment supported the STRAW recommendations that (1) > or =60 days of amenorrhea be used to define the late menopausal transition and (2) that early transition is consistent with a persistent 7 or more day difference in length of consecutive cycles. Serum follicle stimulating hormone (FSH) values > or =40 IU/l was an independent marker of the transition and, when occurring together with a bleeding marker, increased prediction of final menstrual period. Such a FSH criterion could be incorporated into the STRAW paradigm to facilitate prediction of proximity of the final menstrual period.     

Laboratory diagnosis in Ontario and the need for reform relative to the profession of chiropractic

The purpose of this paper is to provide an historical review of the progression of events within the jurisdiction of the province of Ontario related to the issue of laboratory diagnosis and the profession of chiropractic. The provisions of relevant legislation, task forces, Councils, reviews, consensus statements, Commissions and committees, are highlighted and discussed during respective time periods. Chiropractors had entitlement to order and perform laboratory tests until 1972 when a regulatory amendment, made without consultation with the chiropractic profession, precluded their continuing entitlement. Chiropractic patients require access to diagnostic laboratory services and equitable access to necessary laboratory services should be restored and preserved. This is consistent with the academic institutional accreditation standards of chiropractic education and the jurisdictional regulatory mechanisms of chiropractic practice and is consistent with both protecting and enhancing the public interest.     

Systematic and random errors in compression testing of trabecular bone

We sought to quantify the systematic and random errors associated with-artifacts in the platens compression test for trabecular bone. Our hypothesis was that while errors may depend on anatomic site, they do not depend on apparent density and therefore have substantial random components. Trabecular bone specimens were first tested nondestructively using newly developed accurate protocols and then were tested again using the platens compression test. Percentage differences in modulus between the techniques (bovine) proximal tibia [n = 18] and humerus [n = 17] and human lumbar spine, [n = 9] were in the range of 4-86%. These differences did not depend on anatomic site (p = 0.21) and were only weakly dependent on apparent density and specimen aspect ratio (r² < 0.10). The mean percentage difference in modulus was 32.6% representing the systematic component of the end-artifact error. Neglecting the minor variations explained by density and specimen size (approximately 10%), an upper bound on the random error from end-artifacts in this experiment was taken as the SD of the modulus difference (±18.2%). Based on a synthesis of data taken from this study and from the literature, we concluded that the systematic underestimation error in the platens compression test can be only approximated and is in the range of 20-40%; the substantial random error (±12.5%) confounds correction, particularly when the sample size is small. These errors should be considered when interpreting results from the platens test, and more accurate testing techniques should be used when such errors are not acceptable.     

Microvascular reconstruction of complex craniofacial defects.

Many large vault or skull base tumours are best treated by wide surgical excision and primary reconstruction using a microvascular free tissue transfer (free flap). We report 23 patients who were reconstructed using free flaps, eight having been previously treated surgically elsewhere and seven of whom had recurrent disease after radiotherapy. There was one flap failure and a local recurrence rate of 16% (3/19). The outcome at a mean follow-up period of 29 months, was 19 patients alive and four deaths.     

Surgical management of dysrhythmias in infants and small children.

Surgery for cardiac dysrhythmias is infrequently reported in infants and children as compared with adults. This report reviews 55 infants and small children (age, less than or equal to 5 years) operated on during the interval July 1, 1984 to December 31, 1991 for Wolff-Parkinson-White Syndrome (41), atrioventricular node reentry (two), atrial automatic tachycardia (two), and ventricular tachycardia (nine). Ages ranged from 3 weeks to 71 (mean, 29) months. Associated congenital heart defects were present in five (10%). Indications for surgery included failure of medical therapy, life-threatening dysrhythmias, and more recently, failure of catheter ablation. There were no hospital or late deaths. One patient sustained perioperative central nervous system injury. Surgery was successful in 52 of 55 (94.5%) (Wolff-Parkinson-White, 38/41 (93%); atrioventricular node reentry, 2/2 (100%); atrial automatic tachycardia, 3/3 (100%); ventricular tachycardia, 9/9 (100%). Ventricular function returned to normal in all 12 patients in whom it was abnormal before operation. Thus, surgical ablation is highly successful in the management of various forms of refractory or life-threatening dysrhythmias in infants and small children. Catheter ablation techniques require significant fluoroscopic time, are more difficult in infants, and as yet do not have adequate long-term follow-up. Accordingly, surgery may continue to play a role in this particular group of patients.