Weight management issues and strategies for people with high cardiovascular risk undertaking an Australian weight loss program: A focus group study

Obesity is particularly hazardous for people with multiple cardiovascular risk factors and existing cardiovascular disease, although few studies investigate experiences and perceptions of weight loss in this population. This study provides an understanding of participants' knowledge, attitudes, and experiences of managing multiple risk factors and/or existing cardiovascular disease of participants who were undertaking a weight loss program. Thirty‐five participants were recruited from the first 50 completing a multicomponent group‐based weight loss intervention designed to follow cardiovascular disease and diabetes disease management programs. Four focus group interviews were conducted using a semistructured interview schedule. Data were analyzed using an inductive approach, and themes developed. Participants found the process of weight loss to be complex, dynamic, and challenging, as the conflicting needs of existing health conditions, social support, ambivalence, and time limitations required careful balance. In response, participants determinedly developed and tested strategies based on simplified principles, establishing routines for new health habits and portion control, and going back to basics in food selection. Therefore, weight loss programs for this population need to be specifically tailored to support patients' efforts and strategies.     

Undiagnosed Ectopic Pregnancy: A Retrospective Analysis of 31 'Missed' Ectopic Pregnancies at a Teaching Hospital

Summary: The management of 255 surgically proven cases of ectopic pregnancy, treated at a teaching hospital over a 5-year period, was retrospectively reviewed to determine the proportion of cases where the diagnosis was 'missed' at initial presentation. Thirty-one patients (12%) had presented and been discharged with an incorrect diagnosis, then subsequently readmitted for definitive treatment of a tubal ectopic pregnancy. In this group, the mean time from initial presentation to definitive surgery was 8 days. Ten of the 31 women with 'missed' ectopic pregnancies (32%) underwent salpingectomy, whereas the rate of salpingectomy in those women whose ectopic pregnancy was correctly diagnosed at first presentation was 19.5% (44 of 224). We conclude that delays in the diagnosis of ectopic pregnancy may be associated with an increased rate of salpingectomy, which may in turn reduce prospects for future fertility, a finding not previously canvassed in the literature. The factors contributing to misdiagnosis of ectopic pregnancy are discussed and compared with those reported in other studies.     

Deletion analysis for Duchenne (and Becker) muscular dystrophy

Abstract Forty-three unrelated South Australian boys diagnosed as having either Duchenne or Becker muscular dystrophy were screened for deletions using DNA probes to the dystrophin gene. For the 35 boys with Duchenne muscular dystrophy, the deletion frequency was 43% using a simplified probing strategy based on the probes Cf56a, Cf56b, pERT87-15 and XJ (XJ1.1 or XJ2.3). The corresponding deletion frequency for the eight boys with Becker muscular dystrophy was 38%. Members of families in which these disorders result from a deletion can now choose to prevent the birth of further affected boys, using an accurate prenatal test for the specific mutation occurring within the family. Deletion analysis also has the potential to clarify the carrier status of women in these families.     

Pulmonary Thromboembolism Complicating Recurrent Placental Abruption at 29 Weeks'' Gestation

A patient with major pulmonary thromboembolism associated with recurrent placental abruption is described. Delivery by Caesarean section was necessary, followed by full heparinization. The use of peripartum heparinization and Caesarean section is reviewed.     

Prospective Clinical Trial Evaluating a New Implant System for Implant Survival,Implant Stability and Radiographic Bone Changes

Background: There are a few prospective studies reporting on new implant systems. When a new implant is brought to market, prospective trials should be carried out to determine the predictability of that system. Purpose: This prospective study evaluates implant survival, Resonance Frequency Analysis (RFA), and crestal bone level changes for a new implant system (Neoss System, Bimodal surface, Neoss Ltd, Harrogate, UK). Materials and Methods: Seventy‐six patients, 38 females (age ranging from 23 to 57 years) and 38 males (ranging in age from 17 to 85 years) received 100 Neoss implants. Patients were consecutively enrolled in the study if they were missing one or more teeth in either arch, or a single tooth was scheduled for removal and immediate implant replacement. Evaluated implants were 4, 4.5, or 5 mm wide and were 7, 9, 11, 13, or 15 mm long. A one‐stage approach was followed. At first stage and prior to healing abutment placement RFA measurements were taken. Measurements were retaken at second stage. Fifty‐one implants were placed for restoration of single missing teeth and 49 were for short span implant bridges. Results: The cumulative survival rate at 1‐ to 2‐year interval was 93%. Average initial RFA measurement for all implants was 72.06, while the average final score was 72.58. These changes were not statistically significant. Changes in RFA scores for maxillary implants were insignificant. Forty‐two paired mandibular RFA measurements were evaluated. Initial and final mean mandibular RAF measurements were 73.65 (SD 9.203) and 77.186 (SD 6.177), respectively. These changes were statistically significant (p = .02). Sixty‐four paired radiographs were available for evaluation. Between examinations, there was an average –0.6 mm of bone loss, which was statistically significant (p = .03). On average, 4.0‐mm‐wide implants lost 0.1 mm of bone when compared with 5‐mm‐wide implants. These differences were insignificant (p = .86). Bone loss was adjusted for implant length, and tooth position and there were small, but clinically insignificant changes. Five‐millimeter‐wide implants lose 0.2 mm more than 4.0‐mm‐wide implants (p = .7). Maxillary incisors lose the least amount of bone 0.152 (p = .33). Conclusions: The implants tested in this study had initially high RAF readings, indicating good primary stability. RFA readings for implants placed in the mandible improved from baseline and the changes were statistically significant. Marginal bone levels revealed clinically insignificant bone loss from implant installation to second stage. Loss of seven implants with initially high RFA readings is surprising.