The diagnostic classification of most conjunctival tumors is based on case history, inspection, and examination with the slit lamp microscope. Further imaging procedures are rarely indicated when malignant processes are not circumscribed. Clinical classification then also includes palpation and echographic examination of regional lymph nodes. Pigmented and nonpigmented melanocytic nevi are the most frequent conjunctival tumors. An important practical biomicroscopic cardinal symptom of the most frequent nevi is the presence of epithelial pseudocysts. Essential in practice is the histopathological confirmation of the clinical diagnosis, e.g., distinguishing between nonpigmented melanomas and sebaceous gland carcinomas with a pagetoid growth pattern or squamous cell carcinomas. Depending on the course and findings, the following therapeutic measures can be indicated: cryotherapy, chemotherapy, radiotherapy, modified enucleation, orbital exenteration, or a combination of different methods. 相似文献
Examined the changing profiles of intelligence in males with fragile X syndrome as these individuals increased in chronological age. Using a psychometric instrument designed to measure styles of information processing, 21 males aged 4 to 27 years were examined cross-sectionally in sequential processing, simultaneous processing, and achievement. The age of the subject was associated with age-equivalent levels of both simultaneous processing and achievement, but fragile X males did not show higher levels of sequential processing with increasing chronological age. Compared to younger fragile X males, the older subjects were more delayed in sequential processing skills relative to their abilities in other areas. A smaller longitudinal study confirmed the presence of a plateau in sequential processing among those subjects tested two times after the age of 10 years. Implications are discussed for diagnosis, intervention, and the matching of subject groups in mental retardation research.This research was supported in part by the John Merck Fund, the Joseph P. Kennedy, Jr. Foundation, NIH grants RR00125 and HD03008, and NIMH grants MH18268 and MH30929. We thank Wendy Marans and Joel Bregman for their comments on an earlier draft of this paper. 相似文献
Background: The attempts to explain the unpredictability of extent of spinal block provided by plain local anesthetic solutions have resulted in many clinical reports; however, causes of this uncertainty are as yet unknown. Recently, normal values of the human cerebrospinal fluid densities have been studied showing important interindividual variations, especially between females and males. The current study was designed to evaluate as primary endpoint the influence of cerebrospinal fluid density values on the extent of spinal block with plain bupivacaine. The ancillary endpoints were search of factors explaining the interindividual differences in cerebrospinal fluid density values reported and determination of the relation between upper extent and regression of spinal anesthesia.
Methods: Sixty-four consecutive patients undergoing peripheral orthopedic surgery with spinal block were enrolled. Spinal anesthesia was performed in the lateral decubitus position with the operated side upward. Two milliliters of cerebrospinal fluid was sampled before injection of 3 ml plain bupivacaine 0.5%. The patient was immediately turned supine and remained in the horizontal position until the end of the study. Maximal sensory block level and time to sensory regression to L4 were determined for each patient enrolled. Cerebrospinal fluid and bupivacaine densities as well as cerebrospinal proteins, glucose, sodium, and chloride concentrations were measured.
Results: A highly significant correlation between cerebrospinal fluid density and maximal sensory block level was found (P = 0.0004). However, this correlation was poorly predictive (R2 = 0.37). Cerebrospinal fluid density, proteins, and glucose concentrations were significantly higher in men than in women: 1.000567 +/- 0.000091 versus 1.000501 +/- 0.000109 g/ml (P = 0.014), 0.46 +/- 0.18 versus 0.32 +/- 0.13 g/l (P = 0.001), and 3.27 +/- 0.7 versus 2.93 +/- 0.5 mm (P = 0.023), respectively. A highly significant (P = 0.0004) and predictive (R2 = 0.73) inverse correlation was found between maximal upper sensory extent and sensory regression to L4. 相似文献
The paper presents a survey of internet users und suppliers of psychotherapy and counselling. The survey based on a search for relevant homepages was carried out as an online questionnaire. Psychotherapy as such is not on offer in the internet in Austria in compliance with the law, but information on psychotherapy practice, first contacts and short-term counsellling is provided mainly via e-mail. There are some significant differences between patients and psychotherapists who use the internet and those who do not. The demographic data of patients using the internet are similar to those of internet users generally. Psychotherapists providing services on the internet tend to be older and more experienced than the average psychotherapist in private practice. 相似文献
OBJECTIVE: The current study aimed to investigate whether the level of consciousness influenced the F wave generation, as an independent factor. METHODS: Forty three patients with acute stroke were divided according to their level of consciousness in two groups; to those with Glasgow scale (GCS) score 3-7 indicating coma (group I) and those with GCS score 8-15 (group II). A series of 40 electrical stimuli were delivered to the ulnar nerve bilaterally in order to obtain F waves. The following variables were estimated and then compared between groups: F persistence, F wave latency, amplitude and duration. All studies were performed within 3 days from the onset of the stroke symptoms. RESULTS: The main finding to emerge was the significantly reduced F wave persistence in the group of patients with low GCS score as opposed to patients allocated in the group with GCS score 8-15. This result is referred to F waves obtained from both the affected and unaffected limb. F wave minimum latency was also prolonged in the group with low GCS score, whilst the comparison of all other F wave variables revealed no significant differences between groups I and II. F wave persistence measurements did not differ between the affected and unaffected sides. Stroke location and type (ischemic or hemorrhagic) were not associated with alterations of F wave measurements. CONCLUSIONS: Our results on stroke patients suggest that generation of F waves, expressed by the F wave persistence is associated with the level of consciousness. SIGNIFICANCE: F wave study may be useful as an objective measure in documenting the severity of consciousness impairment. 相似文献
ABSTRACT This paper describes further testing of an Activity Index introduced by Hamrin & Wohlin, which was designed especially to evaluate the functional capacity of patients after stroke. The results of reliability tests and validation procedures are presented, in particular in comparison with the internationally well known Katz Index of Independence in Activities of Daily Living. The standardised item alpha reliability coefficient for the Activity Index was 0.97 for the total score (n= 231) and the corresponding value for the Katz Index of ADL was 0.94. Using factor analysis with four factors, 88.3% of the variances of the 16 variables of the Activity Index could be explained, and the different variables were found to have a logical distribution between the factors. In a two-factor analysis of the Katz Index of ADL, 89.6% of the variance of the six variables could be explained, and the hierarchical structure of the test was recognised. Compared with the Katz Index of ADL, the Activity Index had a higher predictive capacity and it also better measured changes in the patient's functional ability between different test occasions. 相似文献
In a retrospective controlled clinical study we investigated the efficacy of bromides (BR) as to the frequency of generalized tonic-clonic seizures (GTCS) as a monotherapy (n = 5) or combined with other antiepileptic drugs (AEDs) (n = 55), and compared the results statistically with those achieved with a treatment based on phenobarbitone (PB) and/or phenytoin (PHT) in a very similar group of another 60 patients. All patients treated with BR had previously proved to be pharmaco-resistant. In most of the cases the epilepsies were based on early cerebral lesions, and were partly associated with severe mental and physical handicaps. Most of the patients were between three and 14 years old. The percentage of responders was 58%, which means a reduction in the GTCS-frequency of more than 50%. The positive result was observed for 28 months on the average. 27% of all patients became free of GTCS for 18 months on the average (range, 44 days to 62 months), and 32% were improved (reduction in GTCS-frequency of more than 50% while not GTCS-free) for nearly three years on the average (range, 79 days to 110 months). Compared to PHT or PB, BR were slightly more efficient and similarly tolerable, but no statistically significant difference was seen (48% responders in the control group versus 58% responders in the BR-group). Thus, the statistical correlation with competitive therapies confirmed the good efficacy of BR against GTCS, which was previously demonstrated by clinical tests without control studies. We recommended BR in the case of every pharmaco-resistant epilepsy with GTCS as a therapeutic alternative. 相似文献
The occurrence of behavioural problems in a population-based series of children with infantile hydrocephalus (non-spina bifida) was analysed, using parent questionnaires. Children with both infantile hydrocephalus and mental retardation had significantly more behavioural problems compared with those with no mental retardation and controls. Inattentiveness and hyperactivity were particularly typical. No differences were found between children with infantile hydrocephalus and no mental retardation and the control group. 相似文献
The purpose of this study was to examine the effect of exacerbations on mild to moderate asthmatic patients' preference-based, health-related, quality of life scores and also to describe the effect of these exacerbations on daily life. In a survey, 100 mild to moderate asthmatic patients in the United Kingdom were asked to rate three different health marker states on a scale between 0 (death) and 100 (perfect health), defined as: your asthma of today, a mild exacerbation, and a severe exacerbation of asthma. They were also asked to describe their symptoms and what they did when experiencing an exacerbation. During exacerbations the vast majority of asthmatic patients have significant symptoms and consume a considerable amount of health care resources, which often overlap. The health marker state “your asthma of today” was given a mean score of 81.0, a mild exacerbation a score of 62.1, and a severe exacerbation a score of 25.6, indicating a large impact on patients' daily life and their health-related quality of life. In conclusion, asthmatic patients are severely affected in their health and daily living by mild and severe exacerbations. Considerable effort should be made to reduce the number and severity of exacerbations. 相似文献