Visual impairment in severe and profound sensorineural deafness

The frequency of reversible and irreversible visual impairment was determined in children with severe and profound sensorineural deafness, as subnormal vision can adversely affect their educational and social development. Eighty three of 87 such children attending an audiology service were examined to assess the incidence and severity of visual impairment. Each child underwent a detailed ophthalmic assessment. The criteria for visual impairment were visual acuity < 6/9 Snellen or equivalent and/or abnormal binocular vision. Forty five had a normal ophthalmic examination (54.2%). Twenty nine had visual impairment (34.9%) and nine had ophthalmological abnormalities that did not interfere with vision (10.9%). A higher proportion of children with risk factors for visual pathology demonstrated visual impairment than those in whom there were no risk factors. None the less, 44% of visual impairment was among patients without risk factors. The results underline the need to examine all children with severe and profound sensorineural deafness soon after diagnosis and indicate that children with multiple handicaps have a greater likelihood of visual impairment (11 of 14 cases).     

Styrene emissions from the spray-up and vacuum injection processes--a quantitative comparison

Styrene emissions were studied during manufacturing of two identical glass-fiber reinforced plastic boats by two different manufacturing methods. The manufacturing methods were spray-up, which is an open method, and vacuum injection, which is a closed method. Changing the manufacturing process from an open method to a closed method decreased the styrene evaporation dramatically in this particular case. By using vacuum injection, the styrene emission during the laminate application was reduced by 98% compared with the styrene emission during laminate application by spray-up. Gel coat application by spraying will remain a major source for styrene emissions. The greatest environmental benefit is achieved with closed manufacturing methods when products without gel coat are made. The whole manufacturing process can then be performed in a closed system virtually free from emissions.     

Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial

Background The outcome of less intensive case management services, such as the strengths model, is still inconclusive, which suggests a need for more controlled studies. The aim of the present study was to investigate the outcome of a strengths model of case management service (SCM) compared to standard care. Methods Seventy-seven clients with a mental illness and a serious impairment in functioning in social contacts, housing or work situation were randomly allocated to SCM or standard care. Outcome was assessed with regard to use of psychiatric services, changes in symptomatology, psychosocial functioning, social network, needs for care, quality of life and client satisfaction with care. The follow-up period was 36 months. Results The results showed a greater reduction in needs for care in clients receiving SCM. No differences in clinical or social outcome were shown. Clients receiving SCM also used significantly less days in psychiatric inpatient services and were generally more satisfied with the psychiatric services offered. Conclusions SCM failed to improve clinical and social outcome compared to standard care, but was more successful in reducing days spent in hospital, and the clients were also more satisfied with the service compared to standard care. Accepted: 5 January 2001     

Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia

Context  Traumatic or bloody lumbar puncture (LP) reduces the diagnostic value of the procedure and may worsen the outcome of patients with acute lymphoblastic leukemia (ALL). Little is known about the risk factors for traumatic and bloody LP. Objectives  To determine the risk factors for traumatic and bloody LP. Design, Setting, and Patients  Retrospective cohort study of 956 consecutive patients with newly diagnosed childhood ALL who were treated at a pediatric cancer center between February 1984 and July 1998. Interventions  All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy. Main Outcome Measure  Traumatic LP was defined as an LP in which cerebrospinal fluid contained at least 10 red blood cells (RBCs) per microliter and bloody LP as one in which the cerebrospinal fluid contained at least 500 RBCs per microliter. Results  Of the 5609 LPs evaluated, 1643 (29%) were traumatic and 581 (10%) were bloody. The estimated odds ratios (ORs) and 95% confidence intervals (CIs) for traumatic LP were 1.5 (95% CI, 1.2-1.8) for black vs white race, 2.3 (95% CI, 1.7-3.0) for age younger than 1 year vs 1 year or older, 1.4 (95% CI, 1.2-1.7) for early vs recent (dedicated procedure area and general anesthesia) treatment era, 1.5 (95% CI, 1.2-1.8) for platelet count of 100 x 10³/µL or more vs less than 100 x 10³/µL, 10.8 (95% CI, 7.7-15.2) for short (1 day) vs longer (>15 days) interval since the previous LP, and 1.4 (95% CI, 1.1-1.8) for the least vs the most experienced practitioners. Analyses for bloody LP yielded similar results. Conclusions  The unmodifiable risk factors for traumatic and bloody LP include black race, age younger than 1 year, a traumatic or bloody previous LP performed within the past 2 weeks, and a previous LP performed when the platelet count was 50 x 10³/µL or less. Modifiable risk factors include procedural factors reflected in treatment era, platelet count of 100 x 10³/µL or less, an interval of 15 days or less between LPs, and a less experienced practitioner.      

关于人眼视力发展的非线性成长率理论

目的使用非线性成长率理论分析人眼视力发展规律。方法使用高斯光学及成像方程推导出两个参数：屈光状态改变率（M）及眼轴成长率（N），用以预测MOS（初始近视）、年龄（A^＊）及其后视力的发展情况。结果当有效焦距F=（21-22）、密码M=（2．67—2．9）（D／mm）时，此计算值符合实验平均值（2．7）。当年龄A^＊=（3，6）岁的屈光度变化已知时，我们计算其MOS预测年龄为A^＊=（7．3，21．8）岁（在不同条件下）。此值反比于M值在A=6及A=3的比值或N=N—N^＊，即非正视态及正视态的眼轴成长率之差。本理论也可用来预测在年龄A=25时的近视度，分别为D=-14及-0．49的上述两例情况，同时也能分析Lain等人的测量值（由出生到青年期的视力发展情况）。结论本理论可预测MOS、其后发展情况及其符合实验值（M）。使用成长率差值（dN）比使用L/rl比值能更准确地预测MOS。     

Intraluminal brachytherapy in the treatment of bile duct carcinomas

Patients with carcinoma of the biliary tract have a poor prognosis because the disease is often unresectable at diagnosis. Intraluminal brachytherapy has been reported as an effective treatment for localized cholangiocarcinoma of the biliary tract. The purpose of our study was to analyse the survival of patients treated with brachytherapy and make some recommendations regarding its use. Fifteen patients underwent brachytherapy via a trans-hepatic approach at the Royal Prince Alfred Hospital from 1983 to 1993. Eleven patients had low-dose rate brachytherapy and four patients had high-dose rate treatment. There were nine males and six females. The median age was 64 years. Other treatment included bypass procedures in two patients, endoscopic stents in 14 patients and external beam irradiation in one patient. The median survival was 12.5 months and 47% of the patients survived 1 year. The only complication reported was cholangitis which was seen in one patient. There did not seem to be any difference in survival or complications between low- and high-dose rate brachytherapy. We conclude that the addition of intraluminal brachytherapy after biliary drainage prolongs survival and is a safe and effective treatment, but patients still have a high rate of local failure, and further studies will be needed to address this problem.     

Uterine leiomyomas in the infertile patient: preoperative localization with MR imaging versus US and hysterosalpingography

Eleven women with a history of infertility and uterine leiomyomas underwent magnetic resonance (MR) imaging of the pelvis prior to myomectomy. Nine also underwent preoperative pelvic ultrasonography (US), and ten underwent hysterosalpingography. All studies were interpreted prospectively by independent observers. With each imaging modality, the location (one of 11 anatomic segments), size, and appearance of detected uterine leiomyomas were determined and compared with surgical and histologic findings. Among the nine patients who underwent both MR and US, the sensitivity (85%) and accuracy (94%) of MR imaging for abnormal segments was significantly better than that of US (sensitivity = 69%, P = .015; accuracy = 87%, P = .043). For the ten patients who underwent both MR and hysterosalpingography, the sensitivity (91%) and accuracy (96%) of MR imaging was better than that of hysterosalpingography (sensitivity = 18%, P = .0005; accuracy = 72%, P = .0005). The specificities of the three modalities did not significantly differ (100%, 97%, and 98% for MR, US, and hysterosalpingography, respectively). These data suggest that MR imaging is superior to US or hysterosalpingography for preoperatively locating uterine leiomyomas.     

Quality assessment and assurance in diagnostic imaging. Theoretical and practical considerations and a quality audit of the excretory urogram

Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals.     

The effect of giving information in advance on the clinical training of medical students

OBJECTIVE: To study whether or not giving written information in advance influences patients' willingness to participate in the clinical training of medical students. SETTING: Dermatology surgery at a university hospital. METHODS AND PARTICIPANTS: Prior to the visit, patients were randomly allocated either to receive a letter about medical education (the experiment group), or not to receive a letter (the control group). MAIN OUTCOME MEASURE: The willingness of patients to participate in clinical training. RESULTS: There was no difference between the 2 groups regarding their willingness to participate. Almost all patients perceived the provided information as good or rather good, but some patients, especially in the control group, did not feel free to refuse to participate. CONCLUSION: The present written-information-in-advance strategy seems to prevent patients from feeling forced to participate, without having any negative influence on their inclination to participate.