Reactance to a Tailored Multimedia Intervention Encouraging Teachers to Promote Cover-the-Cough

Teachers were presented tailored multimedia messages encouraging them to offer cover-the-cough instruction to their students. Messages were tailored by grade level (elementary, higher grade) and stage of change (preaction, action). Among teachers in the action stages, message tailoring did not make a difference. Among teachers in the preaction stages, tailored messages were rated lower than were nontailored messages. The lower ratings of the tailored messages, seemingly a reactance response, did not carry over to postintervention self-efficacy. The intervention was effective in improving self-efficacy in elementary school teachers, particularly among those in the preaction stages.     

Prognostic value of QT interval and QT dispersion in patients with left ventricular systolic dysfunction: results from a cohort of 2265 patients with an ejection fraction of < or =40%

Background Increased QT interval and QT dispersion have been associated with higher mortality in population-based studies and in patients with myocardial infarction. However, the prognostic significance of these measurements in patients with left ventricular (LV) systolic dysfunction is not clear.Methods and Results Rate corrected QT interval (QTc) and QT dispersion (QTd) were measured by means of an automated method from digitized echocardiograms in 2265 patients with an LV ejection fraction ≤40% and were related to survival. Increased QTc was strongly related to mortality in the whole group and in subsets on the basis of age and the level of LV systolic dysfunction. There was a graded increase in mortality rate with an increase in QTc. The effect of QTc on mortality was incremental to the effects of age and ejection fraction. QT interval was measurable in ≥6 leads in 1193 patients in whom QTd was computed. QTd higher than the mean value of 35 ms was associated with an increase in all cause mortality (P = .04). Its mortality impact was most pronounced in the older patients, patients with more severe LV dysfunction, and patients with increased QTc.Conclusions Both QTc prolongation and increased QTd are associated with higher mortality rate in patients with moderate and severe LV dysfunction. (Am Heart J 2003;145:132-8.)     

Bilateral,multicenteric metanephric adenoma associated with Wilms' tumor in a child: A rare presentation with important diagnostic and therapeutic implications

Metanephric adenoma is an uncommon benign renal tumor that occurs predominantly in adult females and rarely in children. On histomorphology it shows a resemblance to Wilms' tumor, nephrogenic rests and papillary renal cell carcinoma. Multifocality along with multicentricity has not been documented in English literature till date. From a diagnostic and therapeutic viewpoint, recognition of this entity is of the utmost importance, because it shows a favorable clinical outcome. We describe a rare case of bilateral, multicentric metanephric adenoma associated with triphasic Wilms' tumor (stage II) of the left kidney in a male child.     

Selective neck dissection in node-positive squamous cell carcinoma of the head and neck

Objective The optimal type of neck dissection in head and neck squamous cell carcinoma (SCC) with clinical cervical metastases has not been determined. The following study was performed to determine the rate of regional control with selective neck dissection (SND) in these patients. Study Design Case series with planned data collection. Settings Single institution, cancer center. Methods and Subjects Patients with cervical lymph node metastases from mucosal cancers of the head and neck who were treated with SND from 2000 to 2010 were selected. Demographics, tumor characteristics, extent of neck dissection, adjuvant treatments, locoregional control, and survival were recorded. Recurrence in the neck and disease-specific survival (DSS) were primary and secondary end points. Results One hundred eight patients underwent SND. Sixty-nine (64%) were male. Median age was 62 (20-89) years. The most common primary site was the oral cavity (71.3%). Ninety-five (88%) received adjuvant treatment. Median follow-up was 21 months. Six patients (5.5%) had isolated recurrence in the dissected neck. Patients with N2C disease had poorer neck recurrence-free survival. At the end of study, 64 (59.3%) patients had no evidence of disease, and 23 (21.3%) had died of disease. Two-year DSS was 76.9%. Number of positive nodes (P = .026) and positive surgical margins (P = .001), among others, were predictors of poorer DSS. Conclusion In a highly selected group of patients with cervical lymph node metastases from head and neck SCC, selective neck dissection is effective in controlling the disease in the neck when performed in the setting of a multimodality treatment, including adjuvant radiotherapy or radiochemotherapy.     

Diagnostic accuracy of 18F-FDG PET in restaging patients with medullary thyroid carcinoma and elevated calcitonin levels.

Medullary thyroid carcinoma (MTC) is a rare endocrine tumor arising from the C-cells of the thyroid gland. Calcitonin is the principal serum tumor marker. A rising calcitonin level after total thyroidectomy for localized disease generally indicates residual, recurrent, or metastatic disease. The role of (18)F-FDG PET in MTC remains somewhat unclear. We reviewed our own experience with (18)F-FDG PET in postthyroidectomy MTC patients with elevated calcitonin. METHODS: From our database, we identified patients with suspected residual, recurrent, or metastatic MTC and elevated calcitonin who had been referred for (18)F-FDG PET between January 2000 and October 2005. (18)F-FDG PET findings were classified as positive or negative on the basis of visual interpretation of the scan. Standardized uptake values (SUVs) were also calculated. The (18)F-FDG PET findings were verified by histopathologic examination, when available, or other imaging studies and clinical follow-up. Any negative (18)F-FDG PET result was considered false-negative. RESULTS: Twenty-eight patients underwent a total of 38 (18)F-FDG PET studies. Calcitonin levels ranged from 106 to 541,000 pg/mL (median, 7,260 pg/mL). There were 23 true-positive, 1 false-positive, and 14 false-negative (18)F-FDG PET scans, yielding an overall sensitivity of 62%. There was no true-positive finding when calcitonin levels were below 509 pg/mL (n = 5). Using an arbitrary cutoff of 1,000 pg/mL, we found that the sensitivity in scans with calcitonin levels greater than 1,000 pg/mL increased to 78% (21/27; 95% confidence interval, 58%-91%). The mean SUV of all lesions with (18)F-FDG uptake was 5.3 +/- 3.2 (range, 2.0-15.9). Among the 14 patients with false-negative (18)F-FDG PET findings, 8 had concurrent anatomic imaging studies and only 2 of these had positive findings. CONCLUSION: (18)F-FDG PET can detect residual, recurrent, or metastatic MTC with a reasonable sensitivity of 78% when the calcitonin level is above 1,000 pg/mL but appears of limited use if the calcitonin level is below 500 pg/mL.     

Cardiovascular disease in South Asians: A burgeoning epidemic

Both native and expatriate South Asians have high levels of coronary artery disease. The most important factors contributing to this situation are the increased prevalences of obesity, metabolic syndrome, and diabetes in developing countries. traditional risk factors are less relevant in South Asians. Understanding the ethnic-specific factors important in risk of coronary artery disease and effective therapies in this population is essential to be able to resolve ethnic differences in cardiovascular disease.