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101.
IJ Griffin TJ Cole KA Duncan AS Hollman MDC Donaldson 《Acta paediatrica (Oslo, Norway : 1992)》1995,84(5):544-549
Recently produced reference curves for various ultrasound dimensions were used to retrospectively assess 67 pelvic ultrasound scans carried out at the initial presentation in girls with sexual precocity. At presentation the group with precocious puberty had significantly increased uterine lengths and ovarian volumes compared with the normal population, and a significantly increased fundal–cervical ratio. Ovarian volume was also significantly increased in thelarche and thelarche variant. The fundal–cervical ratio was significantly increased in thelarche variant. There was considerable overlap between individuals with sexual precocity and normal subjects. The ultrasound findings that best discriminated early or precocious puberty from other forms of sexual precocity were the presence of a midline endometrial echo, and a uterine length above the 97th centile for age. An entirely normal pelvic ultrasound at presentation did not rule out the possibility of precocious puberty. 相似文献
102.
Lawton MT 《Neurosurgery》2002,50(1):1-8; discussion 8-10
OBJECTIVE: To demonstrate that well-trained neurosurgeons can successfully treat patients with basilar apex aneurysms, to encourage young neurosurgeons in appropriate clinical environments to develop this expertise, and to describe a personal experience with an initial series. METHODS: In a consecutive series of 500 aneurysms treated surgically over 3.5 years, 57 aneurysms in 56 patients were located at the basilar apex, 47% of which were large or giant in size. RESULTS: Most aneurysms (77%) were treated by direct clipping through an orbitozygomatic-pterional transsylvian approach. The surgical mortality rate was 9%, and permanent neurological morbidity associated with treatment occurred in 5%. Good outcomes (Glasgow Outcome Scale score 5 or 4) were achieved in 84%. Good outcomes increased from 79% in the first half of the series to 90% in the second half, and the mortality rate decreased from 21 to 4%. CONCLUSION: Young neurosurgeons can acquire technical proficiency with basilar apex aneurysms while achieving optimal patient outcomes. Young neurosurgeons with the right training, talent, and temperament are needed to deal with those patients with basilar aneurysms who require surgery and with a possible shortage of basilar aneurysm surgeons in the future. The learning curve is characterized by increased temporary clipping, better perforator dissection, and more sophisticated permanent clipping technique. The path to proficiency can be as demanding mentally as it is technically. 相似文献
103.
Magnetic source imaging demonstrates altered cortical distribution of function in patients with arteriovenous malformations 总被引:2,自引:0,他引:2
Vates GE Lawton MT Wilson CB McDermott MW Halbach VV Roberts TP Rowley HA 《Neurosurgery》2002,51(3):614-23; discussion 623-7
OBJECTIVE: Arteriovenous malformations (AVMs) can be treated successfully, but treatment can pose unacceptable risks if the AVM is located in eloquent cortex. Because AVMs are developmental lesions, the location of primary cortical function may be deranged. We used magnetic source imaging (MSI) to identify the central sulcus and to determine whether primary cortical function was shifted in a set of 30 patients. We correlated these findings with outcome after treatment. METHODS: We retrospectively analyzed the clinical data of 30 patients with AVMs who underwent MSI. Nonparametric statistical comparisons were made to correlate the proximity of AVMs to primary cortex and somatosensory shift to outcome at 12 months. RESULTS: Using MSI, 14 patients (47%) were found to have AVMs involving primary cortex, and 10 patients (33%) were found to have shift in the somatosensory homunculus. Primary cortical involvement was neither required nor sufficient to cause shift (Mann-Whitney U test, z = -0.02, P = 0.31). Patients with AVMs involving primary cortex fared worse after treatment than did patients with AVMs that spared primary cortex (Mann-Whitney U test, z = -2.3, P = 0.02). The presence or absence of shift did not correlate with outcome after treatment (Mann-Whitney U test, z = -0.18, P = 0.48). CONCLUSION: MSI showed that some patients with AVMs have abnormal cortical distribution of function. The involvement of primary cortex correlated with worse outcome after treatment. Our results suggest that preoperative functional imaging may help to better estimate treatment risks and ultimately to guide therapeutic planning. 相似文献
104.
This paper reviews the rationales and evidence for horizontal and vertical integration involving hospitals. We find a disjunction between the integration rationales espoused by providers and those cited in the academic literature. We also generally find that integration fails to improve hospitals' economic performance. We offer seven lessons from hospitals' efforts to integrate and then suggest four alternative models for achieving integrated delivery of health care services. 相似文献
105.
106.
Daughters and daughters-in-law of presently unmarried elders were studied longitudinally, and the data were analyzed to determine how two transitions in caregiving status affected the women of the younger generation. One transition compared noncaregivers who had become caregivers 1 year later ("caregiving entrants," n = 33) with continuing noncaregivers (n = 56) and with veteran continuing caregivers (n = 78) over the same period. The second transition followed Time 1 new caregivers as they became "new veteran" caregivers (n = 69), comparing them with "old veteran" caregivers (n = 189) over the same year. The transition to caregiving was marked by a decrease in the care receiver's competence and an increase in the amount of care received, but caregiving entrants' quality of life did not change significantly over 1 year, as compared with either continuing noncaregivers or veteran caregivers. Although longitudinal study shows little positive evidence for the wear-and-tear model of caregiving, methodological improvements are needed before discarding the hypothesis that caregiving erodes mental health. 相似文献
107.
Background
The Licensing Act 2003 (The Act) was implemented on the 24th November 2005 across England and Wales. The Act allowed more flexible and longer opening hours for licensed premises. We investigated the effect of The Act on alcohol related attendances to an inner city emergency department in Birmingham, UK. 相似文献108.
Rosemary RC McEachan Rebecca J Lawton Cath Jackson Mark Conner Jennifer Lunt 《BMC public health》2008,8(1):326
Background
The workplace is an ideal setting for health promotion. Helping employees to be more physically active can not only improve their physical and mental health, but can also have economic benefits such as reduced sickness absence. The current paper describes the development of a three month theory-based intervention that aims to increase levels of moderate intensity physical activity amongst employees in sedentary occupations. 相似文献109.
Wang WS; Fan FS; Hsieh RK; Chiou TJ; Lin JK; Lin TC; Yen CC; Liu JH; Hsu H; Chen PM 《Japanese journal of clinical oncology》1997,27(3):174-179
5-Fluorouracil in combination with leucovorin has been shown to be active
in therapeutic trials of metastatic colorectal carcinoma. In this study, we
administered these drugs to 72 patients with metastatic colorectal
carcinoma. Thirty-six of them without previous exposure to 5-fluorouracil
were treated with weekly bolus injections of 5-fluorouracil (425 mg/m2) and
leucovorin (25 mg/m2) supplemented with oral levamisole. Another 36
patients with or without prior 5-fluorouracil treatment received
5-fluorouracil 3,000 mg/m2 and leucovorin 300 mg/m2 in a 48-hour continuous
infusion every two weeks. Clinical efficacy and toxicity were assessed by
WHO criteria. Variables were tested for relations to response and survival
by univariate and multivariate analysis. The response rate was 19.4% in
weekly bolus arm and 13.9% in biweekly high-dose infusion arm (P = 0.527).
Median survivals in the two arms were 18.4 months (weekly) and 21 months
(biweekly) respectively (P = 0.708). Gastrointestinal side effects
including nausea, vomiting, diarrhea and mucositia were the major
toxicities of these regimens. By multivariate analysis, the only factor to
influence response rate was the site of metastases (P = 0.009). The only
factor to affect survival was performance status of the patient (P =
0.0001). We concluded that the two 5-fluorouracil based regimens are
well-tolerated and shown to have a response rate comparable with previous
reports of similar regimens in patients with metastatic colorectal cancer.
Only liver metastases seemed to have a better response to therapy.
Performance status is the most important prognostic factor in patients with
metastatic colorectal cancer.
相似文献
110.
Wang WS; Liu JH; Chiou TJ; Hsieh RK; Yen CC; Chen PM 《Japanese journal of clinical oncology》1997,27(3):180-184
A 28-year-old woman was admitted to our Hospital with a chief complaint of
progressive gingival swelling and loosening of teeth over about a year.
According to past history, she had received total thyroidectomy 2 years
previously due to thyromegaly. The thyroidectomy specimen was at first
interpreted as 'poorly differentiated carcinoma of the thyroid'. One year
ago, she began to be aware of gingival swelling and loosening of teeth. A
gum biopsy was taken and the pathologic features were similar to her
'thyroid carcinoma'. Subsequent investigations, including
immunohistochemical stain, showed the gum was heavily infiltrated with
histiocyte-like Langerhans' cells which were positive for S-100 protein.
Ultrastructural examination of the cells under electron microscope revealed
many typical intra-cytoplasmic Birbeck granules. Langerhans' cell
histiocytosis was diagnosed. Langerhans' cell histiocytosis with thyroid
involvement is extremely rare and may run a relatively indolent course.
Even on a retrospective examination, it may easily be confused with poorly
differentiated carcinoma of the thyroid. We suspect that this error may
have been made on other occasions and that the occurrence of this condition
may be underreported.
相似文献