Use of endoscopic mucosal clips in radiotherapy planning for oesophageal carcinoma: A series of three cases

This paper describes the technique of placing endoscopic mucosal clips to localize oesophageal carcinoma and hence facilitate radiotherapy planning. This technique has been used on three patients in our centre. One was treated radically with external beam radiotherapy and two were treated palliatively (retreatment) with intraluminal brachytherapy. Mucosal hemoclips were placed at the time of endoscopy to indicate the superior and inferior extent of the tumour. The clips provided a radiologically‐recognisable marker of the tumour extent and were visible on simulation films or planning CT scans. The radiation portal included the tumour as demarcated by the clips with an adequate margin. There were no complications related to the placement of the clips. All patients completed the radiotherapy course as planned.     

On the Elusive Nature of Sex Differences in Cognition: Hormonal Influences Contributing to Within-Sex Variation

We argue that within-sex variation resulting from the prenatal organizational and adult activational effects of gonadal steroid hormones has the potential to obscure between sex differences in cognitive performance and functional cerebral asymmetry. Two putative markers for prenatal testosterone, finger ridge count (FRC) asymmetry and the 2D:4D finger length ratio, have been linked to within-sex variation in cognitive performance. In particular, FRC allows the identification of men and women who show a reversal of the typical sex-related pattern of task performance. Three paradigms for the study of activational effects—seasonal, menstrual, and diurnal hormonal cycles—have evaluated changes in task performance and functional cerebral asymmetry. The performance of sex-dimorphic, but not sex-neutral, tasks changes with estrogen across the menstrual cycle and with testosterone across its seasonal and diurnal cycles. Functional cerebral asymmetry also changes systematically across both the menstrual cycle and the diurnal testosterone cycle in such a way that suggests left hemisphere performance increases as testosterone levels decline whereas right hemisphere performance increases as estrogen levels decline. In studies of sex differences, such correlates of within-sex hormone-related differences are rarely measured or controlled. Whatever the explanation for the associations of putative markers and hormone cycles with differences in cognitive abilities and cerebral asymmetry, it is clear that these relationships have the potential to contribute to the elusive nature of sex differences in cognition and functional brain organization.     

Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up

OBJECTIVE: To compare the safety, availability, and long-term sequelae of percutaneous vs. surgical tracheostomy. DESIGN: Prospective, randomized, controlled study. SETTING: Combined medical/surgical intensive care unit in a tertiary referral hospital. PATIENTS: Two hundred critically ill mechanically ventilated patients who required tracheostomy. INTERVENTIONS: Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the intensive care unit. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was the aggregate incidence of predefined moderate or severe complications. The secondary outcome measures were the incidence of each of the components of the primary outcome. Long-term follow-up included clinical assessment, flow volume loops, and bronchoscopy. Both groups were well matched for age, gender, admission Acute Physiology and Chronic Health Evaluation II score, period of endotracheal intubation, reason for intubation, and admission diagnosis. There was no statistical difference between groups for the primary outcome. Bleeding requiring surgical intervention occurred in three percutaneous tracheostomy patients and in no surgical tracheostomy patient (p = .2). Postoperative infection (p = .044) and cosmetic sequelae (p = .08) were more common in surgical tracheostomy patients. There was a shorter delay from randomization to percutaneous tracheostomy vs. surgical tracheostomy (p = .006). Long-term follow-up revealed no complications in either group. CONCLUSIONS: Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the bedside by experienced, skilled practitioners.     

Softform Premier Active mattress: a novel step-up/step-down approach

In the UK it is estimated that as many as 412,000 patients who are already ill will develop pressure ulcers (Bennett et al, 2004), which are an unnecessary and expensive complication to treat (Hitch, 1995). One way to try and reduce these risks is by investing in suitable mattresses. The author's investigations into existing mattress stock in the years 1996-97 illustrated the inadequacy of the NHS standard mattress (Santy, 1995; Fox, 1997). Investigators (e.g. Rithalia, 1996) were recognizing the inadequacy of the pink marbled standard NHS foam mattress for pressure reduction (Medical Device Directorate, 1993; Dunford, 1994) which included reports necessary to help develop guidelines in pressure ulcer prevention and management (Coull, 2004), as well as make value-for-money recommendations about product purchases (Fletcher et al, 1994; Value For Money Update, 1994; Cullum et al, 1995).     

Cognitive-behavioral therapy for comorbid generalized anxiety disorder and panic disorder with agoraphobia

The goal of this study was to evaluate the efficacy of a cognitive-behavioral treatment package for comorbid generalized anxiety disorder (GAD) and panic disorder with agoraphobia (PDA). A single-case, multiple-baseline, across-subjects design was used with 3 primary GAD patients with secondary PDA. The efficacy of the treatment was evaluated with a structured interview, a battery of self-report questionnaires, and daily self-monitoring booklets. Results are promising: At posttreatment, 2 out of 3 participants achieved high endstate functioning and maintained this level at 3-, 6-, and 12-month follow-ups. The 3rd participant also improved but achieved moderate endstate functioning. The strengths and limitations of the treatment are discussed.     

Trends in indirect dentistry: 1. Case selection

Indirect restorations can provide a conservative, functional and aesthetic method for managing a patient's dentition.These restorations, however, are only as good as the environment in which they are placed. Many restorations, though technically satisfactory, may fail because assessment and subsequent treatment planning has been unsatisfactory. This article presents a philosophy of case selection mindful of factors related to the patient, operator and oral environment. The wrong treatment, however skilfully executed, may invite failure.