In pursuit of prognostic factors in children with pilocytic astrocytomas

Objective  

This study described a 23-year experience in the treatment of children with pilocytic astrocytomas (piloA) with the aim of identifying putative clinical, histopathological, and/or immunohistochemical features that could be related to the outcome of these patients.     

Risk for Being a Teen Parent: The Influence of Proactive and Reactive Aggression in a Sample of Latino Adolescents

In order to better understand the link between aggression and risk for teen parenting, the current study evaluated the link between proactive and reactive functions of aggression and teen parenting in a sample of 142 Latino high school students (53.5 % male; Mean age?=?16.24 years, SD?=?1.47) residing in the United States. Additionally, peer rejection was examined as a moderator of these associations, and gender differences in associations were evaluated. Approximately 11 % of the sample reported being a teen parent. Correlation analyses suggested that both proactive and reactive aggression were associated with increased risk for being a teen parent, with the magnitude of the association stronger for proactive than reactive aggression. Further, when associations were simultaneously examined, only proactive aggression was uniquely associated with risk for teen pregnancy, and peer rejection does not appear to play a role in these associations for males or females. Findings suggest that proactive aggression needs to be targeted for the prevention of teen parenting. Recommendations for intervention strategies are discussed.     

Auditory results from cochlear implants in elderly people

According to data from the Brazilian Institute of Geography and Statistics, the elderly population grew 47.8% in the last decade in Brazil. A portion of this population has severe and/or profound hearing loss and do not benefit from conventional hearing aids. Thus, the use of cochlear implant is required.AimTo analyze the benefits of cochlear implants in the elderly based on the comparison of primary auditory thresholds before and after the operation, discrimination of sentences in speech and in talking on the telephone.MethodologyRetrospective cohort study, analyzing medical records from patients aged over 60 years, users of cochlear implant for at least 1 year.ResultsFourteen medical records were analyzed. Mean age of patients was 63.07 years. The mean pure tone thresholds between 500Hz, 1kHz, 2kHz and 4kHz before the implantation was 113dBHL. None of the patients, before operation, could discriminate sentences in open sets and only 3 scored 17% in closed sets sentence recognition. After one year of implantation, the mean sound field thresholds reached 34dBHL, and open set sentences recognition of 93.57%, while 71% of the patients had become able to have a conversation on the telephone.ConclusionThe elderly users of cochlear implant showed important outcomes, with significant improvement in understanding in the open set and in using the telephone.     

A prospective controlled trial of computerized decision support for lipid management in primary care

OBJECTIVES: This study aimed to assess the uptake and effect in primarycare of a computerized decision support system (DSS) for themanagement of hyperlipidaemia. METHOD: A prospective controlled trial was conducted in 25 practicescovering a population of 150 000 in the city of Birmingham.The Primed system, a specialist developed, rule based DSS forgeneral practice, was introduced prospectively after a 3-monthbaseline data collection. The main outcome measures were ninemonths' data on prescribing of lipid lowering agents; use oflaboratory tests; and referrals to secondary care for the investigationof hyperlipidaemia. RESULTS: System use was lower than expected. A shift was observed towardsrequests for appropriate follow-up of previously abnormal lipidresults and a greater emphasis on full lipid profiles, in linewith the DSS guidelines. Referrals showed a 55% decrease onthose expected (NS). The prescribing evaluation revealed a largevariation between practices, but no significant alteration followingsystem use. Views of users favoured decision support as a concept,but criticised technical problems with the system. CONCLUSIONS: Greater integration of DSS software and practice based datahandling systems is needed. The mode of data capture, and henceboth the content and form of knowledge representation, in DSSmust take greater account of the primary care consultation processif such systems are to be of use to practitioners. Keywords. Computerized decision support, hyperlipidaemia, primary care, prospective controlled trial.     

Management of malunited mandibular condylar fractures

The non-surgical treatment of mandibular condylar fractures, may occasionally result in articular imbalance and temporomandibular joint dysfunction. This may be attributed to condylar head displacement and resorption, resulting in a shortened vertical ramus and lost posterior vertical facial height. Restoring the vertical ramus height is essential in the treatment of such dysfunction, and may be accomplished by unilateral, or bilateral ramus osteotomies. Four examples of patients treated with mandibular ramus osteotomies to restore vertical ramus height, with subsequent improvement in occlusal balance and function are presented. The use of the sagittal split mandibular osteotomy and the external vertical ramus osteotomy, stabilized with small osseous plates, and monocortical screws, is discussed.     

High-dose epirubicin as primary chemotherapy in advanced breast carcinoma: a phase II study

Summary A total of 40 patients with metastatic breast cancer were treated with 120 mg/m² i.v. epirubicin every 3 weeks for a maximum of 10 cycles. Nine achieved a complete response and 17 showed a partial response, for an objective response rate of 65% (95% confidence interval, 47%–83%); the median duration of response was 7 months (range, 1–15 months) and median survival amounted to 13 months (range, 2–20 months). Leucopenia (grade 2 or 3) was seen in 14 patients on day 21 of the cycle. A subset of nine patients underwent blood counts on day 10, when all had marked neutropenia (<1×10⁹/l). Other toxicity was frequent and included nausea/vomiting (80%), alopecia (95%) and stomatitis (35%). Five patients showed a significant fall in cardiac output, but this reverted to normal after treatment. Epirubicin should have a role in the development of high-dose regimens for the treatment of advanced breast cancer.     

Minimally invasive direct coronary artery bypass for the treatment of isolated disease of the left anterior descending coronary artery.

BACKGROUND: Treatment of isolated stenosis or occlusion of the left anterior descending (LAD) coronary artery through a left anterior mini-thoracotomy has only recently been advocated as an acceptable alternative to standard coronary artery bypass through a sternotomy and with cardiopulmonary bypass grafting. We reviewed our experience with the minimally invasive direct coronary artery bypass (MIDCAB) procedure. METHODS: A retrospective clinical and angiographic review was conducted on all patients who underwent MIDCAB between October 1998 and February 2002 with subsequent telephone follow-up. RESULTS: Fifty-two consecutive patients (39 men, 13 women, mean [and standard deviation] age 57.3 [12.3] yr) underwent MIDCAB without videoscopic assistance. Eight patients (15%) were converted intraoperatively to sternotomy, and 5 (10%) patients required cardiopulmonary bypass after conversion. There were no perioperative deaths, myocardial infarctions, re-explorations for bleeding or need for transfusions. At a median follow-up time of 27.7 (range 1.9-40.5) months, there were no late deaths or myocardial infarctions. Four patients had anastomotic stenoses and underwent successful percutaneous coronary angioplasty and are asymptomatic. All patients are free of significant anginal symptoms (Canadian Cardiovascular Society class 0 or I). CONCLUSIONS: Excellent early and mid-term clinical results can be obtained with MIDCAB. To ensure optimal graft quality, conversion to sternotomy should be liberally employed. It is anticipated that the use of an endoscope may limit this complication.