The natural history of idiopathic scoliosis. A study of the incidence of treatment

The natural history of idiopathic scoliosis has been studied between 1969 and 1985 in a well-controlled population of school children, 66,200 cases, between 7 and 16 years of age. The incidence of scoliosis needing treatment (25 degrees or more in progress in growing children) was studied with a cross-sectional as well as a longitudinal survey. When using a cross-sectional technique, a decrease of cases being treated was seen after the introduction of a conventional screening program--thus indicating a change in the natural history of moderate scoliosis. This could, however, be explained by the consequence of an accumulation of treated cases, formerly diagnosed and treated later on, seen immediately after the introduction of screening. When the longitudinal method was used, this trend could not be observed. And finally, when taking changes of indication of treatment and of the population into consideration, no tendency at all toward a change in the natural history could be seen.     

Easily overlooked language disabilities during childhood and adolescence. A cognitive-linguistic perspective.

The population of individuals with LLD make up a heterogeneous group. The identification of individuals with LLD may vary depending on the type(s) and adequacy of the tests used. Assessment protocols for evaluating the language functioning of older school-aged and adolescent individuals are few and far between. This state of affairs necessitates speech-language pathologists to begin to develop a variety of informal tools to assess the higher level (and perhaps more subtle) language abilities of these individuals. Because language functioning entails the convergence of a variety of cognitive and linguistic processes, these informal protocols must be informed by the developmental literature so as to take into account both language-specific (e.g., lexical knowledge, syntactic structure, semantic complexity) and general cognitive processes. Careful task and process analyses must be done to characterize the language performance of any individual.     

Association Between Waiting Times for Kidney Transplantation and Rates of Live Donation

A deceased donor (DD) allocation system incorporating net life survival benefit has been proposed. In this system, many kidneys will be shifted to younger recipients, thereby decreasing their waiting times. The goal of this study was to determine the potential effects of altering waiting times on the likelihood of live donor kidney transplantation (LDKT). We analyzed 93,727 waiting list candidates to determine the association of various patient factors with likelihood of LDKT. The proportion of patients receiving LDKT was compared by the median DD waiting time at that patient's transplant center for someone of that patient's age category and race. LDKT was consistently higher as waiting times became longer. After adjusting for all other factors associated with likelihood of LDKT, waiting time remained a significant, independent predictor. Patients with the longest DD waiting times had 2.3-fold higher odds of LDKT (95% CI 2.11-2.58, p < 0.001). In planning the new DD allocation policy, we must account for resulting alterations in LDKT. It is possible that shifting DD kidneys to younger recipients may decrease LDKT or shift it to older recipients, net effects not consistent with the goal of net life survival benefit.     

Survival after gastric adenocarcinoma resection: Eighteen-year experience at a single institution

Gastric adenocarcinoma is the second leading cause of cancer death worldwide. In Western series, survival rates vary widely and are generally lower than those reported from Eastern series. We performed a retrospective analysis of cases operated on at the Johns Hopkins Hospital over the past 18 years and collected data on demographics, tumor characteristics, pathologic stage, treatment methods, complications, survival time, and other relevant factors. Survival according to stage of disease, Lauren tumor type, tumorlocation,time period, andadministration of adjuvant therapy wasanalyzed, andresultswerecompared with those of other Western series. During this period, 436 patients with gastric adenocarcinoma underwent resection. We have shown a statistically significant association between survival and margin status, stage of disease, and Lauren tumor type. Overall 5-year survival was 26%, and 5-year survival after R0 resection was 33%. No significant difference was detected between survival and tumor location, time period of treatment, or administration of adjuvant therapy. Analysis of various Western series reveals major differences between the cohorts under study, such as stage of disease, extent of resection, tumor type, and tumor location. Many of the reported differences among Western series may be due to cohort differences, such as stage of disease, extent of resection, tumor type, and tumor location.     

An open access technique to create pneumoperitoneum in laparoscopic surgery.

BACKGROUND: An open access technique might reduce severe vascular and visceral injuries. An open access technique through the umbilical cicatrix tube has been developed as a routine method with the goal to be easy, safe and used by all surgeons in patients without a previous midline incision. AIM: To evaluate the open technique in a prospective study in 100 consecutive laparoscopic operations regarding time for entrance, surgeons experience and BMI of the patients. METHODS: A midline incision from the linea alba up into the inverted umbilicus was performed in the cicatrix tube and the peritoneum was penetrated allowing air to flow into the abdominal cavity followed by a blunt trocar insertion. RESULTS: Time for access was median 93 seconds. Entrance time in patients with BMI >30 (n=18) was 100 sec and with BMI <30 it was 90 sec (p = 0.71). The median time for consultants was 88 sec and for residents 120 sec (p = 0.003). No gas leakage was seen. Prolonged time for access was seen in three patients; two equipment failures and one obese patent. CONCLUSION: The open access technique is applicable in all patients without a former midline incision. It is fast, easy to learn with very few associated problems.     

A placebo controlled trial of remoxipride in the prevention of relapse in chronic schizophrenia

Sixty-two DSM III chronic schizophrenic inpatients were selected for a double-blind, placebo controlled, multi-centre, relapse prevention study of remoxipride, a selective dopamine (D₂)-receptor antagonist. After a 1 month placebo washout, 23 patients had relapsed and were withdrawn. Of the remaining patients 19 were randomised to remoxipride (150–300 mg daily) and 20 to placebo. Their median age was 58 years, 26 were male, and the median duration of illness was 33 years. After 24 weeks a further total of 8 remoxipride and 17 placebo patients had been withdrawn. Excluding three patients withdrawn for reasons other than relapse, the comparative relapse rates were 37% and 75%, respectively (P=0.015). Efficacy analyses using clinical global impression (P=0.04) and change in BPRS scores (P=0.016) were in favour of remoxipride. Extrapyramidal symptoms were minimal in both groups. Treatment emergent adverse events were similar in the two groups. Remoxipride is therefore of potential value as a safe drug which is both effective and well tolerated in the long term management of chronic schizophrenic patients.