Pacemaker Interference with Screening Mammography

In female pacemaker recipients undergoing screening mammography, the impact of a pulse generator placed in the pectoral region has yet to be reviewed. We evaluated mammograms from 74 female pacemaker patients aged 40 years and older. The pulse generator obscured a portion of the mammogram in 7 patients (12%). During pacemaker implantation in women, the potential for the pulse generator to interfere with screening mammography should be considered. Baseline mammography should be obtained or reviewed; in high risk patients a nonconventional location for the pulse generator may be appropriate.     

人类未来的生育力:对世界人口和迁移的影响

问题的提出在我的一生中 ,世界人口已翻了三番 ,到1 999年 1 0月 1 2日正式达到 6 0亿 ,在 2 1世纪末甚至可能再次翻番 ,虽然一些人口统计学家认为人口可能会停滞在 1 1 0亿的平台期 ( Lutz等 ,1 997)。但有一个共识 ,将来几乎所有增加的人口是在发展中国家 ,在这些国家内 ,人口呈金字塔型年龄结构 ,在每一个年龄段 ,都会有越来越多的年轻人到达生育年龄。相反 ,在发达国家 ,人口的增长几乎停滞 ,在一些国家 ,如日本、德国、意大利、乌克兰和俄罗斯 ,到 2 0 50年将会出现负增长。健康保健的改善导致的寿命延长将使没有生产能力的老年人数量…     

Clinicopathologic Features of Incident and Subsequent Tumors in Patients with Multiple Primary Cutaneous Melanomas

Background

0.6?C12.7% of patients with primary cutaneous melanoma will develop additional melanomas. Pathologic features of tumors in patients with multiple primary cutaneous melanomas have not been well described. In this large, international, multicenter, case?Ccontrol study, we compared the clinicopathologic features of a subsequent melanoma with the preceding (usually the first) melanoma in patients with multiple primary cutaneous melanomas, and with those of melanomas in patients with single primary cutaneous melanomas.

Methods

Multiple primary melanoma (cases) and single primary invasive melanoma (controls) patients from the Genes, Environment and Melanoma (GEM) study were included if their tumors were available for pathologic review and confirmed as melanoma. Clinicopathologic characteristics of invasive subsequent and first melanomas in cases and invasive single melanomas in controls were compared.

Results

A total of 473 pairs comprising a subsequent and a first melanoma and 1,989 single melanomas were reviewed. Forward stepwise regression modeling in 395 pairs with complete data showed that, compared with first melanomas, subsequent melanomas were more commonly contiguous with a dysplastic nevus, more prevalent on the head/neck and legs than other sites, and thinner. Compared with single primary melanomas, subsequent melanomas were more likely to be associated with a contiguous dysplastic nevus, more prevalent on the head/neck and legs, and thinner. The same differences were observed when subsequent melanomas were compared with single melanomas. First melanomas were more likely than single melanomas to have associated solar elastosis and no observed mitoses.

Conclusions

Thinner subsequent than first melanomas suggest earlier diagnosis, perhaps due to closer clinical scrutiny. The association of subsequent melanomas with dysplastic nevi is consistent with the latter being risk factors or risk markers for melanoma.     

COMPREHENSIBILITY OF THE PACKAGE LEAFLETS OF ALL MEDICINAL PRODUCTS FOR HUMAN USE: A QUESTIONNAIRE SURVEY ABOUT THE USE OF SYMBOLS AND PICTOGRAMS

Directive 92/27EEC establishes that the package leaflet is a document, which must be included in the package of medicinal products for human use in EU countries. This informative leaflet is directed at the users and it must give full and comprehensible information. The Law suggests the use of symbols but it does not give advice about the subjects to be represented. In order to evaluate the attitude of patients towards package leaflets provided with symbols, we planned a survey interviewing 1004 patients in pharmacies. The data suggest that Italian patients usually read the package leaflet but they neither understand it easily nor find the needed information readily. Most respondents (74.3%) considered the use of symbols helpful in finding the needed information. We proposed five symbols for each heading (therapeutic indications, side effects, paediatric use, contraindications, use in pregnancy) and asked to select which symbol could be used. In the case of 'side effects', 'paediatric use', 'use in pregnancy' and 'dose', most of the respondents chose the same symbol. In the case of 'therapeutic indications' and 'contraindications' there was no uniformity in the answers. The choice depends greatly on education, age and employment of respondents.     

From the organ bath to the whole person: a review of human colonic motility

Motor function of the colon is essential for health. Our current understanding of the mechanisms that underlie colonic motility are based upon a range of experimental techniques, including molecular biology, single cell studies, recordings from muscle strips, analysis of part or whole organ ex vivo through to in vivo human recordings. For the surgeon involved in the clinical management of colonic conditions this amounts to a formidable volume of material. Here, we synthesize the key findings from these various experimental approaches so that surgeons can be better armed to deal with the complexities of the colon.     

Severe childhood encephalopathy with dyskinesia and prolonged cognitive disturbances: evidence for anti‐N‐methyl‐d‐aspartate receptor encephalitis

Aim We report four cases of acquired severe encephalopathy with massive hyperkinesia, marked neurological and cognitive regression, sleep disturbance, prolonged mutism, and a remarkably delayed recovery (time to full recovery between 5 and 18mo) with an overall good outcome, and its association with anti‐N‐methyl‐d ‐aspartate (anti‐NMDA) receptor antibodies. Method We reviewed the four cases retrospectively and we also reviewed the literature. Results Anti‐NMDA receptor antibodies (without ovarian teratoma detected so far) were found in the two children tested in this study. Interpretation The clinical features are similar to those first reported in 1992 by Sebire et al., 1 and rarely recognized since. Sleep disturbance was not emphasized as part of the disorder, but appears to be an important feature, whereas coma is less certain and difficult to evaluate in this setting. The combination of symptoms, evolution (mainly seizures at onset), severity, paucity of abnormal laboratory findings, very slow recovery, and difficult management justify its recognition as a specific entity. The neuropathological substrate may be anatomically close to that involved in encephalitis lethargica, in which the same target functions (sleep and movement) are affected but in reverse, with hypersomnolence and bradykinesia. This syndrome closely resembles anti‐NMDA receptor encephalitis, which has been reported in adults and is often paraneoplastic.     

The Human Genome Project

In many Western jurisdictions, people with an intellectual disability are over-represented at various stages of the criminal justice system, including appearances before local courts, suspects undergoing police questioning, and in prisons. Whilst the over-representation has been established, little is known about concurrent factors which may contribute to the behaviour which brings them to the attention of the criminal justice system. Conversely, few data are available about people with an intellectual disability who have similar living environments, but who are not involved in criminal acts. This study examines a sample of 60 women, 30 of whom are ex-prisoners, and 30 of whom are presently living in similar unstable residential situations (refuge, welfare organisation accommodation, etc), but who do not have a history of prior imprisonment. No significant differences were found between the two groups in terms of prevalence of intellectual disability; 25% of the total group had an IQ score of 69 or lower, which would place them in the category of intellectual disability. In the ex-prisoner group, this figure was 29.7%, whereas in the non-prisoner group, it was 20%. A further 11.7% were in the borderline category of IQ score 70–79. Low verbal IQ scores correlated with alcohol or benzodiazepine abuse, smoking, self-harm and suicide, poor mental and physical health, low levels of education, and unstable accommodation. For both ex-prisoners and non-prisoners, high intelligence appeared to be a mediating factor, lessening the impact of other factors related to deprived and difficult living circumstances. The low levels of verbal ability revealed indicate the need for tailoring rehabilitation programmes for verbally impaired participants.