Biomedical subjects
Publications and source records attributed to F Biro.
Intra-arterial application of dissolved tablets is associated with a high risk of tissue necrosis. An early active vasodilatating and recanalising treatment is necessary. We present the case of 21-year-old female who applied three dissolved Flunitrazepam tablets into the ulnar artery and was successfully treated with prostaglandin E1 and recombinant tissue plasminogen activator.
BACKGROUND: We prospectively investigated the need for esophagogastroduodenoscopy (EGD), transesophageal echocardiography (TEE) and retinoscopy for pre-interventional screening in patients with peripheral arterial occlusive disease (PAD) prior to intraarterial fibrinolytic therapy. PATIENTS AND METHODS: 212 consecutive patients suffering from PAD (164 male and 48 female, mean age: 64 +/- 11 years, 161 patients stage II of Fontaine's classification, 10 patients at stage III and 41 patients at stage IV) referred for interventional treatment were included. 173 EGDs, 169 TEEs and 188 retinoscopies were performed within one week prior to fibrinolysis. 114 patients had all three examinations. RESULTS: Pathologic findings were detected in 56 (49%) of the 114 patients: 23 erosions, 12 ulcers, 2 esophagites, 1 gastric carcinomata, 3 intracardiac thrombi, 5 aortic thrombi, 11 diabetic and 5 hypertensive retinopathies and 1 with retinal aneurysms. 30 patients (25%) received fibrinolytic therapy, despite a contraindication: The one patient with ventricular thrombus was treated as an ultimate therapy, and amputation was prevented. Two patients showing plaques covered by large thrombi in the descending thoracic aorta were treated because cranial embolism should not occur. Four diabetic patients with multilevel disease, severe claudication and prior retinal bleeding were treated. Fibrinolytic therapy was started on 23 patients after complete healing of the mucosal lesions. CONCLUSION: TEE revealed potential sources of embolization in 4% of the patients and is justified to reduce the individual risk. Retinoscopy should be done in patients with diabetes mellitus and hypertension, and if prior bleeding is present fibrinolysis should be done only if other treatment-regimes are not available.
PURPOSE: To examine the validity of maturation self-assessments and to investigate the association between race and validity of self-assessments among young black and white girls. METHODS: Self-assessments and examiner-assessments of areolar and pubic hair development using line drawings were compared at three visits among a cohort of 11- to 14-year-old girls enrolled in the National Heart, Lung, and Blood Institute's Growth and Health Study. Accuracy rates and kappa coefficients were calculated to measure the agreement between girls and examiners. Logistic regression models were used to assess the racial differences in the accuracy of self-assessments while adjusting for possible confounders. RESULTS: Fair to moderate agreement was found between self- and examiner-assessments (areolar self-assessments: adjusted accuracy rates: 60.7-69.9%, kappa: 0.32-0.51; pubic hair self-assessments: adjusted accuracy rates: 57.9-70.7%, kappa: 0.36-0.55). While there were indications of racial differences in the ability to perform self-assessment with black girls tending to self-assess less accurately, most of the differences disappeared after adjusting for nurse-assessed stage. CONCLUSIONS: These findings suggest that self-assessment can substitute for examiner evaluations only when crude estimates of maturation are needed. However, when accurate maturation stage data are required, examiner-assessments are necessary. Because black girls are usually more pubertally advanced and tend to underestimate their development, the value of self-assessment is questionable for assessing populations with young black and white girls. Use of self-assessment might present biased estimates of maturation and confound research findings.
Background: To date, few studies have used a longitudinal approach in examining risk factors for STD acquisition in teenage girls. In the present study, we examined risk of STD acquisition in adolescent girls over a three-year period using longitudinal analyses.Methods: One hundred and seventy-four girls between the ages of 12 and 16 (mean age = 14.5) participated in a longitudinal study of adolescent romantic relationships. The racial composition of the subject pool was 80% African-American and 20% Caucasian. These girls were followed for three years at six-month intervals. By the end of the study, 127 of the girls were sexually experienced, and thus, were included in the analyses regarding risk for STDs. The risk for history of STD was evaluated using a generalized estimating equations (GEE) model, which allows for the inclusion of data from subjects with missing visits. The following independent variables were entered into the model: age, race, screening IQ score, qualitative cognitive functioning, perceptions of STD prevalence among female friends, and whether a condom was used at last intercourse. Additional independent variables included number of lifetime partners (4 or more lifetime partners, 2 to 3 lifetime partners, only one partner) and age of sexual debut (less than 14 years, 14-16 years, and 17 years and older), five factors from the Family Environment Scale, and three types of parental monitoring (direct, direct when with peers, and indirect).Results: The results of the longitudinal (GEE) model indicated that having a history of an STD was significantly related to a younger age of sexual debut (p <.01), having more partners (p <.0001), being African-American (p =. 01), and having a lower screening IQ score (p <.01).Conclusions: These results suggest that risk of STD is associated with both modifiable and non-modifiable variables. Race and intellectual functioning independently contributed to STD risk, stressing the importance of utilizing prevention programs that are culturally and developmentally specific. For example, less intelligent girls may need to have information presented in a more concrete manner, with a focus on the present rather than the future. The targets of these prevention programs should continue to emphasize delaying initiation, as well as partner selection. Finally, the fact that variables for STD acquisition in this longitudinal model are comparable to previous cross-sectional studies of STD acquisition suggests that these are potent predictors of risk.
Background: Previous research has demonstrated that parents play an important role in adolescents' reduction of risk of STD and unintended pregnancy through knowledge of their daughters whereabouts and by knowing their friends. Little is known, however, about parents; relationships with their daughters' boyfriends. Therefore, we sought to describe the daughters' perceptions of their parents' knowledge of their boyfriends.Methods: Questions regarding relationships with boyfriends and parents were assessed in the last wave of a longitudinal study of adolescent girls' romantic relationships. Of the 137 girls interviewed, 109 had had a boyfriend in the past 6 months, 78 had a current boyfriend. The results of this study were based on this subsample of 109.Results: The 109 adolescent girls had a mean age of 17.6 (range 14.9 to 19.3 years), and 80% were African-American and 20% Caucasian. Of those girls, 92 were sexually experienced (which 88% of their parents knew about), and 80 had engaged in sexual intercourse with this identified boyfriend. Nine of the girls reported that their parents had had no contact with their boyfriend in person or on the phone, and ten reported that they had neither met or talked on the phone to their boyfriend's parents. Three girls reported that neither they nor their boyfriends had had contact with the others' parents. Thirteen girls reported that their parents did not know their boyfriends at all well, 40 reported that their parents knew their boyfriends somewhat, and 56 reported that their parents knew their boyfriends well. Girls who had been involved in the relationship for a longer amount of time (F(2, 105) = 7.90, p <.001) and girls who perceived that their relationship would last a year or longer were more likely to think their parents knew their boyfriends well (chi sq = 14.1, p <.001). The results of the analysis between satisfaction with their romantic relationship and how well their parents knew their boyfriends approached significance (chi square = 5.5, p =.06). Of the six girls with a current boyfriend whose parents did not know their boyfriends, none were "very satisfied" with their relationship. Neither age nor race were related to how well the parents knew the boyfriend.Conclusions: These results indicate that most adolescent girls' parents have some contact with their boyfriends. Contact appeared to be related to length of relationship. Health care professionals should be sensitized to the needs of girls who are beginning new relationships, or are not satisfied with their relationship and who do not have access to parental support. Future research should examine familial/parental factors related to knowledge of the boyfriend and whether the lack of a developmental trend is the result of a restricted age range or of other family issues.
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The hypermobility syndrome has been recognized as a definitive diagnostic entity among children referred to a Pediatric Arthritis Clinic with musculoskeletal complaints. The diagnosis of hypermobility was made by the ability of the patients to perform at least three of the following maneuvers: (1) extension of the wrists and metacarpal phalanges so that the fingers are parallel to the dorsum of the forearm; (2) passive apposition of thumbs to the flexor aspect of the forearm; (3) hyperextension of elbows (greater than or equal to 10 degrees); (4) hyperextension of knees (greater than or equal to 10 degrees); (5) flexion of trunk with knees extended so palms rest on the floor. Of 262 patients, 15 (5.7%) referred to an arthritis clinic between January 1979 and July 1981 were subsequently determined to have hypermobility as the basis for their rheumatic complaints. Three of these 15 had concomitant juvenile arthritis. The presenting complaint of pain was most often localized to the knees, hands, and fingers. Arthritis and elevated ESRs were not seen except in the three patients who had concomitant juvenile arthritis. All patients responded to physical therapy and nonsteroidal analgesic anti-inflammatory drugs. This is an entity not sufficiently well recognized as a source of musculoskeletal complaints in the United States. It will usually respond well to reassurance and symptomatic therapy.