Craniometaphyseal dysplasia: the first successful surgical treatment for associated hearing loss.
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Biomedical subjects
Publications and source records attributed to J Shea.
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A test of the relationship between physical attractiveness and ego development was completed through an interview study of 294 men and women college students. Ss responded to personality measures assessing identity formation, locus of control, and ego functioning and were rated on facial attractiveness and body form scales. Contrary to the physical attractiveness stereotype, attractive and unattractive Ss did not differ in their personality styles.
In our experience, trochanteric fractures fixed with Ender nails achieved a degree of success similar to those treated by nail plating, but the risk of wound infection was much less with the former method. The results of 78 trochanteric fractures of the femur internally fixed with Ender nails have been analysed and compared with the results in 100 similar patients treated by nail plate fixation. The Ender method has advantages over existing operative methods, in that in our series the infection rate was zero and we found that the operation produced less shock. We consider that this method, although technically more difficult, can be used for most intertrochanteric fractures and merits further trial.
In those ears in which the incus and/or malleus are missing or not suitable, a columella made of high density polyethylene sponge has proven to be very effective. Tissue readily grows into the large pores of this material so that it is well tolerated in the body. During the last six months 54 have been implanted with no rejection so far and a good hearing gain in 43 or 80 percent.
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BACKGROUND: Early renal transplant failure necessitating a return to dialysis has been shown to be a poor prognostic factor for survival. Little is known about the outcome of patients with late transplant failure returning to dialysis. It was our clinical impression that late transplant failure (>2 months) carries an increased morbidity and mortality risk in patients returning to dialysis. OBJECTIVE: To determine whether patients with a failed renal transplant have an outcome different to those on dialysis who have never received a kidney transplant. SETTING: Peritoneal dialysis (PD) unit in a teaching hospital. PATIENTS AND DESIGN: All failed renal transplant patients (fTx) in the Toronto Hospital Peritoneal Dialysis program between 1989 and 1996 were identified. This cohort of 42 fTx patients was compared with a cohort of randomly selected never-transplanted PD patients (non-Tx). The PD program was selected because of the availability of well-documented patient archival material. The non-Tx group was matched for age and presence of diabetes. Data were collected until retransplantation, change of dialysis modality or center, death, or until June 1998. RESULTS: There was no difference at initiation of PD between groups in serum albumin, residual renal function, or mean serum parathyroid hormone level. The mean low-density lipoprotein level was significantly higher in the fTx cohort. The duration of dialysis before Tx in fTx patients accounted for the increased total length of dialysis in fTx (mean 15 months). However, post-Tx the duration of PD was similar for both groups (30.7 months for fTx vs 31.6 months for non-Tx). The fTx group had a considerably worse outcome than the non-Tx group. The time to first peritonitis, subsequent episodes of peritonitis, catheter change, or transfer to hemodialysis occurred at a much faster rate in fTx patients. The most dramatic difference was in survival. There were 3 deaths in the non-Tx group and 12 in the fTx group (p < 0.01). The mean age at time of death in the fTx group was 47.5 years. Deaths were due mainly to gram-negative peritonitis and cardiovascular disease. CONCLUSIONS: We conclude that late failed renal transplant patients starting dialysis are at increased risk of complications and have strikingly higher mortality rates than non-Tx patients. A previously failed kidney transplant can be considered an adverse prognostic factor for patients commencing PD; these patients need to be closely monitored. Although this study was limited to PD patients, the same principles likely apply to fTx patients returning to any form of renal replacement therapy.
A program to provide teenage family planning clinic patients with special services designed to improve their ability to practice contraception effectively and avoid conception produced neither of these expected effects. Two types of special services were tested in nine clinics: one, to promote greater involvement of the teenager's family through special counseling sessions (family support); and the other, to provide more frequent contact between the teenager and clinic staff through telephone calls (periodic support). The services were provided in the six weeks following the first clinic visit. Only 36 percent of the girls who agreed to be in the family support group attended any counseling sessions, and only five percent of them came with a parent. Participation was greater in the periodic support group--84 percent of teenagers in the group received the follow-up phone calls. During the 15 months following the initial clinic visit, there were no significant differences in regularity of contraceptive use and pregnancy rates between the teenagers who received the special support services and those who received only the regular clinic services. About 40 percent of the special-service groups reported always using a contraceptive method during the study period, compared with 48 percent of controls; and about 40 percent of the former said they had rarely or never used a method, compared with 27 percent of the latter. The cumulative 15-month pregnancy rate was about 13 percent in both the special-service and the control groups.
Improving communication about sex and birth control between parents and their children has often been cited as a means to encourage young people to use contraceptives more effectively. In an attempt to test this hypothesis, we interviewed 290 adolescents at family planning clinics in southeastern Pennsylvania three times in the course of 15 months about their communication with their families and their use of contraceptives. At the time of their first clinic visit, two-fifths of the teenagers said that their mothers knew that they had gone to the clinic; this proportion rose to almost three-fifths six months later and to about three-quarters at the end of 15 months. However, the proportion of teenagers who said that they had discussed sex or birth control with their mothers remained almost the same; the proportion who said that they would never discuss such topics with their mothers also remained fairly constant. The teenagers whose mothers knew of their clinic attendance at the time of their first visit were no more likely to have had extensive conversations with their mothers about sex or contraception than were the teenagers whose mothers found out afterwards. Among a subsample of the mothers of these young women, fewer than one-third said that they had ever discussed their daughters' sexual activity with them. There was only a modest level of correspondence between the mothers' responses and their daughters' replies; for the most part, the mothers thought that they were much more communicative about sex and birth control than their daughters perceived them to be.(ABSTRACT TRUNCATED AT 250 WORDS)
An attempt to find a reliable way to measure contraceptive continuation among teenagers was made in a study of 445 adolescents under age 18 who made an initial visit to one of nine federally funded family planning clinics in the Philadelphia area in 1980 and 1981. The participants were interviewed at their initial visit and at six and 15 months to collect information on background characteristics, pregnancy history and contraceptive use. A cross-check of the information on contraceptive use reported during the study showed that 38 percent of the respondents who reported that they had been continuous users during the 15 months supplied information at other points indicating that they had not always used contraceptives during that period. In an attempt to examine the effects of adolescent reporting errors on measures of contraceptive use, the investigators constructed three alternative measures of contraceptive continuation. The simplest measure assessed current use at 15 months. A second measure accepted only reports of continuous use at 15 months and ignored inconsistent data. The third measure corrected for inconsistent data. Applying these measures to the study population produced proportions of contraceptive continuation ranging from a low of 43 percent when the most stringent measure was used to a high of 82 percent for the current-use category. Whatever the measure used, much of the discontinuation appears to have occurred in the first three months after the initial visit to a family planning clinic.(ABSTRACT TRUNCATED AT 250 WORDS)
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