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We report two similar rare types of fracture of the lower end of the humerus sustained in fit young adults while throwing a ball. Both cases were seen within 1 week in a busy accident and emergency (A&E) department. The types of fracture in each case are unusual and, in the past, have been attributed to fatigue or to a repetitive strain pattern.
The discharge characteristics of type B left atrial receptors were analyzed during alterations in heart rate. Recordings were made from single-fiber preparations of the left cervical vagus of pentobarbital-anesthetized, open-chest dogs. The heart was paced following a sinoatrial crush at frequencies ranging from 60 to 240 beats/min. Left atrial transmural pressure was varied at each heart rate by the intravenous infusion of warm isotonic NaCl. As heart rate was increased there was a progressive decrease in the level of peak "v" wave left atrial pressure. Concomitantly with the decrease in left atrial pressure, the number of spikes per cardiac cycle decreased as did the maximal instantaneous frequency of discharge. A significant positive relationship could be demonstrated with either the discharge per minute [(spikes per cycle) X heart rate] or discharge per cycle vs. the peak "v" wave of the left atrial pressure, regardless of heart rate. The number of impulses that entered the central nervous system per unit of time remained relatively constant at heart rates between 90 and 240/min. It is concluded from these data that the reflex effects which have been attributed in the past to atrial stretch receptor stimulation during clinical episodes of atrial tachyarrhythmias may be better correlated with some aspect of receptor discharge other than frequency or the number of discharges per cycle.
BACKGROUND: Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of their suffering. METHODS: We conducted semi-structured interviews with 26 asylum seeker and refugee patients from the former country of Yugoslavia who attended the general medicine outpatient clinic of a Swiss teaching Hospital and were identified as presenting with somatisation. Interviews explored patients' illness perspectives and health care expectations. Interviews were audio taped, transcribed verbatim and analyzed to identify key themes in patients' narratives. RESULTS: Patients attributed the onset of symptoms to past traumatic experiences and tended to attribute their persistence to current living conditions and uncertain legal status. Patients formulated their suffering in both medical and social/legal terms, and sought help from physicians for both types of problems. CONCLUSION: Awareness of how asylum seeker and refugee patients make sense of their suffering can help physicians to better understand patients' expectations of the clinical encounter, and the particular nature and constraints of the patient-provider relationship in the context of asylum.
Increased demand for ethanol as a fuel additive has resulted in dramatic growth in ethanol production. Ethanol is produced from corn by either wet milling or dry-grind processing. In wet milling, the corn kernel is fractionated into different components, resulting in several coproducts. Wet-milling plants are capital intensive because of equipment requirements; they produce large volumes of ethanol and are corporate owned. In dry-grind processing, the corn kernel is not fractionated and only one coproduct, distillers' dried grains with solubles (DDGS), is generated. Dry-grind plants require less equipment and capital than wet mills. They generate smaller volumes of ethanol, are producer owned, and add direct benefits to rural economies. Most of the increase in ethanol production during the past decade is attributed to growth in the dry-grind industry. The marketing of coproducts provides income to offset processing costs. For dry-grind plants, this is especially important, because only one coproduct is available. Several issues could affect DDGS marketing. The increasing volume of DDGS accompanying ethanol production could reduce market value; high phosphorous content could limit the use of DDGS, because of animal waste disposal issues. Water removal is a costly processing step and affects the economics of ethanol processing. Technologies to remove germ and fiber from DDGS could produce a new coproduct suitable for feeding to nonruminants; this would expand the markets for DDGS. Reducing phosphorus in DDGS would sustain markets for conventional DDGS. The development of more efficient methods of water removal would increase the efficiency of ethanol processing and reduce the costs of processing. New technologies could contribute to greater stability of dry-grind plants.
Novice drivers (16-year-olds with < or = 6 months' driving experience) have the highest crash involvement rates per 100 million vehicle miles (161 million vehicle km). In the past, this was attributed to greater risk taking or poorly developed psychomotor skills. More recently, however, their high crash involvement rate has been hypothesized to be attributable largely to their relative inability to acquire and assess information in inherently risky situations. The current study seeks to evaluate this hypothesis by recording eye movements while 72 participants (24 novice drivers, 24 younger drivers, and 24 older drivers) drove through 16 risky scenarios in an advanced driving simulator. There were significant age-related differences in driver scanning behavior, consistent with the hypothesis that novice drivers' scanning patterns reflect their failure to acquire information about potential risks and their consequent failure to deal with these risks. Actual or potential applications of this research include modification of these scenarios for display on a PC as a basis for a training module that would enable novice drivers to recognize risky scenarios before they encounter them on the road, in the hope of reducing their high fatality rate.
Pigeons were conditioned to peck a response key under a procedure that alternated periods of food reinforcement with periods of extinction. The pigeons attacked a nearby pigeon at the onset of extinction. Some also attacked a stuffed model of a pigeon. The duration of attack was an inverse function of the time since the last food reinforcement and a direct function of the number of reinforcements. The pigeons attacked after the last food delivery whether or not the conditioned pecking response was required and whether or not the extinction period was signaled. The food had to be eaten; the mere sight and sound of food being delivered did not produce attack. Prior satiation reduced attack. The phenomenon was not attributable to a past history of competition between pigeons since socially deprived pigeons also attacked. Superstitious reinforcement of attack was not found to be a factor. The results indicated that the transition from food reinforcement to extinction was an aversive event that produced aggression.
Detailed observation of manifest dream sequences indicated self-advocating occurrences facilitating the dreamer's self interests, opposed by self-adversarial interferences. Further examination of manifest dream syntactical structure additionally suggested a recurrent, four-step, algorithm for personal problem-solving within an interpersonal matrix consisting of the following cycle: (1) an opening scene setting the stage, (2) for the emergence of a self-concern, (3) which evokes a strategy to deal with dreamer's self-concern, (4) that eventuates in a consequence of the strategy. These steps repeat until the dream ends. Observing these manifest dream structural features, attributable to broadening past theorizing with "bottom-up" approaches, clarifies the dream's problem-solving process by providing an empirical, observable framework for dream interpretation and by contributing to their consensual validation.
Ankylosing spondylitis is reported to involve not only the joints but other organs as well. Among these extra-articular involvements, uncommon complications associated with nervous system such as single root lesions, compression of the myelum and cauda equina syndrome have also been documented. Here we present a patient with long-standing ankylosing spondylitis who developed spastic paraparesis. Extensive study to find the cause of a spastic paraparesis failed and therefore led to the conclusion that this patient was suffering from transverse myelitis. Similar reports in the past have been attributed to an association with multiple sclerosis; however, we suggest that the findings support the diagnosis of a rare complication of ankylosing spondylitis with an unknown etiology.
The metabolic syndrome (MS) is a common metabolic disorder that has been recently related to the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) will be applicable worldwide. The pathophysiology has been largely attributed, in the past years, to insulin-resistance, even if several epidemiological and pathophysiological data are attractive to indicate visceral obesity as a main factor in the occurrence of the MS, promoting new definitions and re-evaluation of the pathogenesis of this syndrome. In this review, we have analyzed the role of visceral obesity in the new definition of the MS such as the pathophysiological role of the abnormal fat distribution in the occurrence of this syndrome. In view of this, relationships between visceral obesity, free fatty acids, dyslipidaemia and insulin-resistance have been reported. In addition, the effects of some adipocytokines and other proinflammatory factors produced by fat accumulation on the appearance of the MS have been also emphasized. Finally, according to recommendations of several international societies, the role of the life-style change and of the weight loss in the prevention and treatment both of obesity and of other associated risk factors has been analyzed.
Iatrogenic obstruction of the spermatic duct or iatrogenic occulusive azospermia, in a wider context, is more frequently diagnosed today than it used to be in the past. This is attributable to general improvement of the system of andrological care. Hints are given on avoidance of that lesion by surgical tactics as well as on provisional treatment and on compulsory notification of injuries that occurred to the spermatic duct. A rating of 20 to 30 per cent of disablement is proposed for irreversible iatrogenic occlusive azospermia. Reference is made to possible modes of financial compensation in the context of mVGE or EmU procedures.
Discovered in 1977 by Rizetto and his collaborators, agent delta is today considered as a virus entirely distinct from the H/B virus. This small RNA virus, transmissible to primate and to man, is defective: its replication in the liver is only possible when there is a pre-existing or simultaneous infection by the H/B virus with HBs antigenaemia. Its clinical importance appears very great as agent delta is very pathogenic to the liver: super-infection by this virus of a patient infected by the H/B virus explains a good number of cases of acute fulminant hepatitis and of chronic active hepatitis developing towards cirrhosis, disorders attributed in the past solely to the hepatitis B virus.
Members of the American Association on Mental Retardation (AAMR) Social Work Division (N = 395) were surveyed to determine their perceptions of their role in assisting older parents in permanency planning. Practitioners, administrators, and educators similarly perceived ease in counseling aging families, but also noted their need for additional resources and specialized training. Written comments revealed (a) that the system must do more; (b) older parents are seen as different from other parents, with practitioners concerned about dependency in these parents' relationships with their sons and daughters and administrators attributing differences to past adverse system interactions; (c) parents old and young are alike in many ways; and (d) siblings should be involved in family caregiving. Recommendations were made with regard to meeting the special needs of older families, reducing "blaming" attitudes among social workers, and expanding best practice knowledge.
Two men with longstanding ankylosing spondylitis (AS) developed spastic paraparesis. Extensive investigation failed to find a cause and it was concluded that some acute undetermined intrinsic spinal cord lesion had occurred. Similar descriptions in the past have been attributed to associated multiple sclerosis, but we suggest that the finding may represent a rare complication of AS with an unknown etiology.
Breast cancer treatment during pregnancy involves a host of psychosocial, ethical, religious, and even legal considerations, as well as medical multidisciplinary decisions, since the effect of treatment on the fetus must be considered. For example, breast or chest wall radiotherapy should be avoided. The absorbed fetal dosage is at least 5 cGy early in pregnancy and increases to several hundred cGy late in pregnancy to the fetal part immediately below the diaphragm. In the second and third trimesters, chemotherapy is associated with intrauterine growth retardation and prematurity in about half of the babies; the risk of birth defects is a concern in the first several weeks. Typical anesthetic agents readily reach the fetus but are not known to be teratogenic. Although abortion will allow full and comprehensive treatment to the mother, it is not known whether the procedure itself is therapeutic. Early in pregnancy, abortion deserves strong consideration, since the effects of treatment on the fetus will not be a consideration. The poor prognosis of pregnancy-associated breast cancer in the past is probably attributable to a combination of initial delay of diagnosis and possibly to unfavorable biologic characteristics of the hormonal milieu of pregnancy. When pregnant patients are matched stage for stage with controls, survivals seem equivalent, although pregnant patients present with more advanced disease.
Neurilemmoma (schwannoma) is a benign, encapsulated perineural tumor of neuroectodermal derivation that originates from the Schwann cells of the neural sheath of motor and sensitive peripheral nerves; the etiology is still unknown. The tumor is normally solitary, smooth-surfaced, slow growing and generally asymptomatic. It may develop at any age and there is no gender predilection. Head and neck are one of the most frequent localizations, but intraoral development is quite uncommon. In this area the mobile portion of the tongue, and in a decreasing order, the palate, the cheek mucosa, the lip and gingiva are the most frequent locations. Although it origins from the nervous tissue, only in 50% of the cases a direct relation with a nerve is demonstrated. The term schwannoma has been attributed in the past either for neurofibroma and neurilemmoma. Their histogenesis remain anyway a controversial argument. Some authors think that both tumors originate from Schwann cells and perineural connective cells. Others think that the first one originate from perineural cells, while the latter from Schwann cells. Diagnosis is confirmed by microscopic examination. Neurilemmoma shows two different components: Antoni type A and Antoni type B tissue. The first one consists of Schwann cells arranged in compact, twisted bundles, associated with delicate reticulin fibres and spindle-shaped nuclei aligned in parallel rows forming a typical palisading pattern. Between the rows there are fine cytoplasmatic fibrils with acellular, eosinophilic masses called Verocay bodies. The second one is formed by irregularly arranged masses of elongated cells and fibers similar in appearance to neurofibroma, with areas of cystic degeneration and edema.(ABSTRACT TRUNCATED AT 250 WORDS)
UNLABELLED: The course of Raynaud's phenomenon (RP) after the end of exposure to vinyl chloride monomer (VCM) is not really well known. Fourty four subjects were studied, from 128 retired patients who were exposed to VCM (end of the exposure since 8 years at least): 17 complained of "white finger crisis", and 27 voluntary retired subject without complaints (table II). The aims of this study were to specify capillaroscopic and clinical characteristics of these complaints to define and to assess the role of VCM. Each patient underwent an interview, a clinical examination and a nailfold capillary microscopy examination. RESULTS: 1) The 17 pensioners with complaints suffered from RP. But for 12 of them the onset of RP was in the exposed period (table I). From the clinical interview, the clinical and capillaroscopic examinations in these 12 RP may be attributed to the past exposure to VCM. 2) The majority of 44 subjects showed no capillary abnormalities. For 3 subjects changes consisted in isolated capillary dystrophia (1 with PR, 2 without PR) and for 2 subjects changes consisted in isolated neocapillaries (1 with PR, 1 without PR). The other microvascular changes were not specific (table III). In conclusion, RP secondary to VCM can still persist after the end of exposure in patients who suffered from RP during the exposure, 9% of the population (12/128). In view of discordance of clinical symptoms and capillaroscopic abnormalities, capillary lesions did not appear as the main physiopathologic factor in the persistence of the PR secondary to CVM.
Testis tumors in children occur infrequently and exibit differences in their histopathology, clinical behaviour and therapy from their adult counterparts. From 1979 to 1994, 17 children and adolescent with testicular tumors were treated at the Pediatric Surgical Department of Vicenza Regional Hospital. Paratesticular rabdomiosarcoma were present in 3 cases, 4 patients had embrional carcinoma, 1 Sertoli cell tumor, 2 Leydig cell gonadal stromal tumor, and leukemic infiltrates of the testis were clinically evident in 7 patients. We report our clinical series and discuss in relation to clinical characteristic, histopathology and therapy and conclude that the improved survival during the past decade is attributable to better diagnostic imaging thecniques, the availability of serum tumor markers to monitor disease activity and more effective chemotherapy.
Allogenic colonies of the cosmopolitan ascidian Botryllus schlosseri may fuse upon contact through their blood vessels to form chimeric entities if they share at least one allele at a highly polymorphic haplotype, termed the fusibility-histocompatibility (Fu/HC) locus. Past studies have attributed several benefits to this chimerism, but none of the suggestions was confirmed by controlled laboratory studies. Furthermore, once Botryllus colonies fuse, a second allorecognition phenomenon begins which usually leads to the resorption of one partner in the chimera. Resorption is probably controlled by a multilevel hierarchial organization of the heterozygosity relatedness for several allorecognition elements (the Fu/HC and resorption loci), which also reflects the relative heterozygosity of each partner's genome. Consequently, the more heterozygotic partner will be the 'winner' in the resorption, leaving alive the most adapted genotype (sensu to the heterosis concept). However, recent studies have recorded that freely circulating stem cells from the 'subordinate' partner in the resorption phenomenon may parasitize the 'winner' for positions on the germ line. All the above studies have been performed on bichimeric entities. It is suggested here that formation of natural multichimeras in this species (resulting from an aggregated cosettlement of Fu/HC compatible colonies) produces more 'equilibrated' chimeric entities and alleviates the costs incurred through the contradicting heterosis and germ cell parasitism processes. This improves the interspecific competitive ability of the multifusion entities. Therefore, in this case, selection acts on the 'group' level, not the colony level, providing the evolutionary forces that shape the phenomenon of natural tissue transplantation in these organisms.