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OBJECTIVES: To review the etiology, epidemiology, classification, diagnosis, staging, prognosis, treatment, and nursing implications of non-Hodgkin's lymphoma. DATA SOURCES: Research studies, review articles, and book chapters pertaining to non-Hodgkin's lymphoma. CONCLUSIONS: Non-Hodgkins's lymphomas are a heterogeneous group of lympho-proliferative disorders, increasing in frequency, for which therapy ranges from supportive to curative. IMPLICATIONS FOR NURSING PRACTICE: An understanding of the variety of presentations and treatments of non-Hodgkin's lymphomas will enable the oncology nurse to assist patients and their families to cope with the disease, make treatment-related decisions, and optimize the patient's quality of life.
OBJECTIVE: To describe the basics of three clinical applications of the flow cytometer. DATA SOURCES: Recent articles and books on flow cytometry and laboratory diagnosis. STUDY SELECTION: Not applicable. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: Immunophenotyping is the classification of cells based on antigens present on their surfaces. These antigens can be detected and quantified by a flow cytometer using monoclonal antibodies conjugated to fluorescent dyes. Reticulocytes are immature red blood cells that contain varying amounts of RNA and DNA. They can be stained with a fluorescent dye and enumerated by a flow cytometer. DNA ploidy analysis of solid tumors involves staining the nuclei of cells with a fluorescent dye. The amount of DNA in each cell is determined, and the percentage of cells in the S phase is calculated. CONCLUSION: Flow cytometry is a relatively new technology in the clinical laboratory. There are many clinically useful applications for which it is suited. As the technology continues to grow, so will the use of the flow cytometer.
After the foundation of the course of pharmaceutical studies at Masaryk University in Brno in 1945, its Institute of Pharmaceutical Chemistry has been founded. In pharmaceutical chemistry, which was divided into the theoretical, synthetic and control-analytical parts, a system of classification was worked out based on classification of drugs according to the kind of effect for which it serves. This conception was incorporated into three editions of the book Chemická léciva (Chemical Drugs). The research programme of the Institute solved the development of novel local anaesthetic and antituberculous agents. After the disestablishment of the Faculty of Pharmacy in Brno, the development of pharmaceutical chemistry, continued at the Department of Pharmaceutical Chemistry, Comenius University, Bratislava, and beginning with 1969 at Charles University Faculty of Pharmacy in Hradec Králové.
Within the scope of the validation process described in this report, the influence of the process parameters on the factors determining the quality of Euphylong pellets during the spraying process is examined. The process is challenged within the meaning of the validation guidelines. Investigations within the scope of product-independent validation of the automated fluid bed coating apparatus (Wurster setup) used here provide the basis for installation qualification and operational qualification as defined by the PIC convention and the GMP guidelines. Within the scope of a classification of risks, potential operating and system errors are examined, giving consideration to the worst case conditions, and the relevance of the "blue book" to the process is discussed. Three critical process parameters (spraying temperature, air velocity and relative humidity) are investigated with respect to their influence on the goal parameter "in-vitro release of the active ingredient after 1 h". Product-related validation of the process is accomplished by means of statistical experimental design (factorial design). Statistical analysis is done using the methods described by Box-Wilson and Yates and by response surface research and grid-search methods via contour plots and isometric graphs. This yields the acceptable range of process parameters with respect to product quality. Finally the differences between validation and optimization are discussed.
Dr. Lyman Augustus Brewer III, a distinguished, colorful thoracic surgeon and among the first to practice that specialty in the West, died on June 25, 1988, in Los Angeles, California, after a courageous battle with lymphoma. Dr. Brewer was a great humanist, innovative clinical surgeon, charismatic teacher, and surgical leader. In World War II, Lieutenant Colonel Brewer served in the Second Auxiliary Surgical Group in the Mediterranean and European theaters and helped define criteria that became the standard for the management of thoracic war injuries. Out of this experience he authored the classic paper, "The Wet Lung in War Casualties." Dr. Brewer's scientific contributions embraced the broad spectrum of thoracic surgical topics, including treatment of tuberculosis, classification of lung cancer, bronchial stump buttressing using the pericardial fat pad (Brewer fat pad), and management of esophageal perforation. Dr Brewer wrote seven books and more than 100 papers, and served as First Vice President of The American College of Surgeons and as President of the American Association for Thoracic Surgery, The Society of Thoracic Surgeons, and The Pacific Coast Surgical Association.
Three documents that considerably facilitate primary care research have been produced in recent years. They are an international glossary of primary care health terms, an international classification of primary care health problems, and a primary care process classification. To describe the full spectrum of primary health care, however, additional classifications are needed that detail the reasons for encounters and indicate health status. Work on these several classifications is in progress and a set of primary care classifications has been proposed as a basis for the 10th revision of the International Classification of Diseases.
In the magazine of Gineco Obstetricia de México, January 1988, 30 to 34, I presented the three first models of the Salas forceps. In this article I describe the fourth and last design of my invention which has been patented in the USA as "Salas Obstetric Spatulas". It is mentioned in this article, the advantages of this instrument, which after being used in 533 applications by Dr. Fernandez del Castillo, SC and Dr. Viesca, MA they have come to the conclusion that the Salas instrument is excellent. Laufe et al in his book describe: There is no doubt that these forceps (Salas) could be made more acceptable to US practitioners. It is insisted in the modern classification of the forceps.
Acute pelvic fractures are potentially lethal, even with modern techniques of poly-trauma care. The appropriate treatment of such fractures is dependent on a thorough understanding of the anatomic features of the pelvic region and the biomechanical basis of the various types of lesions. Although the anterior structures, the symphysis pubis and the pubic rami, contribute approximately 40% to the stiffness of the pelvis, clinical and biomechanical studies have shown that the posterior sacroiliac complex is more important to pelvic-ring stability. Therefore, the classification of pelvic fractures is based on the stability of the posterior lesion. In type A fractures, the pelvic ring is stable. The partially stable type B lesions, such as "open-book" and "bucket-handle" fractures, are caused by external- and internal-rotation forces, respectively. In type C injuries, there is complete disruption of the posterior sacroiliac complex. These unstable fractures are almost always caused by high-energy severe trauma associated with motor vehicle accidents, falls from a height, or crushing injuries. Type A and type B fractures make up 70% to 80% of all pelvic injuries. Because of the complexity of injuries that most often result in acute pelvic fractures, they should be considered in the context of polytrauma management, rather than in isolation. Any classification system must therefore be seen only as a general guide to treatment. The management of each patient requires careful, individualized decision making.
INTRODUCTION: To determine whether the risk of preeclampsia in multiparous women with a previous normal pregnancy is related to changing paternity or to prolonged birth interval, a retrospective study was conducted at the Lyell McEwin Health Service (University of Adelaide). METHODS: The study included all multiparous women known to the hospital because of their preceding 1st delivery in the same hospital followed by their 2nd and/or 3rd ongoing pregnancy resulting in a delivery in the period 2001 - 2003. Case records were analyzed for birth interval, pregnancy interval, paternity and recognized risk factors such as booking weight and smoking. For the analysis both the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition and the more recently introduced classification by the Australian Society for the Study of Hypertension in Pregnancy (ASSHP) were used. RESULTS: In the 656 women in this study cohort, 148 (26.2%) women had a different partner in their 2nd and/or 3rd ongoing pregnancy. Using the ISSHP definition for preeclampsia, changing partners had an odds ratio (OR) of 1.304 (95% CI 0.43 - 3.99); using ASSHP criteria an OR of 1.556 (95% CI 0.6506 - 3721); and looking at the combined group of pregnancy-induced hypertensive disorders an OR of 1.99 (95% CI 1.01 - 3.89). A longer birth interval if anything was associated with a lower risk of preeclampsia (non-significant), whatever definition was used. Also the inter-pregnancy interval did not show a consistent relation with the risk for developing a hypertensive complication. CONCLUSIONS: The results of this study on risk factors for preeclampsia in multiparous women appear to be in line with the primipaternity hypothesis, but are in direct contrast with the so-called birth interval hypothesis.
The first known document on epilepsy in China appeared in The Yellow Emperor's Classic of Internal Medicine, Huang Di Nei Ching, written by a group of physicians around 770-221 B.C. The description of epilepsy in this book and in many others later published was confined to generalized convulsive seizures. No documentation of absence or simple partial seizures was provided. The first classification of epilepsy, probably by Cao Yuan Fang in A.D. 610, listed five types of epilepsy: "Yang Dian," "Yin Dian," "Feng (Wind) Dian," "Shih (Wet) Dian," and "Lao (Labor) Dian." Later, other classifications named seizures after the cry of animals whose cry the "epileptic cry" resembled, or after "visceral organs" believed to be responsible for the seizures. The concept of partial versus generalized seizures, however, was not observed in any of these classifications. The treatment of epilepsy, based on principles of "Yin Yang Wu Xing," consisted of herbs, acupuncture, and massage.
Hippocrates and the medical school of Kos were mainly concerned with the common elements of various diseases and the accurate description of symptoms and signs, as well as their prognostic implications. In contrast, the medical school of Knidos (in neighbouring Asia Minor) and its chief member Euryphon were interested in the systematic classification of diseases according to the systems involved. Galen mentions that Knidian physicians were familiar with four renal diseases, probably the same described in the book About Inner Sufferings, whose author is not known with certainty; most investigators attribute it to the Knidian school (5th century BC), while others consider it to be a Hippocratic work. Both theories are logical and possible, since Hippocrates himself was familiar with the work of the Knidian school and a rival of Euryphon. The first renal disease described in the book is nephrolithiasis with renal colic. Its description is considered a classic one and it is well known for its accuracy and clarity. The second disease corresponds to renal tuberculosis, while the remaining two are somewhat unclear, the third resembles either renal vein thrombosis or bilateral papillary necrosis. The fourth disease, described in the greatest detail of all, corresponds to a chronic suppurative renal infection or a sexually transmitted urethritis, complicated by renal involvement. Some statements concerning treatment follow; they consist of diet modification, physical exercise, ingestion of herbal extracts and surgery, as a last resort. It is therefore evident that Hippocrates is the father of clinical nephrology and that Hippocratic medicine lies at the root of the development of clinical nephrology.
Health care organizations with constrained planning budgets can access data sources which will be of great assistance in strategic and market analysis. The data described in this article can be obtained for $250 or less. For segmenting the market even further, down to the International Classification of Disease (ICD)-9 Code Level, the National Center for Health Statistics of the Department of Health and Human Services publishes an annual data book which indicates the use rates for every ICD-9 Code. This extremely valuable data source is all less than $10. Managers can take inexpensive data from the Census and from HHS and proceed to determine major opportunities and challenges facing their institutions. The same data then serve as the basis for planning about how to meet those challenges or take advantage of those opportunities. Finally, the same data will allow product line management to proceed on the basis of quantitative goals that are established in terms of the actual facts of the local situation. The skills required to perform these analyses are not complex, but the task is time intense.
Using the previously outlined classification of pelvic disruption to assess the displacement and stability, a logical method of treatment for the individual case follows. Anteroposterior fractures of the open-book variety and with intact posterior sacroiliac ligaments require simply reduction of the fracture (closure of the book), and immobilization by a sling, plaster spica or external skeletal fixators. The lateral compression types all produce some degree of inward rotation of the hemipelvis. If the supine position does not reduce the hemipelvis spontaneously, a general anesthetic and the application of external rotation forces are often required. Immobilization can be maintained either by complete bed rest with traction through a supracondylar femoral pin or with external skeletal fixators. Pelvic slings or binders will increase the deformity and are contraindicated. The very unstable types of vertical shear fractures can be reduced easily with traction, but maintenance of reduction is difficult. Fracture healing may be delayed because of instability through the hemipelvis and some degree of compression through the posterior fracture is desirable, either by various forms of external skeletal fixation, or occasionally by open reduction. Pelvic fractures associated with acetabular disruption and requiring open reduction of the acetabular fracture also require anatomic repositioning of the pelvic fragments simultaneously, in order to anatomically restore the integrity of the acetabulum. Finally, the pelvic fracture should not be neglected during the early phase of general resuscitation of the patient, but management should proceed concomitantly with the management of the associated injuries. Delay in treatment of the pelvic injury makes management much more difficult and even hazardous at a later phase.
In this paper we comment our recent book about sexual perversion. This clinic entity is relatively little known, even though very frequent, because the word "perversion" is used in a discriminatory way. The international classifications treat about "paraphilies", but they do not take into account the personality of these patients. We will expose first a psychoanalytical conception of perversion and secondly by means of clinical cases present new forms of this pathology involving a fascination of the pervert toward death. Death and sexuality being inseparable in perversion.
OBJECTIVE: To update basic concepts and management strategies of fetal growth restriction (FGR). DATA SOURCE: An English literature search was conducted for pertinent articles related to FGR from 1976 to 1997. Original research articles, review articles, and book chapters were reviewed. METHODS OF STUDY SELECTION: This study was divided into two parts. For this article, both human data and animal data pertinent to understanding causative factors, pathogenesis, clinical type, and pathophysiology were included. To perform a meaningful comparison, the concept of investigators and their methods of investigation were critically compared between the two study periods: 1976-1985 and 1986-1997. TABULATION, INTEGRATION, AND RESULTS: Older concepts involving basic principles of FGR based on animal models during the first study period were integrated with new research findings obtained from human FGR during the second study period. By comparative analysis of older animal data and new human data, current concepts of FGR were synthesized. CONCLUSION: Fetal growth restriction affects a heterogenous group of infants. Despite development of new technology for investigation, many older basic concepts related to FGR are still fundamentally sound. However, new investigations directly performed on human fetuses are a useful expansion of the older concepts.
This study was conducted on the spread and usage of computer-aided software programme (GDS) in 72 obstetric departments. Standardised questionnaires were sent to universities and hospitals to ask for information on registered perinatal data. The record with the hand-written delivery book cannot record all data needed for quality protection as the PC is able to list. 89% of the obstetricians evaluate their clinical data regularly by statistical survey and classification. By analysing the general trend they can critically assess their actual obstetrical management. The PC is established in 83%, functions without technical problems in 92% and is optimal in the sequence of operation in 57% of all departments questioned. Overtime hours for the staff could be reduced in 11%, if a computer was used, and in 13% the nurses could take more care of mother and child because of less official red tape. Independent of the size of the department and the data processing knowledge of the staff, the software programme runs efficiently. The comprehensive basis data documentation with all perinatal and neonatal data is used to its full extent in 100% of the cases and documents the clinical effectivity. With regard to the standardised hospital quality control process by the modified requirements in the public health legislation, the directors of the hospital departments are able to assess the quality control and show economic independence.
More than 25 years ago, in a book called Clinical Judgment, each act of patient care was described as having an experimental structure. The "experiments" needed substantial scientific improvement, however, in quality of basic data, taxonomic classification of phenomena, and specifications of clinical reasoning. During the past 2 decades, these improvements have not occurred as extensively as expected because many investigators working in clinical forms of clinical research have not addressed these basic scientific challenges in data, taxonomy, and reasoning. Instead, the investigators have applied quantitative "models," derived from non-clinical domains, that focus on hard data, randomized trials, Bayes theorem, quantitative decision analysis, and psychometric strategies for clinimetric measurement. Consequently, the main challenges of clinical judgment still remain generally available for basic scientific research by investigative clinicians.