Sterilisation and mental handicap.
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Adult↗
SEARCH · PubMed Health
Results for “In re Miss F”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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3'-18F-fluoro-3'-deoxy-L-thymidine: a new tracer for staging metastatic melanoma?
UNLABELLED: In this study, the feasibility of 3'-(18)F-fluoro-3'-deoxy-L-thymidine PET ((18)F-FLT PET) for staging patients with clinical stage III melanoma was investigated. METHODS: Ten patients with melanoma and metastases to the locoregional draining lymph nodes, clinical stage III-based on physical examination, chest radiography, lactate dehydrogenase, and histopathologic confirmation-underwent a whole-body (18)F-FLT PET scan 1 h after injection of a median 400-MBq dose (range, 185-430 MBq) of (18)F-FLT. All (18)F-FLT PET lesions were verified using the American Joint Committee on Cancer Staging System, which includes physical examination, spiral CT, ultrasound, chest radiography, and histopathologic examinations. Size and mitotic rate of metastatic lymph nodes and skin metastases were determined. RESULTS: All histopathologic samples and (18)F-FLT PET lesions were categorized over anatomic regions and correlated. All locoregional metastases were correctly visualized by (18)F-FLT PET. Region-based sensitivity for detection of lymph node metastatic disease was 88%. There were 3 true-negative and 2 false-positive lesions. The detection limit for lymph node metastases appeared to be approximately 6 mm or a mitotic rate of 9 mitoses per 2 mm(2). Two patients were upstaged by (18)F-FLT PET, which was confirmed by CT. In 3 patients, (18)F-FLT PET detected a total of 3 additional lesions with therapeutic consequences, without influencing staging. These lesions were initially missed by clinical staging. CONCLUSION: (18)F-FLT PET seems promising for (re)staging purposes in clinical stage III melanoma. Further research is needed, in which (18)F-FLT PET should be compared with (18)F-FDG PET.
Adult↗
A six-canal maxillary first molar: case report.
AIM: The aim of this case report is to describe an unusual six-canal maxillary first molar tooth. CASE REPORT: The maxillary left first molar of a young African-American male was treated as an emergency at the first visit. At the second visit, the five canals (MB1 and 2, Pal1 and 2 and DB) were easily identified at high magnification of 16-25 under an operating microscope. The canals were then instrumented and filled using the Microseal technique. A careful radiographic examination of the final fill indicated that there was a third canal in the palatal root as suggested by a slight extrusion of the filling material between the two canals. At the third visit, the fillings of the palatal canals were removed and the apical 4mm was re-examined. The existence of a third palatal canal exiting between the two apices was verified and subsequently instrumented and obturated. KEY LEARNING POINTS: It should be assumed that all molar teeth have more than the traditionally expected three canals. The location of root canals should be identified at high magnification under the microscope. Careful radiographic re-examination of the fillings should be done in order to identify possibly missed canals.
Adult↗
Critical gaps in the world's largest electronic medical record: Ad Hoc nursing narratives and invisible adverse drug events.
The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs, operates one of the largest healthcare networks in the world. Its electronic medical record (EMR) is fully integrated into clinical practice, having evolved over several decades of design, testing, trial, and error. It is unarguably the world's largest EMR, and as such it makes an important case study for a host of timely informatics issues. The VHA consistently has been at the vanguard of patient safety, especially in its provider-oriented EMR. We describe here a study of a large set of adverse drug events (ADEs) that eluded a rigorous ADE survey based on prospective EMR chart review. These numerous ADEs were undetected (and hence invisible) in the EMR, missed by an otherwise sophisticated ADE detection scheme. We speculate how these invisible nursing ADE narratives persist and what they portend for safety re-engineering.
Adverse Drug Reaction Reporting Systems↗
Statistical power analysis for PET studies in humans.
UNLABELLED: Although simple techniques have been established to determine statistical power when comparing, for example, the means of two groups of sampled data, the analysis is more complicated when establishing a trend in the data, such as with a linear regression. We present an approach to calculate the sample size necessary to reject the hypothesis that there is no trend in the data (slope is not different from zero) at a given level of statistical significance, given the intra- and inter-subject variability of the measurement. METHODS: We have derived analytically the distribution of the t statistic, for a given non-zero slope, and integrated this distribution to determine in what fraction of trials a real trend in the population would be missed. We illustrate our approach by re-examining the issue of an age-related impairment in presynaptic dopamine metabolism as measured by PET. RESULTS: We showed that the sample size necessary to determine whether 6-18F-fluoro-L-dopa retention decreases with age depends critically on both the variability of the quantitative method used and on the magnitude of the expected change. CONCLUSION: The method we have illustrated is a simple statistical test that allows investigators to be certain that an experimental design has a sufficient sample size to demonstrate the effect under study.
Age Factors↗
Life transitions of parents at the unexpected death of a school-age and older child.
The purpose of this study was to describe parents' responses to the unexpected death of a school-age and older child. The nonrandomized sample consisted of 16 mothers and 11 fathers who each were interviewed at least 1 year after their child's death and who were not in active therapy for grief resolution at the time of their participation. Data were collected in single, tape-recorded, private interviews. Using Life Transition Theory as a framework (Selder [Schmitt], 1982), data were analyzed by systematic analytic induction. Study findings suggest there are no time lines for resolution of grief. Parents experience certain processes that recur over time. Processes identified and described are: presencing (the child), which is a way of experiencing memories of their child; reactivation, which is a process of re-experiencing the trauma of the death; and identification of missed options, which involves identifying those things the parent will never experience with their child, such as graduation, marriage, etc.
Adolescent↗
Thoracoscopic vagotomy as a safe adjunct to remedial gastric surgery.
Patients who have had prior subdiaphragmatic dissection with an incomplete vagotomy or Nissen fundoplication present added challenges when they require vagotomy and gastric resection. In this setting, thoracoscopic vagotomy offers significant advantages. A second attempt at vagotomy in a previously dissected field can be prolonged and frustrating. In addition to these concerns, repeat dissection can also lead to failure to find the vagal trunks, perforation of the esophagus, hemorrhage, and/or splenic injury. In our experience, three patients requiring gastrectomy or resection of a marginal ulcer have undergone thoracoscopic vagotomy at the time of transabdominal gastric surgery. The thoracoscopic approach avoided either a thoracoabdominal incision or combined thoracic and abdominal incisions while allowing dissection of the vagal trunks to be performed in normal tissue planes. The minimally invasive approach afforded decreased postoperative pain and excellent clinical results. Thoracoscopic vagotomy offers a welcome alternative to re-exploration of a previously dissected distal esophagus in search of vagal trunks, especially when they have been missed at the time of the first operation. Further application of this approach is recommended.
Adult↗
Retinal function in mucolipidosis IV.
In an 18-month-old girl affected by mucolipidosis IV (ML IV) with mild corneal clouding, normal retinal activity was documented by electroretinogram (ERG) and slightly delayed optic pathway conduction was revealed by visual evoked potential (VEP). Re-examination 9 years later disclosed severe retinal alterations resulting in atrophy with reduced photopic and missing scotopic ERG components and flat VEP. These fundoscopic and electrophysiologic deteriorations in ML IV suggest progressive rod-cone impairment similar to tapetoretinal dystrophy.
Corneal Opacity↗
What proportion of dyspeptic patients having H. pylori breath test subsequently undergo endoscopy?
BACKGROUND: Helicobacter pylori (HP) testing in young patients with uncomplicated dyspepsia has been recommended. A test and treat strategy for dyspeptics positive for HP is recommended by the European H. pylori Study Group and the American Gastroenterology Association. OBJECTIVES: To assess the rates of re-referral for upper GI endoscopy (OGD) and outpatient (OPD) attendance in uncomplicated dyspeptic patients following assessment of HP status. METHODS: 190 patients under 50 years of age with uncomplicated dyspepsia (without alarm symptoms) referred from general practitioners (GPs) to the gastroenterology department underwent HP urea breath test (UBT). GPs were informed of the results of UBT and recommended eradication therapy if positive, and if negative advised symptomatic treatment with an acid suppressant with/without a prokinetic. The patients were analysed for subsequent attendance at OGD or OPD in the following two years. RESULTS: HP was present in 93 of 190 patients. Twenty of 190 (10.5%) patients subsequently were re-referred and underwent OGD for continuing dyspeptic symptoms; a further 6 were seen in OPD but not endoscoped as they have been judged to have uncomplicated gastro-oesophageal reflux disease. At time of OGD all patients were negative on Campylobacter-like organism (CLO) test for HP. Findings at OGD were normal (9), hiatus hernia (6), gastritis (4) and duodenitis (1). No case of peptic ulcer disease or gastric cancer has been identified. CONCLUSIONS: In this group of dyspeptic patients, adopting a test and treat policy after initial analysis of HP resulted in 10.5% being re-referred for subsequent OGD; findings in those endoscoped were normal or minimal. A test and treat strategy for H. pylori in uncomplicated dyspeptics therefore saves endoscopies and outpatient consultations without missing significant underlying pathology.
Adolescent↗
Sympathetic re-innervation after heart transplantation: dual-isotope neurotransmitter scintigraphy, norepinephrine content and histological examination.
Cardiac transplantation entails surgical disruption of the sympathetic nerve fibres from their somata, resulting in sympathetic denervation. In order to investigate the occurrence of sympathetic re-innervation, neurotransmitter scintigraphy using the norepinephrine analogue iodine-123 metaiodobenzylguanidine (MIBG) was performed in 15 patients 2-69 months after transplantation. In addition, norepinephrine content and immunohistochemical reactions of antibodies to Schwann cell-associated S100 protein, to neuron-specific enolase (NSE) and to norepinephrine were examined in 34 endomyocardial biopsies of 29 patients 1-88 months after transplantation. Anterobasal 123I-MIBG uptake indicating partial sympathetic re-innervation could be shown in 40% of the scintigraphically investigated patients 37-69 months after transplantation. In immunohistochemical studies 83% of the patients investigated 1-72 months after transplantation showed nerve fibres in their biopsies but not positive reaction to norepinephrine. Significant norepinephrine content indicating re-innervation could not be detected in any biopsy. It was concluded that in spite of the lack of norepinephrine content there seemed to be immunohistological and scintigraphic evidence of sympathetic re-innervation. An explanation for this contradictory finding may be the reduced or missing norepinephrine storage ability compared to the restored uptake ability of regenerated sympathetic nerve fibres.
3-Iodobenzylguanidine↗
False negative clinical diagnoses of malignant melanoma.
The false negative rate for the clinical diagnosis (FNR) for malignant melanoma is reported to be of the order of 20-50%. The aim of this study was to investigate possible predictor variables for FNR, with particular reference to the features and score of the seven-point check-list within the total population (778) of histologically proved malignant melanomas presenting in Leicestershire between 1982 and 1996. The FNR was 18.5%. The check-list would have failed as a referral indication in only 0.8-1. 1% of the lesions. The major check-list features occurred more commonly than the minor features, excepting size >/= 7 mm, confirming the diagnostic importance of the major criteria. The FNR was unaffected by age or sex. More rarely involved sites had higher rates (31-42%), and the face was a particularly difficult diagnostic site. Clinical features of lesions associated with a higher FNR were lack of irregular pigmentation and shape, altered sensation, the presence of inflammation and size < 7 mm. The FNR was inversely related to the total score and major feature score, but directly related to the minor score. The minor features, in addition to the major features, are potentially valuable in avoiding false negative diagnoses and we suggest their retention as part of the check-list. There was only one patient, in whom the diagnosis of melanoma was initially missed and who was not biopsied on presentation to hospital, who re-presented after 1 year. However, the study illustrates the importance of avoiding a false negative diagnosis as there was marked delay in the excision of such lesions.
Adult↗
The effects of scale: variation in the APOA1/C3/A4/A5 gene cluster.
While there is considerable appeal to the idea of selecting a few SNPs to represent all, or much, of the DNA sequence variability in a local chromosomal region, it is also important to quantify what detail is lost in adopting such an approach. To address this issue, we compared high- and low-resolution depictions of sequence diversity for the same genomic region, the APOA1/C3/A4/A5 gene cluster on chromosome 11. First, extensive re-sequencing identified all nucleotide and sequence haplotype variation of the linked apolipoprotein genes in 72 individuals from three populations: African-Americans from Jackson, Miss., Europeans from North Karelia, Finland, and European-Americans from Rochester, Minn. We identified 124 SNPs in 17.7 kb and significant differences in variation among genes. APOC3 gene diversity was particularly distinctive at high resolution, showing large allele frequency differences ( F(ST) values >0.250) between Jackson and the other two samples, and divergent population-specific haplotype lineages. Next, we selected haplotype-tagging SNPs (htSNPs) for each gene, at a density of approximately one SNP per kb, using an algorithm suggested by Stram et al. (2003). The 17 htSNPs identified were then used to reconstruct low-resolution haplotypes, from which inferences about the structure of variation were also drawn. This comparison showed that while the htSNPs successfully tagged common haplotype variation, they also left much underlying sequence diversity undetected and failed, in some cases, to co-classify groups of closely related haplotypes. The implications of these findings for other haplotype-based descriptions of human variation are discussed.
Apolipoprotein C-III↗
Quality indicators in ambulatory surgery. A prospective study.
Introduction: Ambulatory Surgery has emerged and developed in Spain in a similar way as in other occidental countries. Once established as a model for surgical care, results must be improved using objective quality indicators to assure minimal morbidity, efficient use of resources and satisfaction of patients and family. Objective: To provide a list of quality assessment indicators in Ambulatory Surgery and to discuss the necessity of obtaining a general consensus regarding the complexity of both the operations and the patients undergoing surgery. Design: Prospective and descriptive study. Patients and Methods: The study was performed on 833 ambulatory patients operated on in the Ambulatory Surgical Unit of the Can Misses Hospital of Ibiza. Surgical specialities involved were General Surgery, Ophthalmology, Orthopaedics, Urology, Gynaecology, and E.N.T. All diagnoses and proceedings were classified according to the CIE-9 and DGR systems, showing as an example the codes related to the General Surgery department. Quality Indicators evaluated were: (a) unplanned admission index; (b) re-admission index; (c) emergency department consultations; (d) cancellation index; (e) substitution index; and (f) postoperative pain evaluation. Results: Specialities involved were: Ophthalmology 277 patients (33.2%), General Surgery 189 (22.8%), Orthopaedics 142 (17%), Urology 90 (10.8%), E.N.T. 79 (9.5%) and Gynaecology 56 (6.7%). Unplanned Admission Index was 7.2%; Re-Admission Index 0.4%; Emergency department consultation 1.6%; Cancellation Index 3.3% and Substitution Index 70%. The reasons for unplanned admission were due to specific complications in 36 cases (60.1%), followed by those secondary to an inadequate selection of the patient in 22 cases (36.6%). Conclusions: It is necessary to apply a series of Quality Indicators in Ambulatory Surgery. Their systematic evaluation may help us define national standards in order to continuously improve our results.
Journal Article↗
An alternative approach to nonpalpable breast biopsies.
Traditionally, when a negative specimen radiograph is obtained during biopsy of a nonpalpable breast lesion, immediate re-excision is performed in an attempt to successfully remove the lesion. Based on a retrospective study of the biopsy results of 792 nonpalpable breast lesions, the authors suggest delaying the re-excision, despite a negative specimen x-ray, until postoperative mammography confirms the persistence of the lesion. Utilization of this approach was associated with a comparably low incidence of missed lesions (3%) and had the added advantages of preserving breast tissue and decreasing operative time.
Biopsy↗
Common bile duct exploration: indications and results.
To ascertain the best diagnostic indicators of choledocholithiasis and to decrease the incidence of retained stones in the common bile duct after exploration, the authors carried out a retrospective review of 110 consecutive patients who underwent common bile duct exploration for calculous biliary tract disease. Conditions that were most often associated with choledocholithiasis were cholangitis and clinically obvious jaundice. The serum bilirubin level was helpful in identifying patients with stones in the common bile duct only when the value was greater than 6 mg/dl (103 mumol/l), and alkaline phosphatase only when the value was more than 250 IU (normal 110 IU). When stones are felt in the duct at operation, the diagnosis of choledocholithiasis is certain; positive operative cholangiograms are highly reliable and the coexistence of small gallstones and a dilated cystic duct is suggestive. The retention of stones is best prevented by careful exploration followed by high-quality T-tube cholangiography performed at operation after the exploration is complete. Any missed stones found in this way should be removed by re-exploration at the time of the original operation. Stones left in the common bile duct are best extracted nonoperatively under radiologic control. This technique, while effective and safe, is associated with considerable morbidity.
Cholangiography↗
Chemical rescue of the catalytically disabled clostridial glutamate dehydrogenase mutant D165S by fluoride ion.
The catalytically disabled Asp165-->Ser mutant of clostridial glutamate dehydrogenase shows 100000-fold less activity than the wild-type (WT) enzyme in a standard glutamate oxidation assay and 1000-fold less activity in the reductive-amination reaction. The large reduction in the rate has been attributed to removal of the negative charge and the postulated proton-donor capacity of the aspartate carboxyl group. However, fluoride ion (1 M NaF) causes a 1000-fold activation of the mutant enzyme while simultaneously inhibiting WT activity by 20-fold in the forward reaction. For the reverse reaction, F- (1 M) activates the mutant 4-fold and inhibits WT activity to approx. 64%. The net result when 1 M F- is present is a decrease in the WT:mutant activity ratio from 100000 to 5 for the forward reaction. None of the other halides tested, nor NO3(-), CHCOO- or HCOO-, give comparable activation. Re-activation took 15-30 s under assay conditions, suggesting the possibility of conformational change; CD spectroscopy, however, provided no evidence of a substantial change and kinetics of modification using 5,5'-dithiobis(2-nitrobenzoic acid) suggested only subtle structural rearrangement. This phenomenon is discussed in the light of available information about the structure of the mutant enzyme. It is suggested that the F- ion provides a fixed negative charge at the position of the missing aspartate carboxyl group. Therefore, this appears to be an example of 'chemical rescue'.
Catalysis↗
Progression of periodontal pockets in the age cohort 35-44 years.
In 1985 the Health Department of the Italian Telephone Company decided to launch an oral health programme for all its employees and their relatives, with the collaboration of the WHO Collaborating Centre of the Clinica Odontoiatrica Ospedale S. Paolo, Milan. The programme started with an epidemiological survey of dental and periodontal condition; following data analysis, the company also contracted with private dentists to provide oral care. Four years later, in 1989, several studies were set up to evaluate the programme. The WHO Collaborating Centre Milan was requested to evaluate the periodontal care given to a sample of persons living in the Milan area. Seventy-seven individuals with established periodontal lesions were selected out of a group of 678 aged between 35 and 44 years examined in 1985. The same periodontal and dental indices used in 1985, CPITN (Community Periodontal Index of Treatment Needs) and DMFT (decayed, missing, filled teeth), were re-evaluated in these 77 persons and information about any periodontal care since 1985 was collected and checked against the reimbursement records of the Telephone Company. There was an increase in the percentage of persons with deep pockets (from 55.8 to 72.7 per cent), and of the mean of sextants affected (from 0.9 to 1.9). These individuals had been treated for dental problems, as demonstrated by an increase in the F component and a reduction of the D component of the DMFT, but had undergone virtually no treatment for periodontal problems. This may be considered as a longitudinal study on the natural progression of periodontal pathology in individuals with established periodontal lesions.
Adult↗
Prospects for automated cytology.
Rescreening of Pap smears using automated devices offers the ability to re-examine Paps initially interpreted as within normal limits and to use cell-sorting technology to increase the detection of missed abnormal smears. Only recently has the development of high-resolution imaging techniques and advances in computer sciences and cell classifiers enabled investigators to achieve sensitivity and specificity levels in automated screening and quality control devices.
Confidence Intervals↗