Chronic venous pathology: presentation of a new international classification]

The Authors present a new classification of chronic venous pathology. The first presentation was in Maui during the Congress of the North American Society of Phlebology and the second in London, during the last World Congress of International Union of Phlebology. The aim is to standardize the clinical and instrumental data to propose a common classification to all physicians. Etiological, anatomical, physiopathological and clinical findings were considered.     

Teenage primigravidae: a comparative study

A review of history sheets of obstetric cases recorded in a district hospital in 1992 was done to compare the obstetric outcome in 200 teenage first pregnancies (Study group) with that in Control group i.e. 20 years to 29 years. It revealed that incidence of complications of pregnancy like anaemia, pregnancy induced hypertension (PIH) and preterm labour were significantly higher among teenage mothers. The normal mode of delivery was commoner in teenagers (82.5%) in comparison to control group (76.5%), probably because of higher number of low birth weight babies. The fetal outcome was significantly worse in teenage mothers with high incidence of perinatal mortality (8%) and low birth weight babies (35%). There was not a single newborn with birthweight above 3500 gms, in teenage group, whereas, control group had 5 babies (2.5%) in the category.     

Repeat abortion: a comparative study

In a study of 404 women (simple random sample) 20-29 years of age, 201 women (group A) applying for abortion and 203 women (group B) continuing their pregnancies were given a questionnaire and were also interviewed. The aim of the study was to describe women applying for repeat abortion and to compare them with women having their first abortion and with women continuing their pregnancies. Variables measured were socio-economic, psychological and social problems, relationship with the partner, earlier pregnancies, how the present pregnancy was experienced and decision-making. For presentation of the results, the data have been divided into four subgroups: pregnant women applying for their first abortion (A1, n = 137), women applying for repeat abortion (A2, n = 64), women continuing their pregnancies who have never applied for abortion (B1, n = 142), and women continuing their pregnancies who had previously applied for one or more abortions (B2, n = 58). Women who had had previous abortion/abortions had experienced more psychological problems during their lifetime than the other groups studied. They had more contact with the social welfare service and evaluated their relationship with the partner as less harmonious than women having a first abortion, also in comparison with women continuing their pregnancies with no earlier applications for abortion. Women who have had previous abortion/abortions seem to have a need for special attention. This involves not only being provided with efficient and acceptable contraception, but also with social and psychological support based on the experiences of the women.     

The future of pathology: a Delphi study by pathology department chairmen

This paper reports the results of a study by and of chairmen of pathology departments in American and Canadian medical schools directed toward discovering chairmen's perceptions and attitudes about the future of pathology. Over 100 of a total of 143 chairmen participated in some or all phases of this study in which the Delphi approach was used. Sixty-five chairmen completed all four rounds of questionnaires. Most chairmen are deeply concerned about increasing federal regulation of medicine. They expect to play a greater role in all phases of medical education with more emphasis on the basic science aspects of pathology. They also foresee a desirable shifting of residency training programs away from small hospitals to the larger medical centers. This shift will result in fewer but longer training programs.     

Placental pathology and antiphospholipid antibodies: a descriptive study

We described placental pathology in antiphospholipid antibody (APL) syndrome, APL and no history of recurrent pregnancy loss, and in treated and untreated pregnancies of APL syndrome. Thirty-nine pregnancies of 28 patients were studied: 23 placentas delivered from 23 women with APL (13 with APL syndrome and 10 with serological APL); 8 untreated miscarriages before APL diagnosis from 6 of the 13 patients with APL syndrome and 1 of 10 with serological APL; and 8 miscarriages by 5 additional women before APL syndrome diagnosis. Histopathology was reviewed by a pathologist blinded except to gestational age. Contingency tables and analysis of variance (ANOVA) considered p < 0.05 significant. Comparing the placentas delivered at > 18 weeks' gestation, excessive perivillous coagulation, avascular terminal villi, and chronic villitis/uteroplacental vasculitis tended to be more common in treated APL syndrome than serological APL cases (p = 0.07). Of the 16 miscarriages before diagnosis of APL, 11 were lost at < 18 weeks' gestation. None had pathology typical of APL, but 4 of 11 (36%) had chronic intervillositis. Five of 16 miscarriages before the diagnosis of APL were miscarried between 18-22 weeks. Three of 5 (60%) miscarried after 18 weeks had multifocal uteroplacental thromboses, compared to 6 of 13 (46%) treated pregnancies with APL syndrome and 0 of 10 cases with serological APL.     

Microlaparoscopy: a comparative study of diagnostic accuracy

OBJECTIVE: To investigate the diagnostic accuracy of microlaparoscopy in comparison to laparoscopy with a standard 10-mm laparoscope. DESIGN: Prospective evaluation by two independent observers. SETTING: Academic Medical Center. PATIENT(S): Ten patients scheduled to undergo diagnostic laparoscopy for the indications of infertility and/or chronic pelvic pain. INTERVENTION(S): Two surgeons were present for each operation. Diagnostic laparoscopy was performed using the Microlap 2-mm laparoscope (Imagyn Medical Inc., Lagun Niguel, CA). Standard diagnostic laparoscopy was then performed using a 10-mm laparoscope. After each procedure, each surgeon reported his or her observations in a confidential manner to a third person to record. MAIN OUTCOME MEASURE(S): Endometriosis and adnexal adhesions were staged. Observations made with the microlaparoscope were compared with those obtained with a standard 10-mm laparoscope for each surgeon. The observations of both surgeons were also compared with each other's to evaluate interobserver differences. RESULT(S): Operative findings reported by each individual surgeon using the microlaparoscope correlated with the operative findings reported using the larger laparoscope. Scores for both endometriosis and adnexal adhesions did not differ in any significant way. Endometriosis scores differed by no more than 6 points, and adhesion scores differed by no more than 2 points, with no subsequent change in severity classification for either finding. Furthermore, when comparing the additional operative findings of the two surgeons, no difference was noted when using either the microlaparoscope or a standard 10-mm laparoscope. CONCLUSION(S): The diagnostic accuracy achieved with microlaparoscopy is comparable to that achieved with standard 10-mm laparoscopy.     

Placental pathology in systemic lupus erythematosus: a prospective study

An intravenous (iv) radiofrequency (RF) coil is proposed as a means of obtaining high resolution images of artery wall. The anatomic positioning of peripheral artery/vein pairs was investigated and a phantom mimicking the iliac artery/vein pair was constructed. Imaging results, comparing iv coils with external coils, demonstrated a potential 15- to 20-fold increase in signal-to-noise ratio (SNR) with iv coils. The SNR benefit was measured over a cylindrical volume, adjacent to the coil, and typical of artery position. Prototype expandable iv coils were constructed of Cu-Be loops and introduced via an 8-Fr catheter. The effects of local and remote iv coil tuning were investigated and local tuning was found to provide significant SNR benefits. The in vivo performance of iv RF coils was demonstrated in a porcine animal model. The iv coils were found to be an excellent alternative to intraarterial coils.     

Frozen-section diagnosis in surgical pathology: a quality assurance study

In a quality assurance study we reviewed one thousand four hundred and forty-three consecutive frozen sections performed at department of pathology, VGH-TC from June 1995 to July 1996. The diagnostic accuracy was 92.6%. The diagnosis was deferred in sixty-eight cases (4.7%). False positive for malignant tumor was made in two cases (0.14%) and false negative diagnosis for malignancy in thirty-seven (2.56%). The inaccurate diagnosis was mainly in samples taken from the brain, female breast, and thyroid. Incorrect diagnoses were mainly due to interpretation of the pathologic findings (71.8%), followed by gross sampling (15.4%) and microscopic sampling (12.8 %). Some of the lesions were difficult to diagnose even in permanent sections. Technical skill and diagnostic expertise are essential for frozen diagnosis. We suggest that an accuracy survey of frozen section be periodically performed in every pathology department as part of its quality assurance program.     

Guidelines for the development of comparative pathology

This article reviews the new trends in the diagnosis, treatment and prevention of catheter-related bacteraemia in clinical nephrology. Among these are the newer diagnostic techniques of evaluating and obtaining culture specimens from central lines, such as timed cultures and use of the endoluminal brush. In general, attempts to salvage infected haemodialysis lines are unsuccessful. We review the data that pertain to the use of antibiotic-coated catheters in non-dialysis patients and discuss how these observations may be applied to end-stage renal disease patients.     

Lysosomal storage diseases of animals: an essay in comparative pathology

A wide variety of inherited lysosomal hydrolase deficiencies have been reported in animals and are characterized by accumulation of sphingolipids, glycolipids, oligosaccharides, or mucopolysaccharides within lysosomes. Inhibitors of a lysosomal hydrolase, e.g., swainsonine, may also induce storage disease. Another group of lysosomal storage diseases, the ceroid-lipofuscinoses, involve the accumulation of hydrophobic proteins, but their pathogenesis is unclear. Some of these diseases are of veterinary importance, and those caused by a hydrolase deficiency can be controlled by detection of heterozygotes through the gene dosage phenomenon or by molecular genetic techniques. Other of these diseases are important to biomedical research either as models of the analogous human disease and/or through their ability to help elucidate specific aspects of cell biology. Some of these models have been used to explore possible therapeutic strategies and to define their limitations and expectations.     

Accidents to patients in hospital: a comparative study

A comparative study of 50 reported accident patients (cases) and 50 non-accident patients (controls) was carried out in 10 wards in a large, acute hospital, using primary and secondary data from patients, nurses and records. Folstein's Mini-Mental State test was used to measure the mental status of patients. The mental status of the controls was significantly better than that of the cases. Nurses' responses indicated that significantly more accident patients were incontinent of urine than non-accident patients. There were also indications from patients of three additional unreported accidents. Further study was needed to estimate, more closely, the frequency of unreported patient accidents. This is the second paper in a series of three. The first appeared in Nursing Times on August 17, and the final one will be published on September 28, along with implications for practice and recommendations.     

Preoperative chemoembolization of hepatocellular carcinoma: a comparative study

INTRODUCTION: Inappropriate discharges and/or improper inhibition of bradycardia pacing due to oversensing of extraneous signals in implantable cardioverter defibrillators (ICDs) have been described. With one exception, no previous report involving an intact lead system has cited myopotential oversensing as the cause. METHODS AND RESULTS: Two case reports of myopotential oversensing by a dual chamber ICD system are reported. In the first patient suffering from chronic pulmonary obstructive disease, intermittent myopotential sensing during labored respiration resulted in episodic inhibition of bradycardia pacing. In the second patient, oversensing of sustained myopotentials generated during strenuous isometric activity resulted in an inappropriate ICD discharge. For both, the ICD system consisted of a CPI model 1810 Ventak AV used in conjunction with a model 0125 Endotak lead, incorporating integrated bipolar sensing. CONCLUSION: Although modern ICDs have proven to be highly effective in detecting and terminating malignant tachyarrhythmias, the opportunity for improving their detection specificity remains.     

Manual and computer-aided space analysis: a comparative study

Separate injections of Haemophilus influenzae type b capsular polysaccharide-tetanus conjugate (PRP-T) vaccine and diphtheria-tetanus-pertussis (DTP) reconstitution of freeze-dried PRP-T vaccine with liquid DTP vaccine have been shown to be safe and immunogenic in infants. The present study was conducted to test the safety and immunogenicity of the liquid combination vaccine administered to young infants in the dual-chamber syringe. The study was a monocenter, open clinical trial of 3 month-old infants receiving PRP-T and DTP vaccines in the dual-chamber syringe reconstituted prior to injection. Healthy infants were immunized according to a 3, 4 and 5 months-of-age schedule. The vaccine was administered in a dual-chamber syringe, ready to use with two chambers. The proximal chamber contained freeze-dried PRP-T and the distal chamber contained liquid combination-vaccine DTP. The freeze-dried PRP-T vaccine was reconstituted with the liquid DTP vaccine in the same unidose dual-chamber syringe (0.5 mL) and was injected intramuscularly into the deltoid region. Blood sampling was performed prior to vaccination at 3 months of age and after the third vaccination at 6 months. The primary end-point was the serological response to PRP-T vaccine as expressed by the percentage of infants with an antibody titer greater than or equal to 1 microgram/mL. The reactogenicity was expressed as the percentage of reported local and systemic reactions. A total of 108 infants were included in the study and received the dual-chamber syringe vaccine. After the third injection, all the infants had a PRP antibody titer greater than or equal to 0.15 microgram/mL and 94.4% of infants had a PRP antibody titer greater than or equal to 1 microgram/mL; the pertussis agglutinin titers were over the threshold 40 and 80 in all infants and 98.1% were over the threshold 320. After the third injection, all the infants had diphtheria antibody titers greater than 0.1 IU/mL and 83.3% had titers greater than 1 IU/mL; all the infants had tetanus antibody titers greater than 0.1 IU/mL and 97.2% had results over 1 IU/mL. Thirty-seven infants (34.6%) had local reactions and 64.5% had systemic reactions. The dual-chamber syringe may reduce the cost of vaccine delivery, as well as the workload, and increase the vaccine acceptability and coverage rate of vaccines.     

Functional outcome after brain tumor and acute stroke: a comparative analysis

OBJECTIVE: To compare the functional outcome, length of stay, and discharge disposition of patients with brain tumors and those with acute stroke. DESIGN: Case-controlled, retrospective study at a tertiary care medical center inpatient rehabilitation unit. SUBJECTS: Sixty-three brain tumor patients matched with 63 acute stroke patients according to age, sex, and location of lesion. MAIN OUTCOME MEASURES: The functional independence measure (FIM) was measured on admission and discharge. The FIM change and FIM efficiency were also calculated. The FIM was analyzed in three subsets: activities of daily living (ADL), mobility (MOB), and cognition (COG). Discharge disposition and rehabilitation length of stay were compared. RESULTS: Demographic variables of race, marital status, and payer source were comparable for the two groups. No significant difference was found between the brain tumor and stroke populations with respect to total admission FIM, total discharge FIM, change in total FIM, or FIM efficiency. The admission MOB-FIM was found to be higher in the brain tumor group (13.6 vs 11.1, p = .04), whereas the stroke group had a greater change in ADL-FIM score (10.8 vs 8.3, p = .03). The two groups had similar rates of discharge to community at greater than 85%. The tumor group had a significantly shorter rehabilitation length of stay than the stroke group (25 vs 34 days, p < .01). CONCLUSION: Brain tumor patients can achieve comparable functional outcome and rates of discharge to community and have a shorter rehabilitation length of stay than stroke patients.     

Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study.

This study compared the responses of 184 educators and 111 rehabilitation specialists on a measure of knowledge about childhood traumatic brain injury (TBI). Educators displayed more misconceptions about TBI overall compared to rehabilitation staff. They underestimated the effect of TBI on cognition, behavior, and continued development. More specifically, educators showed more misconceptions than the rehabilitation staff in the following areas: coma, memory and new learning, anger management, and factors affecting recovery. An important task for rehabilitation staff members is to clarify educator misconceptions about TBI as children transition to school. Information provided should increase the level of teacher preparation and help to maximize children's academic success and adaptation following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)