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The dataset generation failed
Error code: DatasetGenerationError
Exception: CastError
Message: Couldn't cast
PMID: string
Title: string
Abstract: string
PublicationDate: string
-- schema metadata --
pandas: '{"index_columns": [], "column_indexes": [], "columns": [{"name":' + 539
to
{'PMID': Value('string'), 'Abstract': Value('string'), 'PublicationDate': Value('string')}
because column names don't match
Traceback: Traceback (most recent call last):
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1405, in compute_config_parquet_and_info_response
fill_builder_info(builder, hf_endpoint=hf_endpoint, hf_token=hf_token, validate=validate)
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 597, in fill_builder_info
num_examples_and_sizes: list[tuple[int, int]] = thread_map(
File "/src/services/worker/.venv/lib/python3.9/site-packages/tqdm/contrib/concurrent.py", line 69, in thread_map
return _executor_map(ThreadPoolExecutor, fn, *iterables, **tqdm_kwargs)
File "/src/services/worker/.venv/lib/python3.9/site-packages/tqdm/contrib/concurrent.py", line 51, in _executor_map
return list(tqdm_class(ex.map(fn, *iterables, chunksize=chunksize), **kwargs))
File "/src/services/worker/.venv/lib/python3.9/site-packages/tqdm/std.py", line 1169, in __iter__
for obj in iterable:
File "/usr/local/lib/python3.9/concurrent/futures/_base.py", line 609, in result_iterator
yield fs.pop().result()
File "/usr/local/lib/python3.9/concurrent/futures/_base.py", line 446, in result
return self.__get_result()
File "/usr/local/lib/python3.9/concurrent/futures/_base.py", line 391, in __get_result
raise self._exception
File "/usr/local/lib/python3.9/concurrent/futures/thread.py", line 58, in run
result = self.fn(*self.args, **self.kwargs)
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 469, in retry_validate_get_num_examples_and_size
validate(pf)
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 535, in validate
raise TooBigRowGroupsError(
worker.job_runners.config.parquet_and_info.TooBigRowGroupsError: Parquet file has too big row groups. First row group has 1102253535 which exceeds the limit of 300000000
During handling of the above exception, another exception occurred:
Traceback (most recent call last):
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1815, in _prepare_split_single
for _, table in generator:
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 692, in wrapped
for item in generator(*args, **kwargs):
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/packaged_modules/parquet/parquet.py", line 106, in _generate_tables
yield f"{file_idx}_{batch_idx}", self._cast_table(pa_table)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/packaged_modules/parquet/parquet.py", line 73, in _cast_table
pa_table = table_cast(pa_table, self.info.features.arrow_schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2272, in table_cast
return cast_table_to_schema(table, schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2218, in cast_table_to_schema
raise CastError(
datasets.table.CastError: Couldn't cast
PMID: string
Title: string
Abstract: string
PublicationDate: string
-- schema metadata --
pandas: '{"index_columns": [], "column_indexes": [], "columns": [{"name":' + 539
to
{'PMID': Value('string'), 'Abstract': Value('string'), 'PublicationDate': Value('string')}
because column names don't match
The above exception was the direct cause of the following exception:
Traceback (most recent call last):
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1428, in compute_config_parquet_and_info_response
parquet_operations, partial, estimated_dataset_info = stream_convert_to_parquet(
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 994, in stream_convert_to_parquet
builder._prepare_split(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1702, in _prepare_split
for job_id, done, content in self._prepare_split_single(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1858, in _prepare_split_single
raise DatasetGenerationError("An error occurred while generating the dataset") from e
datasets.exceptions.DatasetGenerationError: An error occurred while generating the datasetNeed help to make the dataset viewer work? Make sure to review how to configure the dataset viewer, and open a discussion for direct support.
PMID
string | Abstract
string | PublicationDate
string |
|---|---|---|
1129941
|
Studied was the vitamin B12 activity of minced meat obtained under productional conditions from freshly cooled.
|
1975-01-01
|
8585095
|
We studied the ability of four commercially available antivenoms to neutralize several toxic and enzymatic activities of Bothrops asper (terciopelo) venom from Costa Rica. Experiments with preincubation of venom and antivenom were carried out to test the neutralization of lethal, hemorrhagic, coagulant and indirect hemolytic activities. In addition, antibody titers against crude venom and myotoxin II purified from this venom were determined by enzyme immunoassay (ELISA). Results indicate that polyvalent antivenom from Instituto Clodomiro Picado (Costa Rica) has the highest neutralizing ability against lethal, coagulant and indirect hemolytic activities, whereas MYN polyvalent antivenom (México) has the highest neutralization against hemorrhagic activity. Antivenom from Instituto Clodomiro Picado also has the highest antibody titers against crude B. asper venom and against myotoxin II. Antivenoms from Universidad Central de Venezuela (Venezuela), Vencofarma (Brazil) and MYN (México) failed to neutralize the lethal effect of this venom. These results stress the need for rigorous quality control systems to evaluate the neutralizing ability of antivenoms in Central America.
|
1995-09-01
|
9592208
|
This paper presents a detailed review of Suicide, the sociological classic by Durkheim, 100 years after it was first published, The first part of the article focuses on the author's interest in the theme, within the scope of concerns on the importance of studying suicide dating from the 18th century. The article then presents a circumstantial review of the various chapters, preceded by brief remarks on the book's place within Durkheim's work as a whole. The third part of the article comments on the book with reference to the main autors that have studied it. Amongst other qualities, the book's importance lies in the fact that it associates an elaborate theoretical construction with the empirical data, working within the possibilities provided by late 19th-century moral statistics. The article stresses Durkheim's perspective of dealing with the impact of the macrostructures over micro-level phenomena. The distribution of suicides is also reviewed, updating information and the relationship between suicides and professional groups, for example. The paper also provides a critique of authors who stress the importance of 'meanings' in the analysis of suicides, with some notes on the relationship between suicide and mental disease.
|
1998-05-21
|
9592209
|
This article discuss the complex relations between drugs and violence. Drawing on empirical studies and current forms of discourse, it analyzes conceptual and methodological problems related to the establishment of causal nexuses, risks, and associations. By demonstrating the theoretical and practical difficulties in such associations, it also points to the need for a debate in the field of public health and social policies. The article expresses concern that programs and prevention not be contaminated by fallacies, contributing nothing to an understanding of (or action related to) the social issue of drugs.
|
1998-05-21
|
9592210
|
This study is based on a medical audit of the Vila Municipal Health Clinic, Pelotas, Rio Grande do Sul. We collected data from family medical records in 1992,1993, and 1994. The data concerned the Women's Integral Health Care Program. We collected information on age, visits for medical and non-medical reasons, blood pressure, breast examination, coverage of Pap smear testing, and contraceptive methods. On average, women visited the clinic 3.5 to 4 times a year; 53% of the women were between 20 and 39 years of age; 42.5% of the women had had a Pap smear in the previous three years; 19% of the women had had their breasts examined. Blood pressure measurement was the most common procedure recorded in this clinic. We believe quality of medical records is a factor in patient care. We expect a critique of the low-quality medical records found in this audit can serve as the basis for a discussion among the health care team, with a view towards improving medical care, thereby benefiting patients.
|
1998-05-21
|
9592211
|
On the basis of social representations, we detected gender differences in family and individual living experiences for people with Hansen's disease (HD, or leprosy) in a sample of 202 HD patients (132 men and 70 women) enrolled in a public treatment and control program in Ribeirão Preto, São Paulo State. Information was gathered in two stages. First, the HD patients responded to a structured questionnaire, and second, the authors heard reports from 10 men and 10 women on their daily living situations. Data indicated that the disease receives different representations by men as compared to women in the different social groups. HD was found to be a source of gender imbalance, further aggravating existing sociocultural inequalities and creating new sources of biopsychosocial and economic harm, in addition to the stigmata weighing on individual patients. Results should help reorient treatment and control programs aimed at the social rehabilitation of HD patients, besides serving as a paradigm for future research
|
1998-05-21
|
9592212
|
This study focuses on the Pediatric Clinic of the UNICAMP University Hospital, teaching and care facility belonging to the Brazilian National Health System, providing secondary and tertiary health care for children aged 0 to 18 years. A total of 221 questionnaires were applied with users of the general pediatric out patient services and one of the specialties, allowing for comparison of various medical care indicators. Users were found to be quite knowledgeable about their health conditions and satisfied with the care received, despite a weak link in the physician-patient relationship. 43.4% reported problems related to the services, while only 17.6% made suggestions to improve them. Waiting time was found to be quite long. Users of specialized services differed from general care patients with regard to several indicators.
|
1998-05-21
|
9592213
|
This study presents a diagnosis and evaluation of the availability of services related to family violence against women in Greater Metropolitan Buenos Aires, Argentina. The paper focuses on institutional development, theoretical foci, intervention modalities, and production of information and research. Existing networks and interprofessional relationships are also described. Results point to several noteworthy theoretical perspectives. Some programs include gender as an issue, while others do not. The relationship (more informal than formal) between governmental and nongovernmental organizations is also a relevant issue. The paper concludes by proposing these institutional experiences as a model for the design of new public health policies.
|
1998-05-21
|
9592214
|
Drug advertisements for prescription drugs gathered from private clinics and hospitals in southern Brazil were analyzed. None of the 127 advertisement inserts that were analyzed complied with all the criteria specified by Brazilian legislation. The official Brazilian generic drug name was present in 95% of the advertisements, but always in finer and/or fainter print. With regard to the WHO ethical criteria for medicinal drug promotion the study showed that only 59% of the advertisement inserts declared the product composition and only 43% provided information on precautions, and in most of these cases (73%(, the precautions were in fine print and difficult to read. Most of the advertisements declared the product dosage in more properly-sized print. The main advertising claims were efficacy, safety, faster action, and high tolerability. In conclusion, the analysis demonstrated that most advertisements fail to comply with either the Brazilian legislation on medicinal products and/or the WHO ethical criteria for medicinal drug promotion. To improve this situation it thus seems necessary to develop more effective instruments to monitor quality of information provided to prescribers by the drug advertisers.
|
1998-05-21
|
9592215
|
This study presents the results of research done at the Pedro II Psychiatric Center in 1995, as part of a partnership between the Center and the Universidade do Estado do Rio de Janeiro. Research includes the development of a profile for inpatients based on clinical and socioeconomic data from patient files, emergency ward assessment of the group's interactive abilities based on WHO parameters, and a critical analysis of the psychiatric care model employed in the Psychiatric Center. With the psychiatric reform pursued by major sectors of Brazilian society we intend not only to respond to the economic/administrative irrationality created by 'hospital-centrism', but especially to meet the needs of patients, health professionals, and society in general in moving away from a psychiatric care model dominated by the reference patterns of psychiatry and to de-institutionalize mental health. The results of this study criticize the biomedical model and open the door to a care model engaged in psychosocial rehabilitation. The critical analysis based upon the data from the investigation done at the Psychiatric Center should be applicable to other psychiatric hospitals in Brazil's public and private sectors.
|
1998-05-21
|
9592216
|
Failure of intensive chemotherapy to control schistosomiasis in a highly endemic area of Northeast Brazil led to the hypothesis that sociodemographic and/or behavioral variables could be involved in the persistent transmission. A univariate analysis of such variables in relation to infection by Schistosoma mansoni showed that water contact patterns for recreation and personal hygiene are important risk factors in the area. However, sociodemographic variables were not related to infection, probably because the local population lives under evenly precarious socioeconomic and sanitary conditions. We thus recommend that chemotherapy be combined with other measures like snail control, health education, and improved sanitation and water supply.
|
1998-05-21
|
9592218
|
This article is part of a larger study in which epidemiological and anthropological methods were used to help understand the production and maintenance of schistosomiasis in a small endemic area in Pernambuco State. A cross-sectional study identified several local risk factors for schistosomiasis, quantifying socioeconomic, sanitary, and behavioral variables and then relating them to the prevalence and intensity of schistosomiasis infection. Using univariate analysis, three variables (age group, schooling, and human/water contact) showed significant association with S. mansoni infection. Causal factors and confounding variables were identified through multivariate analysis. Quantitative epidemiological analysis is critically discussed regarding a qualitative ethnographic study in relation to environmental risk situations (contamination and transmission) as well as risk practices (economic and behavioral).
|
1998-05-21
|
9592217
|
The main objective of this study was to evaluate the effectiveness of the Program Targeting Children with 'Chest Wheezing' carried in the city of Embu, São Paulo. The study analyzed a total of 434 children aged zero to 14 years, admitted to the program from May 1988 to July 1993. Over 90% had never been treated for this medical problem in outpatient clinics. Only 6.2% had to be referred to other health care services during follow-up in this program. The program successfully performed clinical diagnosis of asthma in children over 2 years of age. The moderate and severe cases followed up for over a year showed the best clinical evolution, with the positive factor being better compliance with medication. The number of exacerbations decreased among the severe patients after a year of regular follow-up, although patients used bronchodilators during the 12 months of our analysis. Of the children enrolled, 53.2% gave up treatment principally in the first six months, most of them from the moderate group. We concluded that children with steadier compliance with the program benefited in spite of both the simplicity and the lack of some currently existing medications.
|
1998-05-21
|
9592219
|
The aim of this study was to evaluate the effectiveness of an educational program carried out in 1993. The intervention took place after the first external quality assessment in coproparasitology, conducted in 77 laboratories of Havana City. Centers receiving training were compared with those that did not, and better results were obtained in the municipalities of 10 de Octubre, Plaza, and Cerro, as well as in all laboratories that sent people to training. Better diagnosis was found for the helminths Trichuris trichiura, Taenia sp., and Fasciola hepatica as well for the protozoans Blastocystis hominis and Endolimax nana in the laboratories that received training. The laboratories that received training had significantly higher scores than those which did not. The results point to the effectiveness of the educational intervention. We recommend external quality assessment in coproparasitology as well as ongoing, mandatory technical education, held at regular intervals. Such measures should assure steady improvement in diagnosis of intestinal parasites by the health services network.
|
1998-05-21
|
9592221
|
This study aimed to establish a correlation between anthropometric and socioeconomic variables and repetition in school for first grade pupils, as well to determine the predictive value of such variables vis-à-vis repetition. A study with a prospective and concurrent approach was developed in four elementary schools in Belo Horizonte, Minas Gerais State, with 699 children (95% of those eligible). After adjustment for confounders, children whose mothers had less than eight years of schooling, of mothers with unskilled jobs, from single-parent households (mother, father, or guardian), whose per capita family income was less than or equal to half the minimum wage, and who had a height/age/sex index under the 10.1 percentile were at greater risk of repeating the first grade. The data are potentially useful for selecting children to be monitored and to prevent repetition in the schools investigated.
|
1998-05-21
|
9592220
|
This paper focuses on specific aspects of male sexuality and how this sexual identity is built in the Aids era, based on conversations with low-income youth, ages 14-21 years, living in Greater Metropolitan Rio de Janeiro. We examine how Aids is perceived and investigate sexuality in this epidemic context. The goal is to provide concrete data to support a prevention campaign and contribute to preventive policies in Brazilian society. The proposal is based on the sexual identity of this gender/age group, comparing their reports on sexual practice. We used a partially open-ended interview protocol. We focus on the way young males choose their sexual identity under the premise that this is how men can become the channel for Aids transmission. Our research was thus based on gender and sexual identity as categories. Our results indicate that for a young man, 'being a man' means having an active sexual life, thus creating a stereotype placing them at risk for HIV transmission.
|
1998-05-21
|
9592222
|
This study reports on deaths due to acute rheumatic fever declined: total from 7.68 to 1.08. ARF-AMR declined (-93.5%) as did CRHD-AMR (-85.1%). Proportional death by ARF and CRHD in patients 45 years old and younger increased. Venezuela experienced a continuous decline in RF-AMR from 1955 to the l980s, followed by a period of stabilization lasting until l994. The reduction could be the consequence of improvement in socioeconomic status and of RF prevention with penicillin, a standard practice in the health care system. The 1980s and 1990s RF-AMR stabilization could be associated with economic setbacks in Venezuela and changes in the agent's virulence patterns.
|
1998-05-21
|
9592223
|
This study evaluates food intake of 244 children between ages 7-13 years using records of ingested foods on three non-consecutive days. The study analyzes energy and nutrient adequacy based on standards for the Brazilian population. Diet was generally found to be energy-deficient: meals consumed at the CIEPs met less than 70% of the requirement. On the other hand, protein was well above recommended levels. Worthy of note was the adequacy of meals in the CIEPs as to vitamin A, thiamin, riboflavin, and niacin, as well as the surprising adequacy of ascorbic acid, resulting from the frequent presence of citrus fruits in school meals. Except for older students, all schoolchildren studied had greater than 90% minimum iron intake. As for calcium, again except for older ones, consumption was 100% or more of minimum required levels. Results showed the need to correct flaws in the nutritional content of school meals, which are central to dietary intake for CIEP students.
|
1998-05-21
|
9592224
|
This paper provides a checklist of 15 known species of the Triatominae subfamily in Maranhão State. On the coastal São Luís Island there are a total of 10 species associated with sylvatic areas (Eratyrus mucronatus, Psammolestes tertius, Panstrongylus diasi) and periurban and urban areas (Panstrongylus geniculatus, Panstrongylus lignarius, Rhodnius nasutus, Rhodnius neglectus, Rhodnius pictipes, Rhodnius robustus and Triatoma rubrofasciata). The last was found only on São Luís Island, while the others have also been found inland. The following were not found in the coastal area: Panstrongylus megistus, Triatoma brasiliensis, Triatoma maculata, Triatoma pseudomaculata and Rhodnius brethesi. These were found mainly on the 'Chapadas' and 'Chapadões' areas in the eastern and southern parts of the State.
|
1998-05-21
|
9592226
|
As more is known about the complexity of the relationships between social, economic, and environmental contexts and the health of the population, it appears clear that the concepts of illness and health, while not independent, are not synonymous. A major challenge now facing the field of public health is to organize a true dialogue between the life sciences working mainly on illness seen as a disturbance in one of the functions of a living organism and human sciences dealing with a population's health. Society's challenge is to grant each individual access to high-quality health care services when needed, while developing public policies to promote the health of the population as a whole.
|
1998-05-21
|
9592225
|
Drug advertisements for non-prescription emphasize absence of risks, with claims such as "no contraindications" inducing consumers to use such drugs indiscriminately. The study showed that drugs were advertised like any other merchandise with no concern over fundamental information such as product identification, precautions, and possible side effects.
|
1998-05-21
|
9592227
|
The nationwide use of a 'Multimixture' a formula based on alternative foods such as rice and/or wheat bran, sesame and squash seeds, cassava, beet and carrot leaves, several indigenous leafy vegetables, and ground egg shells has been proposed by the National Institute of Food and Nutrition (INAN) as an official solution to fight hunger among poor Brazilians. The fragile nutritional state of the target population may make technical or ethical questions appear purely academic, yet nutritional, toxicological, and practical feasibility considerations appear to warrant a revision of the INAN proposal. While the Multimixture approach may prove valid as a temporary solution in cases of extreme poverty, it is not universally applicable for the intended use, failing to take into account the age and nutritional status of the subjects or duration of the intervention.
|
1998-05-21
|
9593996
|
The presence of tuberculosis in the upper Rio Negro region showed 699 cases, with an extremely high annual incidence rate of over two per thousand, predominantly pulmonary cases, and distribution of the disease among all age groups. Data on compliance with outpatient treatment are not reliable. In the present context of deteriorating environmental and socioeconomic conditions among Indians, tuberculosis incidence may increase. Control of this disease could be enhanced by improving living conditions and health services for indigenous peoples.
|
1998-05-21
|
9593998
|
Modern reproductive technologies, particularly in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), have made possible the establishment of new families through the birth of hundreds of thousands of children worldwide. Meanwhile, these technologies have compelled men to face the possibility of intervening at the very origins of their own biological existence, hence creating doubts and questions beyond the domain of medical science. Society is now asking itself whether all that is scientifically and technically possible is necessarily beneficial to mankind. The answer to this question is not to be found in biological science alone, but instead requires multidisciplinary reflection including all forms of knowledge: philosophical, bioethical, and religious, all contributing to the unavoidable adventure that we are endowed with in the search for a better life.
|
1998-05-21
|
9593999
|
The Program for Integrated Women's Health Care a program regulating fertility. This raised suspicions as to disguised promotion of birth control. However, a brief analysis of the history of this program and its social significance suggests that the PAISM was a pioneering undertaking (even within the international scenario) in proposing integrated women's health care as opposed to isolated family planning measures. This helps explain why women's movements in Brazil immediately began to struggle to see it properly implemented. The program contained the definition of reproductive health adopted by the World Health Organization in 1988, which was expanded and consolidated in Cairo in 1994 and Beijing in 1995. Consequently, adoption of the PAISM meant a significant step towards recognition of women's reproductive rights, even before gaining the various international forums for struggle.
|
1998-05-21
|
9594000
|
The purpose of the study is to explore some characteristics of women's perspectives on their sexuality, as there is information that associates the population's sexual culture with the incidence of cervical cancer. The value of sexual pleasure, sexual activity after menopause, and ways of preventing cervical cancer are explored. Data were obtained from a group of women attending primary care clinics in Santiago, Chile, and who were at least a year late for their Pap smear. The value women ascribed to sexuality was more positive than in previous studies performed in Chile. Women want to learn more about their bodies, although a minority still have negative perspectives concerning their sexuality. These results offer health services the opportunity to carry out educational activities with the purpose not only of increasing the number of women who have Pap smears but also of improving their quality of life
|
1998-05-21
|
9594001
|
Reproductive-age women, especially in developing countries, have failed to receive proper attention from the health care sector except during pregnancy. This study's objective was to contribute to the knowledge of the most frequent causes of death in this population group. The main purpose was to evaluate the occurrence and recording of deaths among women 10 to 49 years of age in Recife, Pernambuco, Brazil, during 1992 and 1993, and to identify and group the corrected causes of these deaths. It was a population-based descriptive study. After all death certificates eligible for the study were identified at the Health Secretariat of the State of Pernambuco, coding of the basic cause of death was performed. When necessary for its elucidation, a complementary investigation was also carried out at the hospital, autopsy service, and/or through an interview with the attending physician and a household visit. The 9th Revision of the ICD was used for coding the corrected basic cause of death. One thousand thirteen deaths of reproductive-age women were identified. The most frequent groups of causes of deaths were neoplasms, circulatory diseases, and external causes. Complications associated with pregnancy, delivery, and puerperium were the ninth most common cause of death in this group.
|
1998-05-21
|
9594002
|
Brazil has a high prevalence of tubal ligation. The hypothesis that it indicates undercover birth control efforts specifically addressed to the poorest sector of Brazilian society has been raised. The purpose of this paper is to evaluate whether there are differences in rates of tubal ligation depending on socioeconomic status. Data were gathered from interviews with 1335 women 15-49 years of age, of low or lower-middle socioeconomic status, carried out in 1991 in two regions of the State of São Paulo. The results showed an apparently higher prevalence of tubal ligation among women with less schooling,, but also among those living in better housing. However, after controlling for women's age, these associations disappeared, suggesting that they were explained by lower educational levels and greater economic resources of women of older age, where the latter factor is more heavily associated with a higher prevalence of tubal ligation. The complexity of the associations between socioeconomic status and tubal ligation are discussed, including the correlations between socioeconomic status and C-sections, which are in turn closely related to tubal ligation.
|
1998-05-21
|
9594003
|
Female sterilization is the most widely used contraceptive method among Brazilian women, although it has not been provided by the National Health System. Due to its legal ambiguity, it has not been recommended by Medical Boards as an ethical procedure. A study in which 3,149 women were asked about contraceptive use was carried out in the Greater São Paulo Metropolitan Area between March and July 1992. A total of 407 women under 40 years of age who had been submitted to sterilization at least one year prior to the interview were asked about their adjustment after the operation. Fifteen in-depth interviews with regretful women were analyzed in order to elucidate the nature of such feelings. The results include: adjustment after sterilization, provision of the sterilization procedure, knowledge of contraceptive methods, previous use of methods among sterilized women, and factors associated with regret. The qualitative results focus on the misinformation of sterilized women. Results indicate a need for regulating the procedure in order to ensure women's health, reproductive rights, and the fundamental principles of medical ethics.
|
1998-05-21
|
9594004
|
The objective of this paper is to point out the positive and negative aspects of female sterilization as seen by two groups of sterilized women in Florianópolis, Santa Catarina, Brazil, based on a sociological discussion of their present health status, evaluating the associations that they generally make with the fact that they have been sterilized. The first group included mostly housewives from a low-income neighborhood, while the second involved upper-middle-class female public employees, students, and university professors, totaling 40 women. Data were obtained through a structured questionnaire with open-ended questions. Information on social, economic, and demographic variables was recorded, along with subjective data associated with women's representations of the post-sterilization period. We concluded that there was no consensus as to the consequences of sterilization, since a number of the women (11/40), mostly sterilized before the age of 30, perceived changes in their health status after surgery.
|
1998-05-21
|
9594005
|
The article deals with the psychosocial and cultural dimensions of sexually transmitted diseases. Based on results from a qualitative study with lower-class males and females (young and adult) from a neighbourhood in the metropolitan area of Buenos Aires, the author discusses how lay beliefs (about symptoms, transmission, consequences) and norms regarding sexual matters and gender relations affect people's ability to consider themselves at risk and/or adopt preventive behaviors. Implications of research results for the design of culturally appropriate strategies to promote sexual and reproductive health are also provided.
|
1998-05-21
|
9594006
|
This study aims to identify analytical approaches to situate men in processes pertaining to reproductive health. We challenge the position that identifies them only as actors that can support improvements in the health of women and children. More recently there has been a concern over reshaping their role, as individuals who both reproduce and face risks to their reproductive organs, behaviors, and processes. One possibility for explaining men's presence in such processes is to identify their absence or presence as conditioning the consequences for women and children. The issue is to determine how they hamper or foster maternal health. A second possibility is to delve into the relational, social, and potentially conflictive nature of "sexualized" reproduction. This implies a new approach to the analysis of reproduction as a relational process, rather than as isolated events involving men and women, meanwhile recovering the respective specificities. The gender perspective is used to conceive of processes without denying the power dimension. Thus, a new approach is taken to sexuality, reproduction, and health in terms of interaction, in order to build clearer references with regard to the male population. We base our study on the approach attempting to build reflections on men as related to the dynamics of reproductive health.
|
1998-05-21
|
9594007
|
Vasectomy service providers at the Clínica del Hombre (Men's Clinic) in Bogotá, Colombia, construct their representations concerning male sterilization on the basis of biomedical discourse, their interaction with clinic users, and their own life experiences. During provision of such services, the counselors are the health professionals who have the closest contact with these clients of the clinic. Counselors are in charge of exploring their motivations in requesting the service, in addition to providing information allowing them to take a calm, sound decision. They also directly filter demand based on their experience, knowledge, and skills, in permanent negotiation between institutional criteria (number of children and gap between them, client's age, steadiness of couple's relationship, and conviction concerning the decision), and their perception and assessment of the client. An analysis of the counselors' representations of decision-making as pertaining to vasectomy indicates that it is a relatively simple and harmless procedure as well as a liberating option in terms of family planning.
|
1998-05-21
|
9594008
|
The population's high growth rate, age profile, and geographical distribution have aroused increasing public concern in Paraguay. The country is involved in a moderate demographic transition, compatible with the consequences of modernity and the uneven rate of both social and economic changes. Reduction of mortality and the persistence of high birth rate patterns result in an age structure that consolidates demographic growth, with an increased focus on the dependent population. In the late 1960s the need for a systematic approach to population problems was perceived within the framework of economic planning. National governments had, and currently have, an ambivalent perception of this issue, since population growth is simply considered a positive factor. This concept results from an economic view of the consequences of a reduced domestic market in absolute terms. The lack of a Development Plan, the management deficit, and the shortage of training leave doubts as to the establishment of organically connected policies or programs concerning population.
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1998-05-21
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9594009
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This article is an analytical essay on a historical moment in the formation of public health thinking vis-à-vis adolescent pregnancy: the 1960s. Its relevance lies in the fact that several assertions produced then still bear great influence on ideas and models concerning adolescent maternity in current public health thinking. From the technical and methodological point of view, one can assume two levels: an explicit one pertaining to the documentary record, consisting of messages clearly communicated by authors of scientific texts, and an implicit one, with elements that could only surface in text discourse through stylistic effects. Based on such assumptions, we explored the specialized literature using a metaphorical/metonymical analysis in search of such implicit dimensions.
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1998-05-21
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9594010
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Historically, family planning programs have targeted women almost exclusively. More recently it has become clear that men have a strong influence on their partners' use of contraception, either by opposing the use of any or one specific method, or by deciding that a woman has to either use a given method or be sterilized. In this context, our study aimed to evaluate the male perspective on the role of gender in the decision to use contraceptive methods and to have and raise children. The sample consisted of 776 males from a university in the State of São Paulo: 467 graduate students, 314 employees, and 129 teachers. A structured, previously tested questionnaire was used for the interviews. Data analysis is currently under way. The least familiar contraceptive methods were Billings (29.9%), injectables (35.4%), and jellies (57.8%). Some 80% of the interviewees mentioned other methods. The proportion of men who denied knowledge of any contraceptive method whatsoever was 1.6%. Our findings are similar to those of other authors.
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1998-05-21
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9594011
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Climacteric is constructed by medicine, lay knowledge, and the social sciences. This article examines the interrational models involving these different discourses and proposes that the contribution of the social sciences lies in a reformulation of the cognitive base of the health professions at an integrative level.
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1998-05-21
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9594012
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Catholics do not follow official Roman Catholic teachings on matters of sexuality and reproduction, including the position that contraception, even for married couples, is always evil, and that direct abortion, even to save a woman's life, is always illegal. Less well known is the extent of the Church's involvement in policy-making on these same issues. For example, it has forced the closing of in vitro fertilization (IVF) services from Poland to Uruguay. As the Church has never declared any of the dominant views, over time, regarding when a fetus becomes a person as a doctrine or dogma, there is no theological justification for the absolute condemnation of abortion. Neither is there a theory on "just abortion" similar to the "just war" that allows killing under certain circumstances. The enormous gap between the Church's positions and the views of worshippers has led Catholics to shape a workable and honorable sexual and reproductive ethic of their own The Church could make a positive contribution if it chose to accompany people on this quest rather than to raise roadblocks.
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1998-05-21
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9664733
|
Project Audit of diagnostic and therapeutic procedures in patients with acute coronary syndromes was approved by the Ministry of Health of the Slovak Republic on 13 May 1996. The essence of the project resides in a systematic and complex analysis of quality of provided medical care and the use of sources with the seeking for possibilities of improvement of the provided care aimed at prognosis and quality of life of patients with acute coronary syndrome (acute infarction, unstable angina pectoris, sudden cardiac death). The subsequent step will reside in the Project of Sudden Cardiac Death Prevention and the establishment of the myocardial infarction register.
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1998-07-17
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9664735
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The therapy of AMI is aimed at the prevention of death, minimalization of discomfort caused by the disease and the reduction of the infarction focus (as soon and as markedly as possible) since the success of this step links with the later short-term as well as the long-term prognoses of the patient. (Tab. 2, Ref. 15.)
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1998-07-17
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9664734
|
Diabetes mellitus type 2 (DM type 2) is a common disease that is associated with high mortality and morbidity due to macrovascular and microvascular complications. CHD mortality and morbidity is 2--3 times higher in diabetic than in non-diabetic patients/. There are many potentially atherogenic factors in diabetes these may underlie this problems. Except major risk factors (high serum cholesterol concentration, hypertension, cigarette smoking), insulin resistance is common in DM type 2 patients. The dyslipidemic component of insulin resistance is "atherogenic lipoprotein phenotype", its components include small LDL particles (pattern B) with higher atherogenic risk. Several recent studies have demonstrated the preponderance of small, dense LDL in patients with DM type 2 and IR. The question of whether small, dense LDL can be explained by triglyceride levels alone or whether it is directly related to DM type 2 and insulin resistance is still the subject of debate. If serum triglycerides exceed 1,3 mmol/l, small, dense LDL increases. The practical implication is that serum triglyceride levels should be maintained as low as possible to prevent the deleterious effects of triglycerides on LDL subclass distribution and size. There are several potential mechanisms to explain the increased atherogenicity of dense LDL (small dense LDL is more susceptible to lipid peroxidation and oxidation leading to its increased uptake by macrophages and subsequent removal by scavenger pathway, also has a lower binding affinity to LDL receptors). Theoretical grounds postulate that the treating of diabetic dyslipoproteinemias would reduce atherosclerosis disease. However, to date, there have been no intervention studies specifically designed to test this postulate in the diabetic population Such studies the Diabetes Atherosclerosis Intervention Study (DAIS), Fenofibrate Intervention and Event Lowering in Diabetes (FIELD), Collaborative Atorvastatin in Diabetes Study and lipid in Diabetes Study are currently in progress (Tab. 4, Fig. 2, Ref. 81.).
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1998-07-17
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9664736
|
The article reviews the possibilities of biochemical markers in coincidence with the assessment of prognosis in acute coronary syndromes and in the revealing of effectivity of their therapy. The current options of clinical biochemistry in many cases allow to supplement, confirm, or exclude the results of modern physical and other clinical examination methods and in this way to contribute to the accuracy of the diagnostic process, and enable to comment the prognosis and the risk measure of the patient. A significant progress has been achieved in the assessment of effectivity in thrombolytic therapy in acute myocardial infarction, where especially the series assessment of myoglobin levels or specific troponin cardiomarkers can facilitate the process of physician's decision as to the assessment of the subsequent procedure in the treatment of patients. The assessment of levels of both specific and partly less specific cardiomarkers becomes one of the criteria of the decision in coincidence with ischaemic episodes in the peri and postoperative periods (the diagnosis of peri-operative myocardial infarction). Specific troponin cardiomarkers acquire an extraordinary significance in the prediction of the measure of risk in patients with unstable angina pectoris where already one single assessment of the level of these markers is sufficient for hospitalization of the patient and thus enables to change the physician's strategy of further therapy. (Ref. 95.).
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1998-07-17
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9664737
|
The data gained from clinical studies in the past years have indicated that the thrombolytic therapy (TL) has favourable effect on patients with acute myocardial infarction (AMI). It is aimed at reperfusion in the ischaemic area, a decrease in the extent of infarction site and a decrease in mortality. TL administered within the initial hours after the onset of AMI leads to better results than when administered after several hours. Currently, TL is not limited by age. The patients who were given streptokinase (SK) or anistreplase (APSAC) prior to more than 4 days, if necessary, urokinase or alteplase (rt-PA) should be given. There are differences in the opinions as to the optimal selection of thrombolytic drugs. However, all currently used drugs lead to a significant decrease in mortality due to AMI. The preferential use of accelerated administration of rt-PA in contrast to SK is justified in younger patients with extensive AMI of the anterior wall, in whom the therapy has begun within 4 hours since its onset. The occurence of severe bleeding indicates that TL should be halted and coagulation factors should be replaces by freshly frozen plasma or fibrinogen concentrate, if necessary, transfusion of full blood should take place. If the severe bleeding occurs shortly after the administration of SK, the persisting plasminaemia can be arranged by antifibrinolytic drugs. An improvement in TL results can be achieved by adjuvant antithrombotic therapy. At the same time, in addition to acetylsalicylic acid, the patient treated with rt-PA should be given heparin. Heparin administration is not necessary in patients treated with SK or APSAC. However, heparin is indicated in patients at risk due to systemic embolization in congestive heart disease, extensive infarction or atrial fibrillation. (Tab. 1, Ref. 28).
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1998-07-17
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9664738
|
Reperfusion arrhythmias originate as a consequence of the complex of cellular and humoral reactions accompanying the opening of coronary artery. As the primary cause of their generation are considered the chemically defined substances that are produced and accumulated in myocardium during reperfusion. The key role id ascribed to free oxygen radicals but of importance are also other substances such as calcium, thrombin, platelet activating factor, inositol triphosphate, angiotensin II and others. These chemical mediators of reperfusion arrhythmias operate as modulators of cellular electrophysiology causing the complex changes at the level of ion channels. It is supposed that in the genesis of reperfusion arrhythmias unlike ischemic arrhythmias operate nonreentrant mechanisms such as abnormal or enhanced automacy and triggered activity due to afterdepolarizations. As a typical reperfusion arrhythmia is considered an early (within 6 hours after start of thrombolysis), frequent (> 30 episodes/hour) and repetitive (occurring during > 3 consecutive hours) accelerated idioventricular rhythm (AIVR). AIVR with such characteristics has a high specificity and positive predictive accuracy but relative low sensitivity as a predictor of reperfusion. Thus, in occurrence of AIVR, recanalization of infarction-related coronary artery is very probable, but in absence of AIVR, reperfusion is still not excluded. The following arrhythmias are regarded also as markers of reperfusion: frequent premature ventricular complexes (> twofold increase in frequency within 90 minutes after the start of thrombolysis), a significant increase of episodes in nonsustained ventricular tachycardia, sinus bradycardia and probably also high degree atrioventricular blocks. At present, there is no definite evidence, as to whether sustained ventricular tachycardia and especially ventricular fibrillation can be caused by reperfusion. Reperfusion arrhythmias are an important noninvasive marker of successful recanalization of infarction-related coronary artery. However, they are also a sign of reperfusion injury and a finding which may limit the favourable effect of reperfusion. In account of that, there is a very intensive search for pharmacologic interventions which could protect or attenuate the reperfusion injury and thereby also the genesis of reperfusion arrhythmias. Although promising results were obtained with many substances antagonizing the effects of mediators of reperfusion injury, there is no definite recomendation for their use under clinical conditions. However, the results from the latest clinical trials with ACE inhibitors are very promising. These trials render relative conclusive evidence, that ACE inhibitors could have a protective effect against reperfusion arrhythmias. (Ref. 89, Tab. 1.)
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1998-07-17
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9664739
|
In addition to ventricular arrhythmias, various forms of supraventricular arrhythmias (SVA) and atrioventricular (AV) and intraventricular (IV) conduction disturbances occur also in acute myocardial infarction (AMI). In the setting of AMI, SVA may be caused by relevant atrial ischemia or infarction. SVA complicate the course especially that of inferior, posterior and lateral AMI, SVA occur frequently also in the right ventricular myocardial infarction and in pericarditis. SVA appearing in the late phase of AMI are caused particularly by hemodynamic factors especially those of both left and right ventricular dysfunctions. Atrial dilatation and the increase of intraatrial pressure are also important factors in the genesis of SVA. The autonomous nervous system, electrolyte disturbances, acidosis and global hypoxia may operate as modulating factors in the development of SVA. AV conduction disturbances are significantly more frequent in patients with inferior than with anterior AMI. In inferior AMI, they are frequently caused by reflex parasympathetic activation. In the genesis of AV conduction disturbances, a significant role may be played also by the following mechanisms: Ischemia or necrosis of AV node or AV junction and the negative dromotropic effect of adenosine and potassium which are released to a great extent during myocardial ischemia and reperfusion. A high-degree AV block complicating the course of inferior AMI has a significantly better prognosis than that occurring in the setting of anterior AMI. In inferior AMI, AV block is frequently reversible, whereas in anterior AMI, it is persistent and irreversible. Early AV conduction disturbances, appearing within 24 hours of AMI have a better prognosis than those occurring in the late phase of AMI. Bundle branch blocks (BBB) complicating the course of AMI are caused by occlusion of bundle-related coronary artery or by serious ischemia in its bed. BBB is frequently a marker of a multivessel disease. New BBB appearing in AMI especially the right bundle branch block is considered as an predictor for the development of a complete AV block. Frequent and repetitive SVA as well as serious AV and IV conduction disturbances are frequently associated with a significantly worse clinically course of AMI and with increased mortality, with that of especially hospital mortality. However, this is usually not caused by SVA or AV and IV conduction disturbances per se. The major cause of death in these patients are heart failure cardiogenic shock and malignant ventricular arrthythmias due to larger AMI, significant reduction of left ventricular function and advanced coronary heart disease. Complex SVA as well as serious AV and IV conduction disturbances are usually considered as markers, but not as independent predictors for both increased hospital mortality and in some cases also for that of posthospital mortality. Their occurrence in AMI may help to identify the patients at great risk who require a very intensive treatment including aggressive management of extensive coronary heart disease. (Ref. 62.).
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1998-07-17
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9664740
|
On the basis of long-term personal experiences and critical evaluation of the present literatury sources authors described the role of invasive diagnostic methodes and transcathetral and cardiosurgical possibilities in the recognition and therapy of acute coronary syndromes. These techniques are, and in the forthcoming year shall be available only in specialized institutions. The paper describes the indication for these aggressive techniques as well as their limitations and complications. The goal of the presented article is to inform both the cardiological and frequently broad physician s societies about the possibilities of diaventional cardiology and cardiosurgery which will be gradually more applied in the care of the patients with acute coronary syndromes. (Ref. 39, Tab. 2, Fig.3.).
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1998-07-17
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9664741
|
The confirmation of ischaemic disease of the heart increases the probability of death due to cardiovascular causes to more than 80%. The overcoming of myocardial infarction increases, according to the past AHA data, the risk of the origin of a new coronary episode 5 or 7 fold. The necessity of decreasing this risk in the frame of secondary prevention is therefore very urgent. The first assumption of success in secondary prevention resides in optimal therapy in the acute phase of myocardial infarction. The thrombolytic therapy is accompanied by risks of re-perfusion lesion implying from the increased production of free oxygen radical, activation of leukocytes, intracellular calcium overload at a current deficit in potassium and magnesium, the defects of coronary microcirculation, increased sympathetic activities general disturbances of energetic reserves in myocardium. Very significantly is an early stratification of patients after MI to those indicated to intervention / in case that the mass of ischaemic myocardium exceeds 20%, or if EF is below 40%, and to patients who regarding the low risk are manageable by conservative procedure. Both groups profit from the modification of classical risk factors (hypertension, smoking, hypercholesterolaemia). The values of cholesterol measured within the acute phase of myocardial infarction are not indicative, very often they are low. Finally, also in the later period with so-called adequate values of the total cholesterol, the patient after overcoming IM is increasingly under threat. The aim of secondary prevention is to reduce the chief pathogen, namely LDL cholesterol below 2.6 mmol/l, the level of HDL cholesterol on the opposite should be above 1.0 mmol/l. It is necessary to re-emphasize that the bioactive capacity is borne but by the oxidated form of LDL. Oxidative stress has a direct negative effect on vascular endothelium, and haemocoagulation potential, it participates in the metabolic X syndrome (insulin resistance, hyperinsulinaemia, defects in glucose tolerance, hypertriglyceridaemia, hypertension). (Ref. 41.)
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1998-07-17
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9664742
|
Endothelium represents a large paracrine gland with an enormous reactive surface. By means of its numerous vasodilation and vasospastic factors it manages the basal and working tonus of vessels and thus also the regional flow and the access of target tissues to hormones and metabolic substrates. It manages also the proliferation and migration of myocytes of the vascular wall and thus its adaptation to overload. The dysfunctional states of endothelium are observed in arterial hypertensions, diabetes, dyslipoproteinaemia and they grow with age. They are the first stage of atherothrombogenic processes. They manifest themselves by a decreased vasodilation reserve of the vascular wall to strain, insulin and many other stimuli. On the contrary, quite frequently they paradoxically react to physical strain, acetylcholine, histamine, ATP etc. by vascular spasms which can determine vasospastic and microvascular angina pectoris including spasms and occlusions of e.g. coronary arteries in sites of insignificant stenoses with the origin of infarctions. The damaged endothelium, so to explain, conceives these stimuli in accordance with the encoded programme as a stimulus to the protection from haemorrhage during stress (fight or flight) and develops "suicidal" defensive reaction against them which we are nowadays able to modulate by administration of ACE-inhibitors, beta-blockers, hypolipidaemic drugs, inhibitors of cyclooxygenase-1 (30--100 mg of aspirin), Ca-antagonists and antioxidants including numerous nonpharmacological procedures. We can retard or halt the process of atherothrombogenesis and avoid or lower thus the number of sudden vascular ventricular as well as brain episodes, including the congestive heart failures, limb amputations and ischaemic damage of the brain. (Fig. 4, Ref. 70.).
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1998-07-17
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10036384
|
3)- beta - D -Glucan and she showed some signs of improvement. Case 2: A 52-year-old male with jaundice was hospitalized in November 1997. The third day following the operation on the pancreas head carcinoma, the body temperature rose higher with a negative blood culture. The fourth day, the plasma beta -glucan concentration was positive with negative endotoxin. As some improvements were obserbed from taking FLCZ, he was discharged in January 1998. Case 3: A 19-year-old male with epilepsy was hospitalized for ARDS in August 1997. A butterfly-like shadow was observed in the chest roentgenogram (suspected malignant lymphoma). The high titer of beta -glucan has continued and endotoxin was detected. The symptoms showed some signs of improvement and the titer of beta -glucan reduced with FLCZ. Although a high level of beta -glucan still remained, the patient was discharged, but has to under go regular follow-up examinations. The measurment of beta -glucan proved very useful not only as a diagnosis for the screening of deep mycosis but also as monitoring for therapies.
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1999-02-26
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10036385
|
Clinical isolates which belong to the "Streptococcus milleri" group were identied by the referral uorogenic phenotypic tests described by Whiley et al. and a rapid, commercially available test kits; Fluo-Card Milleri (KEY Scientific Products, Round Rock, Tex., U.S.A.) to the species level. Of 218 clinical isolates included, 196 (89.9%) were correctly identied by the Fluo-Card Milleri when compared with the reference identications. Ten isolates (4.6%) of S. constellatus resulted in the "unidentied" due to the negative interpretations for all the three enzymatic reactions. A total of twelve isolates (5.5%); five of S. anginosus, five of S. constellatus, and two of S. intermedius, were misidentied. The levels of agreement were 95.7% for S. anginosus, 91.3% for S. intermedius, and 92.6% for S. constellatus when the unidentied results were excluded.
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1999-02-26
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10068814
|
Intensive care of the surgical patient is an integral part of the treatment and continuing medical education mission of surgery. Working on the intensive care unit educates surgeons with regard to emergency treatment, pathophysiological thinking, and judging the risks of surgical procedures. The importance of preoperative workup and postoperative care and the diagnosis of postoperative complications are experienced personally and should thus encourage the surgeon to operate nontraumatically and increase their motivation for continuous holistic patient care. This does not mean erecting boundaries or competing with anesthesiologists in surgical intensive care. Rather, the joint aims of surgeons and anesthesiologists should be reinforced. The advantages of close cooperation for successful completion of the mission of patient care and medical education for younger colleagues need to be emphasized. Ideal cooperation between anesthesiologists and surgeons calls for commitment, competence, trust, and personal accord on the part of the persons involved. Under these circumstances, even in hospitals with only one interdisciplinary intensive care unit there should be no problems regarding who takes on official leadership.
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1999-03-09
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10068815
|
Intensive care medicine for both surgical and medical patients has a common scientific and clinical basis. In critically ill patients the medical conditions are complex and can be managed only by specialists thoroughly trained in intensive care medicine. Therefore, surgeons as well as anesthesiologists must have a detailed theoretical and clinical knowledge of intensive care medicine. Surgical training places the emphasis on operative skills, while intraoperative management of the patient by the anesthesiologist calls for skills involved in intensive care medicine. Interdisciplinary cooperation between specialists is essential to improve the quality of intensive care medicine further. The cooperation that already exists between surgeons and anesthesiologists makes closer collaboration in the future a logical step.
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1999-03-09
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10068816
|
The complexity of daily clinical work requires a sophisticated collaboration of surgery and anesthesiology. This can be accomplished by a rational approach to the following topics: clear definition of areas of competence respecting the principle of mutual trust, integration of anesthesiologists into the basic physical examination, proposal of case-oriented preoperative diagnostics, agreement on necessary preoperative therapy, common consultational meetings for outpatient surgery, recovery room available 24 h a day, instruction of the surgical personnel in specific pain therapy, availability of coworkers who are competent and willing to cooperate, no unilateral renunciation of clinical knowledge, ability and execution, no renunciation of organizational and structural self-determination, no monopoly on perioperative medicine.
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1999-03-09
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10068817
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Soaring health care costs are also forcing surgeons and anaesthesiologists to introduce practice patterns that allow more efficient use of expensive hospital resources. Because perioperative ward expenditures account for approximately one-third of the hospital costs incurred for surgical inpatients, with personnel costs being a major component, interventions that decrease the length of stay can result in considerable savings without affecting the quality of care. Interventious that can reduce the length of stay are outpatient preoperative evaluation and same-day admission, improvement of OR efficiency and sufficient cost-effective facilities for qualified postoperative care.
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1999-03-09
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10068818
|
The increasing number of high-risk patients and the limited number of intensive care beds and shrinking hospital budgets make it necessary to review perioperative management processes. Analyzing the data of the Heidelberg Anesthesia documentation system revealed improvement strategies in operating room management. The coordination of all groups involved is optimized by an operating room management group. This independent group plans and coordinates the operating room procedures, together with emergency cases according to personal, room and specific needs. Establishment of a holding area and a postoperative anesthesia care unit next to central operating units will significantly improve the perioperative organization processes. Redistribution of personnel enables intermediate care units to be opened, which provide additional intensive care bed capacity.
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1999-03-09
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10068819
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Perioperative management requires close cooperation between the referring practitioner, anesthesiologist, surgeon, and nursing staff. Standards in diagnostics, risk assessment, and choice of procedure, as well as integration of the anesthesiologist into the surgical out-patient department, are all important prerequisites for the optimum preparation of patients. Elective operations are to be planned in advance, taking into account the surgical resources available. Additional operating rooms with interdisciplinary access should be available for emergency procedures. Turnaraound times between operations can be reduced by separate rooms for pre- and postsurgical preparation and recovery. Small functional units allow for a flexible response to necessary changes in the schedule. These measures increase the quality of treatment and economic efficiency, as well as the satisfaction of patients and staff.
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1999-03-09
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10068820
|
Solid tumors do not grow beyond a size of a few millimetres without supply of nutrients and growth factors by the vascular system. Only when tumors produce angiogenic growth factors new vessels are formed by sprouting of capillaries from the existing vascular system. The tumor can grow and tumor cells reach the circulation through these new and permeable vessels. The vascular endothelial growth factor (VEGF) is the most prominent angiogenic growth factor. VEGF is produced by almost all solid tumors: its receptors are expressed only on vascular endothelial cells and predominantly in vessels in the proximity of the tumor. Therefore, the VEGF/VEGF-receptor system is a target for anti-angiogenic cancer therapy. Experiments show that inhibition of the VEGF-mediated endothelial cell activation interferes with tumor growth and metastases formation. Appropriate therapeutic strategies are currently under clinical investigation.
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1999-03-09
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10068821
|
Video-assisted thoracoscopic surgery is now recommended for the treatment of primary spontaneous pneumothorax. We studied the validity of this method at our general surgical department in a prospective group with regard to effectiveness and complication rate. The combination of thoracoscopic bulla resection with tetracycline pleurodesis resulted in a 100% recurrence-free rate of 28 pneumothoraces at a median follow-up of 19 months. We observed no intraoperative complications. We conclude that video-assisted thoracoscopic surgery is an effective treatment for primary spontaneous pneumothorax and can safely be carried out even in a general surgical unit. The legal aspects are discussed in detail.
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1999-03-09
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10068822
|
Intraoperative radiotherapy received IORT (32 applications). Chemotherapy and percutaneous radiotherapy had already been given to all patients with advanced and recurrent colorectal tumors. The intraoperative irradiation was performed through HDR iridium afterloading. A flexible flab--individually adapted to the "tumor bed"--was used as applicator. The contact dose ranged from 10 to 15 Gy. The mean operation time (rectum resection: 5, rectum amputation: 14, debulking: 8) increased by 30 min on average. Eight patients had postoperative complications: perianal wound infections (3), sacrovesical fistulas (3), leakage of anastomosis (1) and neural ureter dysfunction (1). To date--on average 17.1 months (range: 3-33) after operation--13 patients are free of tumor recurrence or show stable disease. Ten patients--all of them had macroscopic residual tumor--have local tumor progression combined with good quality of life. Only 4 patients died (acute kidney failure, stroke, marasmus, systemic progression). The afterloading flab technique represents a technically simple, minimally harmful procedure in the therapy of colorectal tumor. Even when IORT with electrons is not feasible or the patients have already been irradiated, a higher radiation dose is possible. Given the demonstrated rate of local tumor recurrence, the afterloading flab technique seems to be a valuable treatment alternative to extended, high-risk resections. Long-term follow-ups will be necessary.
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1999-03-09
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10068823
|
BACKGROUND: Although the majority of surgeons regard Hartmann's operation as therapeutic standard in perforations of the colon complicated by peritonitis this procedure has been critically discussed in recent years. Advocates of one-stage techniques criticized bad postoperative results was 19. Seventeen patients died postoperatively (mortality: 16.5%). In 69 patients (80%) intestinal restoration could be performed after an average interval of 122 days (complication rate: 6%, no mortality). On follow-up, patients were asked to give information on their general state, changes of housing, abdominal complaints, and quality of life. RESULTS: Data on 93% of patients could be obtained. The median follow-up time was 75 months. Eleven patients had died; the remaining 72 were investigated. 86% described the quality of their lives as good or very good; only 11% indicated severe loss of activity. Quality of life did not differ between patients in whom intestinal continuity had been restored and those in whom it had not been restored. Anastomotic structures developed in 7% of cases, always after stapled anastomosis. CONCLUSIONS: According to our results, long-term outcome after Hartmann's operation is good. 80% of patients underwent intestinal restoration with low morbidity (6%) and no mortality. A great majority of patients indicated the quality of their lives as good or very good: this assessment was not dependent on restoration of intestinal continuity.
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1999-03-09
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10068831
|
Twenty-seven patients presenting with complete rectal prolapse were treated by extracorporal resection using a stapling device. The mean age of the female patients was 74 +/- 15 years, the mean operation time 61 +/- 17 min, the mean length of hospital stay 17 +/- 8 days. 96% of the patients suffered from at least one concurrent disease necessitating treatment. Perioperative mortality was 3.7%, postoperative complications occurred in 18% of our patients. After surgery 19% of the patients were incontinent. Extracorporal resection using a stapling device proves to be a secure and technically easy-to-perform procedure in the treatment of complete rectal prolapse. Due to several advantages compared with transabdominal procedures, the indication for perineal repair of a complete rectal prolapse by extracorporal resection should not be confined to high-risk patients.
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1999-03-09
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10068832
|
The aim of this study was to investigate postoperative und long-term results after radical tumor surgery in complicated colorectal cancers. One hundred and twenty-six: or perforation (42; 3.9%). Postoperative mortality was significantly higher in complicated than in uncomplicated cancers (19% after bowel obstruction, 38% after perforation, 6% in uncomplicated cases). Development of preoperative organ dysfunction determined survival in both complications. Mortality after perforations was influenced by the degree of peritonitis and tumor stage, while patients after bowel obstruction were at greater risk in the case of cardiac comorbidity. Long-term results depended on tumor stage but not on complications. Our concept of radical tumor surgery in emergency operations was supported by the fact that long-term results of patients surviving the acute stage of complicated colorectal cancers did not differ from those of patients with uncomplicated carcinomas.
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1999-03-09
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10068833
|
Mechanical ventilation is a well-established strategy in intensive care medicine. ICU trauma patients require analgesia, and sedation mostly consists of benzodiazepines and opioids with increasing doses over time. The weaning period is complicated by the withdrawal syndrome, showing tachycardia, hypertonia, tachypnea and restlessness. Although treatment with clonidine can influence these symptoms, tachypnea still remains the main problem in weaning patients from mechanical ventilation. Adding sufentanil, an opioid with greater effects on analgesia than on respiratory depression compared with fentanyl, tachypnea can be reduced to normal frequency. In this way weaning management can be managed more easily for the benefit of both, the patient and physician. In comparison with a group of 50 patients treated with clonidine alone, 72 patients treated with clonidine/sufentanil showed a shorter period from the start of spontaneous ventilation until extubation (4.8 vs 7.6 days) and until discharge from the ICU (7.7 vs 12.4 days). The number of reintubations caused by respiratory exhaustion decreased from 16.0 to 2.8%.
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1999-03-09
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10068834
|
Since 1996 thoracic surgery has been invoiced according to fixed reimbursement rates (Sonderentgelte, SE). The legislator argues that fixed reimbursement rates cover operation costs and justify a 20% reduction in reimbursement for nursing. In order to examine this assumption we performed a cost analysis of thoracic surgery. Taking into account the staff, equipment, and operating theatre supplies, we analyzed 30 cases of five different types of operation prospectivly: wedge resections with more than three wedges (AR: n = 8), lobectomies (LE: n = 8), pneumonectomies (PE: n = 5), thoracoscopic wedge resections (VR: n = 6) and resections of mediastinal tumors (MR: n = 3). Then we calculated the overall costs for each operation. The costs for a LE amounted to DM 9,927, which is DM 4,904 more than the corresponding fixed reimbursement rate. The costs were DM 11,562 for a PE, DM 12,477 for a VR and DM 7,532 for a MR. Thus the costs were DM 5,539, DM 2,435 or DM 1,907 higher than the corresponding fixed reimbursement rates. The fixed reimbursement rate for an AR was DM 866 higher than the actual cost of DM 6,922. Only for a small number of cases do the fixed reimbursement rates cover the actual costs of thoracic surgery. Thus operation costs still need to be at least partly covered by the reimbursement for nursing.
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1999-03-09
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10068835
|
Cryophlebectomy, a more recent technique in varicose veins surgery, was evaluated in comparision with conventional techniques. Group IA: Microphlebectomy, invaginative stripping of the long saphenous vein, tourniquet, n = 90; group IB: only microphlebektomie and tourniquet, n = 72. Group IIA: Cryostripping of the long saphenous vein in combination with cryosurgical distal avulsion of varicosities and microphlebectomy, n = 112; gr. IIB: only cryosurgical distal avulsion of varicosities and microphlebectomy. Data were compared regarding duration of operation and hospitalisation and cosmetic outcome. Hospital stay (gr. IA: 9.1 +/- 5.1 d vs. gr. IIA: 6.1 +/- 2.1 d, gr. IB: 5.5 +/- 2.3 d vs. gr. IIB: 4.8 +/- 2.5 d) and duration of operation (gr. IA: 113.6 +/- 35 min vs. gr. IIA: 67 +/- 21.3 min, gr. IB: 74.4 +/- 35.3 min vs. gr. IIB: 53.3 +/- 15.5 min) were found to be significantly shorter and cosmetic result and postoperative discomforts improved in the cryophlebectomy-group. We conclude that the use of this combination of methods reduces invasivity, rises the patient's well-being and helps in cost-reduction.
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1999-03-09
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10068837
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Mesenteric cysts are a rare cause of disease. In our hospital we treated one patient who suffered from bilateral ureteral obstruction followed by hydronephrosis, caused by a large mesenteric cyst. Because of its extent complete enucleation--the surgical procedure of choice--was not possible. We opened the cyst and made an external percutaneous drainage. After this treatment the patient recovered and even after 6 months there was no recurrence.
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1999-03-09
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10068836
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Intimal sarcoma of the pulmonary artery is an extremely rare type of malignant tumor of the large vessels. Despite systematic diagnostics, distinguishing between pulmonary emboli and tumors is difficult. We report a patient who was referred because of suspected embolic occlusion of the pulmonary artery. The operation was started with the intention of performing a pulmonary artery thromboendarterectomy; however, intraoperative histology revealed a malignant mesenchymal tumor. Therefore, the left lung was resected with the use of extracorporeal circulation, and the pulmonary trunk and right pulmonary artery were reconstructed. A solitary right lung metastasis was resected 3 months later using stapling devices. Complete surgical resection is the treatment of choice for patients with sarcoma of the pulmonary arteries. Surgical therapy often includes extensive reconstructive measures. Since, thromboembolic obstruction cannot be excluded preoperatively, patients with this type of disease should be treated at centers experienced with the broad spectrum of pulmonary artery surgery.
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1999-03-09
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10068838
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Adrenocortical insufficiency (Addison's disease) is a functional diagnosis. At the beginning of this century, tuberculosis was recognized as the main etiological cause (50-70%). Today, however, tuberculosis represents only 10% of the cases. Adrenocortical insufficiency is mainly caused by autoimmune adrenalitis (more than 50%). Unilateral adrenocortical disease is usually asymptomatic or presents, as in the case described, with minor symptoms. This case report of adrenal tuberculosis illustrates the current challenges of diagnosis and therapy.
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1999-03-09
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10068839
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To optimise the microsurgical training in our clinic we organized a permanent possibility to practice microsurgical techniques of vascular anastomosis. This includes step-wise education by means of plastic materials, human placenta and the rat model. The most important role in this concept is played by the placenta. It supplies a realistic simulation of different in vivo situations concerning microvascular anastomosis. As to availability, handling and costs the placenta is superior to animal models and has replaced them almost completely in our educational concept.
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1999-03-09
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10200355
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OBJECTIVE: To understand the allele structure and reveal genetic polymorphism of Y chromosome specific short tandem repeat (Y-specific STR) loci in Chinese Han population. METHODS: The authors used a set of five Y-specific STR loci which were tetrameric tandem repeat loci chosen from the Genome Database. EDTA-blood specimens were collected from the unrelated individuals. DNA was extracted by Chelex method and amplified by the polymerase chain reaction (PCR). The PCR products were analyzed using both the PAGE horizontal electrophoresis with discontinuous buffer system and the automated fluorescence detection approach. RESULTS: The authors observed that the alleles at the five Y-specific STR loci were composed of some complex repeat structures. They successfully prepared a set of human allele ladders for the typing of the five Y-specific STRs and demonstrated the polymorphisms at the five Y-specific STR loci in Chinese Han population. CONCLUSION: Y-specific STRs are good genetic markers for the purpose of analysis of genetic relationship between populations. This preliminary study not only reveals allele frequencies and haplotype distribution of Y-specific STR in Chinese Han population, but also indicates a reference population for detecting male migration events and for reconstructing paternal history.
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1999-04-14
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10200357
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OBJECTIVE: To understand polymorphism of HLA-DRB1, DQB1 in the Hans of north China and obtain more comprehensive and accurate data on genetics at DNA level. METHODS: Polymerase chain reaction-sequence specific primers (PCR-SSP) were used to determine HLA-DRB1, DQB1 alleles in 107 unrelated healthy Han individuals of north China. RESULTS: The authors determined 14 DRB1, 9 DQB1 alleles, which included not only the allele frequencies that corresponded to the gene frequencies of DR, DQ loci determined by other 9 cooperating labs but also the allele frequencies of DRB1*15, DRB1*16, DQB1*0301, DQB1*0302, DQB1*0303, DQB1*05, DQB1*0601, DQB1*0602, and DQB1*0604 that other serology labs did not report. CONCLUSION: This study has obtained a more comprehensive and accurate data set of the normal allele frequencies and linkage disequilibrium parameters of HLA-DRB1,DQB1 in the Hans of north China, which may be of significance in the studies on population genetics and disease association.
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1999-04-14
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10200356
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OBJECTIVE: To compare the HLA-A locus in a population selected from Beijing (northern group) with that in a population selected from Guangzhou (southern group). METHODS: HLA typing was performed by using PCR/SSOP method. A pair of primer and 54 probes were used. RESULTS: In 18 alleles identified, the differences in gene frequency between northern and southern Chinese were found. In northern group, A*0205, 0210 and 2901 were absent, and the frequencies of A*2601, 3001 and 3101 were higher than those of southern group; while in southern group, A*3103, 3201 and 6801 were absent, the frequencies of A*0203 and 1101 were higher than those of northern group; and in addition, six subtypes of A2 serological specificity, namely A*0201, 0203, 0205, 0206, 0207 and 0210, were found, in which A*0201 predominated. CONCLUSION: There are some differences in the genetic background of northern and southern Chinese. A2 subtypes have important implications for unrelated-donor transplantation.
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1999-04-14
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10200358
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OBJECTIVE: To get preliminary genotype and allele frequency distributions of D6S366, D6S477, D12S375, D12S391 and PLA2A loci in Chinese Han population in Chengdu area and to validate more short Tandem repeat (STR) systems for forensic application. METHODS: The polymerase chain reaction (PCR) was used. Five STR systems (D6S366, D6S477, D12S375, D12S391 and PLA2A) were amplified on DNA samples, which were extracted from 108 unrelated individuals EDTA-blood by Phenol/Chloroform method. The PCR products were analyzed by PAG vertical electrophoresis. RESULTS: Seven alleles were found at D6S366 locus, nine alleles at D6S477 locus, five alleles at D12S375 locus, nine alleles at D12S391 locus and seven alleles at PLA2A locus. No deviations from Hardy-Weinberg equilibrium were observed. The heterozygosities observed were 0.69, 0.78, 0.81, 0.68 and 0.79 for D6S366, D6S477, D12S375, D12S391 and PLA2A respectively. The chances of exclusion were 0.3621, 0.6004, 0.4581, 0.7014 and 0.5589 and the discriminating powers were 0.79, 0.93, 0.86, 0.96 and 0.91. CONCLUSION: All of the five loci in this study were useful markers for individual identification and paternity test and for genetics purposes.
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1999-04-14
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10200359
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OBJECTIVE: To observe the CA repeat polymorphism of the type I angiotensin II receptor gene on Chinese Han people, and evaluate the genetic linking to hypertension. METHODS: The CA repeat polymorphism at 3'-flanking region of AT1R gene was studied by amplified fragment length polymorphism (Amp-FLP ) in Chinese Han people from Shandong and Xi'an. RESULTS: There were 9 alleles ranging from 130bp to 146bp in all subjects. The allele frequencies were 0.01 to 0.38, and allele A4 was more frequent in the control. The heterozygosity of CA repeat locus was 0.789, the polymorphic information content, 0.746. There was no significant difference in distribution of CA repeat polymorphism genotype between different regions in same ethnic (P>0.05), but the allele frequency of CA repeat polymorphism in hypertensive group was significantly different from that of control (P<0.05). There was no detectable distortion from Hardy-Weinberg equilibrium in both groups. CONCLUSION: The results suggest that CA repeat polymorphism of AT1R gene be associated with Chinese Han hypertensive people.
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1999-04-14
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10200360
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OBJECTIVE: To study the genetic susceptibility of HLA-DQA1 alleles to duodenal ulcer in Chinese Hans from Wuhan and its nearby regions. METHODS: Seventy patients with duodenal ulcer and fifty healthy controls were examined for HLA-DQA1 genotypes. HLA-DQA1 typing was carried out by digesting the locus specific polymerase chain reaction amplified products with alleles specific restriction enzymes was significantly higher than that in healthy controls was significantly lower than that in healthy controls (26%). CONCLUSION: These findings suggest that DQA1 0301 is a susceptible gene for duodenal ulcer in Wuhan Hans while DQA1 0102 is its resistant gene, and there are immunogenetic differences in HLA-DQA1 locus between duodenal ulcer patients and healthy controls.
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1999-04-14
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10200361
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OBJECTIVE: To analyze the frequency of mutation in exon 8 of Wilson's disease and 11 heterozygous (12.2%). The positive rate of mutation was 16.67%. The Arg778Leu mutation was validated by this study. CONCLUSION: The mutation in exon 8 of WD gene may play an important role in pathogenesis of Wilson's disease in Chinese.
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1999-04-14
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10200362
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OBJECTIVE: To investigate the characteristics of mutations of exons 14 and 18 of Wilson's disease (WD) gene in Chinese patients. METHODS: The subjects of study included 60 unrelated normal controls and 44 unrelated WD patients. Genomic DNA was prepared from peripheral blood leukocytes by a salt-out method. Mutations of exons 14 and 18 in these subjects were screened by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and further confirmed by sequencing. RESULTS: One patient was homozygous for Arg1041Pro mutation of exon 14 and another patient was heterozygous for Asn1270Ser mutation of exon 18. CONCLUSION: The mutations of exons 14 and 18 of WD gene in Chinese patients were confirmed by sequencing for the first time in China. Arg1041Pro was identified as a novel missense mutation. In addition, an Asn1270Ser, previously described mutation, was detected in this study. But exons 14 and 18 are not the hot point mutations of WD gene in Chinese patients.
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1999-04-14
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10200364
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OBJECTIVE: Investigating the correlation between the genotype and spinal muscular atrophy(SMA) clinical phenotype. METHODS: Neuronal apoptosis inhibitory protein(NAIP) gene analysis was performed by PCR amplification of exon 5 in 13 unrelated SMA patients with deletions of SMN gene. RESULTS: Two Type-I patients(2/5, 40%) lacked the NAIP exon 5. CONCLUSION: The results suggest a possible correlation between NAIP gene deletion and the disease severity of SMA.
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1999-04-14
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10200363
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OBJECTIVE: To detect the relation between alpha1-antichymotrpsin(AACT)gene polymorphism and epsilon4 allele of apolipoprotein E (ApoE) gene in Alzheimer disease (AD) in Chinese. METHODS: The gene polymorphisms of ApoE and AACT were genotyped in 125 AD cases and 140 controls with PCR methods and RFLP typing. Then the association between AACT polymorphism and ApoE epsilon4 was analysed. RESULTS: There was no association between AD and any allele or genotype of AACT polymorphism; AACT polymorphism was not associated with AD ApoE epsilon4 or without ApoE epsilon4. In AACT* AT and AACT* TT genotypes, ApoE epsilon4 allele was associated with AD, but no association was observed in AACT* AA genotype. CONCLUSION: AACT may not be associated with AD in Chinese, and this effect can not be influenced by ApoE epsilon4, but AACT gene polymorphism may affect the association between ApoE epsilon4 allele and AD.
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1999-04-14
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10200365
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OBJECTIVE: To search for the minimal overlap region of tumor suppressor gene in laryngeal carcinoma and discuss the correlation of p16 gene with laryngeal carcinogenesis. METHODS: Five microsatellite polymorphism markers near p16 gene were selected to detect loss of heterozygosity (LOH) and microsatellite instability (MI) in 60 cases of laryngeal squamous cell carcinoma. RESULTS: The frequencies of LOH in 5 markers were less than 23.1%, while the frequencies of MI in 2 markers were higher, with the highest frequency (46.1%) in D9S1752. CONCLUSION: The results suggest that the deletion of p16 gene does not play an important role in the laryngeal carcinogenesis and there may exist a gene around D9S1752 participating in the development of laryngeal carcinoma, which correlates with the mutation of repair gene.
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1999-04-14
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10200366
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OBJECTIVE: To determine the influence of aging and sex on the segregation of chromosome 21. METHODS: Lymphocytes were obtained from healthy donors of different ages, both sexes, and were treated with cytochalasin B. Binucleated cells were hybridized with chromosome 21 specific probe, and simultaneously, chromosome 21 loss and non-disjunction were detected. RESULTS: The coefficients of correlation between age and binucleated cells containing 4, 2 and 6 signals were -0.35(P<0.01), 0.18 and 0.38(P<0.01) respectively. The coefficients of correlation between age and nondisjunction of chromosome 21 and micronuclei were 0.56(P<0.01) and 0.70(P<0.01) respectively. CONCLUSION: There is a significant increase with age in the number of micronuclei and missegregation. Nondisjunction of chromosome 21 is much more frequent than loss in vivo and in vitro. No significant difference in nondisjunctioin between male and female was noted. Age effect is more significant in female than in male.
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1999-04-14
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10200367
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OBJECTIVE: To study human ABO genotyping by means of multiplex PCR and restriction fragment length polymorphism. METHODS: Two specific fragments of ABO gene were simultaneously amplified in a single tube, and then the double restriction digestion with RE Kpn I and Alu I was performed in the same tube. The amplified products were analyzed by PAGE and silver staining. A total of 125 Han unrelated individuals living in Wuhan were genotyped. RESULTS: Six genotypes of ABO were detected and the distribution was in good agreement with Hardy-Weinberg equilibrium. CONCLUSION: The results demonstrate that PCR-RFLP based approach is convenient, reliable and should be of value in forensic application.
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1999-04-14
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10200368
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OBJECTIVE: To establish a rapid and convenient single strand conformation polymorphism (SSCP) analysis method for detecting the point mutation of non-deletional alpha-thalassemia. METHODS: The 543bp DNA fragment spanning the hot spot region mainly responsible for non-deletional alpha-thalassemia was nested amplified using the selective amplification of alpha2 globin gene as a template and was denatured with low ionic strength(LIS) solution followed by SSCP analysis. RESULTS: LIS buffer was more efficient for ssDNA formation than formamide buffer was and the formation of ssDNA was very stable. In addition to a normal electrophoresis pattern, at least three SSCP profiles can be detected by the present method when the DNA samples bearing non-deletional genes of Hb H disease were screened. Confirmed by DNA sequencing analysis, the DNAs represented these profiles have turned out to be the different three mutants, i.e., the alphaCS mutation, the alpha QS mutation and the alphaWestmead mutation, respectively. Only 3 hours were needed to complete the electrophoresis procedure of this method. CONCLUSION: PCR-LIS-SSCP can be used as a tool in rapid screening for the alterations in human alpha-globin gene.
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1999-04-14
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10200369
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OBJECTIVE: To develope the method of two-color fluorescence in situ hybridization (FISH) assay and use it for detecting the aneuploidy frequency of human sperm chromosome. METHODS: Sperm sample was washed three times and the slides were prepared. The sperm heads were decondensed with dithiothreitol (DTT) and lithium diiodosalicylate (LIS). Then, the sperm nuclei were hybridized with biotin labeled alpha satellite X chromosome DNA probe (DXZ1) and digoxigenin labeled alpha satellite Y chromosome DNA probe (DYZ3). The hybridization signals were detected with CY3-Streptavidin, goat antistrepavidin for biotin labeled probe and with mouse antidigoxigenin, rabbit antimouse-FITC for digoxigenin labeled probe. RESULTS: Under the Nikon fluorescence microscope, the hybridization signals in the sperm heads were clearly visible. The sperm with one red hybridization signal was X chromosome sperm (X sperm), and the sperm with one green hybridization signal in the sperm head was Y chromosome sperm (Y sperm). In the case of two hybridization signals in one sperm head, the sperm should be a numerical abnormal one. By using two color FISH with one euchromosome probe and one sex chromosome probe, the sperm with same color of two hybridization signals in one sperm head could be identified as aneuploidy sperm or diploid sperm. CONCLUSION: The two color FISH assay may be used to detect the aneuploidy frequency of human sperms that were exposed to mutagents and environmental potential aneuoploidogenic agents.
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1999-04-14
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10399253
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OBJECTIVE: We examined the placental transfer of the calcium antagonists Flunarizine and Verapamil and their effects on the placental metabolism using the dual in vitro perfusion of the human placental lobulus. MATERIAL AND METHODS: Eight placental lobuli were perfused with either 10 micrograms/ml Flunarizine or Verapamil over 6 hours. Two perfusions without any substrate were used as control. RESULTS: The transfer of the control substances antipyrin and kreatinin was not affected by the perfusion with the calcium antagonists. Flunarizine and Verapamil crossed quickly the placental wall, but most of them were accumulated in the perfused placental tissue. Verapamil had a greater placental transfer than Flunarizine. The placental glucose consumption as well as the lactate production were not changed by both of the calcium antagonists. Flunarizine and Verapamil stimulated the placental beta HCG synthesis into the maternal circulation.
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1999-07-10
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10399254
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OBJECTIVE: The objective of the study was to analyse the prognostic impact of several criteria for median survival and recurrence free interval in patients with uterine sarcomas. Factors included to our analysis were the staging according to FIGO, DNA content (ploidy), mitotic index, histology, the kind of primary therapy, grading and menopausal status. MATERIAL AND METHODS: Retrospectively, clinical data of 78 patients (41 leimyosarcomas, 23 carcinosarcomas = homologous malignant mixed Mullerian tumors, 14 endometrial stromal sarcomas--10 low grade, 4 high grade) were analysed. Additionally, in 36 of the cases mitoses were counted. Furthermore, DNA ploidy was determined using image cytometry on paraffine sections stained according to the Feulgen method. Receptor status was determined using immunohistochemical staining. Two and five year survival rates were 22% and 15%. There were 21 cases with local relapse and 27 cases with metastasis. RESULTS: The staging according to FIGO was the main prognostic factor, significantly influencing median survival time (p = 0.001) as well as the recurrence free interval (p = 0.03). There was a significant difference between median survival time compared to mitotic index (p = 0.014) and DNA ploidy (p = 0.02). A mitotic index < 10/10 HPF and diploidy were related with a better prognosis. Receptor status did not have an impact on median survival time. CONCLUSIONS: As our results suggest, DNA ploidy and mitotic index are likely to provide additional information for prognosis in patients with uterine sarcomas and could be used as criteria for selecting patients for adjuvant therapy.
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1999-07-10
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10399255
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OBJECTIVE: The purpose of this study was to evaluate the effects of opioid addiction on pregnancy, perinatal period, and the long-term development of mother and child. MATERIAL AND METHODS: Records of 44 opioid-dependent women and their children were analyzed. Thirty-three patients were enrolled in methadone maintenance treatment (MMT) programs or received codeine. RESULTS: Problems during pregnancy were premature rupture of membranes (n = 8), premature labor (n = 21), premature delivery (n = 9), abruption placentae (n = 2), cesarean section (n = 10), and fetal growth retardation (n = 15). Whereas MMT improved fetal growth, no influence was seen on other problems during pregnancy. Thirty newborns had significant withdrawal symptoms. One child became HIV-positive and two children required treatment for suspected congenital syphilis. One child died of sudden infant death syndrome. CONCLUSIONS: The major goal has to be the avoidance of an unwanted pregnancy. Does it still happen, the patient needs special support. If an opioid-dependent woman presents herself the first time, an anamnesis concerning drugs in addition to a general anamnesis should be arisen.
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1999-07-10
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10399256
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This paper was intended to settle the question whether the so-called gentle sectio caesarea with a high skin incision as described by Cohen in 1972 could be applied in combination with a sectio on the level of the classic Pfannenstiel's incision which would be more satisfying cosmetically. Furthermore a comparison was to be drawn between the postoperative condition of those patients on whom this surgical method had been performed and the condition following a classic Pfannenstiel's incision. Between January 1997 and July 1997 we compared the classic method of Pfannenstiel's incision with the variant of Cohen's method as described above in a prospective randomised study. On applying this surgical technique, the abdomen was opened according to Cohen's method using a surgical knife but for the skin, and the tissue layers underneath were opened blunt with two fingers. Following the extraction of the child only three sutures were made: Uterus, fascia and skin. Redon drainages were not inserted. We were able to show that this method of applying mainly blunt "incision" to sectio caesarea the tissue is at least equal to the sharp opening of the abdominal cavity. In some respects, such as the early postoperative mobilisation, it is, in fact, superior, because the blunt opening causes less bleeding and the reduction to three sutures only, deliberately leaving the two peritoneal membranes open, as well as leaving away the redon drainages, considerably increases the patients' postoperative well-being. It is for these reasons that we call for this method to become part of the routine procedures in caesarean sectio.
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1999-07-10
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10399257
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OBJECTIVE: The objective of this retrospective analysis was to compare the obstetrical procedures at premature birth and delivery at term. The aim was to show the influence of gestational time on mode of delivery and neonatal state. MATERIAL AND METHODS: 339 births from breech presentation between 1988-1990 were compared with premature births and deliveries at term. RESULTS: Frequency of breech presentation totalled 4.1%. 173 deliveries (51.7%) resulted vaginally, 26 cases (7.8%) with freeing of arms and 4 cases (1.2%) as extraction. Frequency of cesarean sections totalled 48.3%. The number of premature births reached in the group of breech presentation 23.1%. Births at term resulted with 58% predominantly vaginally (abdominally in 42%). Between the 31st and 36th gestational week the number of cesarean sections rose to 67.3%, in the 31st week it even reached 78.9%. The neonatal state was described with the help of Apgar-scores and umbilical cord-pH-values. The share of newborns with optimal Apgar-values after 1 minute (8-10) was in premature births with 36.5% only about half as large as in deliveries at term (77.6%). Only 9.6% of the children showed pH-values below 7.20. Number of newborns with these pH-values totalled in premature births in the 31st week 35.3%, for terms between the 31st and 36th week 15.6%, and declined in mature births to only 6.2%. CONCLUSIONS: Estimating the neonatal state of the group of breech presentations the vaginal birth should keep an equal rank in the delivery plan of a clinic. At the appraisal of the childlike early morbidity of a delivery group the number of premature newborns is decisive.
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1999-07-10
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10399258
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Few cases of surgical scar endometriosis have been reported yet, which may occur following episiotomies and caesarean sections. The classic presentation is that of a tender mass becoming symptomatic with menstruation. Patients are complaining of cyclic pain and pre-menstrual swelling. In our case, a 34-year-old gravida III/-para II with osteogenesis imperfecta presented herself with a non-symptomatic scar endometrioma following a caesarean section 4 years previously. The diagnosis based on an incidental finding after scar removal during the subsequent caesarean section. As known so far, surgical intervention is the method of choice if singular endometriosis lesions occur.
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1999-07-10
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10399261
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OBJECTIVE: Endometriosis is one of the most common benign gynaecological diseases. Its aetiology is uncertain and there are many unanswered questions about its pathogenesis and treatment. MATERIAL AND METHODS: Medline search of relevant publications. RESULTS: Particularly the early stages of endometriosis, usually located in the peritoneum, are metabolically highly active and, even from the start, set in motion a vicious circle of progressive organ destruction, adhesions and inflammatory processes. This can lead to chronic cyclic or acyclic pains and/or sterility. Invasiveness and potential for progression are based on the secretion of prostaglandin derivatives and numerous cytokines which, together with the gradual failure of immune resistance and the local hormonal environment, usually dominated by oestrogen, are responsible for the progressive nature of around 50% of endometriosis cases. The estimated incidence of active, progressive endometriosis is 21,000 new cases per year in Germany, placing it on a par with prostate cancer. Subtle microscopic and morphological grading of the activity of the lesions is crucial to the choice of treatment. Early results of clinical trials indicate that the highest pregnancy rates and the lowest recurrence rates at follow-up can be achieved with individualised hormonal and surgical treatment of active endometriosis, even for mild or minimal endometriosis, in comparison with the laparoscopic removal of lesions alone. CONCLUSIONS: The combined use of hormonal and surgical treatment could become the new gold standard for treating active endometriosis.
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1999-07-10
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10399262
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Since February 1997 the Departments of Dentistry and Oral & Maxillofacial Surgery of the University of Munster, Germany, can be visited on the Internet on more than 1400 HTML pages. These Web pages have been organized using an especially designed database which ensures standardized layout of the presented information and systematic navigation. A various amount of the Web pages are created fully automatically from a database (e.g. lectures, list of resources (URLs)); manually created pages are automatically adjusted concerning layout, integrated in the overall structure and given uniform navigation elements. Among other things, the database generates an interactive Web-site index (like a tree view), which facilitates search.
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1999-07-10
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10425500
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The long-postulated reactive intermediates of polar fluoride-inititated trifluoromethylations with Me(3)SiCF(3) (see scheme) were identified by NMR spectroscopy as(-) and(-)(.)
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1999-07-30
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10467687
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In a study 112 patients with histologically confirmed mostly recurrent endometriosis underwent a "three-step" therapy. Surgical removal of endometriosis implants was followed by a 6-months treatment with 3.75 mg of leuprorelin acetate depot as monthly subcutaneous injection and a second look laparoscopy with removal of residuals was performed. The follow-up period was up to 60 months (median 33.5 months). More than 50% of the patients had been pretreated by surgery and 30% by various medications. The r-AFS score pre- and postoperatively at the first- and post-therapeutic at the second look laparoscopy confirmed, that the primary operative intervention reduces the total r-AFS score by only 34%, whereas the combined approach reduces the score by 66%. These data of our own study could confirm, that in patients with symptomatic recurrent endometriosis the recurrence free time was dependent on the r-AFS score reached post-therapeutically and this holds true for all stages. The higher the posttherapeutic r-AFS score the shorter the interval to recurrence. 91/112 (83.3%) patients complained infertility. 43/91 (47.3%) became pregnant during the follow-up period resulting in 36 newborns. Conception was spontaneously in more than 50% and stimulation programs were necessary in the others. Quality of life was regained in 54.9% and improvement of subjective conditions were reported in 52.9%. In our study we could confirm a clear relationship of recurrence of symptomatic endometriosis to the posttherapeutically achieved r-AFS score. Early aggressive therapy of active endometriosis is the optimal prevention of infertility caused by endometriosis.
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1999-09-01
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10467686
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The assessment of the activity of endometriosis provides a challenge during endoscopic procedures. Novel approaches can be developed in future based on more detailed understanding of the mechanisms of the pathogenesis of endometriosis. Angiogenic factors of local immunoreactions are important agents in the development and progression of the disease. Vascular endothelial growth factor (VEGF) is a potent inducer of vascular permeability and of the mitogenesis of endothelial cells. In endometriotic and endometrial tissues VEGF isoforms VEGF121, VEGF165, VEGF189 and VEGF206 are expressed. The amount of VEGF isoforms in the endometrium is regulated depending on the menstrual cycle. Macrophage recruitment by ectopic endometrial implants is an early step in the cascade of implantation and local peritoneal reaction. RANTES (Regulated upon Activation, normal T-cell-Expressed and Secreted) is a specific chemoattractant for monocytes and activated T-cells. Soluble products of activated macrophages play an important role in endometriosis associated infertility. The factors involved in angiogenesis and immune response are potential parameters to determine the activity of endometriotic implants and novel approaches for the treatment of endometriosis.
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1999-09-01
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10467688
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Endometriosis and infertility are frequently associated. There is controversy in the literature about the causal correlation. There is no doubt, that progressed disease causes infertility by mechanical disturbances of the reproductive organs. Mild and moderate endometriosis however is discussed to cause functional infertility by changes of the peritoneal fluid, by endocrine and immunological dysfunction. Ovulation, ovum transport, fertilisation and implantation has been shown to be negatively influenced in patients with endometriosis. Some randomised prospective clinical studies however have demonstrated, that pregnancy rates after medical or surgical treatment of endometriosis are not improved compared with no treatment of the disease. The morphological data of this study may explain these conflicting data of the past: inactive, not proliferative endometriosis is not a cause of infertility, but in contrast active proliferating disease reduces fertility and needs sufficient treatment.
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1999-09-01
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10467689
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Endometriosis is a proliferative disease, which is often diagnosed with delay. Laparoscopy and histology are necessary for diagnosis. Different factors influence the success of therapy. Proliferative markers are very important for the differential diagnosis of active and inactive endometriosis. In a study it could be shown that endometriosis with high proliferative activity (high expression of Ki67) has a high response rate to GnRH-analogues treatment. Active endometriosis has to b distinguished to select an optimal treatment. A high proliferative activity of endometriosis should be treated with a hormonal-surgical combination.
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1999-09-01
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10467690
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A total of 94 pre- or peri-menopausal patients from eight centres with intractable uterine bleedings and completed family planning were assessed as part of a clinical trial on the use of leuprorelin acetate monthly depot prior to endometrial ablation. The primary target criterion was flattening of the endometrium after two injections of 3.75 mg leuprorelin acetate depot with an interval of one month between injections. Endometrial thickness before the first injection was compared with the thickness prior to surgery (two weeks after the second injection). Mean endometrial flattening of 4.0 +/- 4.1 mm was found. Sufficient pretreatment was achieved in 91.3% of the patients with > 50% decrease. In terms of clinical response, the development of amenorrhoea, hypomenorrhoea or normal menstruation was assessed six weeks and still 83% after six months. In view of the good study results, hormone-suppressive pretreatment can be recommended prior to hysteroscopic endometrial ablation. Surgery should then take place about two weeks after the second injection.
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1999-09-01
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10467691
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GnRH agonist (GnRHa) administered for 6 months leads to an effective desensitisation of the pituitary and hypoestrogenism without exerting a particular effect on the whole metabolism. At the end of the first month's a suppression of the serum estradiol levels are achieved, the level of LH and FSH decline in the hypogonadotropic range. No negative influence on the lipid metabolism after administration of GnRH agonist has been observed. The balance of HDL/LDL does not change during the treatment. There were neither any negative changes in the liver metabolism, kidney function nor in the electrolyte values. In anaemic premenopausal women, for example due to serious menstrual problems, a normalisation of the haemoglobin concentration is obtainable already after a 12-week treatment. With regard to the hemostatis system a significant reduction of the procoagulant activity, fibrin turnover rate and a significant improvement of fibrinolytic activity can be observed under a GnRHa therapy. Although the use of GnRHa leads without doubt to a drastic reduction in the uterus blood flow there are no signs that this also leads to a change in the cerebral arteries blood flow. Menstrual bleeding occurs on average 3 months after the last injection of an GnRHa depot injection; with daily injection or nasal spray 3 to 4 weeks earlier. Theoretical considerations as well as the world-wide use as part of the infertility treatment--in some countries more than 90% of all IVF-cycles are performed using GnRH--,contradict the fact that GnRHa cause a teratogenic effect. Domineering undesirable side-effects during a treatment with GnRH can be traced back almost exclusively to the effective hormonal deprivation. In this context it is remarkable which percentage patients complain about trouble of this spectrum before GnRHa treatment is initiated. The chronicle reduction of the sexual hormone level leads without a doubt to a reduction of bone mineral density. The clinical relevance is furthermore a matter of controversial discussion. Prevention measures can be undertaken through an add-back therapy. This can also be of help in the case of vegetative side-effects caused by a decrease in sexual hormones. The question arises to what extent effective non hormonal add-back therapies are at disposal in the treatment of sexual hormone related malignant tumours. Also men with testosterone deprivation can suffer from distinctive hot flushes, sleeping disturbances and depression which requires some kind of relief in order to maintain an acceptable quality of life.
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1999-09-01
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10467692
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In a European, randomised Phase III trial, we studied ovarian ablation using a GnRH-agonist (leuprorelin acetate 3M depot, Takeda Pharma GmbH, Aachen) with CMF combination chemotherapy in pre- and peri-menopausal, hormone receptor-positive patients with involvement of 1-9 axillary lymph nodes. All planned 600 patients were recruited. We carried out an interim analysis of the hormonal effects and tolerability in 133 patients. The "castration effect" of the chemotherapy has previously been suspected but not systematically investigated. The hormonal effect should be an important aspect of adjuvant chemotherapy for node-positive breast cancer. For the first time we were able to demonstrate a pronounced estradiol-lowering effect of a "standard" chemotherapy regimen at least for the duration of the treatment. The side-effect profile of the two treatments in the interim analysis revealed marked advantages in favour of the GnRHa therapy. Currently no differences in efficacy are noted. However, sound conclusions can only be drawn after a far longer observation period, particularly after stratification according to the extent of node involvement and hormone receptor status.
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1999-09-01
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Date: June 16, 2025
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