RESUMO
BACKGROUND AND OBJECTIVES: Muscular variations of the ventral thoracic wall are generally common and of great clinical interest. MATERIALS AND METHODS: An unusual muscular variation of the ventral thoracic wall was observed and dissected in a West-European female body donor. RESULTS: An interclavicularis anticus digastricus muscle was observed and studied. It originated from the manubrium sterni and inserted bilaterally to the clavicles. Both muscle bellies were interconnected by a tendon on the ventral surface of the manubrium sterni. The muscle was innervated by branches of the lateral pectoral nerve. CONCLUSIONS: The interclavicularis anticus digastricus muscle is a muscular variation of the ventral thoracic wall of unknown prevalence. This variation might be of clinical interest in orthopaedics and thoracic surgery. It is also a vulnerable structure during infraclavicular insertion of a subclavian vein catheter or fractures of the clavicle.
Assuntos
Tendões , Parede Torácica , Clavícula , Feminino , Humanos , Manúbrio , Músculo Esquelético , Músculos PeitoraisRESUMO
BACKGROUND: A hormonal aetiology is one explanation for the lower incidence of myeloid leukaemia in women compared with men. METHODS: In this population-based case-control study, we evaluated associations between exogenous hormone use and reproductive history and myeloid leukaemia, overall and by disease subtype. RESULTS: We observed a suggestive association between oral contraceptive use and acute myeloid leukaemia (odds ratio=0.55, 95% confidence interval=0.32-0.96). Hormone replacement therapy and reproductive factors were not associated with risk. CONCLUSION: Despite the biological plausibility for a role of oestrogen in leukaemogenesis, other aetiologic factors are likely to explain the differing incidence rates in males and females.
Assuntos
Anticoncepcionais Orais/efeitos adversos , Estrogênios/efeitos adversos , Terapia de Reposição Hormonal , Leucemia Mieloide/etiologia , História Reprodutiva , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Infant leukaemia is likely initiated in utero. METHODS: We examined whether analgesic use during pregnancy was associated with risk by completing telephone interviews of the mothers of 441 infant leukaemia cases and 323 frequency-matched controls, using unconditional logistic regression. RESULTS: With the exception of a reduced risk for infant acute myeloid leukaemias with non-aspirin non-steroidal anti-inflammatory drugs (NSAID) use early in pregnancy (odds ratios=0.60; confidence intervals: 0.37-0.97), no statistically significant associations were observed for aspirin, non-aspirin NSAIDs, or acetaminophen use in early pregnancy or after knowledge of pregnancy. CONCLUSION: Overall, analgesic use during pregnancy was not significantly associated with the risk of infant leukaemia.
Assuntos
Analgésicos/efeitos adversos , Leucemia/etiologia , Efeitos Tardios da Exposição Pré-Natal , Adolescente , Adulto , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides , Aspirina , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Adulto JovemRESUMO
BACKGROUND: Prenatal supplementation has been inversely associated with childhood, but not with infant, leukaemia. METHODS: Mothers of 443 cases of infant leukaemia diagnosed during 1996-2006 and 324 frequency-matched controls completed interviews. Associations were evaluated by unconditional logistic regression. RESULTS: We observed no associations between prenatal vitamin (odds ratio (OR)=0.79, 95% confidence interval (CI): 0.44-1.42) or iron supplementation (OR=1.07, 95% CI: 0.75-1.52) and infant leukaemia after adjustment for race/ethnicity and income. Similar results were observed for leukaemia subtypes analysed separately. CONCLUSION: The observed null associations may be attributable to high supplementation rates and/or national fortification programmes.
Assuntos
Ferro da Dieta/administração & dosagem , Leucemia/etiologia , Vitaminas/administração & dosagem , Adulto , Suplementos Nutricionais , Feminino , Humanos , Modelos Logísticos , Masculino , Gravidez , RiscoRESUMO
Six patients developed severe, unexplained, chronic bronchopulmonary disease from 3 to 13 years after the onset of nonspecific inflammatory disease of the colon. All had chronic bronchitis, bronchiectasis was diagnosed in four, and an obstructive type of pulmonary dysfunction was noted in five. Four of the six, including the two with only chronic bronchitis, had no history of smoking. There was an initial correlation between the pulmonary symptoms and the intestinal disease, except in two patients who developed overt pulmonary disease following total proctocolectomy. The frequent occurence of extraintestinal lesions has suggested that ulcerative colitis and regional enteritis are systemic disorders. Chronic unexplained bronchopulmonary disease may be another infrequent complication in such patients.
Assuntos
Broncopatias/complicações , Colite Ulcerativa/complicações , Doença de Crohn/complicações , Pneumopatias/complicações , Brônquios/patologia , Broncopatias/patologia , Bronquiectasia/patologia , Bronquite/patologia , Doença Crônica , Colite Ulcerativa/patologia , Doença de Crohn/patologia , Feminino , Humanos , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
In a total of 10 patients with dementia of the Alzheimer-type (DAT) and in 10 healthy controls near-infrared spectroscopy (NIRS), a new non-invasive optical method, was used to measure the changes of concentrations of oxy- (O2HB) and deoxyhemoglobin (HHB) in left and right hemispheric prefrontal brain tissue areas during performance of the Verbal Fluency Test (VFT). On a neuropsychological level, the healthy subjects performed better in the VFT than patients with DAT. Statistical analysis of the relative concentrations of O2HB and HHB measured with NIRS during performance of the VFT revealed a significant interaction of the hemispheric effects with the diagnosis. A possible interpretation of this finding is that a good performance in the VFT relies on a predominantly left hemispheric activation observed in controls, whereas a low number of correct responses is associated with a loss of this asymmetric activation in patients with DAT. Although both, patients and controls, performed better in the category version of the VFT, the metabolic effects of this task were significantly less pronounced than in the letter version. This indicates that different energy demands, according to the type of access to the memory stores, may be interpreted as the result of a less energy-demanding access to categorically stored information and adds further evidence to the view that memory departments in humans are organized according to categorical principles.
Assuntos
Doença de Alzheimer/fisiopatologia , Dominância Cerebral/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho , Adulto , Idoso , Análise de Variância , Estudos de Casos e Controles , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Comportamento Verbal/fisiologiaRESUMO
Five hundred amniocenteses were carried out at midtrimester for prenatal diagnosis. A 22-gauge spinal needle with a stylet was used. The needle was guided by a real-time sector ultrasonograph. A transducer was placed adjacent to the puncture site and the needle tip was observed entering the amniotic cavity. By this technique, a bloody tap was avoided. There were only three (0.6%) spontaneous abortions in this group of 496 patients. Amniocentesis guided by ultrasound is a safe method for the mother and the fetus.
Assuntos
Amniocentese/métodos , Aberrações Cromossômicas/diagnóstico , Ultrassonografia , Amniocentese/efeitos adversos , Transtornos Cromossômicos , Feminino , Humanos , Idade Materna , Agulhas , Gravidez , Segundo Trimestre da Gravidez , Gravidez de Alto Risco , RiscoRESUMO
In search of a simpler and less traumatic method of oocyte retrieval for in vitro fertilization (IVF), 37 infertile patients underwent ultrasound-guided transvaginal needle aspiration of the follicles instead of the conventional laparoscopic aspiration. Although only intravenous analgesics and sedatives were used, patients experienced little discomfort. There were no infections or bleeding complications after the procedure. Eleven patients (30%) achieved ongoing pregnancies; this rate of success is comparable to that with our laparoscopic method. Considering this reasonable pregnancy rate, lack of substantial morbidity, and good patient acceptance, laparoscopic oocyte retrieval for IVF can be largely replaced by the ultrasound-guided transvaginal needle aspiration technique.
Assuntos
Biópsia por Agulha/métodos , Fertilização in vitro , Infertilidade Feminina/terapia , Oócitos , Folículo Ovariano/citologia , Ultrassonografia , Adulto , Transferência Embrionária , Estudos de Avaliação como Assunto , Feminino , Humanos , Infertilidade Feminina/sangue , Laparoscopia , GravidezRESUMO
A rare but typical case of trisomy 9 mosaicism is reported. The infant showed the characteristic phenotype of this syndrome: low-set malformed ears, micrognathia, broad nose with bulbous tip, abnormal brain, congenital heart disease, abnormal hands and feet, cryptorchidism, micropenis, and early death. This infant, however, did not have dislocation of joints or microcephaly; the head was larger than normal and had almost a cloverleaf shape.
Assuntos
Anormalidades Múltiplas , Cromossomos Humanos 6-12 e X , Face/anormalidades , Trissomia , Humanos , Recém-Nascido , Cariotipagem , Masculino , Mosaicismo , FenótipoRESUMO
Pregnancies achieved by IVF and resulting in blighted ovum were karyotyped. The rate of aneuploidy was found to be 38% (5/13). In vitro fertilization does not appear to be a risk factor for chromosome anomaly in live births or miscarriages, and the data reported so far may suggest that aneuploid rates are actually lower for pregnancies achieved by IVF.
Assuntos
Aberrações Cromossômicas , Transtornos Cromossômicos , Óvulo/patologia , Aborto Espontâneo , Adulto , Feminino , Fertilização in vitro , Humanos , Cariotipagem , Óvulo/citologia , GravidezRESUMO
In at least 4 of 7 cases, fertilization of intact human oocytes was more successful when spermatozoa were pretreated with TEST yolk medium at 5 degrees C for 2 hours as compared with the standard treatment with Ham's F-10 only. Both pregnancies that were obtained after the transfer of the fertilized oocytes resulted from oocytes fertilized by TEST yolk-treated spermatozoa. No decrease in fertilization occurred in any of the cases after TEST yolk treatment. If these results hold true for a larger series of patients, it may be worthwhile for the standard IVF incubation system of spermatozoa to include TEST yolk.
Assuntos
Fertilização in vitro , Espermatozoides/efeitos dos fármacos , Meios de Cultura , Gema de Ovo , Humanos , MasculinoRESUMO
Airway obstruction in children has many causes. Although vascular rings may have early onset of symptoms there was considerable delay in establishing the correct diagnosis. Barium swallow is diagnostic. Other tests, such as angiocardiography, bronchoscopy, bronchography, and lung scan are usually unnecessary. Pulmonary sling is a less common cause of vascular obstruction. Barium swallow showing anterior indentation at the level of the pulmonary hilum is diagnostic. Cysts and tumors are other causes of severe airway obstruction. The diagnostic and operative problems in three patients are discussed as examples. It is concluded that barium swallow is the most important single investigation in the evaluation of airway obstruction.
Assuntos
Obstrução das Vias Respiratórias/diagnóstico por imagem , Sulfato de Bário , Radioisótopos , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Aorta Torácica/anormalidades , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/cirurgia , Complicações Pós-Operatórias , Artéria Pulmonar/anormalidades , RadiografiaRESUMO
A new oxygenator the Shiley S-100-A has been evaluated. It incorporates a heat exchanger based on an anodised aluminium tube which replaces the polyurethane coated tube of the previous S-100 model. Data from 46 patients perfused with the Shiley S-100-A were reviewed and compared with figures derived from a previous group of 225 patients in whom the S-100 model was used. The gas transfer capacity of the S-100-A model is very good and comparable to that of the S-100 oxygenator at a low gas flow/blood flow ratio. However both "in vitro" and "in vivo" studies confirmed the superiority of the heat exchange capacity of the S-100-A model. The times required for cooling (from 36.5 to 29.6 degrees C) and rewarming (from 29.6 to 37 degrees C) for an adult patient of average build were 9.1 and 26 minutes for the S-100 model and 6.7 and 15 minutes for the S-100-A model respectively. In a separate group of patients cooled to and rewarmed from 26 degrees C the cooling and rewarming times were 12.4 and 23 minutes respectively.
Assuntos
Oxigenadores/instrumentação , Adulto , Animais , Velocidade do Fluxo Sanguíneo , Temperatura Corporal , Regulação da Temperatura Corporal , Dióxido de Carbono/sangue , Procedimentos Cirúrgicos Cardíacos/instrumentação , Bovinos , Eficiência , Máquina Coração-Pulmão/instrumentação , Humanos , Concentração de Íons de Hidrogênio , Oxigênio/sangue , Oxigenadores/normas , TempoRESUMO
Clinical follow-up of 24 patients who developed left ventricular aneurysm early after myocardial infarction is presented. All patients developed left ventricular failure within two weeks of infarction. The indication for operation was resistant left ventricular failure in 21 patients and a combination of left ventricular failure and unstable angina in three. Complete occlusion or severe stenosis (greater than 70 per cent) of the left anterior descending coronary artery was the most common findings. There were 3 hospital (12.5 per cent) and 2 late (8.3 per cent) deaths. Impairment of septal mobility was associated with a poor prognosis. All patients who develop progressive left ventricular failure early following myocardial infarction should be clinically and haemodynamically evaluated for the presence of left ventricular aneurysm. Surgical resection of the aneurysm and correction of associated lesions should be aggressively pursued.
Assuntos
Aneurisma Cardíaco/cirurgia , Infarto do Miocárdio/complicações , Adulto , Idoso , Angina Pectoris/etiologia , Feminino , Seguimentos , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/mortalidade , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
This qualitative study was conducted to determine cultural influences in end-of-life care among Jewish people. The conceptual framework for this study was drawn from Leininger's culture care theory. Informants consisted of 16 professional caregivers, family members, and rabbis who had experience with end-of-life care for Jewish patients. Interviews using open-ended and focused questions were used to gather informants' descriptions of their generic values, beliefs, and practices. Findings revealed the strong influence of religious, cultural, and historical factors in caring. Sanctity of life and life promotion are central to Judaism. Caring is a communal obligation that unites the family and community into a cohesive unit. Attitudes toward death are influenced by beliefs about afterlife and suffering. The value put on expert knowledge influences patients' and family members' expectations of professional caregivers. Similarities and differences were noted among different groups of informants.
Assuntos
Judeus , Religião , Assistência Terminal , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Between 1968 and 1980, 51 children had an operation for various forms of vascular ring. Additional cardiac malformations were present in five patients, and six had noncardiac congenital anomalies. Although symptoms started within the first month of life in 39 infants, only 16 came to operation under three months of age, and a delay of more than six months occurred in 15. Stridor, often life-threatening, and recurrent infections were the most common symptoms, but dysphagia was also important. The reasons for delay in diagnosis are discussed. Barium swallow provided the diagnosis in 44 patients and suggested it in a further four patients. Innominate artery compression of the trachea was not diagnosed by barium swallow. Operations of various types were performed. Accuracy in diagnosis is important because not all patients could be treated through the classic left thoracotomy. Severe tracheomalacia was responsible for the only two deaths in the series; one of these had tracheostomy performed in the referring hospital, the second child also had Fallot's tetralogy. The large majority of the patients have done well, 76% being asymptomatic at follow-up. Minimal to moderate stridor persists among the remainder to the present time.
Assuntos
Aorta Torácica/anormalidades , Malformações Arteriovenosas/cirurgia , Malformações Arteriovenosas/diagnóstico , Pré-Escolar , Transtornos de Deglutição/diagnóstico , Estenose Esofágica/diagnóstico , Humanos , Lactente , Recém-Nascido , Artéria Pulmonar/anormalidades , Sons Respiratórios/diagnóstico , Artéria Subclávia/anormalidades , Estenose Traqueal/diagnósticoRESUMO
A common problem encountered by in vitro fertilization (IVF) programs is the premature occurrence of the spontaneous luteinizing hormone (LH) surge during ovarian stimulation cycles. Administration of gonadotropin-releasing hormone agonists (GnRH-a) for 2 to 3 weeks produces a state of hypogonadotropic hypogonadism, thus allowing ovarian stimulation to proceed uncomplicated by a spontaneous LH surge. We have elected to treat seven patients with GnRH-a in a "short-term" protocol, with GnRH-a initiated on cycle day 3 along with exogenous gonadotropins. In this series, we found that the spontaneous LH surge was abolished, while ovarian responsiveness seemed to be improved. These results suggest that the initial surge of gonadotropins elicited by GnRH-a administration may enhance ovarian stimulation and that spontaneous LH surge is blocked when GnRH-a and exogenous gonadotropins are initiated concomitantly.
Assuntos
Fertilização in vitro , Hormônio Liberador de Gonadotropina/análogos & derivados , Adulto , Feminino , Hormônio Foliculoestimulante/uso terapêutico , Hormônio Liberador de Gonadotropina/farmacologia , Humanos , Infertilidade Feminina/tratamento farmacológico , Leuprolida , Hormônio Luteinizante/sangue , Menotropinas/uso terapêuticoRESUMO
Although gonadoblastoma is known to be associated with the presence of a Y chromosome, this case report of a 15-year-old patient with gonadal dysgenesis, gonadoblastoma, and an idic(Xq-) chromosome provides evidence for the occurrence of gonadoblastoma even in the absence of a Y chromosome. A review of previous cases reported to have gonadoblastoma in the absence of a Y chromosome revealed that the presence of some breast development was the common denominator among those patients. Therefore, a patient who presents with gonadal dysgenesis with some breast development, but lacks a Y chromosome may observe as close scrutiny as the patient with gonadal dysgenesis in the presence of a Y chromosome.
Assuntos
Disgerminoma/genética , Neoplasias Ovarianas/genética , Síndrome de Turner/complicações , Cromossomo X , Adolescente , Bandeamento Cromossômico , Feminino , Humanos , CariotipagemRESUMO
OBJECTIVE: We sought to assess the fertilization, implantation, and ongoing pregnancy rates with a minimal precycle and ongoing cycle monitoring protocol for in vitro fertilization and embryo transfer. STUDY DESIGN: Retrospective review was conducted of 103 consecutive cycles of fresh in vitro fertilization and embryo transfer from 1996 to 1998. Precycle screening included semen analysis without strict morphologic analysis, and hysterosalpingography-sonohysterography within the last year. Serum prolactin, serum thyroid-stimulating hormone, reactive plasma reagin, human immunodeficiency virus, rubella titer, blood type, hepatitis B surface antigen, and hepatitis C antibody testing was performed on all patients within 3 months of cycle initiation. Women > or =37 years old underwent clomiphene challenge testing. The monitoring protocol included the following: baseline transvaginal ultrasonography after 12 to 14 days of midluteal gonadotropin-releasing hormone agonist down-regulation to assess endometrial thickness and adnexal appearance, transvaginal ultrasonography for follicle evaluation at 7 and 10 days, serum estradiol assay if > or =20 follicles, quantitative beta-human chorionic gonadotropin 12 to 14 days after pre-embryo transfer, repeat quantitative beta-human chorionic gonadotropin 3 to 5 days later, and transvaginal ultrasonography for intrauterine gestational sac confirmation 7 to 9 days after the initial positive pregnancy test result. The dose of gonadotropin used remained constant unless the sonogram obtained on day 7 indicated a suboptimal response (<3 follicles each, with an average diameter of 10 to 12 mm) or hyperresponse (> or =15 follicles with an average diameter of 10 to 12 mm). RESULTS: The per embryo implantation rate (fetal cardiac activity) was 13.1%, and the live birth rate per 100 pre-embryo transfers was 31.5 for patients < or =40 years old. The average number of pre-embryos transferred was 3.1. The singleton pregnancy rate was 71%, and there were no multiple gestations greater than twins. The mean number of oocytes fertilized was 66%. There was 1 case of failed fertilization with intracytoplasmic sperm injection. There were two other cases of failed fertilization. One case of severe ovarian hyperstimulation occurred in spite of cryopreservation of all embryos. CONCLUSIONS: In vitro fertilization and embryo transfer can be accomplished with minimal precycle testing and ongoing cycle monitoring without compromising fertilization, implantation, and ongoing pregnancy rates. This results in reduced overall costs for couples.
Assuntos
Implantação do Embrião , Transferência Embrionária , Fertilização in vitro , Fertilização , Ciclo Menstrual , Gravidez/fisiologia , Adulto , Coeficiente de Natalidade , Feminino , Humanos , Síndrome de Hiperestimulação Ovariana/etiologia , Taxa de Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas , Falha de TratamentoRESUMO
Ten consecutive patients with pure mitral regurgitation due to floppy valve underwent valve repair operations. Postoperative mitral continence or regurgitation and diastolic flow across the valve were evaluated by Doppler echocardiography. Mean follow-up was 6.4 months. Four patients showed minimal and 3 mild regurgitation; no regurgitation was detected in 3. A significant peak diastolic atrioventricular gradient (10 mmHg) was observed in only one patient. All patients showed symptomatic improvement and a decrease in ventricular diameters. Repair of floppy mitral valves is feasible and gives good results. Doppler echocardiography is a useful technique for monitoring postoperative valve function.