bluuebunny/crossref_metadata_2025 huggingface dataset:
Sonographic Measurement of the Fetal Iliac Angle Cannot Be Used Alone as a Marker for Trisomy 21
Authors: Grangé Gilles , Thoury Anne , Dupont Jean-Michel , Pannier Emmanuelle , LeRhun Françoise , Goussot Souchet Michèle , Goffinet François , Cabrol Dominique
Published: April 2003

The fetal iliac wings angle was studied in 255 fetuses before amniocentesis at 16.7 weeks (± 1.3), using a sonographic axial view of the fetal pelvis. The measurement could be performed in 208 fetuses (81.6%), of whom 4 had trisomy 21 (T 21). The mean iliac angle was greater in fetuses with T 21 than in normal fetuses (69.8° vs. 88.7°; p = 0.03). This measurement is subject to significant intra- and interexaminer variability (interclass correlation coefficient: 0.65 and 0.23, respectively). When a 90° value is used as a threshold, specificity, sensitivity, positive and negative predictive values are, respectively, 80, 75, 7.0 and 99.4%. The 20% rate of false-positives rules out the use of this measurement as the sole criterion for the indication of amniocentesis for T 21 antenatal diagnosis.
High Sensitivity of Fetal DNA in Plasma Compared to Serum and Nucleated Cells Using Unnested PCR in Maternal Blood
Authors: Houfflin-Debarge Véronique , O’Donnell Hilary , Overton Timothy , Bennett Phillip R. , Fisk Nicholas M.
Published: April 2003

DNA analysis of blood is conventionally performed on cells – plasma and serum are discarded. Free DNA has been demonstrated in serum in cancer and autoimmune disorders and in pregnancy. We investigated possible noninvasive prenatal diagnosis using fetal DNA from maternal plasma and serum in pregnancy. Fetal gender was determined by PCR on DNA from maternal venous blood, serum and plasma of 65 women by boiling with or without phenol/chloroform extraction. When sensitivities were compared for plasma, additional phenol/chloroform extraction proved more sensitive than boiling alone (89 vs. 50%), the observed difference was 50% (CI 19 to 81%). Extracted plasma amplified better than extracted serum (89 vs. 46%), the observed difference being 44% (CI 22 to 66%). In contrast, fetal gender could not reliably be determined from DNA extracted from maternal nucleated blood cells. The size of plasma and serum DNA at 15–17 weeks of gestation was >1,500 bp. This work confirms the presence of fetal DNA in maternal plasma and serum which may be applicable to noninvasive prenatal diagnosis of paternally derived DNA sequences. We conclude that optimal sensitivity requires two methods of DNA extraction and that the use of plasma is preferred to that of serum.
Contrast-Enhanced Ultrasonography of Uteroplacental Circulation Does Not Evoke Harmful CTG Changes or Perinatal Events
Authors: Ordén Maija-Riitta , Leinonen Minna , Kirkinen Pertti
Published: April 2003

Objective: To determine whether an intravascular ultrasound contrast agent used in the examination of uteroplacental circulation in late pregnancy has any effect on fetal cardiotocographic (CTG) parameters or fetal well-being. Methods: The uteroplacental circulation of 69 women with singleton third trimester pregnancies was examined by power Doppler with contrast agent (Levovist®; Schering AG, Berlin, Germany) enhancement. Computed CTG examination using Dawes/Redman criteria was recorded just before and after ultrasonographic examination in 25 subjects examined with contrast agent and in 15 control patients who were given only physiological saline injection during ultrasonography. Umbilical artery blood flow velocity waveform was examined in 15 subjects before and 5 min after maternal contrast agent injection. Obstetric outcome of all the 69 subjects was evaluated by birthweight, placental weight, fetal and neonatal distress, prenatal hemorrhages, cord arterial and venous blood pH and macroscopic placental examination. Results: No apparent fetal or maternal harmful effects caused by the contrast-enhanced ultrasonography were observed. In CTG examination there was a statistically significant increase in the number of accelerations and fetal movements and in short-term variation after administration of the contrast agent in both subjects and controls. There were no significant changes in the umbilical artery blood flow velocity waveform after administration of the contrast agent. Conclusions: Contrast agent enhancement in the examination of uteroplacental circulation does not produce any harmful fetal or placental effects in late pregnancy. Ultrasonographic examination itself, obviously due to maternal stress reaction, is associated with a slight activation of fetal behavioral status.
Prenatal Diagnosis and Elective Termination of Neural Tube Defects in Hawaii, 1986–1997
Authors: Forrester Mathias B. , Merz Ruth D.
Published: April 2003

Objective: To determine the influence of various factors on the prenatal diagnosis and elective termination of neural tube defects (NTDs) in Hawaii in 1986–1997. Methods: Data from a birth defects registry were analyzed and included 245 cases. Results: 74% of the cases were prenatally diagnosed and 48% were terminated. Anencephaly was more likely to be prenatally diagnosed and electively terminated than spina bifida or encephalocele. Other factors such as maternal age, race/ethnicity, place of residence, and elevated maternal serum α-fetoprotein influenced the prenatal diagnosis and/or elective termination of NTD-affected pregnancies. However, a given factor may influence prenatal diagnosis and elective termination in different ways. Conclusions: Various diagnostic and demographic factors can influence the prenatal diagnosis and the subsequent termination of NTD-affected pregnancies.
Detection of Skin Over Cysts with Spina bifida May Be Useful Not Only for Preventing Neurological Damage during Labor but Also for Predicting Fetal Prognosis
Authors: Oya Naomi , Suzuki Yoshikatsu , Tanemura Mitsuyo , Kojima Kazuhisa , Kajiura Syoji , Murakami Isamu , Yamashita Nobuko , Suzumori Kaoru
Published: April 2003

Spina bifida is one of the most common open neural tube defects. There are two common types of spina bifida cystica, myelomeningocele and meningocele. Special attention to the thickness of the cystic sac (presence of intact skin and subcutaneous tissue) on magnetic resonance imaging is advantageous for determination of whether the child will profit from cesarean section in order to prevent neurological change (infection and drying of nerve tissue) and for management of spina bifida (most meningocele) during the perinatal period. Furthermore, skin detection may help to predict the prognosis of spina bifida after birth. Meningocele, with intact skin over the cyst, has a better clinical course than myelomeningocele. Some myelomeningoceles with neural tube defects in a lower position, also frequently having an intact skin over the cyst, have almost the same clinical course as a meningocele. From this, we hypothesize that a baby with spina bifida who has intact skin over the cyst might have a good prognosis neurologically. In this report, we concentrate attention on the skin over cysts in 3 cases (1 meningocele and 2 myelomeningoceles).
Neonatal Periventricular Leukomalacia Preceded by Fetal Periventricular Echodensity
Authors: Yamamoto Nobuhiro , Utsu Masaji , Serizawa Mariko , Ohki Shigeru , Murakoshi Takeshi , Seguchi Masashi , Iwase Kazuhiro , Maeda Kazuo
Published: April 2003

Objective: The purpose of this prospective study is to verify whether fetal periventricular echodensity (PVE) precedes neonatal periventricular leukomalacia (PVL). Methods: Fetal brains were studied with transvaginal scan in 63 high-risk fetuses from 17 to 32 weeks of pregnancy, PVE echogenicity was quantified with ultrasonic histogram, and neonatal brains and clinical courses were studied after birth. Results: No fetal cystic PVL was found, instead, fetal PVE was detected in 42 fetuses. The quantified echogenicity value was higher in PVE than in normal brain. Four cases developed neonatal PVL among 28 preterm and 1 among 14 term births. Neonatal PVL developed in the 23 cases of persistent fetal PVE, whereas no neonatal PVL was found when fetal PVE was negative or disappeared. Cord compression signs were common in PVL cases. Conclusion: Neonatal PVL was preceded by antepartum persistent fetal PVE in the present study.
Intracardiac Echogenic Focus: No Apparent Association with Structural Cardiac Abnormality
Authors: Wolman Igal , Jaffa Ariel , Geva Eli , Diamant Shmuel , Strauss Simon , Lessing Joseph B. , Yaron Yuval
Published: April 2003

Objective: The aim of our study was to evaluate whether intracardiac echogenic foci (ICEFs) may be associated with increased risk for structural cardiac anomalies in the low-risk population. Methods: During a 24-month period, 3,744 low-risk patients were prospectively screened for ICEFs by prenatal sonography. The study group was composed of 138 fetuses (3.7%) with ICEF. The control group was composed of 167 fetuses without ICEF. In all fetuses a complete echocardiographic evaluation was performed. Results: Among the 138 fetuses in the study group, 108 (78%) ICEFs were found in the left ventricle, 25 (18%) were found in the right ventricle, and 5 (4%) were found to be bilateral. No statistically significant difference was found between the study and the control group regarding the presence of cardiac anomalies. Only 1 case (0.7%) of pulmonic stenosis was found in the study group, compared to 1 case (0.6%) of bicuspid aortic valve in the control group. Conclusions: We conclude that ICEFs found in low-risk patients are not associated with a significant increase in the risk of cardiac anomalies.
Contribution of Transvaginal Ultrasonography and Fetal Cerebral MRI in a Case of Congenital Cytomegalovirus Infection
Authors: Soussotte Catherine , Maugey-Laulom Brigitte , Carles Dominique , Diard François
Published: April 2003

Cytomegalovirus is the most common cause of congenital viral infection. In utero this infection is usually suspected on the basis of ultrasound findings. We present a case in which routine ultrasound examination demonstrated a decrease in fetal cephalic dimensions at 32 weeks’ gestation in an asymptomatic patient. Transvaginal ultrasound revealed echogenic vessels in the thalami and lesions in the subependymal region. Suspected diagnosis of fetal cytomegalovirus infection was confirmed by positive titers of anti-cytomegalovirus-IgM antibodies in fetal blood and amniotic-fluid PCR studies. Fetal cerebral MRI demonstrated parenchymal atrophy and polymicrogyria. The parents decided to terminate the pregnancy, and necropsy confirmed the diagnosis. Suspicion of CMV fetal infection should prompt transvaginal ultrasound and fetal brain MRI.
Salvage of a Fetus with Congenital High Airway Obstruction Syndrome by ex utero Intrapartum Treatment (EXIT) Procedure
Authors: Crombleholme Timothy M. , Sylvester Karl , Flake Alan W. , Adzick N. Scott
Published: April 2003

A fetus with congenital high airway obstruction syndrome (CHAOS) due to complete tracheal atresia was referred at 31 weeks of gestation after 12 weeks of massive hydrops. The fetus was delivered by the ex utero intrapartum treatment procedure allowing sufficient time while on placental support for bronchoscopy to confirm tracheal atresia and tracheostomy to secure the airway. His postnatal course was complicated by severe capillary leak syndrome secondary to hydrops, diaphragmatic paralysis, tracheobronchial malacia, and the need for chronic ventilatory support. The infant’s tracheobronchial malacia resolved by 5 months of age and normal diaphragmatic function was restored at 9 months allowing him to be weaned from mechanical ventilation. He underwent tracheal reconstruction at 17 months of age. At follow up at 32 months of age he has a patent airway and is the first long-term survivor with CHAOS.
Fetal-Placental and Decidual-Placental Units: Role of Endocrine and Paracrine Regulations in Parturition
Authors: Carbillon Lionel , Uzan Michele , Challier Jean-Claude , Merviel Philippe , Uzan Serge
Published: April 2003

In primates, fetal adrenal and placental steroidogenic enzymatic systems are complementary in a fetal-placental unit, synchronizing fetal maturation and myometrial activation in late gestation. Moreover, as hemochorial placentation characterizes rodents and primates, paracrine regulations between decidua and placenta are essential to the immunotolerance of the conceptus and its development. Thus, the decidual-placental unit remains in a striking state of decidual quiescence throughout gestation, and the reversal of this quiescence is thought to play a key role in myometrial stimulation and the onset of parturition. A comprehensive view of the control of myometrial contractility, through the interaction of paracrine and endocrine modifications in late gestation, is proposed. The failure of these mechanisms underlie prematurity and the use of fetal therapy in threatened preterm labor.
Percutaneous Laser Ablation of Fetal Congenital Cystic Adenomatoid Malformation: Too Little, Too Late?
Authors: Bruner Joseph P. , Jarnagin Barry K. , Reinisch Lou
Published: April 2003

Objective: Congenital cystic adenomatoid malformation, type III (CCAM III) lesions are large, bulky tumors which can cause mediastinal shift, prevent normal pulmonary growth, and compress the esophagus, thus leading to complications of nonimmune hydrops, pulmonary hypoplasia and polyhydramnios. Because the mortality rate of untreated fetuses with CCAM and hydrops is high, early delivery or intrauterine resection of the enlarged pulmonary lobe (lobectomy) is indicated; however, open fetal resection of CCAM at less than 30 weeks is associated with perioperative mortality that approaches 40%, as well as the usual maternal and fetal morbidity of open fetal surgery. As an alternative, percutaneous laser ablation of a CCAM III lesion with hydrops was attempted. Methods: A 30-year-old G3 P1011 with CCAM III in the left fetal hemithorax developed mediastinal shift, hydrops and polyhydramnios at 23 weeks’ gestation. After pregnancy termination and open fetal resection were declined, an 18-gauge needle was placed into the fetal tumor percutaneously under real-time ultrasonographic guidance, using sterile technique with light sedation. A cleaved 400-μm Nd:YAG laser fiber was passed through the needle lumen, and using a power setting of 15 W, a total of 2,943 J of laser energy was delivered in pulses of 1.0 s at 0.2-second intervals over two sessions one week apart. Results: Although tumor size decreased, the hydrops worsened and fetal death occurred. Conclusions: The fetus with CCAM complicated by hydrops is already so compromised by the advanced state of the disease that insufficient time is available for necrotic tissue reabsorption after minimally invasive therapy with laser energy. Until earlier markers for intervention are determined, percutaneous laser debulking of CCAM is unlikely to be successful.
Medical and Educational Fields in Logopedics in The Netherlands:A Comparison in Historical and European Perspective
Authors: Raaijmakers M.F. , Dekker J. , Dejonckere P.H. , van der Zee J.
Published: April 2003

This study describes differences between medical and educational fields in logopedics practice in The Netherlands. This dichotomy of fields is also found in other Western European countries and may result from the historical development of the profession. The four settings where logopedists work the most (institutional care, private practice, community care and special schools) were studied. One hundred and seventy-two logopedists in 103 practices or departments collected data on 1,761 patients. For each patient a standard registration form was filled in, containing information on (i) patient characteristics, (ii) logopedic diagnostic assessment, and (iii) aspects of treatment. The historical dichotomy into medical and educational fields is still demonstrable in present-day logopedics in The Netherlands. However, the settings within each field also show some differences. Private practice shows a mixture of medical and educational characteristics.
The Relationship between Oral and Written Language
Authors: de Montfort Supple Marie
Published: April 2003

It has been agreed for some time now that reading is primarily a language-based activity and that deficits in oral language will be reflected in deficits in reading ability. This paper explores the association between specific aspects of oral and written language as reflected in current literature and research.
Neuroimaging Studies of Brain Activation for Language, with an Emphasis on Functional Magnetic Resonance Imaging: A Review
Authors: Kent Raymond D.
Published: April 2003

Neuroimaging studies have greatly enhanced the potential to understand brain-behavior relationships in complex behaviors such as language. The method of functional magnetic resonance imaging (fMRI) is one of the newest tools for neuroimaging, and it will in all likelihood contribute substantially to new knowledge about brain activation for language processing. This review summarizes basic information about fMRI, including principles of operation, experimental pitfalls and examples of application to language.
IALP and the World: Global Perspectives
Authors: Nasser Kotby M.
Published: April 2003

IALP is an association that guards, coordinates, and enhances internationally the field of communicative sciences and disorders. On the occasion of its 75th anniversary an attempt is made in this presentation to introduce the Association and the lines of possible future development in relation to its global responsibilities. An introduction to human communication aims at highlighting the importance of the field of interest of IALP. The history and present status of IALP is given. Future development focuses on aspects of the specialty and on promotion of the goals of IALP with reference to the importance of developing international contacts. Finances, an important aspect in the development of any establishment, are referred to, stressing their sound features at present. Suggested global tasks are put forward as a visionary and even a missionary plan for IALP in its coming decades.
Tracheoesophageal Voice Restoration: Origin – Evolution – State-of-the-Art
Authors: Blom Eric D.
Published: April 2003

Tracheoesophageal voice has gradually evolved worldwide as a viable option for voice restoration following total laryngectomy. This article presents a brief overview of the principal surgical and prosthetic aspects of this technique.
Comprehensive Rehabilitation after Total Laryngectomy Is More than Voice Alone
Authors: Hilgers Frans J.M. , Ackerstaff Annemieke H.
Published: April 2003

Comprehensive rehabilitation after total laryngectomy is more than voice alone. The removal of the larynx and the subsequent disconnection of the upper and lower airways not only has consequences for the vocal function but also for the respiratory system, and for the olfactory acuity of the patient. The results of the research program on these three subjects in the Netherlands Cancer Institute over the last 12 years are discussed in detail along with some of the relevant other literature on the topics. The considerable progress in these areas over the last 2 decades has clearly improved the quality of life of laryngectomized patients.
Audiology on the Way into the Next Millennium
Authors: Kiessling Jürgen
Published: April 2003

The article gives an overview of current developments in audiology. Present challenges and questions are discussed and possible solutions are suggested. The scope includes diagnostic and rehabilitative features of audiology and focuses on basic assessment of hearing functions, localization of the site of lesion, objective assessment of auditory functions, and hearing instruments, both traditional and implantable ones. Finally, new attempts at tinnitus treatment and possible approaches to the future prevention of hearing loss and protection of hearing by medication are briefly described. Due to the vast diversity of modern audiology only the major trends are covered. Thus this article does not claim to provide a complete survey of all that is going on in audiology today.
Speech Disorders following Severe Traumatic Brain Injury: Kinematic Analysis of Syllable Repetitions Using Electromagnetic Articulography
Authors: Jaeger Marion , Hertrich Ingo , Stattrop Ulrich , Schönle Paul-Walter , Ackermann Hermann
Published: April 2003

Using electromagnetic articulography, the lips, the tip of the tongue, and the tongue dorsum were tracked during repetitions of the syllables [pa], [ta] and [ka] in 10 speakers with dysarthria following severe traumatic brain injury and in 10 age-matched control subjects. When asked to produce the syllable trains as fast as possible, the patient group showed a rather homogeneous pattern of movement abnormalities including prolonged syllable durations and reduced peak velocity/amplitude ratios. Most presumably, limited speed generation gives rise to the impaired ability to increase speech rate. During the habitual speaking condition, reduced velocity/amplitude ratios were restricted to the tongue tip and tongue dorsum. Obviously, the tongue and the lips are differentially affected in dysarthria following severe traumatic brain injury.
A Method to Measure Speaking Time and Speech Sound Pressure Level
Authors: Airo E. , Olkinuora P. , Sala E.
Published: April 2003

Many voice disorders are associated with vocal loading, but easy measurement of the vocal load has not been possible so far. To fulfil this need, an easily accessible method was developed and tested. Speaking time and speaking sound level can be recorded during normal work, and measurement can be made in a noisy environment. The measurement is made with a pair of modern noise exposure analysers from which the data is transferred to a personal computer, and the voice speaking time and the related sound pressure levels are calculated with a spreadsheet program. Suitable meters are available from various manufacturers. The method may be applied to measure the need of voice use in different professions, assessing a person’s performance in his or her work or evaluating the effects of voice therapy on speaking performance.
Carrying and Washing of Grass Roots by Free-Ranging Japanese Macaques at Katsuyama
Authors: Nakamichi Masayuki , Kato Eiko , Kojima Yasuo , Itoigawa Naosuke
Published: April 2003

The acquisition and transmission of new feeding behaviours in Japanese macaques (Macaca fuscata) such as sweet potato washing [1, 2], wheat washing [2] and caramel eating [3, 4] have been well documented. These behaviours are all related to provisioned food. Here we report carrying and washing of grass roots by Japanese macaques in a free-ranging group. This would appear to be the first report of washing of dirt from natural food, such as grass roots, among macaques. Furthermore, some monkeys in the present study rubbed dirt from roots by rolling them along the surface of a flat rock at the edge of a river. This may be considered a tool-using behaviour.
The Mother’s Participation in Infant Carrying in Captive Groups of Leontopithecus chrysomelas and Callithrix jacchus
Authors: de Oliveira Marcelina Souza , Lopes Fívia Araújo , Alonso Carmen , Yamamoto Maria Emília
Published: April 2003

Callithrix and Leontopithecus exhibit ecological differences that have implications for the patterns of infant care. In C. jacchus, which uses a small home range because it depends mainly on plant exudates, infants can forage independently early in their life. L. chrysomelas, which feeds mainly on fruits and insects, needs larger home ranges and, therefore, its infants have a more extensive period of dependence. Three families of C. jacchus and four families of L. chrysomelas were studied in captivity. The animals were observed starting from the birth of the infants up to their 8th week of age. Our results suggest that the pattern of infant transfer in L. chrysomelas did not follow the one reported for L. rosalia in that transfers from the mother occurred much earlier. L. chrysomelas infants were carried for about 15% of total time during the 8th week of life against less than 1% in C. jacchus in the same week. Infant care seems to be more extensive in L. chrysomelas than in C. jacchus, and the period of exclusive mother carrying in L. chrysomelas is shorter than that observed in L. rosalia.
Prolactin Levels of Fathers and Helpers Related to Alloparental Care in Common Marmosets, Callithrix jacchus
Authors: Mota M.T. , Sousa M.B.C.
Published: April 2003

Previous studies have suggested that prolactin may play a role in regulating allocare behaviour in cotton-top tamarins, Saguinus oedipus. In this study, we investigate the prolactin profile of 3 groups of captive common marmosets, Callithrix jacchus. Carrying behaviour in this species was observed after parturition. Prolactin assays of blood samples of both fathers and helpers (sub-adult non-fathers) in 3 family groups were taken for 8 weeks before and after birth of the infants. The after-birth condition was divided into 2 groups: carrying and non-carrying animals. The results suggest a relationship between prolactin levels and allocare behaviour, with carrying behaviour being associated with increased prolactin in both fathers and helpers. This suggests that extra prolactin is produced in response to physical contact, and may be associated with carrying behaviour. Also, prolactin production may be related to learning parental skills in Neotropical primates.
Risk Factors for Early Emergency Hospital Readmission in Elderly Medical Patients
Authors: Chu Leung-Wing , Pei Conrad K.W.
Published: April 2003

Background: Early emergency readmissions is a common and important problem in the elderly patient. Identification of the risk factors for early emergency readmissions is needed to prevent this occurring. Objective: The aim of this study was to study the risk factors for early emergency readmission in the elderly medical patient. Methods: A case-control study (sex- and age-matched) was conducted from March to December 1996. 380 elderly (age 65 years or over) medical patients with emergency hospital readmission (within 28 days) and 380 matched controls were recruited from an acute university general hospital in Hong Kong. Potential risk factors which included demographic, socio-economic, principal medical diseases, comorbid diseases, dysphagia, physical functional status and mental status were studied. Results: In bivariate analyses for the risk factors of early emergency readmission, institutional carer, previous visiting nurse service, adverse drug reaction, chronic obstructive pulmonary disease, end-stage renal failure, mobility being chair- or bed-bound, dysphagia, use of a nasogastric tube feeding, urinary incontinence and bowel incontinence were significant. Readmission cases had higher mean number of comorbid diseases, lower mean Barthel Index, higher mean number of impairments in Activities of Daily Living (ADL) tasks and lower mean Abbreviated Mental Test score than controls. In multivariate logistic regression model, the number of ADL impairments (OR = 1.13, 95% CI = 1.08–1.19), no income (OR = 2.28, 95% CI = 1.19–4.37), adverse drug reaction (OR = 4.19, 95% CI = 1.56–11.2), advanced malignancy (OR = 2.45, 95% CI = 1.37–4.37), congestive heart failure (OR = 1.63, 95% CI = 1.05–2.53), chronic obstructive airways disease (OR = 2.1, 95% CI = 1.47–3.02), end-stage renal failure (OR = 5.48, 95% CI = 1.69–17.75), dysphagia (OR = 3.9, 95% CI = 1.5–10.11) and the number of comorbid diseases (OR = 1.3, 95% CI = 1.13–1.49) were significant risk factors for early emergency readmissions. Living in a private old aged home was associated with a lower risk of readmissions (OR = 0.53, 95% CI = 0.36–0.93). Conclusions: Definite medical, functional and socio-economic factors were found to be risk factors for early emergency readmissions in the elderly medical patient. A multiple risk factors intervention approach should be considered in designing future prevention strategies.
Age-Dependent Changes of the Kidneys: Pharmacological Implications
Authors: Mühlberg W. , Platt D.
Published: April 2003

About 40% of the intoxications after drug administration occur in the elderly. A significant proportion of the disease states in elderly patients is related to adverse reactions to prescribed drugs. Declining renal function, a reduction in both renal blood flow and glomerular filtration rate, is a major contributor to drug toxicity in the elderly. Therefore, a review (based on newer papers from Medline) of age-dependent changes of the kidneys and their consequences for drug therapy in geriatric patients is presented. Renal changes that occur with aging are: a decrease of renal weight, a thickening of the intrarenal vascular intima, sclerogenous changes of the glomeruli, and infiltration of chronic inflammatory cells and fibrosis in the stroma. Altered renal tubular function, including impaired handling of water, sodium, acid, and glucose, is also frequently present in old age. Impaired ‘endocrinologic’ functioning manifested by changes of the renin-angiotensin system, vitamin D metabolism, and antidiuretic hormone responsiveness has been reported. The aging kidney is constantly exposed to the effects of a variety of potential toxic processes, i.e., drugs and chronic illnesses including hypertension, diabetes, and atherosclerotic disease. Renal changes that occur with aging also consist of impairment in the ability to concentrate urine and to conserve sodium and water. These physiological changes increase the risks of volume depletion and prerenal type of acute renal failure. A frequent cause of acute renal failure in the elderly is drug-induced nephropathy. Nonsteroidal anti-inflammatory drugs, antibiotics, and diuretics are most often involved. Due to the age-dependent decline of renal function, the pharmacokinetics of many drugs are altered in elderly patients. Therefore, the most important renal function to monitor with aging is the creatinine clearance. Changes in pharmacokinetics of many drugs and most decisions on drug dosage can be based on this information alone, as tubular functions of the kidney decrease at rates paralleling the age-dependent decrease in glomerular filtration rate (which is approximately measured by the creatinine clearance). As a conclusion, age-dependent changes of renal function are not only responsible for changes in pharmacokinetics and pharmacodynamics. In many cases, the kidneys are the target organ of adverse drug reactions too.
Aging and Spatial Localization during Feature Search
Authors: Owsley Cynthia , Burton-Danner Kerri , Jackson Gregory R.
Published: April 2003

Background: Previous studies indicate that older adults, like young adults, can efficiently search for a briefly presented visual target defined by a single salient feature presented amidst background distractors. However, little is known about older adults’ ability to identify the spatial location of targets during this aspect of preattentive processing. Objective: This study examined the extent to which older adults exhibit localization problems during feature search for a target with high conspicuity. Their performance was compared to that of younger adults. Methods: Twenty older adults (mean age 70 years, 8 men and 12 women) and 20 younger adults (mean age 25 years, 6 men and 14 women) with good central and peripheral vision were tested. Subjects were asked to indicate via a computerized touch-screen the location of a briefly presented (80 ms) target presented amidst distracting stimuli (set size 8, 16, or 32). Targets were presented at either 10Results: Compared to young adults, older adults committed more localization errors during feature search, a problem which was accentuated with increasing target eccentricity. In addition, older adults’ mislocalizations deviated from the correct location by greater distances. Conclusions: Older adults have spatial localization problems in preattentive processing during feature search, which could be detrimental to the guidance and deployment of visual attention.
Péritonite chimique après rupture iatrogène d’un kyste dermoïde de l’ovaire traité par cœlioscopie
Authors: Achtari C. , Genolet P.M. , Bouzourene H. , De Grandi P.
Published: April 2003

Le kyste dermoïde est la tumeur ovarienne bénigne la plus fréquente. Sa rupture en péritoine libre peut entraîner une réaction de type péritonite chimique. Il s’agit d’une issue rare mais potentiellement dangereuse. Son traitement peut nécessiter une ou plusieurs réinterventions. Nous rapportons ici le cas d’une patiente opérée en urgence pour une torsion de kyste dermoïde, avec dissémination intrapéritonéale de son contenu lors de la cœliochirurgie. Le contact prolongé du matériel sébacé avec le péritoine a entraîné une péritonite chimique. Deux nouvelles interventions, associées à un traitement anti-inflammatoire systémique, ont été nécessaires à la résolution de la symptomatologie. Nous proposons ici une attitude visant à éviter cette complication: 1) ponction du kyste à l’aide d’un trocard et évacuation de son contenu; 2) extraction du kyste dans un endobag et 3) lavage abondant de la cavité péritonéale.
Der vorzeitige Mutterschutz in Tirol
Authors: Ludescher Karin , Baumgartner Egmont , Roner Annette , Brezinka Christoph
Published: April 2003

Der vorzeitige Mutterschutz ist in Österreich ein vom Amtsarzt des Bezirkes ausgestellter Bescheid, mit dem das Arbeitsverbot für berufstätige Schwangere, das im Normalfall mit der 32. SSW beginnt, auf einen früheren Zeitpunkt vorverlegt wird. Betroffen sind Frauen, die an potentiell gefährlichen Arbeitsplätzen arbeiten, sowie Frauen, die anamnestisch oder aktuell Risiken auf eine Frühgeburt aufweisen. Die Amtsärzte aller neun Tiroler Bezirke wurden zur Praxis des vorzeitigen Mutterschutzes befragt und stellten ihre Daten zur Verfügung. Bei 100 Schwangeren der Risikoambulanz der Universitätsklinik für Frauenheilkunde in Innsbruck wurde der Weg in den vorzeitigen Mutterschutz rekonstruiert. Die höchste Rate von vorzeitigem Mutterschutz findet sich in den Bezirken Innsbruck-Stadt und Innsbruck-Land. 1997 lag die Rate für Innsbruck-Stadt bei 24,3% und für das gesamte Bundesland Tirol bei 13,4%. Ausschlaggebend für die Erteilung des amtsärztlichen Bescheides sind zu mehr als 80% die Gutachten von Gynäkologen. Knapp ein Drittel der Mutterschutzbescheide wird vor der 12. SSW erlassen, meist bei Frauen mit Mehrlingsschwangerschaften und/oder belastender Anamnese. Mit der derzeitigen Praxis des vorzeitigen Mutterschutzes wird ein grosser Teil der berufstätigen Risikoschwangeren erfasst. Nach Meinung der Amtsärzte könnte eine bessere Organisation am Arbeitsplatz und ein verstärktes Auftreten des Arbeitsinspektorates die Fälle von vorzeitigem Mutterschutz reduzieren, ohne dadurch Schwangere zu gefährden.
Präoperative Aufklärung: wie weit? – Dokumentation: wie ausführlich?
Authors: Haller U. , Hepp H. , Reinold E. , Winter R.
Published: April 2003

Die präoperative Information der Patientin mit entsprechender Dokumentation wird zunehmend bedeutungsvoll. Besonders über die Art der Dokumentation besteht wenig Konsens, wobei das Aufklärungsprotokoll nur ein Hilfsmittel zur Dokumentation des Aufklärungsgesprächs darstellt. Die Patientin muss wissen, wofür sie ihre Zustimmung gegeben hat. Behandlungs- oder operationsspezifische Aufklärungsprotokolle dienen der Behandlungsqualität und der Beweissicherung für allfällige Haftpflichtfälle. Die während des Aufklärungsgesprächs angelegte Operationsskizze ist ein wichtiges Dokument. 21 operationsspezifische Aufklärungsprotokollformulare wurden in einer Pilotphase getestet und werden weiterhin von der Patientenorganisation evaluiert. Informations- und Dokumentationskonzepte gehören in die Hand der Fachgesellschaften, bevor Versicherungen und staatliche Gesundheitsorganisationen ihre Konzepte am grünen Tisch entwerfen.
Frauen unter dem Messer – auch eine Geschichte der Chirurgie
Authors: Tröhler U.
Published: April 2003

Im 19. Jahrhundert entwickelte sich die Chirurgie von der handwerklichen ‘äusseren’ Wundheilkunst zur wissenschaftlichen ‘inneren’ Operationsbehandlung. Dabei war die Ovarektomie ab 1860 die ‘Schlüsseloperation’ zur Überwindung traditioneller Grenzen. Die zunehmende Sicherheit der Eingriffe führte bald zu unspezifisch indizierten Operationen an normalen Bauchorganen zur Heilung ‘typisch weiblicher’ Geisteszustände, also zu einer Art Psychochirurgie, die sich vereinzelt noch heute findet. Die operative Behandlung von normalen Situationen hat in den 1970er und 1980er Jahren in Gynäkologie (Hysterektomien) und Geburtshilfe (Kaiserschnitte) sogar zugenommen. Sie wurde also vom sogenannten traditionellen ärztlichen Ethos nicht verhindert. Neue Gebiete waren ebenfalls die plastische und Schönheitschirurgie mit ihren um 1900 erkannten ethischen Problemen. Wegen der relativen Kropfhäufigkeit mit den entsprechenden Operationen standen nach 1883 Frauen auch am Beginn der Konzepte der inneren Sekretion, der Organtransplantation und der physiologischen Chirurgie. Fazit: Kultur- und geschlechtergeschichtlich betrachtet, haben sich soziokulturelle Faktoren für die Häufigkeit einzelner Operationen an Frauen als mindestens ebenso ausschlaggebend erwiesen wie medizinisch-wissenschaftliche ‘Fakten’.
Der Kardiotokographiescore nach Hammacher in der elektronischen Analyse
Authors: Roemer V.M.
Published: April 2003

Fragestellung: Nachdem die quantitative, voll computerisierte Kardiotokographie (CTG)-Auswertung (G.S. Dawes) zu verlässlichen Resultaten geführt hat, sollte überprüft werden, ob auch eine semiquantitative CTG-Analyse in Verbindung mit einem CTG-Score (K. Hammacher) ähnlich brauchbare Ergebnisse zeitigt. Methodik: Die letzten 120 direkt abgeleiteten, intrapartalen CTG-Minuten (HP 8040A, 80300A) von 393 Feten, die auf vaginalem Weg zur Welt gekommen waren, wurden mit einfachen Hilfsmitteln (Lupe, Stechzirkel, Plexiglasschublehre) ausgewertet. Bestimmt wurden die Anzahl der Umkehrpunkte, die Bandbreite und das mittlere Frequenzniveau für jede individuelle CTG-Minute. Weiterhin wurden alle Dezelerationen sowohl qualitativ (28 Schlüsselpositionen) wie auch quantitativ nummerisch erfasst (Beginn, Ende und Tiefe der Dezelerationen). Der CTG-Score nach Hammacher wurde in Fortran IV programmiert und als Subroutine in ein grösseres Programmsystem integriert. Ergebnisse: Während der letzten 30 min ante partum wurde der Score 4 am häufigsten (35,4%) angetroffen. Die Scorewerte 10, 11, 12, 14, 15, 16, 17 und 18 kamen nicht einmal zur Beobachtung. Anhand der «prozentualen Punktvergabe» für die drei Komponenten des Scores liess sich zeigen, dass das Dezelerationsgeschehen im Vergleich mit den beiden anderen Komponenten numerisch überbewertet ist. Die Rangkorrelation zwischen Scorewert und aktuellem pH im Nabelarterienblut war hochsignifikant (p ≪ 0,001). Die Punktbewertung des CTGs steigt erst ab einem pH von 7,15 erkennbar an. Die Sensitivität für Score ≤4 beträgt für den pH von 7,10 87,2% und erreicht für den pH 7,00 eine Sensitivität von 100,0%. Schlussfolgerungen: Die CTG-Interpretation mit dem Hammacher-Score, basierend auf einer semiquantitativen Auswertung, führt zu klinisch brauchbaren Resultaten. Es ist davon auszugehen, dass diese Resultate durch eine Veränderung der Scorearchitektur weiterhin verbessert werden können. Die semiquantitative CTG-Analyse ist neben der vollcomputerisierten Analyse geeignet, den Stellenwert dieser Überwachungsmethode endgültig zu bestimmen.
Neurofibromatose der Brust beiMorbus von Recklinghausen
Authors: Fink D. , Schneider C. , Wight E. , Perucchini D. , Haller U.
Published: April 2003

Die Neurofibromatose ist eine seltene autosomaldominant vererbte Erkrankung, welche in mehrere Subtypen unterteilt wird. Gemeinsam ist diesen das Auftreten von spezifischen Hautveränderungen. Eine Mitbeteiligung der Mamma ist eine Seltenheit, wobei sich die Neurofibrome in diesem Fall hauptsächlich im Bereich der Areola finden. In dieser Kasuistik wird über eine 46-jährige Patientin mit Neurofibromen an den Areolae bei bekanntem Morbus von Recklinghausen berichtet und die Literatur diskutiert.
Individual and Collective Representations in Social Context: A Modest Contribution to Resuming the Interrupted Project of a Sociocultural Developmental Psychology
Authors: Nicolopoulou, Ageliki , Weintraub Jeff
Published: April 2003

This article suggests an approach to representation – simultaneously constructivist, sociocultural, and interpretive – that can address the complementary roles of culture and individual agency in development. The necessary starting point is to recognize, following Durkheim, that collective representations are an irreducible reality sui generis and play a constitutive role in the formation and structuring of individual representations. Development must be understood as a genuinely dialectical process that includes the active appropriation (not just passive absorption) of collective representations through various modes of socially structured symbolic action. This requires both distinguishing and grasping the interplay of three analytical levels: individual, relational or interactional, and collective. Piaget’s work is shown to offer an instructive case of how promising tendencies in this direction have become derailed. The authors also offer a concrete illustration of one line of research informed by the kind of theoretical approach advocated here.
I Create You to Control Me:A Gli mpse Into Basic Processes of Semiotic Mediation
Authors: Valsiner Jaan
Published: April 2003

Miltenburg and Singer outline a direction of analysis of therapy processes that go beyond the realm of therapy and touch upon basic processes of human cultural development. Human beings regulate their conduct by creating hierarchically organized and often personified semiotic means to regulate their ongoing relationships with the environment. These means allow for changing, maintaining, and aggravating current psychological states. The structure of these control mechanisms entails multiple levels that regulate one another, aside from organizing thinking, feeling, and action. I will argue that personal contruction of goal orientations becomes a necessary super-organizer of such complex system of personal-cultural means, such that examination of phenomena of volition returns to the stage of the theater of psychological research as a centrally relevant topic.
Cognitive Theory at the Crossroads:Head Fitting, Head Splitting, orSomewhere in Between?
Authors: Prawat RichardS.
Published: April 2003

Modernist, head-fitting views of cognition and postmodernist, language oriented views are both problematic, I argue. The former because they are associated with a dualist epistemology (i.e., a spectator theory of knowledge), the latter because they fail to adequately grapple with key issues like the individual’s role in promoting language change, the relation between language and reality, and the connection between local and societal level language practice. Fortunately, there is an alternative which represents a kind of epistemological ‘in-between’ perspective. In this approach, developed by Dewey and Vygotsky in the last years of his life, meaning-making is cast as a complex semiotic process that is simultaneously social, embodied, and transactional in nature.
Recovering History in the Study of Schooling: From the Longue Durée to Everyday Co-Construction
Authors: Rockwell Elsie
Published: April 2003

Although the search for more effective schooling is frequently invoked in Vygotskian research, schools themselves are rarely studied from a cultural-historical perspective. By examining three intersecting planes – the longue durée, relative continuity, and everyday co-construction – we may be able to integrate both the historicity and cultural diversity of school environments, and the profound subjectivity of school experience. All three dimensions are needed to reexamine the question of the cognitive consequences of schooling, for child development, as well as for the history of humanity.
Intervention with Clarithromycin in Patients with Stable Coronary Heart Disease
Authors: Hansen Stig , Als-Nielsen Bodil , Damgaard Morten , Helø Olav H. , Petersen Lars , Jespersen Christian M.
Published: April 2003

Background: There is a growing body of evidence linking Chlamydia pneumoniae to the progression of coronary heart disease. Smaller studies have indicated that intervention with macrolide antibiotics might reduce coronary events in patients with cardiovascular diseases. Objective: To describe the design of a large-scale intervention study on the effects of a macrolide antibiotic on coronary events in patients with stable coronary heart disease (documented myocardial infarction and/or angina pectoris). Methods: This study is a double-blind, randomised, placebo-controlled, multicentre study with parallel groups. Patients are randomised to 14 days of treatment with clarithromycin (500 mg, once daily) or matching placebo. The follow-up period is 2 years, and the primary end point is a composite end point of death, non-fatal myocardial infarction or unstable angina pectoris, whichever occurs first. Recruitment began in October 1999 and will be completed in 2000. In total, 4,600 patients will be randomised. Prospectives: The study is powered to detect a reduction in coronary events of 20%. Also, the study will examine the question of whether the presence of a C. pneumoniae antibody titre is associated with a significantly increased risk of future coronary events. Finally, in the case of a significant outcome, it will be possible to test whether the effect is restricted to patients with C. pneumoniae antibodies only, or to a universal effect without any coherence to C. pneumoniae antibodies.
Optimizing Reperfusion Therapy: Adjunct Use of Glycoprotein IIb/IIIa Antagonists with Fibrinolytic Therapy in Acute Myocardial Infarction
Authors: Menown Ian B.A. , Adgey A.A. Jennifer
Published: April 2003

The efficacy of fibrinolytic therapy in acute myocardial infarction may be limited by three factors: failure to achieve reperfusion of the epicardial culprit artery, failure to achieve myocardial reperfusion, or reocclusion of the culprit artery following initial reperfusion. Platelet activation plays a central role in the acute thrombotic process, and the adjunct use of aspirin (a relatively weak antiplatelet agent) with fibrinolytic therapy has been shown to reduce mortality and probably reocclusion. In this review, we discuss the rationale for antiplatelet therapy, the importance of the glycoprotein IIb/IIIa receptor on the platelet surface (the final common pathway in platelet activation) and the findings from recent studies using specific glycoprotein IIb/IIIa antagonists as adjuncts to fibrinolytic therapy in acute myocardial infarction.