bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical management of recurrent aggressive angiomyxoma with gonadotropin‐releasing hormone agonist
Authors: SHINOHARA NOBUO , NONOMURA KATSUYA , ISHIKAWA SHUHEI , SEKI HARUO , KOYANAGI TOMOHIKO 
Published: May 2004

AbstractPatients with aggressive angiomyxoma may experience local recurrences. We report a case of recurrent aggressive angiomyxoma medically treated successfully with a gonadotropin‐releasing hormone agonist. A 34‐year‐old woman with a huge perineal tumor underwent an extensive resection of the abdominoperineal tumor combined with total pelvic exenteration. Histology showed aggressive angiomyxoma and the tumor cells were immunoreactive for estrogen and progesterone receptors. Although the patient had experienced no local recurrence for 12 months under adjuvant therapy with a gonadotropin‐releasing hormone agonist, a recurrence occurred 3 months after the completion of adjuvant therapy. The patient underwent medical treatment with a gonadotropin‐releasing hormone agonist and had a complete resolution of the recurrent tumor again. Hormonal treatment with a gonadotropin‐releasing hormone agonist can be applied for small primary aggressive angiomyxomas in addition to adjuvant therapy for residual tumors.
Cut‐to‐the‐light technique and potassium titanyl phosphate laser ureterotomy for complete ureteral obstruction
Authors: GODA KAZUMASA , KAWABATA GAKU , YASUFUKU TOMIHIKO , HARA ISAO , FUJISAWA MASATO , KAMIDONO SADAO , OKADA HIROSHI 
Published: May 2004

AbstractWe describe a case of complete ureteral obstruction managed by endoscopic recanalization using a ‘cut‐to‐the‐light’ technique followed by potassium titanyl phosphate (KTP) laser ureterotomy. A 53‐year‐old man developed a ureteral obstruction following the transurethral resection of a bladder tumor (TUR‐Bt) at the left ureteral orifice. The length of the obstructed segment was estimated at 1 cm based on combined antegrade and retrograde contrast studies. Histopathological analysis indicated that the obstruction was caused by fibrosis. The ‘cut‐to‐the‐light’ technique was used for recanalization, and KTP laser ureterotomy was performed to obtain an adequate ureteral lumen. A 14 F/7 F endoureterotomy stent was removed 6 weeks after the operation. No significant complications and no signs of stenosis were observed 24 months after endoscopic repair. Endoscopic recanalization is a safe, effective technique for the management of a completely obliterated ureteral segment, especially in combination with subsequent KTP laser ureterotomy.
Long‐term results of adjuvant hormonal therapy plus radiotherapy following radical prostatectomy for patients with pT3N0 or pT3N1 prostate cancer
Authors: MIYAKE HIDEAKI , SAKAI IORI , HARADA KEN‐ICHI , HARA ISAO , ETO HIROSHI 
Published: May 2004

AbstractBackground: The objective of the present study was to evaluate the efficacy of adjuvant androgen suppression in conjunction with external beam irradiation after radical prostatectomy in patients with pathologically confirmed extraprostatic disease.Methods: Between July 1988 and October 1999, 38 patients with pT3N0 or pT3N1 prostate cancer received adjuvant hormonal therapy and external beam irradiation following radical retropubic prostatectomy and pelvic lymphadenectomy. Administration of luteinizing hormone‐releasing hormone analog or castration were initiated as an adjuvant androgen suppression within 4 weeks after surgery, whereas pelvic irradiation was performed at a median dose of 50 G within 3 months after surgery. The prognostic advantage of this combined adjuvant therapy was analyzed.Results: During the median observation period of 92 months, biochemical recurrence occurred in four of the 38 patients and five patients died. Of these five patients, only one died of prostate cancer progression. The 10‐year biochemical recurrence‐free, cancer‐specific and overall survival rates of the 38 patients were 86.7%, 90.9% and 78.7%, respectively. Among several factors examined, only tumor grade was significantly associated with biochemical recurrence‐free survival in these patients; however, there were no factors that were independent predictors for biochemical recurrence, based on multivariate analysis. Furthermore, biochemical recurrence‐free survival in the 38 patients was significantly superior to that in 54 patients with locally advanced disease who did not receive any postoperative therapies until biochemical recurrence; however, there was no significant difference in cancer‐specific and overall survival between these two groups.Conclusion: Despite retrospective analysis with a relatively small number of patients, results of the present study suggest favorable effects of the combined adjuvant treatments with androgen ablation and pelvic irradiation on cancer control for patients with pT3N0 or pT3N1 disease. However, considering the absence of a significant difference in cancer‐specific and overall survival between patients with and without adjuvant treatments, it might not be necessary to routinely perform combined hormonal and radiation therapies in an adjuvant setting for pT3N0 or pT3N1 prostate cancer.
Metastatic malignant ameloblastoma of the kidneys
Authors: HAYAKAWA KUNIHIRO , HAYASHI EIRI , AOYAGI TEIICHIRO , HATA MAKOTO , KURAMOTO CHIKA , TONOGI MORIO , YAMANE GEN‐YUKI , TANAKA YOUICHI 
Published: May 2004

AbstractAmeloblastoma is an uncommon disease in the urological field. The resulting tumors or cysts are of odontogenic epithelial origin, are usually benign in nature and rarely metastasize to distant organs. We describe a case of metastatic ameloblastic carcinoma in both kidneys of a 38‐year‐old Japanese man, who had a history of malignant ameloblastoma and was referred to us for evaluation because of gross hematuria and left flank pain. Computed tomography showed irregular cystic masses in both kidneys. After we confirmed that the primary lesion and the lung metastatic lesion had not recurred, we treated the patient surgically. Approximately 4 months postoperatively the patient suffered a local recurrence of tumors that was very invasive and aggressive. The patient died 2 months later and the autopsy showed local metastasis only, without any metastatic lesion in the lungs or other organs. The present case showed that malignant ameloblastoma is highly aggressive, and in the case of metastases the prognosis is usually extremely poor.
Office Evaluation and Treatment of Elderly Patients with Acute Bronchitis
Authors: Steinman Michael A. , Sauaia Angela , Maselli Judy H. , Houck Peter M. , Gonzales Ralph 
Published: May 2004

Objectives: To assess the office evaluation of seniors with uncomplicated acute bronchitis and to determine the association between elements of the clinical evaluation and antibiotic prescribing decisions.Design: Cross‐sectional chart review.Setting: Seventy‐seven community‐based office practices in the Denver metropolitan area.Participants: Elderly fee‐for‐service Medicare patients.Measurements: Medicare administrative data to identify patients with acute bronchitis; medical record review to confirm the diagnosis and record other clinical data.Results: Of 198 elderly patients with acute bronchitis, the mean age±standard deviation was 76±8.6; 53% had at least one comorbid condition. Clinically important vital signs were frequently not recorded; temperature was missing from 34% of charts and pulse from 50% of charts. When recorded, significant vital sign abnormalities were uncommon, with 7% having a temperature of 100°F and 8% having a pulse of 100 beats per minute or greater. However, antibiotics were prescribed to 83% of patients, with more than half of these prescriptions being for extended‐spectrum antibiotics. Treatment with antibiotics was more common in men than women (92% vs 78%, P=.007) but was not associated with clinical factors including vital sign measurement, vital sign results, chest radiography, patient age, duration of illness, or the presence of comorbidities.Conclusion: The vast majority of seniors with acute bronchitis are treated with antibiotics, regardless of patient characteristics or the type of evaluation received. Reducing inappropriate antibiotic use in seniors with acute bronchitis may depend on improving the evaluation of these patients and encouraging clinicians to act appropriately on the results.
Body Mass Index, Body Cell Mass, and 4‐Year All‐Cause Mortality Risk in Older Nursing Home Residents
Authors: Volpato Stefano , Romagnoni Franco , Soattin Lucia , Blè Alessandro , Leoci Vincenzo , Bollini Cristina , Fellin Renato , Zuliani Giovanni 
Published: May 2004

Objectives: To investigate the relationship between body composition (assessed using body mass index (BMI) and body cell mass (BCM)) and all‐cause mortality in a sample of older nursing home residents.Design: Prospective study with a median follow‐up period of 3.5 years.Setting: Istituto di Riposo per Anziani, Padua, Italy.Participants: A total of 344 participants (79.1% women) aged 65 and older at baseline.Measurements: Anthropometric, nutritional, and metabolic parameters were measured at baseline. BCM was measured using tetrapolar bioelectric impedance analysis. Up to 4 years of follow‐up data for vital status were available. Survival analysis was conducted using Kaplan‐Meier curves and multivariate Cox proportional hazards models.Results: During the follow‐up period, there were 179 deaths. After adjustment for age and sex, subjects with low BMI and low BCM (lowest sex‐specific tertiles) had significantly higher mortality than those with higher BMI or BCM levels. In a fully adjusted regression model, there was no association between BMI levels and risk of mortality, with subjects in the top tertile having the same likelihood of mortality as subjects in the lowest tertile (relative risk (RR)=0.94, 95% confidence interval (CI)=0.61–1.43). Conversely, there was a strong and significant inverse association between BCM levels and mortality (RR for tertile III=0.55, 95% CI=0.35–0.87; P<.01). Furthermore, participants who had high BCM had comparable survival rates in all BMI tertiles.Conclusion: In this sample of older nursing home residents, BCM was a strong and independent risk factor for mortality. BCM assessment might provide more useful prognostic information for clinicians than BMI.
Tai Chi and Self‐Rated Quality of Sleep and Daytime Sleepiness in Older Adults: A Randomized Controlled Trial
Authors: Li Fuzhong , Fisher K. John , Harmer Peter , Irbe Dainis , Tearse Robert G. , Weimer Cheryl 
Published: May 2004

Objectives: To determine the effectiveness of tai chi on self‐rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints.Design: Randomized, controlled trial with allocation to tai chi or exercise control.Setting: General community.Participants: One hundred eighteen women and men aged 60 to 92.Intervention: Participants were randomized into tai chi or low‐impact exercise and participated in a 60‐minute session, three times per week, for 24 consecutive weeks.Measurements: Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50‐foot speed walk) and 12‐item short form (SF‐12) physical and mental summary scores.Results: Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep‐onset latency, sleep duration, sleep efficiency, sleep disturbances) (P<.01), PSQI global score (P=.001), and ESS scores (P=.002) in comparison with the low‐impact exercise participants. Tai chi participants reported sleep‐onset latency of about 18 minutes less per night (95% confidence interval (CI)=–28.64 to –7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71–82.41) than low‐impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low‐impact exercise participants. Both groups reported improvements in SF‐12 mental summary scores.Conclusion: Older adults with moderate sleep complaints can improve self‐rated sleep quality through a 6‐month, low‐ to moderate‐intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep‐disturbed elderly individuals.
Whole‐Body‐Vibration Training Increases Knee‐Extension Strength and Speed of Movement in Older Women
Authors: Roelants Machteld , Delecluse Christophe , Verschueren Sabine M. 
Published: May 2004

Objectives: To investigate the effects of 24 weeks of whole‐body‐vibration (WBV) training on knee‐extension strength and speed of movement and on counter‐movement jump performance in older women.Design: A randomized, controlled trial.Setting: Exercise Physiology and Biomechanics Laboratory, Leuven, BelgiumParticipants: Eighty‐nine postmenopausal women, off hormone replacement therapy, aged 58 to 74, were randomly assigned to a WBV group (n=30), a resistance‐training group (RES, n=30), or a control group (n=29).Intervention: The WBV group and the RES group trained three times a week for 24 weeks. The WBV group performed unloaded static and dynamic knee‐extensor exercises on a vibration platform, which provokes reflexive muscle activity. The RES group trained knee‐extensors by performing dynamic leg‐press and leg‐extension exercises increasing from low (20 repetitions maximum (RM)) to high (8RM) resistance. The control group did not participate in any training.Measurements: Pre‐, mid‐ (12 weeks), and post‐ (24 weeks) isometric strength and dynamic strength of knee extensors were measured using a motor‐driven dynamometer. Speed of movement of knee extension was assessed using an external resistance equivalent to 1%, 20%, 40%, and 60% of isometric maximum. Counter‐movement jump performance was determined using a contact mat.Results: Isometric and dynamic knee extensor strength increased significantly (P<.001) in the WBV group (mean±standard error 15.0±2.1% and 16.1±3.1%, respectively) and the RES group (18.4±2.8% and 13.9±2.7%, respectively) after 24 weeks of training, with the training effects not significantly different between the groups (P=.558). Speed of movement of knee extension significantly increased at low resistance (1% or 20% of isometric maximum) in the WBV group only (7.4±1.8% and 6.3±2.0%, respectively) after 24 weeks of training, with no significant differences in training effect between the WBV and the RES groups (P=.391; P=.142). Counter‐movement jump height enhanced significantly (P<.001) in the WBV group (19.4±2.8%) and the RES group (12.9±2.9%) after 24 weeks of training. Most of the gain in knee‐extension strength and speed of movement and in counter‐movement jump performance had been realized after 12 weeks of training.Conclusion: WBV is a suitable training method and is as efficient as conventional RES training to improve knee‐extension strength and speed of movement and counter‐movement jump performance in older women. As previously shown in young women, it is suggested that the strength gain in older women is mainly due to the vibration stimulus and not only to the unloaded exercises performed on the WBV platform.
Thoracic Kyphosis and Ventilatory Dysfunction in Unselected Older Persons: An Epidemiological Study in Dicomano, Italy
Authors: Di Bari Mauro , Chiarlone Melisenda , Matteuzzi Daniela , Zacchei Simona , Pozzi Claudia , Bellia Vincenzo , Tarantini Francesca , Pini Riccardo , Masotti Giulio , Marchionni Niccoló 
Published: May 2004

Objectives: To assess whether kyphosis is associated with ventilatory dysfunction in older community dwellers.Design: Cross‐sectional study.Setting: The unselected population of Dicomano, Italy aged≥65 years.Participants: A total of 323 nonheart failure participants underwent clinical evaluation for the presence of kyphosis and spirometry. The severity of kyphosis was estimated from the difference between standing stature and knee‐height‐derived stature and from the occiput‐wall distance.Measurements: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and prevalence of obstructive and restrictive ventilatory pattern.Results: The 130 kyphotic participants (40.2%) had an adjusted 2.5 prevalence odds ratio (POR) for dyspnea (95% confidence interval (CI)=1.1–5.8). FVC% and FEV1% were lower in the presence of kyphosis (P<.01); their deficit was proportional to kyphosis severity. The ventilatory dysfunction was underestimated when reference spirometric parameters were calculated based on standing stature, compared with knee‐height derived stature. Of the kyphotic participants, 56.2%, 26.9%, and 16.9% had spirometric normal, obstructive, and restrictive patterns, respectively. Kyphosis was associated with a restrictive (adjusted POR=2.3, 95% CI=1.1–4.8; P=.021) and an obstructive ventilatory pattern (adjusted POR=3.3, 95% CI=1.7–6.5; P<.001).Conclusion: In unselected older persons, kyphosis is associated with dyspnea and ventilatory dysfunction of a restrictive and an obstructive type. Kyphosis should be included in the differential diagnosis of dyspnea and ventilatory dysfunction in the elderly.
Determinants of Lower‐Body Muscle Power in Early Postmenopausal Women
Authors: Sipilä Sarianna , Koskinen Satu O. A. , Taaffe Dennis R. , Takala Timo E. S. , Cheng Sulin , Rantanen Taina , Toivanen Jarmo , Suominen Harri 
Published: May 2004

Objectives: To investigate the association between muscle size, density, and fiber composition; body composition; maximal isometric knee extension strength (KES); and lower‐body muscle power in healthy postmenopausal women.Design: Cross‐sectional analysis of baseline data from a 1‐year randomized controlled experiment.Setting: University‐based research laboratory.Participants: Seventy‐eight healthy postmenopausal women aged 50 to 57.Measurements: Maximal lower‐body muscle power was assessed using vertical jump height (VJH). Maximal isometric KES was measured on a dynamometer chair. Computed tomography scans were used to determine lean‐tissue cross‐sectional area and density of the thigh and lower leg muscles. Relative area occupied by type I, IIa, IIax, and IIx muscle fibers was assessed from the vastus lateralis muscle. Lean body mass and total body fat mass were assessed using bioelectrical impedance.Results: High VJH was associated with low body fat mass, high KES, and high density of thigh and lower leg muscles. Multivariate linear regression modeling revealed that high thigh muscle density (β=0.242; P=.019), relative area occupied by the fastest muscle fiber types (IIax+IIx; β=0.246; P=.007), KES (β=0.247; P=.007), and low body fat mass (β=−0.455; P<.001) were independently associated with high VJH, accounting for 45% of the variability in VJH.Conclusion: This study showed that thigh muscle composition, muscle strength, and body fat mass are important determinants of lower‐body muscle power production during weight‐bearing activity in healthy postmenopausal women.
The “Nondipper” Elderly: A Clinical Entity or a Bias?
Authors: Pasqualini Rita , Foroni Micaela , Salvioli Gianfranco , Mussi Chiara 
Published: May 2004

Objectives: To determine the prevalence of nondipper (ND) blood pressure profile in the elderly and to ascertain whether the ND pattern of ambulatory blood pressure in the elderly is an artifact or represents a specific clinical entity.Design: Cross‐sectional, observational study.Setting: Cardiovascular diagnostic center, division of geriatrics, secondary care, institutional practice.Participants: Sixty‐five consecutive community‐dwelling elderly hypertensive patients referred to the cardiovascular center.Measurements: The patients underwent actigraphy and ambulatory blood pressure monitoring and completed a sleep assessment questionnaire. Patients were divided based on the night‐time decrease in blood pressure (>10%: “dippers” (n=19); <10%: “NDs” (n=46)).Results: Nondippers displayed poorer quality of sleep, as demonstrated objectively by actigraphic data; they obtained a higher mean score±standard deviation on the sleep questionnaire (4.6±2.9 vs 3.0±1.1, P=.030) and were taking more benzodiazepines (33.1% vs 10.7%, P=.035), indicating that their usual sleep quality was worse than that of dippers. Multivariate analysis showed a strong correlation between nondipper profile and quality of sleep and also with comorbidity, total number of drugs being taken, and pulse pressure.Conclusion: Actigraphy demonstrates impaired sleep in the nondipper elderly. Nevertheless, the nondipping pattern seems independent of the discomfort of cuff‐inflation during the night and occurs in association with higher comorbidity and polypharmacy; therefore, it cannot be considered a “bias,” but is related to detrimental clinical conditions that should be studied in depth.
Development and Validation of a Geriatric Knowledge Test for Medical Students
Authors: Lee Ming , Wilkerson LuAnn , Reuben David B. , Ferrell Bruce A. 
Published: May 2004

Objectives: To assesses the reliability and validity of a geriatrics knowledge test designed for medical students.Design: Cross‐sectional studies.Setting: An academic medical center.Participants: A total of 343 (86% of those sampled) medical students participated in the initial study, including 137 (76%) first‐year, 163 (96%) third‐year, and 43 (86% of those sampled) fourth‐year students in the 2000–2001 academic year. To cross‐validate the instrument, another 165 (92%) third‐year and 137 (76%) first‐year students participated in the study in the 2001–2002 academic year.Measurements: An 18‐item geriatrics knowledge test was developed. The items were selected from a pool of 23 items. An established instrument assessing the clinical skills of medical students was included in the validation procedure.Results: The instrument demonstrated good reliability (Cronbach α=0.80) and known‐groups and concurrent validity. Geriatrics knowledge scores increased progressively with the higher level of medical training (mean percentage correct=31.3, 65.3, and 66.5 for the first‐year, third‐year, and fourth‐year classes, respectively, P<.001). A significant (P<.01) relationship was found between the third‐year students' geriatrics knowledge and their clinical skills. Similar results, except the relationship between knowledge and clinical skills, were found in the cross‐validation study, supporting the reliability and known‐groups validity of the test.Conclusion: The 18‐item geriatrics knowledge test demonstrated sound reliability and validity. The average scores of the student groups indicated substantial room for growth. The relationship between geriatrics knowledge and overall clinical skills needs further investigation.
HPA‐5b (Bra) neonatal alloimmune thrombocytopenia in Quebec: incidence and clinical outcome in 31 cases
Authors: Rousseau Julie , Goldman Mindy , David Michèle 
Published: May 2004

BACKGROUND:  Clinical detection of neonatal allo‐immune thrombocytopenia (NAITP) is often less than the incidence predicted in prospective studies. The aims of this study were to calculate the observed and expected incidence of NAITP in Quebec, Canada, and to evaluate the clinical outcome of infants with anti‐HPA‐5b NAITP.STUDY DESIGN AND METHODS:  Records from 1998 to 2002 of the only PLT serology laboratory for the province of Quebec were reviewed, as were hospital charts of all HPA‐5 cases. The number of expected NAITP cases was estimated with known alloantigen gene frequencies.RESULTS:  Ninety cases of NAITP were identified. The clinical detection rate was 1 in 4100, with 9 to 30 percent of expected HPA‐1a and 11 to 23 percent of expected HPA‐5b NAITP cases detected. Seventy‐eight percent of cases of HPA‐5b NAITP were asymptomatic. Sixty‐three percent of all deliveries but 94 percent of HPA‐5b cases occurred in hospitals performing cord blood PLT counts.CONCLUSION:  The NAITP detection rate was 25 to 50 percent of the rate reported in prospective trials. The less severe clinical presentation of NAITP owing to HPA‐5b was confirmed. The frequent routine determination of cord blood PLT counts may explain increased detection of asymptomatic NAITP involving anti‐HPA‐5b.