Subsidiary Examinations Research Articles

Immunization stress-related responses presenting as psychogenic non-epileptic seizures following HPV vaccination in Rio Branco, Brazil

The absence of a positive diagnosis of psychogenic non-epileptic seizures (PNES) in immunization stress-related response (ISRR) clusters may have not only a direct impact on affected patients' health but may also reduce compliance to national vaccination programs. It is therefore crucial to develop efficient diagnostic tools and a feasible proposal for proper communication and treatment of ISRR. To explore the psychogenic nature of patients' convulsive seizures in a suspected outbreak of an ISRR cluster following human papillomavirus vaccination in Rio Branco, Brazil. Twelve patients with convulsive seizures were submitted to prolonged intensive video-electroencephalography monitoring, brain magnetic resonance imaging, cerebrospinal fluid diagnostic testing, laboratory subsidiary examinations, and complete neurological and psychiatric evaluations. Ten patients received the positive diagnosis of PNES, and two patients received the diagnosis of idiopathic generalized epilepsy. No biological association was found between the HPV vaccine and the clinical problems presented by the patients. Prolonged VEEG monitoring can contribute significantly to the positive diagnosis of PNES in ISRR clusters and to avoid hesitancy to vaccinate.

Pediatric syndromes with noncraniofacial anomalies impacting the airways

Syndromes with noncraniofacial abnormalities can be a real challenge in terms of airway management. The key to success is effective preparation, presence of personnel with expertise in difficult pediatric airway management, regular training and familiarity with difficult intubation equipment, and teamwork. Considering that there are a very large number of syndromes, with variable phenotypic expression, the management strategy of every case will be dictated by the anatomical and functional airway as assessed on physical examination and subsidiary examinations before induction of anesthesia.

DIAGNOSTIC AND THERAPEUTIC ARTHROSCOPY IN SYMPTOMATIC PATIENTS AFTER KNEE ARTHROPLASTY

Objectives: Assess the worthiness of arthroscopy in investigating and treating knee pain after arthroplasty unexplained by clinical and subsidiary examinations. Methods: Among 402 patients submitted to total or unicompartimental arthroplasty between September 2001 and April 2007 at a public university hospital, 17 presented with pain on prosthetic articulation, without clear diagnosis by clinical, X-ray, laboratory, scintiscan, or nuclear magnetic resonance tests. All patients were submitted to arthroscopy and symptoms were assessed by using the Lysholm scale, comparing pre-and post-arthroscopy periods. Peroperative findings have been recorded. Results: The procedure was effective for pain relief in 14 of 17 patients (82.35%). The median for Lysholm scale climbed from 36 points before arthroscopy to 94 points after the procedure (p < 0.001). Most of the patients (12) were arthroscopically diagnosed with fibrosis known as “cyclop”; on the remaining five patients, anterior synovitis was found. All patients were treated by resection. Conclusions: Knee arthroscopy after arthroplasty in patients presenting unclear persistent pain shows localized arthrofibrosis (“cyclops”) or synovitis, which can be treated by using the same procedure, resulting in pain relief.

Diagnosis of Appendicitis with Left Lower Quadrant Pain

Abdominal pain is one of the most common chief complaints of patients presenting to the emergency department and, among the diagnoses of abdominal pain, appendicitis is the most common surgical disorder. Traditionally, the diagnosis of appendicitis is based on well-established clinical criteria combined with physician experience. However, appendicitis presenting with rare and misleading left lower quadrant (LLQ) pain may result in an initial false-negative diagnosis by the physician and even result in failure to order the subsidiary examination of computed tomography (CT) or ultrasound, so increasing the risk of perforation/abscess formation and prolonged hospital stay. In this report, we present 2 cases of atypical appendicitis with LLQ pain where the correct diagnosis was not initially considered. One patient had right-sided appendicitis; the inflamed appendix was 12 cm in length and projected into the LLQ. Local peritonitis developed during observation. With the aid of CT, the diagnosis was established in time. The other patient had left-sided appendicitis with situs inversus totalis. Adverse outcomes with appendiceal rupture and abscess formation occurred due to inadvertent physical examinations and inadequate observation. Early clinical suspicion and adequate observation are indicated in patients with uncertain clinical features. However, in patients with unresolved clinical symptoms and/or local peritonitis that develop during observation, imaging studies play a significant role in preoperative diagnosis and determination of proper treatment.

Análise do custo-benefício da avaliação ocular de pacientes portadores de rosácea

To observe the main ocular manifestations of patients with rosacea and to evaluate the cost-benefit of supplementary diagnostic examinations. Twenty patients with acne rosacea from the Dermatology Service of the São Paulo Federal University (UNIFESP) were interviewed through a questionnaire, submitted to ophthalmologic examination and tested with Schirmer I, fluorescein and rose Bengal staining, impression cytology and conjunctival scrub. The costs of these examinations were abstracted from the Public Health System's values (SUS), Brazilian Medical Association values (AMB) and values charged by a private service. Twenty patients were enrolled initially in the study, but only 16 completed it. Eleven patients were female (55%), 19 were white (95%) and the average age was 56 years. All patients had at least one complaint related to rosacea. The most common symptoms were itching (40%), tearing (35%), foreign body sensation (30%). The most common signs were telangiectasis of lid margins (70%), hyperemia of lid margins (70%), meibomitis (65%) and blepharitis (50%). Most subsidiary examination showed normal results. There was difference of costs between the different paying sources. The main ocular manifestations in rosacea were related with meibomian gland disease. Considering the subsidiary examination costs and their results, the ophthalmologic check-up presents the best cost-benefit for the patient with rosacea.

Back to the future: A methodology for comparing old A-level and new AS standards

Curriculum 2000 has meant significant change for the post-16 sector. New qualifications have been introduced (e.g. the new Advanced Subsidiary examination) and the number of students involved in education and training post-16 has increased. In this scenario how can the standards of new qualifications, particularly the new Advanced Subsidiary examinations, be compared with those of previous qualifications? One method is to use the prior achievement of candidates (i.e. GCSE results) as a basis for comparison of their results on subsequent qualifications (i.e. A levels and AS). This method of comparability and its limitations will be explored using examples with actual data.

A Level

This article discusses the new specification for English Advanced Subsidiary and Advanced Level Examinations and what is new about it. It considers the way the examination has been developed in the past, the purposes of the examination, its relation to the National Curriculum, to GCSE and university courses and its usefulness as an assessment tool.

Tunelização esofágica na fístula esofagotraqueobrônquica

Foram estudados 121 casos de câncer avançado do esôfago e da cárdia submetidos a tunelização esofágica por via endoscópica ou cirúrgica. Os doentes foram avaliados, tratados e seguidos segundo protocolo que constou de avaliação clínica, exames subsidiários, estadiamento, tratamento, avaliação intra e pós-operatória imediata. Verificaram-se a taxa de mortalidade, período de internação, complicações tardias, sobrevida e causa de óbito. Foram submetidos a tunelização cirúrgica 69 (53%) doentes, e 52 (47%) a tunelização endoscópica. Nos 17 casos de fístula esofagotraqueobrônquica houve sua oclusão eficiente pela tunelização endoscópica em 80% dos casos, com mortalidade de 13,3%, credenciando o método para tratamento dessa complicação tumoral. Os resultados obtidos com a tunelização endoscópica e cirúrgica recomendam seu uso em doentes com câncer avançado do esôfago e da cárdia.

Foods and diseases.

An examination was made of the statistical correlations between the main foodstuff and nutrient intakes and the chief causes of mortality in 20 different countries, comprising 17 in Europe, and Canada, USA, and Japan. Subsidiary examinations were made of the effects of including and excluding Japan, and of the effects of various statistical standardisation procedures. Complex food patterns were identified and related both to geographical latitude and to levels of affluence; these, in turn, were related to complex patterns of mortality. Criteria for drawing special attention to specific associations were identified, based partly on statistical significance tests and also on strength-of-association yardsticks supplied by diseases with known causes. Findings suggesting causal interpretations were: (a) alcohol intakes and cirrhosis of the liver, cancer of the mouth, and cancer of the larynx; (b) total fat intakes and multiple sclerosis, cancer of the large intestine, and cancer of the breast; and (c) beer and cancer of the rectum.

Drift mobility studies in vitreous arsenic triselenide

Abstract The drift of charge carriers in thin vitreous films of arsenic triselenide has been examined by a transit time technique. The specimens used were prepared by cooling from the molten state, rather than by evaporation. Electron mobility measurements were found to be impractical, the mobility being estimated as less than 10−10 m2 v−1 sec−1 at room temperature. The hole mobility was measurable, however, and was found to be strongly dependent on temperature and applied electric field. The hole transit pulses were of a ‘rounded’ form, indicating a spread of carrier transit times. The field dependence was of a form attributable to the Poole–Frenkel effect (field-stimulated emission of carriers from charged trapping centres). After extrapolation of the measurements to zero applied field, the temperature dependence of the mobility indicated an activation energy of about 0·43 ev. These results, and those of a subsidiary examination of the temperature and field dependence of the specimen conductivity, are d...

Efeitos do tiotixene (P-4657 B) em crianças e adolescentes psicóticos

Foram estudados os efeitos do tiotixene (P-4657B) em 34 crianças e adolescentes psicóticos dos quais '29 eram esquizofrênicos, tendo 17 deles menos de um ano de tempo de doença e 12 mais de um ano de doença. Foram obtidos bons resultados em 20 casos com nítida melhora na sintomatologia psíquica. Os efeitos colaterais foram de pequena intensidade. Os exames subsidiários (hemograma, provas de função hepática e eletrencefalograma) não revelaram alterações significativas. Assim o tietixene confirmou sua atividade antipsicótica não só nos casos em que foi o primeiro tratamento instituído como também em alguns pacientes que tinham sido tratados com outras drogas antipsicóticas sem resultados satisfatórios. Foi assinalado efeito nítido sobre o apragmatismo e o embotamento afetivo. Ocorreu ação sedativa nas agitações psicomotoras devendo-se salientar que o resultado positivo se fez quase sempre sentir com dose mínima (5 — 10 mg/dia) já nos primeiros dias de tratamento. Foi ótima a tolerância ao medicamento. Os efeitos colaterais foram mínimos. Sendo a esquizofrenia em crianças e adolescentes de difícil tratamento, a existência desta nova droga é, na opinião dos autores, uma util contribuição para sua terapêutica.

Air Survey and Photography

Abstract INTRODUCTION. A perusal of back numbers of “The Australian Surveyor” discloses the fact that little material has been placed before members to enable them to form an opinion as to the professional and economic value of modern developments in Aerial Surveying. The up-to-date surveyor should know something of these matters, and as it is generally agreed among us that we should endeavour to widen the scope of our profession—in New South Wales steps have already been taken towards holding subsidiary examinations to the Land Surveyors' Examination — the writer feels that this paper may be of assistance to younger members and students. Daily, it becomes clearer that for Australia, nay, the British Empire, to survive, a tide of emigrants of British stock must be directed to all the outposts of the Empire; and the writer is of the opinion that Australia will shortly take steps to fill up some of our areas of dangerously low population density. It is probable that in the next few years the problem of migration will become a major issue; in such case it behoves all surveyors to be in touch with a method of survey that will certainly be used when large areas of country are to be speedlly designed for settlement.