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[Blunt rupture of the intrapericardial inferior vena cava: report of two cases]. | descending aortic rupture and the patient was taken to surgery. He died of massive hemorrhage from the aortic rupture. Exploration revealed a rupture of intrapericardial IVC. Recent literatures were reviewed and the mechanism of IVC rupture is discussed. | 10667027 | [
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[Ineffective and recurrent cases of thoracoscopic sympathectomy for hyperhidrosis and intractable pain]. | We reported the cases of thoracoscopic sympathectomy; that is; six cases of hyperhidrosis; three of post herpetic neuralgia; and four of reflex sympathetic dystrophy; including recurrent or incompletely resected or ineffective ones. Recently this procedure for hyperhidrosis had been performed frequently because of its effectiveness; less pain; early discharge and cosmetic aspect. For an ineffective case of hyperhidrosis abdominal respiration which emphasized the exhalation and using an upper abdomen decreas | 10667025 | [
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[Ineffective and recurrent cases of thoracoscopic sympathectomy for hyperhidrosis and intractable pain]. | ed the sweating. The balance of autonomic nerve system; toward parasympathetic dominant; was thought to be improved by conscious respiration. The decrease of sweating right after the operation in a case of incomplete resection indicated that intraoperative maneuver could restrict the sympathetic nerve. This procedure for a pain control could be less effective than that for hyperhidrosis; so an adequate preoperative informed consent was thought to be necessary. | 10667025 | [
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[Ventricular septal defect with pulmonary hypertension and concomitant left atrial myxoma in elder patient: a successful surgical case report]. | A 70-year-old man was admitted with syncope attack on exertion. Ventricular septal defect with pulmonary hypertension and left atrial myxoma were confirmed by ultrasonography and cardiac catheterization. Preoperative Pp/Ps was 0.95 and pulmonary vascular resistance was 16 units. Pulmonary vascular resistance decreased to 9.6 units by the administration of Isoproterenol and decreased to 8.5 units with PGE1. Patch closure of VSD and excision of left atrial myxoma were performed simultaneously. The patient rec | 10667028 | [
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[Ventricular septal defect with pulmonary hypertension and concomitant left atrial myxoma in elder patient: a successful surgical case report]. | overed completely; although he suffered from pneumonia and jaundice due to liver congestion postoperatively. Cardiac catheterization before discharge revealed Pp/Ps 0.38 and PVR 10.1 units. | 10667028 | [
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[A case report of primary hemangiopericytoma of the chest wall]. | A 35-year-male was found to have an abnormal shadow with an extrapleural sign located in the right lower lung field by a chest X-ray. Chest CT revealed a well demarcated tumor in the chest wall adjacent to the 4th rib. Chest MRI showed that the tumor contained punctate or linear low-intensity areas; which were considered to be small blood vessels. A diagnosis of hemangiopericytoma was established by percutaneous needle biopsy. Under the definite diagnosis; extended resection of the chest wall was performed | 10667029 | [
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[A case report of primary hemangiopericytoma of the chest wall]. | to remove the tumor with a surgical margin of more than 5 cm; corresponding to surgery for other malignant soft-tissue neoplasmas. Hemangiopericytomas rarely arise in the chest wall; although they can be found in any region which contains pericytes. Preoperative definite diagnoses of hemangiopericytoma have rarely been reported. However; preoperative diagnosis is an important factor in deciding the operative procedure for hemangiopericytoma. It has been reported that hemangiopericytomas show local recurrenc | 10667029 | [
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[A case report of primary hemangiopericytoma of the chest wall]. | es and distant metastases; although they are histologically benign. We consider that hemangiopericytomas in the chest wall should be treated with extensive resection corresponding to surgery for other malignant soft-tissue neoplasmas. | 10667029 | [
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[A case of mediastinal mature teratoma accompanying elevated CA 19-9 and CEA in the cystic fluid]. | Fourteen year old female visited our hospital suffering from anterior chest pain. Chest CT revealed anterior mediastinal mass which had multiple cystic lesions; 8.5 x 7.0 x 5.5 cm in size. Tumor extirpation had performed by median sternotomy and pathological diagnosis was mature teratoma. CA 19-9 and CEA in the cystic fluid had elevated 32;790 U/ml and 768 ng/ml; respectively. | 10667030 | [
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[A case of teratoma in both the mediastinum and the intrapulmonary system]. | A rare case of mature teratoma in both the mediastinum and the intrapulmonary system is presented. A 30-year-old male was admitted to our hospital due to tumor masses in the mediastinum and the left lung. We performed mediastinal tumor resection and left upper partial lobectomy. Neither tumor communicated with each other. Pathological findings revealed teratoma in the mediastinal lymph node and the intrapulmonary system including no malignant cells in either tumor. In this case; because metastasis and perfo | 10667031 | [
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[A case of teratoma in both the mediastinum and the intrapulmonary system]. | ration were negative; we proposed that both tumors occurred at the same time in the early embryo. | 10667031 | [
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[Postoperative interstitial pneumonia: 2 cases after lobectomy]. | Two patients with postoperative interstitial pneumonia are reported. Preoperative diagnosis was primary lung cancer without idiopathic interstitial pneumonia (IIP). Within one week after operation acute interstitial pneumonia (AIP) occurred on the nonoperated side and developed. Steroid therapy was performed but one was dead. AIP is a fatal complication after pulmonary resection and steroid therapy may be useful in some cases of postoperative AIP. | 10667032 | [
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The value of peri-operative consultation on a general surgical ward by the internist. | Medical peri-operative consultation plays an important role in the practice of the internist. It represents 13-33% of the total consultation done by the internist. The value of preoperative consultation by the internist is still unclear and the place of the consultations is under discussion.Consecutive medical consultations--by internist-intensivists from the surgical ICU--of 408 patients in the department of Surgery of the University Hospital Groningen were retrospectively analyzed; with specific attention | 10667035 | [
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The value of peri-operative consultation on a general surgical ward by the internist. | to the consultation request; the consultation report and the outcome of the consultation.The main problems were cardiac (34%) or pulmonary (20%). In 78% well defined questions about the patients were asked and in 29% of the preoperative requests; the requesting surgeon asked specific advice about diagnosis and management. In 49% the requesting physician asked for an 'evaluation' of the patients. Of all consultations 271 (67%) were preoperative consultations. In 12% the findings of the preoperative consulta | 10667035 | [
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The value of peri-operative consultation on a general surgical ward by the internist. | tion had a significant impact on the course of the patient; whereas in 7% of the preoperative requests the operation was postponed. The consulting internist recommended in 2% to cancel the operation for this admission; which was shared by the surgeon and anesthesiologist. In 10% of all cases new diseases or processes were diagnosed; or were found not to be treated adequately before consultation; so the diagnosis or management was changed.Our data show that (semi-) elective consultations by internists at the | 10667035 | [
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Clinical and pharmacological aspects of accidental triamcinolone acetonide overdosage: a case study. | Local administration of corticosteroids for rheumatic diseases have had a long history of effective and well-tolerated use. We report here the pharmacodynamics and pharmacokinetics of an accidental triamcinolone acetonide (TCA) overdose. The presented patient was treated with 200 mg TCA and developed Cushing's syndrome 6 weeks later (cortisol and ACTH concentrations were below limits of detection; TCA concentrations were > 3 micrograms/l). Because of her severe symptoms; mifepristone was administered for a | 10667036 | [
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Clinical and pharmacological aspects of accidental triamcinolone acetonide overdosage: a case study. | period of 19 days. Cortisol concentrations became detectable 2 days after initiation of mifepristone treatment and persisted; being detectable for a period of at least a week after cessation of the drug. Twenty days after cessation; cortisol concentrations were undetectable again. Cushing's syndrome persisted more than 6 months while TCA concentrations remained detectable for at least 80 days. Based on plasma TCA concentrations in our patient; we calculated a terminal half-life of TCA of 33 days as opposed | 10667036 | [
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Clinical and pharmacological aspects of accidental triamcinolone acetonide overdosage: a case study. | to 5 days observed after intra-articular administration of a therapeutic dose of 40 mg TCA. We conclude that after an accidental overdose in this patient; body TCA disappearance was strongly prolonged due to a very slow (absorption) half-life of the drug in comparison to a therapeutic dose. This finding is explained by a 'flap-flop phenomenon' where drug absorption is the rate-limiting step of overall drug disposition. Caution is; therefore; needed to prevent undesired accumulation of TCA that may lead to p | 10667036 | [
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Clinical and pharmacological aspects of accidental triamcinolone acetonide overdosage: a case study. | rotracted Cushing's syndrome. | 10667036 | [
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Inflammatory pseudotumor of the fossa pterygopalatina: diagnosis and treatment. | Pseudotumor is a term used to describe a space-occupying inflammatory lesion of unknown etiology that clinically simulates a neoplastic process. Pseudotumors of the fossa pterygopalatina and fossa infratemporalis are very rare. In this paper; we describe a patient who developed a pseudotumor in the left fossa pterygopalatina; secondary to an unclassified autoimmune disease; which caused progressive left-sided facialdynia and swelling. The tumor was detected with somatostatin receptor scintigraphy. The lesio | 10667037 | [
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Inflammatory pseudotumor of the fossa pterygopalatina: diagnosis and treatment. | n was refractory to steroids; also in combination with azathioprine; as well as to surgical intervention. An excellent clinical response was observed after cyclosporine was added. This case is presented here in order to draw attention to the use of somatostatin receptor scintigraphy as a diagnostic tool in visualizing pseudotumors and to document a case that responded excellently to treatment with a combination of low-dose cyclosporine and steroids. | 10667037 | [
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A homozygous M694V mutation of the MEFV gene in a patient with periodic fever and thoracic pain. | A Turkish patient with episodic fever and thoracic pain is described in whom a homozygous M694V mutation of the MEFV gene confirmed the clinical diagnosis of familial Mediterranean fever. The role of DNA analysis is discussed with respect to understanding the pathogenesis of the fever and assessing the risk of amyloidosis in specific mutations of the MEFV gene. | 10667038 | [
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Chylothorax. | Chylothorax is defined as an accumulation of chyle in the pleural space caused by disruption of the thoracic duct or one of its major divisions. Chyle has a high content of triglycerides. The odorless fluid is turbid and milky due to the presence of fat containing particles; the chylomicrons. The etiology of chylothorax can be divided into four major categories: tumor; trauma; idiopathic and miscellaneous. Although chylothorax is uncommon; it is a serious and potentially hazardous disorder. Loss of chyle le | 10667039 | [
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Chylothorax. | ads to metabolic disturbances; malnutrition and immunodeficiency. Treatment consists of treatment of the underlying disease; conservative treatment (medium chain triglyceride diet; parenteral nutrition) or surgical intervention. Appropriate timing of surgical intervention is essential. Since the ligation of the thoracic duct can be performed during thoracoscopy; this minimal interventional technique is the procedure of choice when conservative treatment fails. | 10667039 | [
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[Image of the month. Isolated appendicular polyposis]. | nan | 10667040 | [
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[How I treat ... idiopathic hyperhidrosis]. | Palmo-plantar and/or axillary idiopathic hyperhidrosis is unpleasant and sometimes invalidating. Its malodorous variant which is due to biodegradation by bacterias is called bromhidrosis. According to the severity of the condition; several therapies exist including psychotherapy; various topical products; iontophoresis; botulinic toxin injections and thoracic sympathectomy. | 10667041 | [
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[Clinical case of the month. Cerebral salt wasting syndrome: report of a case]. | A 75 year old woman was found to have a posterior cerebellar lesion which after surgical removal was shown to be a meningioma. Her postoperative course was complicated by a MRSA meningitis and on day 23 after resection; a polyuria up to 11.7 1/24 h became apparent. The diagnosis of cerebral wasting syndrome (CSWS) was made based on biological and clinical features such as an excessive natriuresis (143 mmol/l) resulting in hyponatremia (130 mmol/l) and an osmolarity higher in urine than in blood. A low centr | 10667042 | [
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[Clinical case of the month. Cerebral salt wasting syndrome: report of a case]. | al venous pressure and a low wedge pressure confirming a volumic depletion indicated the diagnosis of CSWS. This syndrome has marked similarities with the Inappropriate Secretion of Antidiuretic Hormone Syndrome (SIADH) in terms of biological finding with regards to clinical context and presentation. Without an adequate assessment; a patient with CSWS may be misdiagnosed as SIADH. However recognition is important; as water restriction which is part of SIADH treatment; is detrimental to patients with CSWS an | 10667042 | [
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[Clinical case of the month. Cerebral salt wasting syndrome: report of a case]. | d can possibly be lethal. | 10667042 | [
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[Medication compliance]. | Compliance is defined as the extent to which a patient's behaviour coincides with medical or health advice. Medication compliance seems to be rather low as 30 to 60% of no or poor adherence to medical recommendation have been reported. Numerous factors may influence medication compliance among which patient's characteristics; disease particularities; drug treatment modalities or physician's attitudes. The consequences of medication non-compliance may not only be dangerous for patient's health; but also dram | 10667043 | [
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[Medication compliance]. | atically increase the financial cost for public health services. Thus; all energies should be devoted to improve drug compliance; including treatment optimization and simplification; patient's information and education; use of practical means that facilitate adherence to medical recommendation; the patient being responsible for his/her treatment. | 10667043 | [
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[Anatomic-clinica dilemma. Case report of renal cell carcinoma]. | The authors report the case of a patient with a history of hypertension and multiple intracerebral hemorrhages who was found at post mortem examination to have a renal cell carcinoma. The relationship between renal carcinoma and hypertensive intracerebral hemorrhages is discussed. | 10667044 | [
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[Winter skin diseases]. | Winter climate is prone to induce cutaneous and systemic alterations mediated by cold. Xerosis due to the impairment of the desquamation process is not rare on the limbs. Chilbain results from reversible alterations of the dermal vasculature. Cold panniculitis is the consequence of lipid crystallization within adipocytes. More dramatic issues occur when cold exposure extends beyond skin. They are represented by frostbite and body hypothermia. Intensity and duration of cold exposure combined with wind speed; | 10667045 | [
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[Winter skin diseases]. | altitude and environmental hygrometric value govern the potential type of low temperature-dependent pathology. Ultraviolet irradiation can also induce cutaneous lesions during winter time. | 10667045 | [
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[New players in the physiopathology of water metabolism: the aquaporins]. | Aquaporins are transmembrane proteins mediating water transport across plasma membrane of animal; vegetal or bacterial cells. Among the ten aquaporins known in mammals; six are located in kidney and take part in urine concentration. AQP2 is vasopressin regulated; it is the only family member to be implicated in human pathology; such as nephrogenic diabetes insipidus; congestive heart failure; hepatic cirrhosis; nephrotic syndrome or SIADH. Aquaporins are expressed in a wide variety of tissues; such as brain | 10667046 | [
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[New players in the physiopathology of water metabolism: the aquaporins]. | or gastrointestinal tractus; and suggest a role in water tissue exchange; but their real function is still not define. To know the physiological impact of aquaporins; AQP1; AQP3; AQP4 and AQP5 knockout mice have been created and their phenotype analysed. | 10667046 | [
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[Surgery, radiotherapy or hormonal therapy in the treatment of prostate cancer]. | een designed to allow medical castration with less complications; especially regarding sexual potency. | 10667047 | [
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[Treatment of border-line dilatation of the ascending aorta using the Robicsek intervention]. | The technique and the results of the external contention of the dilated ascending aorta by the application of an external Dacron graft are reported. This technique; without replacing the usual graft interposition; can efficiently and expeditiously treat borderline dilatation of the ascending aorta; as frequently encountered in aortic valve disease. If the sinotubular junction is not dilated; this technique may stop the aneurysmal evolution of the ascending aorta. | 10667048 | [
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[Results of artificial sphincter for the treatment of sphincter incontinence]. | 47 patients were treated since 1987 by implantation of an artificial sphincter. The majority of female patients were operated for bladder neck hypermotility. In the male population; incontinence was mostly a complication of prostatic surgery. The indication; preoperatory assessment; surgical techniques and results are discussed. During a mean follow-up of 38 months; 92.9% of females remained perfectly continent and results were good in 76.7% of males. The results are similar to those reported in the literat | 10667049 | [
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[Results of artificial sphincter for the treatment of sphincter incontinence]. | ure. | 10667049 | [
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[How I assess ... home glycemic control in diabetic patients]. | Self blood glucose monitoring is now a key element in the management of diabetic patients. However; in order to improve overall blood glucose control; self-monitoring should lead to self-management. This implies that the patient modifies his/her behaviour (diet; exercise; oral antidiabetic agents; insulin doses) to ameliorate the metabolic status according to his/her blood glucose measurements. While the place of home blood glucose monitoring is rather well defined in type 1 diabetes; it remains more contro | 10667050 | [
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[How I assess ... home glycemic control in diabetic patients]. | versial in type 2 diabetes. | 10667050 | [
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[Clinical study of the month. Does chronic sleep deprivation predispose to metabolic syndrome?]. | According to a recent experimental study published in the Lancet; sleep debt; frequently imposed by the life habits of industrialized countries; results in profound metabolic (impaired glucose tolerance) and endocrine (increased sympathetic activity and evening cortisol levels) alterations; which mimic those of normal ageing and may have pathophysiological consequences in the long term. Another study recently published in the International Journal of Obesity demonstrated a significant positive relationship | 10667051 | [
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] |
[Are sanitation services complaints an indicator of quality of care?]. | A retrospective analysis of 211 consecutive complaints treated at the Direction of Health and Social Assistance of Paris was undertaken in order to specify the nature of the complaints and to evaluate their pertinence as an indicator of quality of care. The majority of complaints concern public and private health establishments; in particular surgery and psychiatric services. Although the study confirms the dysfunctioning of the organisation of services and also of therapeutic methods and medical treatments | 10667053 | [
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] |
[Are sanitation services complaints an indicator of quality of care?]. | ; the evaluation of iatrogenic risks and their avoidable nature is difficult and requires precise instruction. Complaints seem to be a neglected indicator of quality; yet they concern information that is accessible and could; if used with other information; be a first milestone in the vigilance of medical treatments. | 10667053 | [
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[Situation and role of local structures of hospital ethics: s survey of Hospital Public Care in Paris]. | This article presents the main results of a survey carried out among the local structures for hospital ethics of the Public Assistance sector of the Hospitals of Paris. The results show that the situation of these structures has completely transformed itself since the law of 1988 on human research. Only four ethics committees subsist out of the 16 university-hospital committees that existed in 1991. Seven new structures have been created since 1994; which are open to all categories of personnel and within w | 10667054 | [
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[Situation and role of local structures of hospital ethics: s survey of Hospital Public Care in Paris]. | hich doctors are a minority. The four ethics committees provide almost no decision making opinions anymore and are; like the new groups; fora for discussion; reflection; or even information on issues of hospital ethics. Almost none of these structures has an official mission. This situation presents the question of the role that a local ethics structure can hold within a hospital. | 10667054 | [
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[Feasibility of drug use detection among individuals 15-25 years of age in community medicine]. | The objective of this work is to study the feasibility of the detection of drug use or misused substances during a visit with a municipal doctor; and to describe the interrogatory strategies used spontaneously by doctors. One tenth of the clients aged 15-25 of the 26 participating doctors; (the majority of them men visiting the doctor for a psychological problem); showed a "warning" signal and were detected. The doctors often chose to approach the problem of drugs directly and detected usage in two-thirds o | 10667055 | [
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[Feasibility of drug use detection among individuals 15-25 years of age in community medicine]. | f the cases. Cannabis was most often concerned; but the use of psychotropic drugs with alcohol was the case in one-third of the subjects interrogated. On the other hand; a certain frustration was felt by the doctors because of the difficulty of approaching the root problems and of acquiring psychotherapeutic monitoring. | 10667055 | [
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[Contributions to the sociologic analysis of the impact of sickle cell disease on families from Northern Tunisia]. | The improvement of the conditions of care and quality of life of people living with drepanocytosis now constitutes a major concern of health authorities and voluntary groups (associations of sick people and their parents). In order to examine the conditions and methods of care for children living with drepanocytosis in the Bizerte region of Northern Tunisia and to understand the problems and difficulties experienced by them and their families in their daily lives; an anthropological study was carried out in | 10667056 | [
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] |
[Contributions to the sociologic analysis of the impact of sickle cell disease on families from Northern Tunisia]. | the region between January 16 and February 12; 1997. Thirty-three interviews were carried out with families of infected children. The interviews were semi-directive using a pre-established protocol (interview guide). Thirty interviews were then analysed. A multitude of information concerning various medical and psycho-social aspects of drepanocytosis in the region were revealed. The data were regrouped into the following categories: circumstances of discovering the illness; explicative model of the illness | 10667056 | [
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[Contributions to the sociologic analysis of the impact of sickle cell disease on families from Northern Tunisia]. | as perceived by the people interviewed; conditions and methods of care of the sick child; degree of satisfaction with the health care system; psychological profile of the children interviewed; educational level of the children interviewed; repercussions the illness has on the family; impact of the illness on household budget; suggestions and comments of the people interviewed. In light of the information collected; various actions have been proposed with the goal of improving the conditions of care and qua | 10667056 | [
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[Contributions to the sociologic analysis of the impact of sickle cell disease on families from Northern Tunisia]. | lity of life of people living with drepanocytosis in the region. | 10667056 | [
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[Occupational hazards in the Moroccan craft sector and proposal for occupational health services]. | The absence of occupational health services; the numerous occupational hazards and the high number of people working in the handicraft sector have sparked this study. Descriptive; cross-sectional epidemiological studies were carried out throughout 1996 for different artisan activities: iron-work; jewellery making; rug making; tannery; "zellige"; pottery; and woodworking. The study included 449 artisans and consisted of an analysis of work conditions; a medico-social questionnaire; a clinical examination and | 10667057 | [
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[Occupational hazards in the Moroccan craft sector and proposal for occupational health services]. | among certain artisans; a biological check-up; a respiratory check-up (thoracic x-ray and lung function testing); and a toxicological check-up. Poor work conditions and the absence of any technical protection (collective or individual) are common to all the workshops visited. Multiple risks as well as various and frequent pathologies were observed for all the artisan activities. The most common ailments are those linked to posture and musculo-skeletal problems (67.6%); oral (58.2%); ocular (46.9%); dermato | 10667057 | [
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[Occupational hazards in the Moroccan craft sector and proposal for occupational health services]. | logical (35.7%); ear/nose/throat (35.3%); respiratory (31.1%); digestive (21.1%) and neurological (20.7%). Often the same artisan showed several simultaneous conditions linked to work. The legislative texts related to occupational health and safety are many and dispersed; and would profit by being updated and regrouped within a work code which would make them easier to consult and would allow all partners in the social sector to get to know them. In addition; this legislation which has been strengthened; is | 10667057 | [
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] |
[Occupational hazards in the Moroccan craft sector and proposal for occupational health services]. | unfortunately not enforced. We should support every initiative focused on developing the prevention of occupational hazards and the spirit of safety within artisan workshops. The concern for occupational risks within the artisan milieu owes its importance to their abundance; the diversity of the professions involved; and the number of different risks to which artisans are exposed. The role of a worksite doctor is therefore considerable; and his field of intervention in this milieu is vast. The broader goal | 10667057 | [
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] |
[Occupational hazards in the Moroccan craft sector and proposal for occupational health services]. | of occupational health services is to protect and improve the physical; mental; and social well-being of its workers; it is natural that these services should give more attention to general health promotion (vaccinations; health education...). Given that the artisan sector is organised around its structures of production; it seems urgent to introduce medical coverage and to improve health and safety conditions within the sector. | 10667057 | [
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] |
[Palliative care at a university hospital center: physicians' opinions (1992-1996)]. | To evaluate the evolution of doctors' opinions in a university hospital centre concerning care for terminally ill patients following the creation of a Mobile Palliative Care Unit (MPCU).In the relevant services of a university hospital in Paris (1095 beds); (1) the first survey in 1992 included interviews with 17 doctors; (2) the second interview was carried out in 1996 by self questionnaire among 55 doctors.(1) The doctors stressed their wishes to accompany their patients "until the end" and stressed the r | 10667058 | [
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[Palliative care at a university hospital center: physicians' opinions (1992-1996)]. | ole of the patients' family (support system) and of nurses. They indicated their wishes especially for training then for the creation of a MPCU. (2) The MPCU; solicited by 87% of doctors; teaches palliative care and provides therapeutic; psychological and relational assistance; judged as very satisfactory; to carers and families. The doctors would like to see these activities sustained. | 10667058 | [
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[Physicians' opinions and practices on the use of medical referrals at hospitals]. | This work aims to take stock of the actual utilisation of medical standards (references); through a study of opinions and practices of the medical managers working in the clinical services of a university hospital centre. A survey through interviews was proposed to 103 medical managers; 101 responded to the questionnaire (38 Unit directors and 63 directors of "UF" units). Medical standards are used essentially as a teaching aid by 80% of doctors. Some of them (48%) make them available to prescribing doctors | 10667059 | [
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[Physicians' opinions and practices on the use of medical referrals at hospitals]. | in the unit; and for 36% there exists an informational procedure for new residents. Evaluation studies concerning the implementation of medical standards remain rare (7 studies). Medical standards appear to be more useful for improving quality of care (90%) then for controlling health expenditures (72%). The majority of medical managers (72%) consider that certain standards should be opposable to hospitals. The medical managers of the university hospital centre are in favour of developing standards of clin | 10667059 | [
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[Physicians' opinions and practices on the use of medical referrals at hospitals]. | ical practice. | 10667059 | [
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[Effectiveness of a program for improving drug prescriptions and hospitalization reporting at a university hospital]. | To evaluate the effectiveness of a method for improving the quality of care applied to the formulation of medical prescriptions and to the release of hospitalisation reports. The actions comprised the diffusion of results of audits and recommendations of good practice.For each of the 41 services; 30 visits from 1996 were selected at random. 3289 prescriptions and 1067 correspondence files were analyzed. The results were compared to those obtained from the previous two years.Patient identification was comple | 10667060 | [
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[Effectiveness of a program for improving drug prescriptions and hospitalization reporting at a university hospital]. | te in 44% of prescriptions; the identification of the prescribing doctor and his signature were present in 62% and 19% of cases respectively. 37% of medicines included all information. 7 indicators out of 12 for the quality of prescriptions improved (p < 0.0001). Files were found for 83% of hospital visits and 56% were sent (released) within a week. The practitioner was identified in 79% of cases; the main diagnosis in 96% and the treatment in 65% of cases. Five out of nine indicators of the quality of corr | 10667060 | [
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[Effectiveness of a program for improving drug prescriptions and hospitalization reporting at a university hospital]. | espondence improved (p < 0.01). For each theme; the number of indicators improving was similar (p > 0.05). The services that improved for one theme didn't necessarily improve for the second (p > 0.05).The evaluation of the programme; based on a strategy of quality assurance; shows modest progress. Given that the improvement of two themes for a given service are not correlated; the programme appears to sensitise professionals at an individual level rather than collectively. However; this programme is an impo | 10667060 | [
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[Effectiveness of a program for improving drug prescriptions and hospitalization reporting at a university hospital]. | rtant step for introducing a mode of continued improvement of quality. | 10667060 | [
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[Lack of communications between general medicine and the mental health sector]. | Mental health problems today account for a rising number of visits to general practitioners; which require collaboration between general practitioners and psychiatrists. A KAP study (Knowledge; Attitudes; Practice) was carried out among general practitioners of three towns in the "Meurthe et Moselle" region; in the common territory shared by both a child and an adult psychiatric sector. Twenty-three doctors participated in the study. General practitioners know the different psychiatric structures but they d | 10667061 | [
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[Lack of communications between general medicine and the mental health sector]. | o not know their areas of speciality or how they are organised. All recognise the high frequency of mental health problems among their patients; the most frequent being depressive pathologies. They have a negative image of the sector which is perceived as a complex "world" from which they feel excluded as soon as they refer a patient because of the difficulty they have in communicating with psychiatrists. | 10667061 | [
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[The internet and public health: access to information]. | nan | 10667062 | [
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[When ideology is a barrier to violence prevention]. | nan | 10667063 | [
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[Introduction to molecular and cellular biology of chloroplast biogenesis]. | nan | 10667064 | [
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[Structure and function of the plastid-dividing apparatus]. | nan | 10667065 | [
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[Molecular organization and dynamism of chloroplast nucleoid, a eukaryo-prokaryotic hybrid]. | nan | 10667066 | [
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[Transcriptional regulation in the chloroplast: mechanisms of coordinated expression of photosynthesis genes]. | nan | 10667067 | [
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[Post-transcriptional regulation of chloroplast gene expression]. | nan | 10667068 | [
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[Protein transport of chloroplast proteins]. | nan | 10667069 | [
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[Imaging and manipulation of DNA molecules using scanning tunneling microscopy]. | nan | 10667073 | [
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[Deblocking aminopeptidase from Pyrococcus furiosus and its application for proteomics]. | nan | 10667074 | [
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[The role of paraxial protocadherin in morphogenetic cell movement during gastrulation]. | nan | 10667072 | [
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[Check-up examinations from the cardiologic viewpoint]. | The concept of the primary prevention of coronary disease is certainly widely accepted today and supports check-up visits of apparently healthy persons. The goals of check-up's viewed by the cardiologist are the detection of coronary risk factors and the identification of asymptomatic patients with coronary disease to initial preventive measures. In some instances; a personal health problem forces the patient to a check-up visit. The major coronary risk factors of heredity; cigarette-smoking; hypercholester | 10667076 | [
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[Check-up examinations from the cardiologic viewpoint]. | emia; hypertension can be detected by taking the history; performing a physical examination and a blood-sampling for cholesterol. Additional investigations such as an ECG or an exercise-test are only indicated in symptomatic patients or in persons at high coronary risk. | 10667076 | [
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[Check-up and screening]. | nan | 10667075 | [
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[Screening, diagnosis and management of diabetes mellitus and diabetic complications]. | Diabetes mellitus comprises a group of metabolic disturbances that are characterized by hyperglycemia. In 1997 the American Diabetes Association (ADA) proposed new criteria for the diagnosis and classification of diabetes mellitus; which was also adopted by WHO. Although the criteria is the same; the ADA puts emphasis on the use of the fasting plasma glucose (FPG) for screening and diagnosis; whereas WHO maintains the use of the OGTT and recommends the FPG only if an OGTT can not be performed. Different pat | 10667077 | [
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[Screening, diagnosis and management of diabetes mellitus and diabetic complications]. | hogenetic processes are involved in the development of diabetes ranging from autoimmune destruction of beta-cells resulting in an absolute insulin deficiency to insulin with a defect on insulin secretion. The new classification is based on the etiology of the disease. Diabetes is classified into one of four categories: Type-1; type-2 Diabetes mellitus; specific forms of diabetes; and gestational diabetes. For screening and diagnosis FPG or the two hour value after the OGTT can be used. Glycosylated hemoglob | 10667077 | [
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[Screening, diagnosis and management of diabetes mellitus and diabetic complications]. | in is not suitable for screening and diagnosis of diabetes despite some contradictory statements. For many decades clear evidence was missing that chronic hyperglycemia caused diabetic late complications; complications including dysfunction or failure of several organ systems; in particular eyes; kidneys; nerves; and the cardiovascular system. The results of two large prospective trials--the Diabetes Control and Complications Trial (DCCT; 1993) and the United Kingdom Prospective Study (UKPDS; 1998)--that we | 10667077 | [
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[Screening, diagnosis and management of diabetes mellitus and diabetic complications]. | re recently published provided the final proof that normoglycemia prevents or delays the progression of these late complications. Due to the insidious nature of these complications they are often not diagnosed and have to be looked for in each patients with diabetes and have to be controlled regularly. Based on the results of the UKPDS and other studies; evidence based therapeutic goals could be defined. Multifactorial interventions with increased physical activity; cessation of smoking; aspirin treatment; | 10667077 | [
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[Screening, diagnosis and management of diabetes mellitus and diabetic complications]. | lowering of HbA1c; blood pressure; and lipids in patients with type 2 diabetes have been proven to drastically reduce the risk of developing diabetic nephropathy or cardiovascular complications drastically. We recommend the following treatment strategy for patients with type 2 diabetes in clinical practice: 1) Treatment should be individualized. 2) Treatment should be started step by step to document efficacy of treatment and compliance of patients. 3) Plasma glucose and blood pressure should be normalized | 10667077 | [
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[Screening, diagnosis and management of diabetes mellitus and diabetic complications]. | in all patients with type 2 diabetes (up to an age of 70 years); since there are no threshold values for HbA1c and blood pressure. 4) Therapeutic goals should be checked every three to six months. 5) In the case that therapeutic goals can not be met; treatment should be intensified. Often a combination therapy with many different drugs is required. 6) A specialist for diabetes should be consulted; if the therapeutic goals can not be met over a period of six months. | 10667077 | [
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[Skin check-up--who and when?]. | The skin is easy to access and therefore this organ is also an important diagnostic tool for the general practitioner to establish a systemic and complex disease. In addition skin cancer is the most prevalent malignancy and therefore non-dermatologists should be able to make the diagnosis of an early skin cancer. It is recommended to perform a whole body examination in all first visits. With experience a whole skin check lasts no longer than five minutes. It is important to recognise patients at risk for sk | 10667078 | [
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[Skin check-up--who and when?]. | in malignancies because they clearly profit from a regular screening. Patients with atypical moles or with familial melanoma syndrome and patients who already had malignant melanoma should get a yearly skin examination performed by a trained expert. Patients who had basal cell carcinoma run an almost 50% risk to produce a second basal cell carcinoma within three to five years and therefore they are good candidates for a screening at a regular base. The number of organ transplanted people is rising dramatica | 10667078 | [
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[Skin check-up--who and when?]. | lly. In general these patients are under marked immunosuppression and therefore they often develop malignancies of the skin. In our Department such patients receive at least one dermatological visit a year. | 10667078 | [
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