WorldWideScience

Sample records for thoracic symptoms changed

  1. Mechanism of the formation for thoracic impedance change.

    Science.gov (United States)

    Kuang, Ming-Xing; Xiao, Qiu-Jin; Cui, Chao-Ying; Kuang, Nan-Zhen; Hong, Wen-Qin; Hu, Ai-Rong

    2010-03-01

    The purpose of this study is to investigate the mechanism of the formation for thoracic impedance change. On the basis of Ohm's law and the electrical field distribution in the cylindrical volume conductor, the formula about the thoracic impedance change are deduced, and they are demonstrated with the model experiment. The results indicate that the thoracic impedance change caused by single blood vessel is directly proportional to the ratio of the impedance change to the basal impedance of the blood vessel itself, to the length of the blood vessel appearing between the current electrodes, and to the basal impedance between two detective electrodes on the chest surface, while it is inversely proportional to the distance between the blood vessel and the line joining two detective electrodes. The thoracic impedance change caused by multiple blood vessels together is equal to the algebraic addition of all thoracic impedance changes resulting from the individual blood vessels. That is, the impedance changes obey the principle of adding scalars in the measurement of the electrical impedance graph. The present study can offer the theoretical basis for the waveform reconstruction of Impedance cardiography (ICG).

  2. American Thoracic Society Member Survey on Climate Change and Health

    Science.gov (United States)

    Bloodhart, Brittany; Ewart, Gary; Thurston, George D.; Balmes, John R.; Guidotti, Tee L.; Maibach, Edward W.

    2015-01-01

    The American Thoracic Society (ATS), in collaboration with George Mason University, surveyed a random sample of ATS members to assess their perceptions of, clinical experiences with, and preferred policy responses to climate change. An e-mail containing an invitation from the ATS President and a link to an online survey was sent to 5,500 randomly selected U.S. members; up to four reminder e-mails were sent to nonrespondents. Responses were received from members in 49 states and the District of Columbia (n = 915); the response rate was 17%. Geographic distribution of respondents mirrored that of the sample. Survey estimates’ confidence intervals were ±3.5% or smaller. Results indicate that a large majority of ATS members have concluded that climate change is happening (89%), that it is driven by human activity (68%), and that it is relevant to patient care (“a great deal”/“a moderate amount”) (65%). A majority of respondents indicated they were already observing health impacts of climate change among their patients, most commonly as increases in chronic disease severity from air pollution (77%), allergic symptoms from exposure to plants or mold (58%), and severe weather injuries (57%). A larger majority anticipated seeing these climate-related health impacts in the next 2 decades. Respondents indicated that physicians and physician organizations should play an active role in educating patients, the public, and policy makers on the human health effects of climate change. Overall, ATS members are observing that human health is already adversely affected by climate change and support responses to address this situation. PMID:25535822

  3. American Thoracic Society member survey on climate change and health.

    Science.gov (United States)

    Sarfaty, Mona; Bloodhart, Brittany; Ewart, Gary; Thurston, George D; Balmes, John R; Guidotti, Tee L; Maibach, Edward W

    2015-02-01

    The American Thoracic Society (ATS), in collaboration with George Mason University, surveyed a random sample of ATS members to assess their perceptions of, clinical experiences with, and preferred policy responses to climate change. An e-mail containing an invitation from the ATS President and a link to an online survey was sent to 5,500 randomly selected U.S. members; up to four reminder e-mails were sent to nonrespondents. Responses were received from members in 49 states and the District of Columbia (n = 915); the response rate was 17%. Geographic distribution of respondents mirrored that of the sample. Survey estimates' confidence intervals were ±3.5% or smaller. Results indicate that a large majority of ATS members have concluded that climate change is happening (89%), that it is driven by human activity (68%), and that it is relevant to patient care ("a great deal"/"a moderate amount") (65%). A majority of respondents indicated they were already observing health impacts of climate change among their patients, most commonly as increases in chronic disease severity from air pollution (77%), allergic symptoms from exposure to plants or mold (58%), and severe weather injuries (57%). A larger majority anticipated seeing these climate-related health impacts in the next 2 decades. Respondents indicated that physicians and physician organizations should play an active role in educating patients, the public, and policy makers on the human health effects of climate change. Overall, ATS members are observing that human health is already adversely affected by climate change and support responses to address this situation.

  4. Early structural changes in sheep lung following thoracic irradiation

    International Nuclear Information System (INIS)

    Guerry-Force, M.L.; Perkett, E.A.; Brigham, K.L.; Meyrick, B.

    1988-01-01

    Using a large animal model of radiation lung injury--the sheep exposed to bilateral thoracic irradiation--we have recently shown the development of sustained pulmonary hypertension during the first 4 weeks following radiation. This is the period prior to the onset of pneumonitis and pulmonary fibrosis. In the present study, we have examined biopsy and autopsy lung tissue from these same sheep and assessed the sequential changes in lung morphology. Six unanesthetized sheep received bilateral thoracic irradiation (a total of 15 Gy); control sheep were sham irradiated. Lung biopsy tissue was taken prior to and at weekly or biweekly intervals during the 4 weeks immediately following radiation. The lungs were also removed at autopsy for light and electron microscopic examination. Our results show early (Week 1) interstitial and progressive intraalveolar edema accompanied by endothelial and epithelial injury. A gradual increase in number of interstitial mononuclear cells was evident from Week 1, both in the lung tissue and in perivascular cuffs. The number of peripheral lung interstitial mononuclear cells was twice baseline from Week 3 and included accumulation of lymphocytes, fibroblasts, and intravascular macrophages. The increased numbers of mononuclear cells paralleled the development of chronic pulmonary hypertension, perhaps suggesting their involvement in the pathogenesis of this disease. Alternatively, it may be that increased mononuclear cell number represents a stage of lung repair

  5. Early structural changes in sheep lung following thoracic irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Guerry-Force, M.L.; Perkett, E.A.; Brigham, K.L.; Meyrick, B.

    1988-04-01

    Using a large animal model of radiation lung injury--the sheep exposed to bilateral thoracic irradiation--we have recently shown the development of sustained pulmonary hypertension during the first 4 weeks following radiation. This is the period prior to the onset of pneumonitis and pulmonary fibrosis. In the present study, we have examined biopsy and autopsy lung tissue from these same sheep and assessed the sequential changes in lung morphology. Six unanesthetized sheep received bilateral thoracic irradiation (a total of 15 Gy); control sheep were sham irradiated. Lung biopsy tissue was taken prior to and at weekly or biweekly intervals during the 4 weeks immediately following radiation. The lungs were also removed at autopsy for light and electron microscopic examination. Our results show early (Week 1) interstitial and progressive intraalveolar edema accompanied by endothelial and epithelial injury. A gradual increase in number of interstitial mononuclear cells was evident from Week 1, both in the lung tissue and in perivascular cuffs. The number of peripheral lung interstitial mononuclear cells was twice baseline from Week 3 and included accumulation of lymphocytes, fibroblasts, and intravascular macrophages. The increased numbers of mononuclear cells paralleled the development of chronic pulmonary hypertension, perhaps suggesting their involvement in the pathogenesis of this disease. Alternatively, it may be that increased mononuclear cell number represents a stage of lung repair.

  6. Intercostal neuralgia as a symptom of an osteoblastoma in thoracic spine.

    Science.gov (United States)

    Kobayashi, Hiroshi; Shinoda, Yusuke; Ohki, Takahiro; Kawano, Hirotaka

    2015-07-02

    An osteoblastoma is a benign bone lesion most commonly affecting the spine; it is frequently found in the posterior elements of the vertebra. When an osteoblastoma originates in the spine, it usually causes dull and localised dorsal pain, but the period between symptom development and diagnosis can be long. MRI shows intense peritumoural oedema accompanying the osteoblastoma. We present a case of a 15-year-old boy with osteoblastoma at the level of the T8-9 left laminae causing intercostal neuralgia without direct invasion to the intercostal nerve. Immediately after surgery, intercostal neuralgia was diminished. To our knowledge, this is the first case of an osteoblastoma with intercostal neuralgia, which is possibly the key symptom for diagnosing an osteoblastoma in the thoracic spine. 2015 BMJ Publishing Group Ltd.

  7. Intercostal neuralgia as a symptom of an osteoblastoma in thoracic spine

    Science.gov (United States)

    Kobayashi, Hiroshi; Shinoda, Yusuke; Ohki, Takahiro; Kawano, Hirotaka

    2015-01-01

    An osteoblastoma is a benign bone lesion most commonly affecting the spine; it is frequently found in the posterior elements of the vertebra. When an osteoblastoma originates in the spine, it usually causes dull and localised dorsal pain, but the period between symptom development and diagnosis can be long. MRI shows intense peritumoural oedema accompanying the osteoblastoma. We present a case of a 15-year-old boy with osteoblastoma at the level of the T8–9 left laminae causing intercostal neuralgia without direct invasion to the intercostal nerve. Immediately after surgery, intercostal neuralgia was diminished. To our knowledge, this is the first case of an osteoblastoma with intercostal neuralgia, which is possibly the key symptom for diagnosing an osteoblastoma in the thoracic spine. PMID:26139654

  8. NTOS symptoms and mobility: a case study on neurogenic thoracic outlet syndrome involving massage therapy.

    Science.gov (United States)

    Streit, Robin S

    2014-01-01

    Neurogenic thoracic outlet syndrome (NTOS) is a neuromuscular condition affecting brachial plexus functionality. NTOS is characterized by paresthesia, pain, muscle fatigue, and restricted mobility in the upper extremity. This study quantified massage therapy's possible contribution to treatment of NTOS. A 24-year-old female with NTOS received eight treatments over 35 days. Treatment included myofascial release, trigger point therapy, cross fiber friction, muscle stripping, and gentle passive stretching. Abduction and lateral rotation at the glenohumeral (GH joint) assessments measured range of motion (ROM). A resisted muscle test evaluated upper extremity strength. The client rated symptoms daily via a visual analog scale (VAS). Findings showed improvement in ROM at the GH joint. VAS ratings revealed a reduction in muscle weakness, pain, numbness, and 'paresthesia'. Results suggest massage may be useful as part of a broad approach to managing NTOS symptoms and improving mobility. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Cobb angle changes in thoracic and lumbar spine fractures ...

    African Journals Online (AJOL)

    Background: This is a retrospective study to evaluate the short-term clinical outcome of conservative treatment of all consecutive patients that were treated for closed thoracic and lumbar spine fractures following Road Traffic Injury (RTI) at the University of Abuja Teaching Hospital (UATH) Gwagwalada, Abuja Nigeria.

  10. Cobb Angle Changes in Thoracic and Lumbar Spine Fractures ...

    African Journals Online (AJOL)

    The annual incidence of spinal column fracture is 350 per million populations. with Motor vehicular accident being the major single cause of spine injuries. The victims are predominantly young and male. The aim of this study to evaluate the clinical outcome of conservative treatment of closed thoracic and lumbar spine ...

  11. EFFECT OF SITTING POSTURE ON THORACIC CONFIGURATION AND CHANGES IN VOLUME OF HEMITHORACES

    Directory of Open Access Journals (Sweden)

    Shōbo A

    2017-06-01

    Full Text Available Background: Poor posture is detrimental to breathing. Our purpose was to investigate the effect of upright and hunchbacked sitting on thoracic configuration and changes in the volume of the thorax during quiet and volitional deep breathing. Methods: The participants were 11 healthy men with a mean age of 21.6 years, mean body mass of 59.8 kg, mean height of 169.7 cm and a body mass index of 20.7 kg/m2. Eighty-four reflective markers were placed on the trunk. Three-dimensional motion analysis measured the volume within the hemithoraces. To calculate upper and lower thoracic volumes, six imaginary hexahedra were visualized using four reflective markers for each on both aspects of the thorax. Each hexahedron was divided into three imaginary triangular pyramids to calculate positional vectors. Finally, the volume for the hexahedra and triangular pyramids was calculated. Upper thoracic volume encompassed a space from the sternal notch to a midpoint on the ventral aspect of the third rib and the lower thoracic volume from the xiphoid process to the midpoint on tenth rib’s dorsal aspect. Results: In hunchbacked sitting during quiet breathing the left lower hemithorax yielded a significantly larger volume (p=0.003, and both breathing patterns during inspiration and expiration yielded a significantly greater change in thoracic configuration (p=0.01, p=0.016. Conclusion: Findings suggested that, in a hunchbacked sitting, there was decreased thoracic asymmetry with re-establishment of thoracic vertebral alignment, consequently stabilizing the sitting position, but breathing was suppressed and tidal volume decreased. Physiotherapy should aim at ensuring correction of hunchbacked posture and maintenance of thoracic symmetry.

  12. Lhermitte Sign as a Presenting Symptom of Thoracic Spinal Pathology: A Case Study

    Directory of Open Access Journals (Sweden)

    Adam Hills

    2015-01-01

    Full Text Available A 54-year-old male with ankylosing spondylitis presented with complaints of progressively worsening bilateral leg weakness and difficulty ambulating of 2-week duration. He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk. There was no history of trauma or other inciting events within the 2 weeks prior to presentation. Thoracic MRI at this visit showed a three-column fracture at T11-T12. He underwent spinal fusion surgery and within 2 days after surgery the radiating electrical sensation with spinal flexion had completely resolved.

  13. Changes in pulmonary epithelial permeability due to thoracic irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Anazawa, Yoshiki; Isawa, Toyoharu; Teshima, Takeo; Miki, Makoto; Motomiya, Masakichi (Tohoku Univ., Sendai (Japan). Research Inst. for Chest Diseases and Cancer)

    1992-05-01

    The changes in pulmonary epithelial permeability during and following radiation therapy were studied in 10 patients with malignant diseases of the chest; 9 patients with bronchogenic carcinoma and one with thymoma. {sup 99m}Tc-DTPA aerosol was inhaled during tidal breathing with the patient in supine position, and radioactivity was measured anteriorly by a gamma camera and recorded on a computer. Half time clearance (t{sub 1/2}) was calculated from exponential fitting of time activity curves by regression analysis in various regions of interest in the initial 7 min following completion of aerosol inhalation. Studies were made every two weeks. In patients who developed radiation pneumonitis, t{sub 1/2} values decreased and reached the nadir at the time of manifest pneumonitis, indicating increased pulmonary epithelial permeability. Increased pulmonary epithelial permeability was observed not only in the pneumonic regions but also in the contralateral normal lung regions. Steroid therapy reversed these changes. Increased pulmonary epithelial permeability was observed in 2 out of 5 patients who did not develop radiation pneumonitis. In summary, pulmonary epithelial permeability changes occur not only in regions of radiation pneumonitis but also in non-irradiated lung regions following radiation therapy. We consider that the judicious use of this method enables detection of changes in pulmonary epithelial permeability prior to the development of clinical manifestations of radiation pneumonitis. (author).

  14. Lower thoracic syndrome.

    Science.gov (United States)

    Farooq, Muhammad Nazim

    2017-01-01

    The role of thoracic spine related dysfunction in producing lower extremity symptoms is not clear. This case study describes the assessment and treatment of a patient with low back pain and bilateral lower extremity (BLE) symptoms. It was found that patient education about postural awareness and passive mobilization are valuable aids to decrease BLE symptoms due to sympathetic nervous system (SNS) dysfunction and lower thoracic hypomobility. The clinicians need to consider examination and treatment of the lower thoracic area in patients with BLE symptoms. More research is required to explore the role of SNS dysfunction in producing BLE symptoms.

  15. Scapular kinematics pre- and post-thoracic thrust manipulation in individuals with and without shoulder impingement symptoms: a randomized controlled study.

    Science.gov (United States)

    Haik, Melina N; Alburquerque-Sendín, Francisco; Silva, Caroline Z; Siqueira-Junior, Aristides L; Ribeiro, Ivana L; Camargo, Paula R

    2014-07-01

    Randomized controlled trial with immediate follow-up. To evaluate the immediate effects of a low-amplitude, high-velocity thrust thoracic spine manipulation (TSM) on pain and scapular kinematics during elevation and lowering of the arm in individuals with shoulder impingement syndrome (SIS). The secondary objective was to evaluate the immediate effects of TSM on scapular kinematics during elevation and lowering of the arm in individuals without symptoms. Considering the regional interdependence among the shoulder and the thoracic and cervical spines, TSM may improve pain and function in individuals with SIS. Comparing individuals with SIS to those without shoulder pathology may provide information on the effects of TSM specifically in those with SIS. Fifty subjects (mean ± SD age, 31.8 ± 10.9 years) with SIS and 47 subjects (age, 25.8 ± 5.0 years) asymptomatic for shoulder dysfunction were randomly assigned to 1 of 2 interventions: TSM or a sham intervention. Scapular kinematics were analyzed during elevation and lowering of the arm in the sagittal plane, and a numeric pain rating scale was used to assess shoulder pain during arm movement at preintervention and postintervention. For those in the SIS group, shoulder pain was reduced immediately after TSM and the sham intervention (mean ± SD preintervention, 2.9 ± 2.5; postintervention, 2.3 ± 2.5; PShoulder pain in individuals with SIS immediately decreased after a TSM. The observed changes in scapular kinematics following TSM were not considered clinically important. Therapy, level 4. J Orthop Sports Phys Ther 2014;44(7):475-487. Epub 22 May 2014. doi:10.2519/jospt.2014.4760.

  16. Thoracic impedance change equation deduced on the basis of parallel impedance model and Ohm's law.

    Science.gov (United States)

    Qiu-Jin, Xiao; Zhen, Wang; Ming-Xing, Kuang; Ping, Wen; Pei, Liu; Jian-Feng, Ji

    2012-02-01

    The aim of the present study is to investigate an impedance change equation suited with the measurement of the impedance cardiograph (ICG). Based on a parallel impedance model and Ohm's law, an impedance change equation differed from Nyboer's equation is deduced. It is verified with the experiments of the impedance cardiography in 100 healthy adults. This equation shows that the thoracic impedance change (ΔZ) is directly proportional to the value of the volume change (ΔV) of the blood vessel, to the ratio of the basic impedance to the body height (Z(0)/H), while it is inversely proportional to the square of the chest circumference (C(t) (2)). These are supported by the experimental results in the measurement of the ICG. The equation proposed in the present paper is coincident with the actual condition in the measurement of the ICG.

  17. Indication of Cognitive Change and Associated Risk Factor after Thoracic Surgery in the Elderly: A Pilot Study

    Science.gov (United States)

    Kulason, Kay; Nouchi, Rui; Hoshikawa, Yasushi; Noda, Masafumi; Okada, Yoshinori; Kawashima, Ryuta

    2017-01-01

    Background: This pilot study investigated the effects of partial pulmonary lobectomy lung surgery on cognitive functions of elderly Japanese patients. It is recognized that elderly patients undergoing surgery have increased risk of Postoperative Cognitive Decline (POCD), a condition in which learning, memory, and processing speed is greatly reduced after surgery. Since elderly patients are more likely to exhibit symptoms of POCD, the incidence is increasing as the population receiving surgery is aging. Methods: Cognitive function was measured for all subjects (n = 12) before and after surgery using three different cognitive tests: Mini-Mental Status Exam-Japanese (MMSE-J), Frontal Assessment Battery (FAB), and a computerized Cogstate Brief Battery (CBB). Changes in these measures indicate changes in cognitive function. In addition, the 12-item General Health Questionnaire (GHQ-12), the Geriatric Depression Scale (GDS), and the 5-item Quality of Life questionnaire (QOL-5) were administered at each time point to measure mental and emotional state. Changes in outcome measures were analyzed via Wilcoxon signed-rank test. Exploratory correlation analysis was conducted using Spearman’s rho. Results: Data show a decline in detection (DET; p = 0.045) and identification (IDN; p = 0.038). Spearman’s correlation coefficient show a significant correlation between postoperative DET scores and postoperative IDN scores (ρ = 0.78, p = 0.005), a significant correlation between change in IDN and baseline GHQ-12 scores (ρ = -0.595, p = 0.027), and a significant correlation between change in one-back (OBK) scores and duration of anesthesia (ρ = -0.72, p = 0.012). Discussion: This was the first report to examine cognitive decline after major thoracic surgery in Japanese patients. Previous studies have evidenced that POCD is a common phenomenon after surgery, and that age is a major risk factor. The CCB measured significant change in two cognitive domains: attention and

  18. Indication of Cognitive Change and Associated Risk Factor after Thoracic Surgery in the Elderly: A Pilot Study.

    Science.gov (United States)

    Kulason, Kay; Nouchi, Rui; Hoshikawa, Yasushi; Noda, Masafumi; Okada, Yoshinori; Kawashima, Ryuta

    2017-01-01

    Background: This pilot study investigated the effects of partial pulmonary lobectomy lung surgery on cognitive functions of elderly Japanese patients. It is recognized that elderly patients undergoing surgery have increased risk of Postoperative Cognitive Decline (POCD), a condition in which learning, memory, and processing speed is greatly reduced after surgery. Since elderly patients are more likely to exhibit symptoms of POCD, the incidence is increasing as the population receiving surgery is aging. Methods: Cognitive function was measured for all subjects ( n = 12) before and after surgery using three different cognitive tests: Mini-Mental Status Exam-Japanese (MMSE-J), Frontal Assessment Battery (FAB), and a computerized Cogstate Brief Battery (CBB). Changes in these measures indicate changes in cognitive function. In addition, the 12-item General Health Questionnaire (GHQ-12), the Geriatric Depression Scale (GDS), and the 5-item Quality of Life questionnaire (QOL-5) were administered at each time point to measure mental and emotional state. Changes in outcome measures were analyzed via Wilcoxon signed-rank test. Exploratory correlation analysis was conducted using Spearman's rho. Results: Data show a decline in detection (DET; p = 0.045) and identification (IDN; p = 0.038). Spearman's correlation coefficient show a significant correlation between postoperative DET scores and postoperative IDN scores (ρ = 0.78, p = 0.005), a significant correlation between change in IDN and baseline GHQ-12 scores (ρ = -0.595, p = 0.027), and a significant correlation between change in one-back (OBK) scores and duration of anesthesia (ρ = -0.72, p = 0.012). Discussion: This was the first report to examine cognitive decline after major thoracic surgery in Japanese patients. Previous studies have evidenced that POCD is a common phenomenon after surgery, and that age is a major risk factor. The CCB measured significant change in two cognitive domains: attention and psycomotor

  19. Indication of Cognitive Change and Associated Risk Factor after Thoracic Surgery in the Elderly: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Kay Kulason

    2017-12-01

    Full Text Available Background: This pilot study investigated the effects of partial pulmonary lobectomy lung surgery on cognitive functions of elderly Japanese patients. It is recognized that elderly patients undergoing surgery have increased risk of Postoperative Cognitive Decline (POCD, a condition in which learning, memory, and processing speed is greatly reduced after surgery. Since elderly patients are more likely to exhibit symptoms of POCD, the incidence is increasing as the population receiving surgery is aging.Methods: Cognitive function was measured for all subjects (n = 12 before and after surgery using three different cognitive tests: Mini-Mental Status Exam-Japanese (MMSE-J, Frontal Assessment Battery (FAB, and a computerized Cogstate Brief Battery (CBB. Changes in these measures indicate changes in cognitive function. In addition, the 12-item General Health Questionnaire (GHQ-12, the Geriatric Depression Scale (GDS, and the 5-item Quality of Life questionnaire (QOL-5 were administered at each time point to measure mental and emotional state. Changes in outcome measures were analyzed via Wilcoxon signed-rank test. Exploratory correlation analysis was conducted using Spearman’s rho.Results: Data show a decline in detection (DET; p = 0.045 and identification (IDN; p = 0.038. Spearman’s correlation coefficient show a significant correlation between postoperative DET scores and postoperative IDN scores (ρ = 0.78, p = 0.005, a significant correlation between change in IDN and baseline GHQ-12 scores (ρ = -0.595, p = 0.027, and a significant correlation between change in one-back (OBK scores and duration of anesthesia (ρ = -0.72, p = 0.012.Discussion: This was the first report to examine cognitive decline after major thoracic surgery in Japanese patients. Previous studies have evidenced that POCD is a common phenomenon after surgery, and that age is a major risk factor. The CCB measured significant change in two cognitive domains: attention and

  20. Body Image Change and Adolescent Depressive Symptoms.

    Science.gov (United States)

    Siegel, Judith M.

    2002-01-01

    Examined the temporal association between body image and depressive symptoms in African American, Asian American, Hispanic American, and white adolescents. Found that girls were more influenced by body image change than boys. Compared to other ethnic groups, African American girls experienced a greater increase in psychological distress as body…

  1. Comparison of histopathologic changes following X-irradiation of mid-thoracic and lumbosacral levels of neonatal rat spinal cord

    International Nuclear Information System (INIS)

    Heard, J.K.; Gilmore, S.A.

    1985-01-01

    Light microscopic changes were studied in the dorsal funiculi of spinal cords from rats irradiated (4000 R) at 3 days of age and killed from 9-60 days postirradiation (P-I). The irradiated site was limited to a 5-mm length of mid-thoracic spinal cord (T only) in one group of rats, to a 5-mm length of lumbosacral spinal cord (L only) in a second group, and to 5-mm lengths of both mid-thoracic and lumbosacral spinal cord (T/L) in the third group. Changes in the lumbosacral regions were essentially the same in both L only and T/L irradiated groups. These changes included a decreased neuroglial population and a concurrent state of hypomyelination from 9-30 days P-I. In contrast, in the mid-thoracic regions of T only and T/L irradiated groups the decrease in the neuroglial population was obvious only through 13 days P-I, and by 30 days this population resembled that of the controls. The irradiated mid-thoracic areas were hypomyelinated, with the fasciculus gracilis showing a greater degree of hypomyelination than the fasciculus cuneatus. By 25 days P-I, myelination appeared to be normal in these areas. Scattered hemorrhages were noted in both lumbosacral and mid-thoracic regions, but necrotic areas occurred only at the lumbosacral level. In general, the mid-thoracic area appeared to be less sensitive to x-radiation at 3 days of age than the lumbosacral area. These data suggest that there may be marked differences in the developmental states of cells at these two levels at 3 days of age

  2. Temporal Change in Brain Natriuretic Peptide After Radiotherapy for Thoracic Esophageal Cancer

    International Nuclear Information System (INIS)

    Jingu, Keiichi; Nemoto, Kenji; Kaneta, Tomohiro; Oikawa, Minako; Ogawa, Yoshihiro; Ariga, Hisanori; Takeda, Ken; Sakayauchi, Toru; Fujimoto, Keisuke; Narazaki, Kakutaro; Takai, Yoshihiro; Nakata, Eiko; Fukuda, Hiroshi; Takahashi, Shoki; Yamada, Shogo

    2007-01-01

    Purpose: To investigate the relationships of plasma levels of brain natriuretic peptide (BNP) with abnormal 18 F-fluorodeoxyglucose (FDG) accumulation in the myocardium corresponding to irradiated fields and temporal changes in BNP, which is used as an index of heart remodeling, after radiotherapy for the mediastinum. Materials and Methods: Brain natriuretic peptide concentrations were measured before and after radiotherapy for thoracic esophageal cancer, and the change in BNP concentration after radiotherapy was investigated. Moreover, FDG accumulation in the myocardium was investigated in patients who had undergone FDG positron emission tomography less than 14 days before or after measurement of BNP concentration, and the Mann-Whitney U test was used to detect significant difference between BNP concentrations in patients with and without abnormal FDG accumulation corresponding to the irradiated field. Results: There was significant difference between the levels of BNP in patients without abnormal FDG accumulation in the irradiated myocardium and in patients with abnormal FDG accumulation (p 24 months after radiotherapy group were significantly higher than the levels in the before radiotherapy group, immediately after radiotherapy group, 1-2 months after radiotherapy group, and control group. Conclusions: The level of BNP was significantly increased more than 9 months after the start of radiotherapy and was significantly higher in patients who had high FDG accumulation corresponding to the irradiated field. The results of this study indicate that BNP concentration might be an early indicator of radiation-induced myocardial damage

  3. Thoracic CT

    Science.gov (United States)

    ... through a vein (IV) in your hand or forearm. It may be given through the rectum using ... CT scan Vertebra, thoracic (mid back) Normal lung anatomy Thoracic organs References Gotway MB, Panse PM, Gruden ...

  4. The thoracic limb of the suricate (Suricata suricatta): osteology, radiologic anatomy, and functional morphologic changes.

    Science.gov (United States)

    van Staden, Sheryl L

    2014-09-01

    The purpose of the study was to identify unique features of the normal osteology and radiologic anatomy of the thoracic limb of the meerkat or suricate (Suricata suricatta), as no comprehensive information has been published. Bone specimens of 19 suricates were studied. Individual bones of the manus of one preserved carcass were studied in situ. Radiographic evaluation was performed in six animals. Comparisons to domestic carnivores were made and functional morphologic changes were identified. A suprahamate process was present on the scapula spine. Both supratrochlear and supracondylar foramina were present in the distal humerus, with a small Fossa coronoidea seen cranially. The medial epicondyle was markedly larger than the lateral epicondyle. The Tuberositas radii was located caudally. The proximal end of the olecranon was prominent medially. The large medial coronoid process had an extensive proximal articulation facet for the humeral trochlea. The ulna styloid process articulated with the ulnar and accessory carpal bones. The manus was similar to that of domestic carnivores; however, Os metacarpalis I was markedly reduced with the absence of the first digit. There were seven carpal bones. Os carpi radiale was the largest, with a large palmaro-medial process and a small sesamoid bone present medially. Ossa metacarpalia II-V and corresponding phalanges were slender, with an elongated Processus unguicularis (third phalanx) present. Radiologic findings demonstrated increased mobility of the scapula and shoulder joint, with ease of abduction. On the cranio-caudal view of the humerus and elbow joint, the distal radius and manus were consistently rotated in a supinated position. Morphologic changes were identified for the enhanced, predominant function of the shoulder, elbow, carpal, and digital flexor muscles associated with superior digging ability, and supination of the antebrachium and manus. Reference values for size parameters of the long bones are reported. The

  5. Relation of murine thoracic aortic structural and cellular changes with aging to passive and active mechanical properties.

    Science.gov (United States)

    Wheeler, Jason B; Mukherjee, Rupak; Stroud, Robert E; Jones, Jeffrey A; Ikonomidis, John S

    2015-02-25

    Maintenance of the structure and mechanical properties of the thoracic aorta contributes to aortic function and is dependent on the composition of the extracellular matrix and the cellular content within the aortic wall. Age-related alterations in the aorta include changes in cellular content and composition of the extracellular matrix; however, the precise roles of these age-related changes in altering aortic mechanical function are not well understood. Thoracic aortic rings from the descending segment were harvested from C57BL/6 mice aged 6 and 21 months. Thoracic aortic diameter and wall thickness were higher in the old mice. Cellular density was reduced in the medial layer of aortas from the old mice; concomitantly, collagen content was higher in old mice, but elastin content was similar between young and old mice. Stress relaxation, an index of compliance, was reduced in aortas from old mice and correlated with collagen fraction. Contractility of the aortic rings following potassium stimulation was reduced in old versus young mice. Furthermore, collagen gel contraction by aortic smooth muscle cells was reduced with age. These results demonstrate that numerous age-related structural changes occurred in the thoracic aorta and were related to alterations in mechanical properties. Aortic contractility decreased with age, likely because of a reduction in medial cell number in addition to a smooth muscle contractile deficit. Together, these unique findings provide evidence that the age-related changes in structure and mechanical function coalesce to provide an aortic substrate that may be predisposed to aortopathies. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  6. Dynamic aortic changes in patients with thoracic aortic aneurysms evaluated with electrocardiography-triggered computed tomographic angiography before and after thoracic endovascular aneurysm repair: preliminary results.

    NARCIS (Netherlands)

    Prehn, J. van; Bartels, L.W.; Mestres, G.; Vincken, K.L.; Prokop, M.; Verhagen, H.J.; Moll, F.L.; Herwaarden, J.A. van

    2009-01-01

    The purpose of this study was to utilize dynamic computed tomographic angiography (CTA) on pre- and postoperative thoracic endovascular aneurysm repair (TEVAR) patients to characterize cardiac pulsatility-induced aortic motion on essential TEVAR proximal sealing zones and to study the influence of

  7. Chronic spinal cord changes in a high-fat diet-fed male rat model of thoracic spinal contusion.

    Science.gov (United States)

    Spann, Redin A; Lawson, William J; Grill, Raymond J; Garrett, Michael R; Grayson, Bernadette E

    2017-09-01

    Individuals that suffer injury to the spinal cord can result in long-term, debilitating sequelae. Spinal cord-injured patients have increased risk for the development of metabolic disease, which can further hinder the effectiveness of treatments to rehabilitate the cord and improve quality of life. In the present study, we sought to understand the impact of high-fat diet (HFD)-induced obesity on spinal cord injury (SCI) by examining transcriptome changes in the area of the injury and rostral and caudal to site of damage 12 wk after injury. Adult, male Long-Evans rats received either thoracic level contusion of the spinal cord or sham laminectomy and then were allowed to recover on normal rat chow for 4 wk and further on HFD for an additional 8 wk. Spinal cord tissues harvested from the rats were processed for Affymetrix microarray and further transcriptomic analysis. Diverse changes in gene expression were identified in the injured cord in genes such as MMP12, APOC4, GPNMB, and IGF1 and 2. The greatest signaling changes occurred in pathways involved in cholesterol biosynthesis and immune cell trafficking. Together, the cord changes in the chronically obese rat following thoracic SCI reveal further potential targets for therapy. These could be further explored as they overlap with genes involved in metabolic disease. Copyright © 2017 the American Physiological Society.

  8. Thoracic outlet syndrome.

    Science.gov (United States)

    Kuhn, John E; Lebus V, George F; Bible, Jesse E

    2015-04-01

    Thoracic outlet syndrome is a well-described disorder caused by thoracic outlet compression of the brachial plexus and/or the subclavian vessels. Neurogenic thoracic outlet syndrome is the most common manifestation, presenting with pain, numbness, tingling, weakness, and vasomotor changes of the upper extremity. Vascular complications of thoracic outlet syndrome are uncommon and include thromboembolic phenomena and swelling. The clinical presentation is highly variable, and no reproducible study exists to confirm the diagnosis; instead, the diagnosis is based on a physician's judgment after a meticulous history and physical examination. Both nonsurgical and surgical treatment methods are available for thoracic outlet syndrome. Whereas nonsurgical management appears to be effective in some persons, surgical treatment has been shown to provide predictable long-term cure rates for carefully selected patients. In addition, physicians who do not regularly treat patients with thoracic outlet syndrome may not have an accurate view of this disorder, its treatment, or the possible success rate of treatment. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

  9. [Change of paradigms in the surgical treatment of complex thoracic aortic disease].

    Science.gov (United States)

    Herold, Ulf; Tsagakis, Konstantinos; Kamler, Markus; Massoudy, Parwis; Assenmacher, Eva; Eggebrecht, Holger; Buck, Thomas; Jakob, Heinz

    2006-08-01

    One of the main issues in complex thoracic aortic disease, requiring the replacement of the ascending aorta, the entire aortic arch and the descending aorta, is the vast amount of surgery necessary to cure the patient. Though one-stage repair is feasible by a clamshell thoracotomy, the associated surgical trauma and perioperative morbidity limit this approach to younger patients only. Classic surgical repair consist of a two-stage strategy, whereby, in the first step, the ascending aorta and the aortic arch are replaced via a midline sternotomy. In the second step, via a lateral thoracotomy, the descending aorta is replaced. The two stages may sum up to a mortality of 20%; furthermore, the waiting period between the stages is associated with a mortality rate of 10% of its own. Additionally, the two-stage strategy has an inherent limitation, due to the comorbidity and advanced age of the majority of patients. Therefore, the second stage cannot be offered to up to 30% of patients. New developments and improvements in aortic surgery were introduced to overcome these shortcomings and to simplify the surgical repair. The "elephant trunk" principle, introduced by Borst et al. in 1983, was an important step to facilitate surgical repair, but still required the second step. With the introduction of endovascular repair of thoracic aortic disease with stent grafts implanted retrograde via the femoral artery, new therapeutic concepts emerged. In the late 1990s, two Japanese groups reported first trials to stabilize the free-floating "elephant trunk" prosthesis by implantation of nitinol stent grafts into the vascular graft. The applied devices were purely custom-made and nonstandardized. The availability of industrially made and CE-marked stent-graft devices raised the possibility to apply them in open aortic arch surgery. The experience with stent-graft devices implanted antegrade into the descending aorta (Medtronic Talent) was reported first by the Essen and the Vienna

  10. Age-related changes in thoracic skeletal geometry of elderly females.

    Science.gov (United States)

    Holcombe, Sven A; Wang, Stewart C; Grotberg, James B

    2017-05-29

    Both females and the elderly have been identified as vulnerable populations with increased injury and mortality risk in multiple crash scenarios. Particularly in frontal impacts, older females show higher risk to the chest and thorax than their younger or male counterparts. Thoracic geometry plays a role in this increase, and this study aims to quantify key parts of that geometry in a way that can directly inform human body models that incorporate the concept of person age. Computed tomography scans from 2 female subject groups aged 20-35 and 65-99 were selected from the International Center for Automotive Medicine scan database representing young and old female populations. A model of thoracic skeletal anatomy was built for each subject from independent parametric models of the spine, ribs, and sternum, along with further parametric models of those components' spatial relationships. Parameter values between the 2 groups are directly compared, and average parameter values within each group are used to generate statistically average skeletal geometry for young and old females. In addition to the anatomic measures explicitly used in the parameterization scheme, key measures of rib cage depth and spine curvature are taken from both the underlying subject pool and from the resultant representative geometries. Statistically significant differences were seen between the young and old groups' spine and rib anatomic components, with no significant differences in local sternal geometry found. Vertebral segments in older females had higher angles relative to their inferior neighbors, providing a quantification of the kyphotic curvature known to be associated with age. Ribs in older females had greater end-to-end span, greater aspect ratio, and reduced out-of-plane deviation, producing an elongated and overall flatter curvature that leads to distal rib ends extending further anteriorly in older individuals. Combined differences in spine curvature and rib geometry led to an 18

  11. Thoracic and abdominal aortas stiffen through unique extracellular matrix changes in intrauterine growth restricted fetal sheep.

    Science.gov (United States)

    Dodson, R Blair; Rozance, Paul J; Petrash, Carson C; Hunter, Kendall S; Ferguson, Virginia L

    2014-02-01

    Intrauterine growth restriction (IUGR) is a fetal complication of pregnancy epidemiologically linked to cardiovascular disease in the newborn later in life. However, the mechanism is poorly understood with very little research on the vascular structure and function during development in healthy and IUGR neonates. Previously, we found vascular remodeling and increased stiffness in the carotid and umbilical arteries, but here we examine the remodeling and biomechanics in the larger vessels more proximal to the heart. To study this question, thoracic and abdominal aortas were collected from a sheep model of placental insufficiency IUGR (PI-IUGR) due to exposure to elevated ambient temperatures. Aortas from control (n = 12) and PI-IUGR fetuses (n = 10) were analyzed for functional biomechanics and structural remodeling. PI-IUGR aortas had a significant increase in stiffness (P fetal vascular remodeling in PI-IUGR may set the stage for possible altered growth and development and help to explain the pathophysiology of adult cardiovascular disease in previously IUGR individuals.

  12. Sexual orientation identity change and depressive symptoms: a longitudinal analysis.

    Science.gov (United States)

    Everett, Bethany

    2015-03-01

    Several new studies have documented high rates of sexual identity mobility among young adults, but little work has investigated the links between identity change and mental health. This study uses the National Longitudinal Study of Adolescent to Adult Health (N = 11,727) and employs multivariate regression and propensity score matching to investigate the impact of identity change on depressive symptoms. The results reveal that only changes in sexual identity toward more same-sex-oriented identities are associated with increases in depressive symptoms. Moreover, the negative impacts of identity change are concentrated among individuals who at baseline identified as heterosexual or had not reported same-sex romantic attraction or relationships. No differences in depressive symptoms by sexual orientation identity were found among respondents who reported stable identities. Future research should continue to investigate the factors that contribute to the relationship between identity change and depression, such as stigma surrounding sexual fluidity. © American Sociological Association 2015.

  13. Longitudinal change instead of baseline testosterone predicts depressive symptoms.

    Science.gov (United States)

    Kische, Hanna; Pieper, Lars; Venz, John; Klotsche, Jens; März, Winfried; Koch-Gromus, Uwe; Pittrow, David; Lehnert, Hendrik; Silber, Sigmund; Stalla, G K; Zeiher, Andreas M; Wittchen, Hans-Ulrich; Haring, Robin

    2018-03-01

    The association between total testosterone (T) and depression mostly relies on single sex hormone assessment and remains inconclusive. Thus, we investigated the comparative predictive performance of baseline T and change in T with development of depressive symptoms and incident depressive episodes. We used data from 6493 primary care patients (2653 men and 3840 women) of the DETECT study (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment), including four-year follow-up, repeated immunoassay-based measurement of serum T and depressive symptoms assessed by the Depression Screening Questionnaire (DSQ). Cross-sectional and longitudinal associations of baseline T and one-year change in T with prevalent and incident depression were investigated using age- and multivariable-adjusted regression models. Baseline T showed no association with prevalent or incident depressive symptoms and episodes in both sexes. In men, a positive change in T (higher T at one-year follow-up compared to baseline) was associated with a lower burden of depressive symptoms (β-coefficient per unit change in T: -0.17; 95% CI: -0.31 to -0.04) and lower risk of incident depressive symptoms (odds ratio per unit change in T: 0.84; 95% CI: 0.72-0.98) at four-year follow-up. In women, the association of T change with incident depressive episodes was rendered non-significant after multivariable adjustment. The present study observed a sex-specific inverse association of T change, but not baseline T, with increased depressive symptom burden in men. Future studies should assess longitudinal changes in sex hormone status as predictor of adverse health outcomes related to low T. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Thoracic endometriosis syndrome: CT and MRI features

    International Nuclear Information System (INIS)

    Rousset, P.; Rousset-Jablonski, C.; Alifano, M.; Mansuet-Lupo, A.; Buy, J.-N.; Revel, M.-P.

    2014-01-01

    Thoracic endometriosis is considered to be rare, but is the most frequent form of extra-abdominopelvic endometriosis. Thoracic endometriosis syndrome affects women of reproductive age. Diagnosis is mainly based on clinical findings, which can include catamenial pneumothorax and haemothorax, non-catamenial endometriosis-related pneumothorax, catamenial haemoptysis, lung nodules, and isolated catamenial chest pain. Symptoms are typically cyclical and recurrent, with a right-sided predominance. Computed tomography (CT) is the first-line imaging method, but is poorly specific; therefore, its main role is to rule out other pulmonary diseases. However, in women with a typical clinical history, some key CT findings may help to confirm this often under-diagnosed syndrome. MRI can also assist with the diagnosis, by showing signal changes typical of haemorrhage within diaphragmatic or pleural lesions

  15. Brain changes in diabetes mellitus patients with gastrointestinal symptoms

    DEFF Research Database (Denmark)

    Drewes, Anne M; Søfteland, Eirik; Dimcevski, Georg

    2016-01-01

    to stimulation of GI organs. Imaging studies on patients with diabetes and GI symptoms mainly showed microstructural changes, especially in brain areas involved in visceral sensory processing. As the electrophysiological and imaging changes were associated with GI and autonomic symptoms they may represent...... neuropathy of the central nervous system (CNS) may play a major role. This systematic review provides an overview of the neurodegenerative changes that occur as a consequence of diabetes with a focus on the CNS changes and gastrointestinal (GI) dysfunction. Animal models where diabetes was induced...... experimentally support that the disease induces changes in CNS. Recent investigations with electroencephalography and functional brain imaging in patients with diabetes confirm these structural and functional brain changes. Encephalographic studies demonstrated that altered insular processing of sensory stimuli...

  16. Minimising NOx emissions: a symptom of managing change

    Energy Technology Data Exchange (ETDEWEB)

    Howard, J. [UltraMax Corporation (USA)

    2000-07-01

    Minimizing NOx emissions is but a symptom of a bigger issues for utility companies in today's world. The bigger issue is determining how to successfully manage change. The companies that manage change well will solve the environmental issues and solve them profitably. NOx reduction can be achieved. It can be achieved while creating a capability to manage change. Solving the ability to manage change is the best route to take. Reducing NOx can be done but it may create other problems such as increased carbon in ash. The combination of software and hardware solutions have been carefully thought through and efficiently implemented. 7 figs., 2 tabs.

  17. Thoracic textilomas: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Dianne Melo; Zanetti, Glaucia; Araujo Neto, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Silva, Jorge Luiz Pereira e; Guimaraes, Marcos Duarte; Escuissato, Dante Luiz; Souza Junior, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Hospital Universitario Antonio Pedro (HUAP/UFF), Niteroi, RJ (Brazil)

    2014-09-15

    Objective: the aim of this study was to analyze chest CT scans of patients with thoracic textiloma. Methods: this was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. Results: the majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). Conclusions: it is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. (author)

  18. Variability of 4D flow parameters when subjected to changes in MRI acquisition parameters using a realistic thoracic aortic phantom.

    Science.gov (United States)

    Montalba, Cristian; Urbina, Jesus; Sotelo, Julio; Andia, Marcelo E; Tejos, Cristian; Irarrazaval, Pablo; Hurtado, Daniel E; Valverde, Israel; Uribe, Sergio

    2018-04-01

    To assess the variability of peak flow, mean velocity, stroke volume, and wall shear stress measurements derived from 3D cine phase contrast (4D flow) sequences under different conditions of spatial and temporal resolutions. We performed controlled experiments using a thoracic aortic phantom. The phantom was connected to a pulsatile flow pump, which simulated nine physiological conditions. For each condition, 4D flow data were acquired with different spatial and temporal resolutions. The 2D cine phase contrast and 4D flow data with the highest available spatio-temporal resolution were considered as a reference for comparison purposes. When comparing 4D flow acquisitions (spatial and temporal resolution of 2.0 × 2.0 × 2.0 mm 3 and 40 ms, respectively) with 2D phase-contrast flow acquisitions, the underestimation of peak flow, mean velocity, and stroke volume were 10.5, 10 and 5%, respectively. However, the calculated wall shear stress showed an underestimation larger than 70% for the former acquisition, with respect to 4D flow, with spatial and temporal resolution of 1.0 × 1.0 × 1.0 mm 3 and 20 ms, respectively. Peak flow, mean velocity, and stroke volume from 4D flow data are more sensitive to changes of temporal than spatial resolution, as opposed to wall shear stress, which is more sensitive to changes in spatial resolution. Magn Reson Med 79:1882-1892, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  19. Changes in mechanical load and extensor muscle activity in the cervico-thoracic spine induced by sitting posture modification.

    Science.gov (United States)

    Edmondston, Stephen J; Sharp, Michael; Symes, Andew; Alhabib, Nawaf; Allison, Garry T

    2011-02-01

    The influence of whole body sitting posture on cervico-thoracic posture, mechanical load and extensor muscle activity was examined in 23 asymptomatic adults. Cervical and upper thoracic extensor muscle activity measured in guided slouched and lumbo-pelvic neutral postures was normalised to that measured in a self-selected habitual posture. Head and neck posture and gravitational load moment measurements were obtained in each posture. Sagittal head translation, upper cervical extension and load moment were significantly greater in the slouched posture (p sitting postures reduce the demand on the cervical extensor muscles and modify the relative contribution of cervical and thoracic extensors to the control of head and neck posture. Postures that promote these patterns of muscular activity may reduce cervical spine loading and the development of posture-related neck pain.

  20. An Unusual Cause of Thoracic Outlet Syndrome.

    Science.gov (United States)

    Zampieri, Davide; Marulli, Giuseppe; Mammana, Marco; Calabrese, Francesca; Schiavon, Marco; Rea, Federico

    2016-12-01

    Thoracic outlet syndrome (TOS) is a condition arising from compression of the subclavian vessels and/or brachial plexus. Many factors or diseases may cause compression of the neurovascular bundle at the thoracic outlet. We describe the case of a 41-year-old woman with TOS who presented with vascular venous symptoms. Chest computed tomography (CT) scan showed a cystic mass at the level of cervico-thoracic junction, located between the left subclavian artery and vein, which appeared compressed. The cystic mass was removed through a cervical approach and it was found to be a cyst arising from the thoracic duct compressing and anteriorly dislocating the left subclavian vein. After surgery symptoms promptly disappeared. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  1. Change in Job Strain as A Predictor of Change in Insomnia Symptoms

    DEFF Research Database (Denmark)

    Halonen, Jaana I.; Lallukka, Tea; Pentti, Jaana

    2017-01-01

    STUDY OBJECTIVES: To examine whether change in job strain lead to change in insomnia symptoms. METHODS: Among 24,873 adults (82% women, mean age 44 years) who participated in a minimum of three consecutive study waves (2000-2012), job strain was assessed at the first and second wave and insomnia...... symptoms at all three waves. We analyzed observational data as a "pseudo-trial" including participants with no job strain in the first wave and no insomnia symptoms in the first and second wave (n=7354) to examine whether the onset of job strain between the first and second waves predicted the onset...... of insomnia symptoms in the third wave. We used a corresponding approach, including those with job strain in the first wave and insomnia symptoms in the first and second wave (n=2332), to examine whether the disappearance of job strain between the first two waves predicted remission of insomnia symptoms...

  2. [Thoracic Outlet Syndrome].

    Science.gov (United States)

    Seifert, Sven; Sebesta, Pavel; Klenske, Marian; Esche, Mirko

    2017-02-01

    Introduction Thoracic outlet syndrome (TOS) is one of the most extensively discussed diagnoses. There is neither a clear and homogenous clinical presentation nor an accepted definition. The term describes a complex of symptoms and complaints caused by the compression of nerves and vascular structures at one of the three defined constrictions of the upper thoracic aperture. Methods Based on a comprehensive literature review, this article presents the etiology, epidemiology and clinical diagnostics as well as the possibilities and outcomes of surgical treatment. Results The thoracic outlet syndrome is currently subdivided into three main forms: vascular TOS (vasTOS) including arterial TOS (aTOS) and venous TOS (vTOS), neurogenic TOS (nTOS), which is further subdivided into typical (nTOS) and atypical TOS (disTOS), and a mixed form of nTOS and vasTOS (nvasTOS). The diagnosis is complex and difficult since the disTOS group comprises over 90 % of all patients. In addition to conservative treatment attempts, nTOS may be treated by surgical procedures focusing on the decompression of neurovascular structures. A significant improvement after surgery was found in up to 92 % of cases. The most common access sites are supraclavicular and transaxillary. 50 to 80 % of patients benefit from surgery in the long run. The rates of vascular or neurological complications reported by specialised centres are 0 to 2 %; minor complications such as pneumothorax, bleeding and lymphatic fistula are reported in up to 25 % of cases. Summary Most patients suffering from any form of TOS benefit from surgical treatment. Duration of symptoms, socioeconomic factors and, most notably, stringent diagnostic workup and an adequate operative procedure performed by an experienced centre are crucial to success. Georg Thieme Verlag KG Stuttgart · New York.

  3. The effect of sleep pattern changes on postpartum depressive symptoms

    OpenAIRE

    Lewis, Beth A.; Gjerdingen, Dwenda; Schuver, Katie; Avery, Melissa; Marcus, Bess H.

    2018-01-01

    Background Research indicates that poor sleep is associated with postpartum depression; however, little is known regarding this relationship among postpartum women who are at high for postpartum depression. This study examined the relationship between changes in self-reported sleep patterns (from six weeks to seven months postpartum) and depressive symptoms at seven months postpartum among women who were at high risk for postpartum depression. Methods Participants (n = 122) were postpartum wo...

  4. [Analysis of changes in lower urinary tract symptoms with aging].

    Science.gov (United States)

    Soga, Norihito; Sugimura, Yoshiki

    2004-09-01

    Urination disorders start to appear in an age-dependent fashion, which contribute to the degradation of quality of life (QOL) in erderly persons. This study focused on elucidating changes of the lower urinary tract symptoms (LUTS) and changing of voiding condition with aging in the subjects, who offered the health checks. We evaluated urinary function in 225 Japanese males (age 20-79), estimated International prostate symptom score (IPSS), QOL score, uroflowmetry, prostate volume and residual urine (estimated from transabdominal ultrasonography). In addition, 539 females (age 20-89) were assigned IPSS and QOL scores. The distribution of severity of symptoms significantly changed with age in both sexes. QOL scores tended to increase in males, IPSS, prostate volume and residual urine were significantly increasing related to age, and advanced age was associated with a decline of voiding volume and Qmax. Comparison of QOL scores and IPSS criteria demonstrated a significantly positive correlation with incomplete emptying and a weak stream. A significant negative correlation was found between the QOL score and Qmax. The distribution of middle level of symptom, divided by clinical guideline for benign prostatic hyperplasia, significantly increased with age. On the other hand, in females, the QOL score seemed to be stable whilst there was a slight increase of IPSS. In contrast, frequency and incomplete emptying were significantly related to QOL scores. These investigations supported changing of lower urinary tract disorder with aging in both sexes. Since the approximate 50% of sixth and seventh decade males, classified to the middle level of symtom, which need treatment, the high incident of degradation of the LUTS with age, should predict for the future.

  5. Thoracic outlet syndrome: Case report

    International Nuclear Information System (INIS)

    Marquez, Juan Camilo; Acosta, Mauricio Fernando; Uribe Jorge Ricardo

    2009-01-01

    We report a case of vascular thoracic outlet syndrome in a young man, diagnosed with upper limb arteriography, leading to repeated arterio-arterial emboli originating from a post-stenotic subclavian artery aneurysm. It is of our interest due to its low incidence and the small number of cases reported that have been diagnosed by arteriography. The thoracic outlet is the path through which vascular and neural structures goes from the neck to the axilla, and it has three anatomical strictures, that when pronounced, can compress the brachial plexus or subclavian vessels, leading to different symptoms and signs.

  6. Changes in Swallowing Symptoms and Esophageal Motility After Thyroid Surgery

    DEFF Research Database (Denmark)

    Sorensen, Jesper Roed; Markoew, Simone; Døssing, Helle

    2018-01-01

    esophageal sphincter (UES) pressure increased significantly from 70.6 ± 27.7 to 87.7 ± 43.2 mmHg after surgery (p = 0.04). Using regression analyses, there was no significant correlation between change in goiter symptoms and weight of the removed goiter, motility parameters, or motility disturbances. However......-three patients with benign nodular goiter undergoing thyroid surgery were included. All completed high-resolution esophageal manometry examinations and the goiter symptom scale score, assessed by the thyroid-specific patient-reported outcome measure. The evaluations were performed before and 6 months after...... to esophageal motility disturbances. This information is essential when interpreting dysphagia in patients with nodular goiter, and when balancing patients' expectations to surgical goiter therapy. REGISTRATION NUMBER: NCT03100357 ( www.clinicaltrials.org )....

  7. The effect of sleep pattern changes on postpartum depressive symptoms.

    Science.gov (United States)

    Lewis, Beth A; Gjerdingen, Dwenda; Schuver, Katie; Avery, Melissa; Marcus, Bess H

    2018-01-09

    Research indicates that poor sleep is associated with postpartum depression; however, little is known regarding this relationship among postpartum women who are at high for postpartum depression. This study examined the relationship between changes in self-reported sleep patterns (from six weeks to seven months postpartum) and depressive symptoms at seven months postpartum among women who were at high risk for postpartum depression. Participants (n = 122) were postpartum women who were at an increased risk for postpartum depression (personal or maternal history of depression) and had participated in a randomized exercise intervention trial. For the current trial, participants completed the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 (PHQ-9; assessed depression) at six weeks and seven months postpartum. Overall, sleep problems significantly improved from six weeks to seven months postpartum. However, linear regression analyses indicated that worsening or minimal improvement of sleep problems were associated with higher depressive symptoms at seven month postpartum. Regarding the specific types of sleep problems, self-reported changes in sleep latency (i.e., how long it takes to fall asleep at night), daytime dysfunction (i.e., difficulty staying awake during the day), and sleep quality (i.e., subjective rating of sleep quality) were associated with higher levels of depressive symptoms. Sleep problems typically improve during the postpartum phase. However, postpartum women who are at high risk for postpartum depression are at an increased risk for depressive symptoms later in the postpartum phase if sleep problems worsen or show only minimal improvement over time. Therefore, at the six-week postpartum clinic visit, women should receive education regarding potential worsening of sleep patterns and strategies for preventing sleep-related problems. Registered with ClinicalTrials.gov ( NCT00961402 ) on August 18, 2009 prior to the start of the

  8. Religious Involvement, Gratitude, and Change in Depressive Symptoms Over Time

    Science.gov (United States)

    Krause, Neal

    2010-01-01

    Three hypotheses are evaluated in this study. The first predicts that feelings of gratitude will offset (i.e., moderate) the deleterious effects of chronic financial strain on depressive symptoms over time. The second hypothesis specifies that people who go to church more often will be more likely to feel grateful. The third hypothesis predicts that individuals with a strong sense of God-mediated control will also feel more grateful. Data from a nationwide longitudinal study of older adults in the United States (N = 818) provide support for all three hypotheses. The data suggest that the effects of ongoing economic difficulty on depressive symptoms are especially pronounced for older people who are less grateful. But in contrast, persistent financial difficulties fail to exert a statistically significant effect on depressive symptoms over time for older individuals who are especially grateful. The results further reveal that more frequent church attendance and stronger God-mediated control beliefs are associated with positive changes in gratitude over time. PMID:20333271

  9. SU-F-T-421: Dosimetry Change During Radiotherapy and Dosimetry Difference for Rigid and Deformed Registration in the Mid-Thoracic Esophageal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Tao, C; Liu, T; Chen, J; Zhu, J; Yin, Y [Shandong Cancer Hospital and Institute, Jinan, Shandong (China)

    2016-06-15

    Purpose: This study aimed to analyze dosimetry changes during radiotherapy for the mid-thoracic esophageal carcinoma, and investigate dosimetry difference between rigid and deformed registration. Methods: Twelve patients with primary middle thoracic esophageal carcinoma were selected randomly. Based on first CT scanning of each patient, plans-o were generated by experience physicists. After 20 fractions treatment, the corresponding plans-re were created with second CT scanning. And then, these two CT images were rigid and deformed registration respectively, and the dose was accumulated plan-o with plan-re. The dosimetry variation of these plans (plan-o: with 30 fractions, plan-rig: the accumulated dose with rigid registration and plan-def: the accumulated dose with deformed registration) were evaluated by paired T-test. Results: The V20 value of total lung were 32.68%, 30.3% and 29.71% for plan-o, plan-rig and plan-def respectively. The mean dose of total lung was 17.19 Gy, 16.67 Gy and 16.51 Gy for plan-o plan-rig and plan-def respectively. There were significant differences between plan-o and plan-rig or plan-def for both V20 and mean dose of total lung (with p= 0.003, p= 0.000 for V20 and p=0.008, p= 0.000 for mean dose respectively). There was no significant difference between plan-rig and plan-def (with p=0.118 for V20 and p=0.384 for mean dose). The max dose of spinal-cord was 41.95 Gy, 41.48 Gy and 41.4 Gy for plan-o, plan-rig and plan-def respectively. There were no significant differences for the max dose of spinal-cord between these plans. Conclusion: The target volume changes and anatomic position displacement of mid-thoracic esophageal carcinoma should not be neglected in clinics. These changes would cause overdose in normal tissue. Therefore, it is necessary to have another CT scanning and re-plan during the mid-thoracic esophageal carcinoma radiotherapy. And the dosimetry difference between rigid and deformed fusions was not found in this study.

  10. Thoracic outlet anatomy (image)

    Science.gov (United States)

    Thoracic outlet syndrome is a rare condition that occurs when there is compression of vessels and nerves in the ... the last 3 fingers and inner forearm. Thoracic outlet syndrome is usually treated with physical therapy which ...

  11. Is the development of Modic changes associated with clinical symptoms?

    DEFF Research Database (Denmark)

    Jensen, Rikke Krüger; Leboeuf-Yde, Charlotte; Wedderkopp, Niels

    2012-01-01

    /or the pathological type of MCs were associated with changes in clinical symptoms in a cohort of patients with persistent LBP and MCs. METHODS: Information on LBP intensity and detailed information from MRI on the presence, type and size of MCs was collected at baseline and follow-up. Changes in type (Type I, II, III...... developmental path from Type I (here Type I or I/II) to Type II (here Type II or II/III) or Type I to Type I/II. In general, the bigger the size of the MC at baseline, the more likely it was that it remained unchanged in size after 14 months. Patients who had MC Type I at both baseline and 14-month follow......PURPOSE: Modic changes (MCs) have been suggested to be a diagnostic subgroup of low back pain (LBP). However, the clinical implications of MCs remain unclear. For this reason, the aims of this study were to investigate how MCs developed over a 14-month period and if changes in the size and...

  12. Patient's quality of life after high-dose radiation therapy for thoracic carcinomas. Changes over time and influence on clinical outcome

    International Nuclear Information System (INIS)

    Schroeder, Christina; Engenhart-Cabillic, Rita; Vorwerk, Hilke; Schmidt, Michael; Huhnt, Winfried; Blank, Eyck; Sidow, Dietrich; Buchali, Andre

    2017-01-01

    Quality of life (QoL) is an important factor in patient care. This analysis is focused on QoL before and after radio(chemo)therapy in patients with thoracic carcinomas, as well as on its influence on clinical follow-up and survival, and the correlation with treatment-related toxicities. The analysis included 81 patients with intrathoracic carcinoma receiving radio(chemo)therapy. For analysis of QoL, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the lung cancer-specific supplement (EORTC QLQ-LC13) were used. QoL data were collected before radiation treatment (RT), and 6 weeks, 12 weeks, 6 months, and 12 months after RT. Other factors were additionally analyzed, including clinical outcome, survival, and side effects. The functional scales showed maximum values or at least a recovery 12 weeks after RT. Symptoms with a high mean symptom score (> 40) at all appointments were fatigue, dyspnea, and coughing. Insomnia, peripheral neuropathy, appetite loss, dyspnea (from QLQ-LC13), and all pain parameters had an intermediate mean score (10-40). There were low mean scores of < 10 for nausea and vomiting, diarrhea, sore mouth, and hemoptysis. There was a significant correlation between clinical dysphagia and radiation pneumonitis with the associated symptom scales. None of the QoL scores had a significant influence on local and distant control or survival. 12 weeks after RT the QLQ-C30 functional scales show the highest scores or at least a temporary recovery. The symptom scales accurately reflect the common symptoms and treatment-related toxicities. QoL did not prove to be a significant predictor for local and distant control or survival. (orig.) [de

  13. Comparison between continuous thoracic epidural block and continuous thoracic paravertebral block in the management of thoracic trauma.

    Science.gov (United States)

    Singh, Shalendra; Jacob, Mathews; Hasnain, S; Krishnakumar, Mathangi

    2017-04-01

    Postoperative pain is thought to be the single most important factor leading to ineffective ventilation and impaired secretion clearance after thoracic trauma. Effective pain relief can be provided by thoracic epidural analgesia but may have side effects or contraindications. Paravertebral block is an effective alternative method without the side effects of a thoracic epidural. We did this study to compare efficacy of thoracic epidural and paravertebral block in providing analgesia to thoracic trauma patients. After ethical clearance, 50 patients who had thoracic trauma were randomized into two groups. One was a thoracic epidural group (25), and second was a paravertebral group (25). Both groups received 10 ml of bolus of plain 0.125% bupivacaine and a continuous infusion of 0.25% bupivacaine at the rate of 0.1 ml/kg/h for 24 h. Assessment of pain, hemodynamic parameters, and spirometric measurements of pulmonary function were done before and after procedure. Visual analog scale (VAS) scores were accepted as main outcome of the study and taken for power analysis. There was significant decrease in postoperative pain in both the groups as measured by VAS score. However, the degree of pain relief between the groups was comparable. There was a significant improvement in pulmonary function tests in both the groups post-procedure. The change in amount of inflammatory markers between both the groups was not significantly different. Paravertebral block for analgesia is comparable to thoracic epidural in thoracic trauma patients and is associated with fewer side effects.

  14. A progressive compression model of thoracic spinal cord injury in mice: function assessment and pathological changes in spinal cord

    Directory of Open Access Journals (Sweden)

    Guo-dong Sun

    2017-01-01

    Full Text Available Non-traumatic injury accounts for approximately half of clinical spinal cord injury, including chronic spinal cord compression. However, previous rodent spinal cord compression models are mainly designed for rats, few are available for mice. Our aim is to develop a thoracic progressive compression mice model of spinal cord injury. In this study, adult wild-type C57BL/6 mice were divided into two groups: in the surgery group, a screw was inserted at T9 lamina to compress the spinal cord, and the compression was increased by turning it further into the canal (0.2 mm post-surgery every 2 weeks up to 8 weeks. In the control group, a hole was drilled into the lamina without inserting a screw. The results showed that Basso Mouse Scale scores were lower and gait worsened. In addition, the degree of hindlimb dysfunction in mice was consistent with the degree of spinal cord compression. The number of motor neurons in the anterior horn of the spinal cord was reduced in all groups of mice, whereas astrocytes and microglia were gradually activated and proliferated. In conclusion, this progressive compression of thoracic spinal cord injury in mice is a preferable model for chronic progressive spinal cord compression injury.

  15. Thoracic organ transplantation.

    Science.gov (United States)

    Pierson, Richard N; Barr, Mark L; McCullough, Keith P; Egan, Thomas; Garrity, Edward; Jessup, Mariell; Murray, Susan

    2004-01-01

    This article presents an overview of factors associated with thoracic transplantation outcomes over the past decade and provides valuable information regarding the heart, lung, and heart-lung waiting lists and thoracic organ transplant recipients. Waiting list and post-transplant information is used to assess the importance of patient demographics, risk factors, and primary cardiopulmonary disease on outcomes. The time that the typical listed patient has been waiting for a heart, lung, or heart-lung transplant has markedly increased over the past decade, while the number of transplants performed has declined slightly and survival after transplant has plateaued. Waiting list mortality, however, appears to be declining for each organ and for most diseases and high-severity subgroups, perhaps in response to recent changes in organ allocation algorithms. Based on perceived inequity in organ access and in response to a mandate from Health Resources and Services Administration, the lung transplant community is developing a lung allocation system designed to minimize deaths on the waiting list while maximizing the benefit of transplant by incorporating post-transplant survival and quality of life into the algorithm. Areas where improved data collection could inform evolving organ allocation and candidate selection policies are emphasized.

  16. Veterans’ PTSD Symptoms and their Partners’ Desired Changes in Key Relationship Domains

    OpenAIRE

    LaMotte, Adam D.; Taft, Casey T.; Reardon, Annemarie F.; Miller, Mark W.

    2015-01-01

    There is a growing literature investigating the connection between veterans’ posttraumatic stress disorder (PTSD) symptoms and intimate relationship problems. Little to no work, however, has examined the connection between veterans’ PTSD symptoms and their partners’ perceptions of specific relationship areas in need of change. We examined associations between overall PTSD symptoms and symptom cluster scores with partners’ desired changes in the areas of intimacy, shared activities, and respon...

  17. Shape of change in cognitive behavioral therapy for youth anxiety: symptom trajectory and predictors of change.

    Science.gov (United States)

    Chu, Brian C; Skriner, Laura C; Zandberg, Laurie J

    2013-08-01

    Multilevel growth analysis was used to establish the mean growth trajectory (shape of change) for cognitive behavioral therapy (CBT) for youth with anxiety disorders. Two-level growth analysis was conducted to identify important between-youth predictors of session-by-session symptom change. Fifty-five youth (ages 7-17; 50.9% male) and their parents participated in a 16- to 20-week CBT that emphasized affective, cognitive, and exposure-based exercises. Multilevel growth models (MLMs) were estimated to model session symptom data taking into account an "anxiety spike" hypothesized to occur at initiation of exposure sessions. Three models were compared: a cubic curve, a log-linear curve plus an exposure covariate, and a linear curve plus exposure covariate. Two-level MLM examined the effect of demographic traits (sex, age, race/ethnicity), pretreatment symptom severity, comorbid school refusal, early treatment factors (use of selective serotonin reuptake inhibitor medication, therapeutic alliance, treatment attrition), and pretreatment coping (engagement, disengagement, and involuntary coping). Fit indices provided support for the cubic growth model using either parent or youth anxiety data. Level 2 analysis identified youth age, symptom severity (anxiety, externalizing), early attrition, and engagement and disengagement coping as significant predictors of symptom trajectories. Predictors accounted for 34%-37% of between-youth variance in midtreatment anxiety scores. Findings suggest that the symptom course of CBT, and the effect of between-youth factors on treatment outcomes, is more complex than previously thought. Educating therapists and clients about findings can aid treatment expectations and dissemination efforts of empirically supported treatments. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  18. Venous Thoracic Outlet Syndrome as a Cause of Intractable Migraines.

    Science.gov (United States)

    Chahwala, Veer; Tashiro, Jun; Li, Xiaoyi; Baqai, Atif; Rey, Jorge; Robinson, Handel R

    2017-02-01

    Thoracic outlet syndrome (TOS) refers to the compression of the neurovascular bundle within the thoracic outlet. Cases are classified by primary etiology-arterial, neurogenic, or venous. In addition to the typical symptoms of arm swelling and paresthesias, headaches have been reported as a potential symptom of TOS. In this report, we describe a patient with debilitating migraines, which were consistently preceded by unilateral arm swelling. Resolution of symptoms occurred only after thoracic outlet decompression. Patients with migraines and concomitant swelling and/or paresthesias, especially related to provocative arm maneuvers, should be considered a possible atypical presentation of TOS and evaluated in more detail. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Thoracic manifestation of tuberculosis

    International Nuclear Information System (INIS)

    Kienzl-Palma, D.; Prosch, H.

    2016-01-01

    Tuberculosis (TB) is a granulomatous disease caused by Mycobacterium tuberculosis and transmission is via an airborne route by droplet infection. In the majority of cases patients have thoracic TB, which most frequently presents with hilar lymphadenopathy and pulmonary manifestation. Due to the rise in incidence of TB in central Europe to be expected over the coming years, it is essential to be acquainted with the radiological manifestations of pulmonary TB, particularly to be able to discriminate active from inactive TB. Due to the use of molecular techniques entailing DNA fingerprinting, the traditional classification of TB in primary and postprimary TB is being challenged. These genetic studies have revealed that variations in the clinical and radiographic appearance of TB are mainly affected by the immune status of the patients. Due to the low prevalence of TB in central Europe and the wide variation of radiological presentations, the diagnosis and therapy of TB is often delayed. In this article, the radiographic manifestations of thoracic TB are summarized and discussed. Together with the medical history and bacteriological tests, chest X-ray imaging and computed tomography (CT) play a major role not only in the detection of TB but also in the follow-up during and after therapy. Chest X-radiographs should be the primary diagnostic method in patients with suspected TB in screening as well as for diagnosis and therapy monitoring. The use of CT is more sensitive than chest radiographs and is frequently performed after chest radiographs to obtain detailed information about subtle parenchymal changes or lymph node manifestation. When active TB is suspected CT should be performed. Tree in bud, lobular consolidations, centrilobular nodules, cavities and ground-glass opacification are typical changes in active TB. (orig.) [de

  20. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome.

    Science.gov (United States)

    Illig, Karl A; Donahue, Dean; Duncan, Audra; Freischlag, Julie; Gelabert, Hugh; Johansen, Kaj; Jordan, Sheldon; Sanders, Richard; Thompson, Robert

    2016-09-01

    Thoracic outlet syndrome (TOS) is a group of disorders all having in common compression at the thoracic outlet. Three structures are at risk: the brachial plexus, the subclavian vein, and the subclavian artery, producing neurogenic (NTOS), venous (VTOS), and arterial (ATOS) thoracic outlet syndromes, respectively. Each of these three are separate entities, though they can coexist and possibly overlap. The treatment of NTOS, in particular, has been hampered by lack of data, which in turn is the result of inconsistent definitions and diagnosis, uncertainty with regard to treatment options, and lack of consistent outcome measures. The Committee has defined NTOS as being present when three of the following four criteria are present: signs and symptoms of pathology occurring at the thoracic outlet (pain and/or tenderness), signs and symptoms of nerve compression (distal neurologic changes, often worse with arms overhead or dangling), absence of other pathology potentially explaining the symptoms, and a positive response to a properly performed scalene muscle test injection. Reporting standards for workup, treatment, and assessment of results are presented, as are reporting standards for all phases of VTOS and ATOS. The overall goal is to produce consistency in diagnosis, description of treatment, and assessment of results, in turn then allowing more valuable data to be presented. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  1. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome: Executive summary.

    Science.gov (United States)

    Illig, Karl A; Donahue, Dean; Duncan, Audra; Freischlag, Julie; Gelabert, Hugh; Johansen, Kaj; Jordan, Sheldon; Sanders, Richard; Thompson, Robert

    2016-09-01

    Thoracic outlet syndrome (TOS) is a group of disorders all having in common compression at the thoracic outlet. Three structures are at risk: the brachial plexus, the subclavian vein, and the subclavian artery, producing neurogenic (NTOS), venous (VTOS), and arterial (ATOS) thoracic outlet syndromes, respectively. Each of these three are separate entities, though they can coexist and possibly overlap. The treatment of NTOS, in particular, has been hampered by lack of data, which in turn is the result of inconsistent definitions and diagnosis, uncertainty with regard to treatment options, and lack of consistent outcome measures. The Committee has defined NTOS as being present when three of the following four criteria are present: signs and symptoms of pathology occurring at the thoracic outlet (pain and/or tenderness), signs and symptoms of nerve compression (distal neurologic changes, often worse with arms overhead or dangling), absence of other pathology potentially explaining the symptoms, and a positive response to a properly performed scalene muscle test injection. Reporting standards for workup, treatment, and assessment of results are presented, as are reporting standards for all phases of VTOS and ATOS. The overall goal is to produce consistency in diagnosis, description of treatment, and assessment of results, in turn then allowing more valuable data to be presented. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  2. Change in Autism Symptoms and Maladaptive Behaviors in Adolescents and Adults with an Autism Spectrum Disorder

    OpenAIRE

    Shattuck, Paul T.; Seltzer, Marsha Mailick; Greenberg, Jan S.; Orsmond, Gael I.; Bolt, Daniel; Kring, Sheilah; Lounds, Julie; Lord, Catherine

    2006-01-01

    This study examined change prospectively in autism symptoms and maladaptive behaviors during a 4.5 year period in 241 adolescents and adults with an autism spectrum disorder who were 10–52 years old (mean = 22.0) when the study began. Although many individuals’ symptoms remained stable, a greater proportion of the sample experienced declines than increases in their level of autism symptoms and maladaptive behaviors, and there were significant improvements in mean levels of symptoms. Individua...

  3. DSM-5 changes enhance parent identification of symptoms in adolescents with ADHD.

    Science.gov (United States)

    Sibley, Margaret H; Kuriyan, Aparajita B

    2016-08-30

    This study evaluates the impact of the DSM-5 ADHD symptom wording changes on symptom endorsement among adolescents with ADHD. Parents of adolescents with systematically diagnosed DSM-IV-TR ADHD (N=78) completed counterbalanced DSM-IV-TR and DSM-5 ADHD symptom checklists in a single sitting. General linear models were conducted to evaluate whether the new DSM-5 symptom descriptors influenced the total number of ADHD symptoms and overall ADHD symptom severity endorsed by parents, how demographic factors were associated with noted changes in symptom endorsement when moving to the DSM-5, and which DSM ADHD items displayed notable changes in endorsement rates under the new wording. On average, parents identified 1.15 additional symptoms of ADHD in adolescents when moving from the DSM-IV-TR to the DSM-5. Increased symptom identification was not specific to age, sex, ethnicity, race, or socioeconomic status. Over half of the sample experienced increased symptom endorsement when changing texts (59.0%). Under the new DSM-5 wording, four symptoms had statistically significant endorsement increases (range: 11.2-16.7%): difficulty sustaining attention, easily distracted, difficulty organizing tasks and activities, and does not seem to listen. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. An official American Thoracic Society workshop report

    DEFF Research Database (Denmark)

    Rosenfeld, Margaret; Allen, Julian; Arets, Bert H G M

    2013-01-01

    lung function in this age range. Ongoing research in lung function testing in infants, toddlers, and preschoolers has resulted in techniques that show promise as safe, feasible, and potentially clinically useful tests. Official American Thoracic Society workshops were convened in 2009 and 2010......, such as ongoing symptoms or monitoring response to treatment, and as outcome measures in clinical research studies....

  5. Thoracic spine pain

    Directory of Open Access Journals (Sweden)

    Aleksey Ivanovich Isaikin

    2013-01-01

    Full Text Available Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis may be the drug of choice in the treatment of musculoskeletal pain.

  6. Thoracic and lumbar vertebral bone mineral density changes in a natural occurring dog model of diffuse idiopathic skeletal hyperostosis.

    Directory of Open Access Journals (Sweden)

    Steven De Decker

    Full Text Available Ankylosing spinal disorders can be associated with alterations in vertebral bone mineral density (BMD. There is however controversy about vertebral BMD in patients wuse idiopathic skeletal hyperostosis (DISH. DISH in Boxer dogs has been considered a natural occurring disease model for DISH in people. The purpose of this study was to compare vertebral BMD between Boxers with and without DISH. Fifty-nine Boxers with (n=30 or without (n=29 DISH that underwent computed tomography were included. Vertebral BMD was calculated for each thoracic and lumbar vertebra by using an earlier reported and validated protocol. For each vertebral body, a region of interest was drawn on the axial computed tomographic images at three separate locations: immediately inferior to the superior end plate, in the middle of the vertebral body, and superior to the inferior end plate. Values from the three axial slices were averaged to give a mean Hounsfield Unit value for each vertebral body. Univariate statistical analysis was performed to identify factors to be included in a multivariate model. The multivariate model including all dogs demonstrated that vertebral DISH status (Coefficient 24.63; 95% CI 16.07 to 33.19; p <0.001, lumbar vertebrae (Coefficient -17.25; 95% CI -23.42 to -11.09; p < 0.01, and to a lesser extent higher age (Coefficient -0.56; 95% CI -1.07 to -0.05; p = 0.03 were significant predictors for vertebral BMD. When the multivariate model was repeated using only dogs with DISH, vertebral DISH status (Coefficient 20.67; 95% CI, 10.98 to 30.37; p < 0.001 and lumbar anatomical region (Coefficient -38.24; 95% CI, -47.75 to -28.73; p < 0.001 were again predictors for vertebral BMD but age was not. The results of this study indicate that DISH can be associated with decreased vertebral BMD. Further studies are necessary to evaluate the clinical importance and pathophysiology of this finding.

  7. Patient's quality of life after high-dose radiation therapy for thoracic carcinomas. Changes over time and influence on clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Schroeder, Christina [University Clinic Giessen and Marburg, Clinic for Radiotherapy and Radiation Oncology, Marburg (Germany); Ruppiner Kliniken GmbH, Clinic for Radiotherapy and Radiation Oncology, Neuruppin (Germany); Engenhart-Cabillic, Rita; Vorwerk, Hilke [University Clinic Giessen and Marburg, Clinic for Radiotherapy and Radiation Oncology, Marburg (Germany); Schmidt, Michael; Huhnt, Winfried; Blank, Eyck; Sidow, Dietrich; Buchali, Andre [Ruppiner Kliniken GmbH, Clinic for Radiotherapy and Radiation Oncology, Neuruppin (Germany)

    2017-02-15

    Quality of life (QoL) is an important factor in patient care. This analysis is focused on QoL before and after radio(chemo)therapy in patients with thoracic carcinomas, as well as on its influence on clinical follow-up and survival, and the correlation with treatment-related toxicities. The analysis included 81 patients with intrathoracic carcinoma receiving radio(chemo)therapy. For analysis of QoL, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the lung cancer-specific supplement (EORTC QLQ-LC13) were used. QoL data were collected before radiation treatment (RT), and 6 weeks, 12 weeks, 6 months, and 12 months after RT. Other factors were additionally analyzed, including clinical outcome, survival, and side effects. The functional scales showed maximum values or at least a recovery 12 weeks after RT. Symptoms with a high mean symptom score (> 40) at all appointments were fatigue, dyspnea, and coughing. Insomnia, peripheral neuropathy, appetite loss, dyspnea (from QLQ-LC13), and all pain parameters had an intermediate mean score (10-40). There were low mean scores of < 10 for nausea and vomiting, diarrhea, sore mouth, and hemoptysis. There was a significant correlation between clinical dysphagia and radiation pneumonitis with the associated symptom scales. None of the QoL scores had a significant influence on local and distant control or survival. 12 weeks after RT the QLQ-C30 functional scales show the highest scores or at least a temporary recovery. The symptom scales accurately reflect the common symptoms and treatment-related toxicities. QoL did not prove to be a significant predictor for local and distant control or survival. (orig.) [German] Die Lebensqualitaet (QoL) ist ein entscheidender Faktor in der Patientenversorgung. In der vorliegenden Untersuchung lag der Fokus auf der QoL vor und nach Radio(chemo)therapie von Patienten mit thorakalen Tumoren sowie deren Einfluss auf das klinische

  8. Depressive Symptoms and Change in Abdominal Obesity Among Older Persons

    Science.gov (United States)

    Vogelzangs, Nicole; Kritchevsky, Stephen B; Beekman, Aartjan TF; Newman, Anne B; Satterfield, Suzanne; Simonsick, Eleanor M; Yaffe, Kristine; Harris, Tamara B; Penninx, Brenda WJH

    2012-01-01

    Context Depression has been hypothesized to result in abdominal obesity through the accumulation of visceral fat. No large study has tested this hypothesis longitudinally. Objective To examine whether depressive symptoms predict an increase in abdominal obesity in a large population-based sample of well-functioning older persons. Design The Health, Aging, and Body Composition Study, an ongoing prospective cohort study, with 5 years of follow-up. Setting Community-dwelling older persons residing in the areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee. Participants 2088 well-functioning white and black persons aged 70–79 years. Main Outcome Measures Baseline depression was defined as a Center for Epidemiological Studies Depression (CES-D) score of ≥ 16. At baseline and after 5 years, overall obesity measures included body mass index and percent body fat (measured by dual energy x-ray absorptiometry). Abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computed tomography). Results After adjustment for sociodemographics, lifestyle, diseases and overall obesity, baseline depression was associated with a 5-year increase in sagittal diameter (β=.054, p=.01) and visceral fat (β=.080, p=.001). Conclusions This study shows that depressive symptoms result in an increase in abdominal obesity, independent of overall obesity, suggesting that there may be specific pathophysiological mechanisms which link depression with visceral fat accumulation. These results might also help explain why depression increases risk of diabetes and cardiovascular disease. PMID:19047525

  9. Thoracic Insufficiency Syndrome

    Science.gov (United States)

    ... Radiation Exposure in Scoliosis Kyphosis Adolescent Back Pain Spondylolysis For Adolescents For Adults Common Questions & Glossary Resources ... Radiation Exposure in Scoliosis Kyphosis Adolescent Back Pain Spondylolysis For Adolescents For Adults Thoracic Insufficiency Syndrome (TIS) ...

  10. Self-esteem and insight as predictors of symptom change in schizophrenia: a longitudinal study.

    Science.gov (United States)

    Erickson, Molly A; Lysaker, Paul H

    2012-07-01

    Though it is known that symptom profiles in schizophrenia change throughout the course of the illness, it is not yet clear which psychological antecedents predict these changes. The purpose of the present study was to explore "level of insight into mental illness" and "self-esteem" as predictors of positive symptom change in schizophrenia patients. Fifty-seven schizophrenia patients completed assessments of self-esteem, insight into mental illness, positive symptoms and paranoia once every four weeks for a total of eight individual testing sessions. Hierarchical linear regression analysis revealed that changes in self-esteem predicted future changes in paranoia as well as positive symptoms more broadly; decreases in self-esteem at any given time point were associated with an increase in persecutory beliefs and other positive symptoms at the following assessment. On the other hand, decreases in insight were not significantly associated with paranoia or positive symptoms, either as a stable trait of the mental illness or as a predictor of change over time. Taken together, these results suggest that change in self-esteem, but not insight, has a significant and unique association with positive symptoms of schizophrenia, and may be a valuable target for future treatment.

  11. Nanotechnology in Thoracic Surgery*

    Science.gov (United States)

    Schulz, Morgan D.; Khullar, Onkar; Frangioni, John V.; Grinstaff, Mark W.; Colson, Yolonda L.

    2011-01-01

    Nanotechnology is an exciting and rapidly progressive field offering potential solutions to multiple challenges in the diagnosis and treatment of lung cancer, with the potential for improving imaging and mapping techniques, drug delivery and ablative therapy. With promising preclinical results in many applications directly applicable to thoracic oncology, it is possible that the frontiers of minimally invasive thoracic surgery will eventually be explored on a nanoscale. PMID:20494008

  12. Understanding Thoracic Outlet Syndrome

    OpenAIRE

    Freischlag, Julie; Orion, Kristine

    2014-01-01

    The diagnosis of thoracic outlet syndrome was once debated in the world of vascular surgery. Today, it is more understood and surprisingly less infrequent than once thought. Thoracic outlet syndrome (TOS) is composed of three types: neurogenic, venous, and arterial. Each type is in distinction to the others when considering patient presentation and diagnosis. Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients. Dedicated centers of e...

  13. Atypical thoracic outlet syndrome and reverse flow thromboembolism.

    Science.gov (United States)

    Bains, Robert D; Platt, Jennica; MacGregor, Daune; Borschel, Gregory H

    2014-09-01

    Thoracic outlet syndrome is rare in children but may have serious consequences. Compression of the neurovascular structures at the thoracic outlet by anomalous soft tissues or cervical ribs may cause neurological deficits in the upper limb and venous or arterial insufficiency. The symptoms and signs of this condition are well documented, but we describe two patients with an atypical presentation. We review similar published cases where delay in diagnosis resulted in cerebrovascular catastrophe. Our patients presented with relatively nonspecific central nervous system symptoms and were found to have thoracic outlet compression. Both were treated by surgical decompression of the thoracic outlet, and the symptoms completely resolved with no long-lasting neurological consequences. We highlight the importance of these rare cases because of the risk of stroke and discuss the theory behind the pathological process. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure.

    Science.gov (United States)

    Zalta, Alyson K; Gillihan, Seth J; Fisher, Aaron J; Mintz, Jim; McLean, Carmen P; Yehuda, Rachel; Foa, Edna B

    2014-02-01

    The goal of the current study was to examine mechanisms of change in prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD). Emotional processing theory of PTSD proposes that disconfirmation of erroneous cognitions associated with PTSD is a central mechanism in PTSD symptom reduction; but to date, the causal relationship between change in pathological cognitions and change in PTSD severity has not been established. Female sexual or nonsexual assault survivors (N = 64) with a primary diagnosis of PTSD received 10 weekly sessions of PE. Self-reported PTSD symptoms, depression symptoms, and PTSD-related cognitions were assessed at pretreatment, each of the 10 PE treatment sessions, and posttreatment. Lagged mixed-effect regression models indicated that session-to-session reductions in PTSD-related cognitions drove successive reductions in PTSD symptoms. By contrast, the reverse effect of PTSD symptom change on change in cognitions was smaller and did not reach statistical significance. Similarly, reductions in PTSD-related cognitions drove successive reductions in depression symptoms, whereas the reverse effect of depression symptoms on subsequent cognition change was smaller and not significant. Notably, the relationships between changes in cognitions and PTSD symptoms were stronger than the relationships between changes in cognitions and depression symptoms. To our knowledge, this is the 1st study to establish change in PTSD-related cognitions as a central mechanism of PE treatment. These findings are consistent with emotional processing theory and have important clinical implications for the effective implementation of PE. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  15. Thoracic staging with {sup 18}F-FDG PET/MR in non-small cell lung cancer - does it change therapeutic decisions in comparison to {sup 18}F-FDG PET/CT?

    Energy Technology Data Exchange (ETDEWEB)

    Schaarschmidt, Benedikt M. [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Duesseldorf (Germany); University Duisburg-Essen, Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Grueneisen, Johannes; Umutlu, Lale [University Duisburg-Essen, Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Metzenmacher, Martin [University Duisburg-Essen, Medical Faculty, Department of Medical Oncology, Essen (Germany); Gomez, Benedikt; Ruhlmann, Verena [University Duisburg-Essen, Medical Faculty, Department of Nuclear Medicine, Essen (Germany); Gauler, Thomas [University Duisburg-Essen, Medical Faculty, Radiation and Tumour Clinic, Essen (Germany); Roesel, Christian [University Duisburg-Essen, Ruhrlandklinik, Thoracic Surgery and Endoscopy, Essen (Germany); Heusch, Philipp; Antoch, Gerald; Buchbender, Christian [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Duesseldorf (Germany)

    2017-02-15

    To investigate whether differences in thoracic tumour staging between {sup 18}F-FDG PET/CT and PET/MR imaging lead to different therapeutic decisions in Non-Small Cell Lung Cancer (NSCLC). Seventy-seven NSCLC patients that underwent whole-body {sup 18}F-FDG PET/CT from the base of skull to the upper thighs and thoracic PET/MR were enrolled in this retrospective study. Thoracic PET/CT and PET/MR images were staged according to the 7th edition of the AJCC staging manual. Staging results of both modalities were discussed separately in a simulated interdisciplinary tumour board and therapeutic decisions based on both imaging modalities were recorded. Descriptive statistics were used to compare the results and reasons for changes in the therapeutic decision were investigated. Staging results differed in 35 % of patients (27 patients) between thoracic PET/CT and PET/MR. Differences were detected when assessing the T-stage in 18 % (n = 14), the N-stage in 23 % (n = 18), and the M-stage in 1 % (n = 1). However, patient therapy management was changed in only six patients (8 %). Despite the variability of thoracic {sup 18}F-FDG PET/CT and PET/MR in TNM-staging, both modalities lead to comparable therapeutic decisions in patients suffering from NSCLC. Hence, {sup 18}F-FDG PET/MR can be considered an possible alternative to {sup 18}F-FDG PET/CT for clinical NSCLC staging. (orig.)

  16. Emotionally biased cognitive processes: the weakest link predicts prospective changes in depressive symptom severity.

    Science.gov (United States)

    Everaert, Jonas; Duyck, Wouter; Koster, Ernst H W

    2015-01-01

    Emotional biases in attention, interpretation, and memory are predictive of future depressive symptoms. It remains unknown, however, how these biased cognitive processes interact to predict depressive symptom levels in the long-term. In the present study, we tested the predictive value of two integrative approaches to model relations between multiple biased cognitive processes, namely the additive (i.e., cognitive processes have a cumulative effect) vs. the weakest link (i.e., the dominant pathogenic process is important) model. We also tested whether these integrative models interacted with perceived stress to predict prospective changes in depressive symptom severity. At Time 1, participants completed measures of depressive symptom severity and emotional biases in attention, interpretation, and memory. At Time 2, one year later, participants were reassessed to determine depressive symptom levels and perceived stress. Results revealed that the weakest link model had incremental validity over the additive model in predicting prospective changes in depressive symptoms, though both models explained a significant proportion of variance in the change in depressive symptoms from Time 1 to Time 2. None of the integrative models interacted with perceived stress to predict changes in depressive symptomatology. These findings suggest that the best cognitive marker of the evolution in depressive symptoms is the cognitive process that is dominantly biased toward negative material, which operates independent from experienced stress. This highlights the importance of considering idiographic cognitive profiles with multiple cognitive processes for understanding and modifying effects of cognitive biases in depression.

  17. Psychosocial Predictors of Change in Depressive Symptoms Following Gastric Banding Surgery.

    Science.gov (United States)

    Preiss, Kymberlie; Clarke, David; O'Brien, Paul; de la Piedad Garcia, Xochitl; Hindle, Annemarie; Brennan, Leah

    2018-02-08

    The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery. Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery. Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery. Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.

  18. Change in Depressive Symptoms among Treatment-Seeking College Students Who Are Sexual Minorities

    Science.gov (United States)

    Effrig, Jessica C.; Maloch, Janelle K.; McAleavey, Andrew; Locke, Benjamin D.; Bieschke, Kathleen J.

    2014-01-01

    Changes in students' depressive symptoms during the course of treatment at college counseling centers were examined by sexual orientation. In Study 1, results showed that depressive symptoms decreased similarly across sexual orientation groups during the course of treatment. In Study 2, family support did not moderate the relationship between…

  19. Predicting Changes in Eating Disorder Symptoms among Adolescents in China: An 18-Month Prospective Study

    Science.gov (United States)

    Jackson, Todd; Chen, Hong

    2008-01-01

    This 18-month prospective study investigated factors that contributed to changes in eating disorder symptoms among adolescents living in the People's Republic of China. Five hundred forty-one Chinese middle school and high school students (182 boys, 359 girls) completed measures of eating disorder symptoms; body dissatisfaction; appearance ideal…

  20. Veterans’ PTSD Symptoms and their Partners’ Desired Changes in Key Relationship Domains

    Science.gov (United States)

    LaMotte, Adam D.; Taft, Casey T.; Reardon, Annemarie F.; Miller, Mark W.

    2015-01-01

    There is a growing literature investigating the connection between veterans’ posttraumatic stress disorder (PTSD) symptoms and intimate relationship problems. Little to no work, however, has examined the connection between veterans’ PTSD symptoms and their partners’ perceptions of specific relationship areas in need of change. We examined associations between overall PTSD symptoms and symptom cluster scores with partners’ desired changes in the areas of intimacy, shared activities, and responsibilities. The sample consisted of 249 male veterans of different service eras and their female partners. Results indicated that veterans’ PTSD symptoms were associated with greater desired changes from their partners in the veterans’ intimacy behaviors and participation in shared activities. When examining the contribution of each symptom cluster individually, only the veterans’ emotional numbing symptoms emerged as a significant unique predictor and were associated with partners’ desired changes in intimacy. The findings suggest that intimacy and shared activities may be relevant areas to address in PTSD treatment for veterans and their partners, and highlight the particular significance of emotional numbing symptoms to intimacy in veterans’ relationships. PMID:26010109

  1. Change in Autism Symptoms and Maladaptive Behaviors in Adolescents and Adults with an Autism Spectrum Disorder

    Science.gov (United States)

    Shattuck, Paul T.; Seltzer, Marsha Mailick; Greenberg, Jan S.; Orsmond, Gael I.; Bolt, Daniel; Kring, Sheilah; Lounds, Julie; Lord, Catherine

    2007-01-01

    This study examined change prospectively in autism symptoms and maladaptive behaviors during a 4.5 year period in 241 adolescents and adults with an autism spectrum disorder who were 10-52 years old (mean=22.0) when the study began. Although many individuals' symptoms remained stable, a greater proportion of the sample experienced declines than…

  2. Heterogeneity in development of aspects of working memory predicts longitudinal attention deficit hyperactivity disorder symptom change.

    Science.gov (United States)

    Karalunas, Sarah L; Gustafsson, Hanna C; Dieckmann, Nathan F; Tipsord, Jessica; Mitchell, Suzanne H; Nigg, Joel T

    2017-08-01

    The role of cognitive mechanisms in the clinical course of neurodevelopmental disorders is poorly understood. Attention Deficit Hyperactivity Disorder (ADHD) is emblematic in that numerous alterations in cognitive development are apparent, yet how they relate to changes in symptom expression with age is unclear. To resolve the role of cognitive mechanisms in ADHD, a developmental perspective that takes into account expected within-group heterogeneity is needed. The current study uses an accelerated longitudinal design and latent trajectory growth mixture models in a sample of children ages 7-13 years carefully characterized as with (n = 437) and without (n = 297) ADHD to (a) identify heterogeneous developmental trajectories for response inhibition, visual spatial working memory maintenance, and delayed reward discounting and (b) to assess the relationships between these cognitive trajectories and ADHD symptom change. Best-fitting models indicated multiple trajectory classes in both the ADHD and typically developing samples, as well as distinct relationships between each cognitive process and ADHD symptom change. Developmental change in response inhibition and delayed reward discounting were unrelated to ADHD symptom change, while individual differences in the rate of visual spatial working memory maintenance improvement predicted symptom remission in ADHD. Characterizing heterogeneity in cognitive development will be crucial for clarifying mechanisms of symptom persistence and recovery. Results here suggest working memory maintenance may be uniquely related to ADHD symptom improvement. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  3. Changes in physical activity, self-efficacy and depressive symptoms in adolescent girls.

    Science.gov (United States)

    Neissaar, Inga; Raudsepp, Lennart

    2011-08-01

    The purpose of this study was to examine the longitudinal relationships between naturally occurring changes in leisure-time physical activity, depressive symptoms and self-efficacy in adolescent girls. We also aimed to test whether depressive symptoms would moderate the self-efficacy-physical activity relationship. Participants were 181 urban adolescent girls. Physical activity was measured using the 3-Day Physical Activity Recall. Self-efficacy and depressive symptoms were assessed using questionnaires. Body height and body mass were measured and body mass index (BMI) was calculated. Data were collected on three occasions over a 2-year period. There was a decrease in physical activity and self-efficacy and increase in depressive symptoms across three measurement occasions. There were statistically significant and negative relationships between initial level and change for physical activity and depressive symptoms. Initially higher levels of physical activity were related with initially lower levels of depressive symptoms, and change in physical activity across time was inversely associated with change in levels of depressive symptoms across measurements. There were statistically significant and positive relationships between initial level and change for physical activity and self-efficacy after controlling effect of BMI. Latent growth modeling (LGM) also indicated a moderating effect of depressive symptoms on the self-efficacy-physical activity relationship. Girls who had high initial levels of self-efficacy and smaller increases in depressive symptoms had the lowest decline in physical activity participation. Our results encourage the design of interventions that reduce depressive symptoms and increase self-efficacy as a possible of means of increasing adolescent girls' physical activity.

  4. Chiari Malformation: Symptoms

    Science.gov (United States)

    ... hearing, vomiting, double vision, vision loss, blackouts, apnea, vertigo, loss of peripheral vision, nystagmus, earache, snoring, thoracic pain, hypotension, wake up choking, leg pain, palpitations, hypertension, gag reflex, and face pain/tingling. Symptom Headache ...

  5. Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes

    DEFF Research Database (Denmark)

    Verdelho, Ana; Madureira, Sofia; Moleiro, Carla

    2013-01-01

    Depressive symptoms (DS) have been associated with increased risk of cognitive decline. Our aim was to evaluate the longitudinal influence of DS on cognition in independent older people, accounting for the severity of white matter changes (WMC)....

  6. Measuring negative symptom change in schizophrenia: considering alternatives to self-report.

    Science.gov (United States)

    Gupta, Maya; Holshausen, Katherine; Gou, Lisa; Bowie, Christopher

    2014-08-01

    Treatment of negative symptoms in schizophrenia is a priority, but is approaching stagnation, due in part to the methods used to assess change in these symptoms. Traditional methods for assessing negative symptoms employ subjective self-report and/or clinician-rated scales, both of which are contaminated by considerable measurement error. The purpose of this article is to highlight the limitations in current assessment measures for negative symptoms and discuss the advantages of quantitative objective measurement, particularly in the context of clinical trial research. Recent research from psychology, neuroscience and computer technology has produced objective quantitative measures such as facial analysis and virtual reality that are more precise and sensitive to change; these objective measures are poised to revolutionize the measurement of this critical symptom.

  7. Catastrophic Misinterpretations as a Predictor of Symptom Change during Treatment for Panic Disorder

    Science.gov (United States)

    Teachman, Bethany A.; Marker, Craig D.; Clerkin, Elise M.

    2010-01-01

    Objective: Cognitive models of panic disorder suggest that change in catastrophic misinterpretations of bodily sensations will predict symptom reduction. To examine change processes, we used a repeated measures design to evaluate whether the trajectory of change in misinterpretations over the course of 12-week cognitive behavior therapy is related…

  8. Implant Strategy-Specific Changes in Symptoms in Response to Left Ventricular Assist Devices.

    Science.gov (United States)

    Lee, Christopher S; Gelow, Jill M; Chien, Christopher V; Hiatt, Shirin O; Bidwell, Julie T; Denfeld, Quin E; Grady, Kathleen L; Mudd, James O

    Although we know that the quality of life generally improves after left ventricular assist device (LVAD) implantation, we know little about how symptoms change in response to LVAD. The purpose of this study was to compare the changes in symptoms between bridge and destination therapy patients as part of a prospective cohort study. Physical (dyspnea and wake disturbances) and affective symptoms (depression and anxiety) were measured before LVAD and at 1, 3, and 6 months after LVAD. Multiphase growth modeling was used to capture the 2 major phases of change: initial improvements between preimplant and 1 month after LVAD and subsequent improvements between 1 and 6 months after LVAD. The sample included 64 bridge and 22 destination therapy patients as the preimplant strategy. Destination patients had worse preimplant dyspnea and wake disturbances, and they experienced greater initial improvements in these symptoms compared with bridge patients (all P .05). Destination patients had worse preimplant depression (P = .042) but experienced similar initial and subsequent improvements in depression in response to LVAD compared with bridge patients (both P > .05). Destination patients had similar preimplant anxiety (P = .279) but experienced less initial and greater subsequent improvements in anxiety after LVAD compared with bridge patients (both P < .05). There are many differences in the magnitude and timing of change in symptom responses to LVAD between bridge and destination therapy patients. Detailed information on changes in specific symptoms may better inform shared decision-making regarding LVAD.

  9. [Effect of group psychotherapy on changes in symptoms and personality traits in patients with anxiety syndromes].

    Science.gov (United States)

    Kamiński, R

    2001-01-01

    Psychotherapy remains the most efficient form of treatment in neurotic and personality disorders. It is a process whereby the therapist can influence and change the patient's personality. As a result, patients are able to better understand their experiences and behavior and are given a chance to be freed from symptoms. The goal of the present study was to establish the relationship between group psychotherapy and specific symptom clusters, and to follow changes in the personality structure of patients of both genders diagnosed according to ICD-10 classification. The Symptoms Questionnaire and the Personality Factor test were used to determine the severity of symptoms and study personality traits. The study group consisted of 115 patients (76 women and 39 men) with neurotic or personality disorders, participating in group therapy at the Day Care Unit of the Department of Psychiatry, Pomeranian Academy of Medicine in Szczecin between 1992 and 1998. Four groups were formed depending on the diagnosis according to ICD-10 classification: anxiety disorders--F41; somatic disorders--F45; neurotic disorders--F48; and personality disorders--F60 (Table 1). Treatment started and ended with a CV Questionnaire, Symptoms Questionnaire and Personality Factor test. Group psychotherapy was in the open form and the duration of treatment was 12 weeks with 2 sessions per day. In order to detect any improvement in mental health and symptoms, patients were given the Symptoms Questionnaire on a weekly basis. Statistics were done with the SPSS software package. It was found that the global intensity of symptoms before treatment was highest in patients with somatic form of the disorder. In this group after therapy, the intensity of symptoms was lowest, probably because of conversion of primary to secondary anxiety. A considerable decrease in the intensity of symptoms may also be explained by stronger motivation of these patients to benefit from therapy because of their severe symptoms. A

  10. Society of Thoracic Surgeons

    Science.gov (United States)

    ... Society of Thoracic Surgeons Facebook Twitter LinkedIn YouTube Instagram Flickr About STS Governance and Leadership Bylaws Policies ... Tweets by @STS_CTsurgery Facebook Twitter LinkedIn YouTube Instagram Flickr Footer menu Home Contact Us CT Surgery ...

  11. Nomothetic and idiographic symptom change trajectories in acute-phase cognitive therapy for recurrent depression.

    Science.gov (United States)

    Vittengl, Jeffrey R; Clark, Lee Anna; Thase, Michael E; Jarrett, Robin B

    2013-08-01

    We tested nomothetic and idiographic convergence and change in 3 symptom measures during acute-phase cognitive therapy (CT) for depression and compared outcomes among patients showing different change patterns. Outpatients (N = 362; 69% women; 85% White; age M = 43 years) with recurrent major depressive disorder according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) completed the Hamilton Rating Scale for Depression (Hamilton, 1960), Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), and Inventory for Depressive Symptomatology-Self-Report (Rush, Gullion, Basco, Jarrett, & Trivedi, 1996) on 14 occasions as well as pre/post-CT measures of social-interpersonal functioning and negative cognitive content. The 3 symptom measures marked the same severity and change constructs, and we offer improved formulas for intermeasure score conversions via their common factor. Pre/post-CT symptom reductions were large (ds = 1.71-1.92), and nomothetic symptom curves were log-linear (larger improvements earlier and smaller improvements later in CT). Nonetheless, only 30% of individual patients showed clear log-linear changes, whereas other patients showed linear (e.g., steady decreases; 20%), 1-step (e.g., a quick drop; 16%), and unclassified (34%) patterns. Log-linear, linear, and 1-step patients were generally similar to one another and superior to unclassified patients post-CT in symptom levels, response and stable remission rates, social-interpersonal functioning, and cognitive content (median d = 0.69). Reaching a low-symptom "destination" at the end of CT via any coherent "path" is more important in the short term than which path patients take. We discuss implications for theories of change, clinical monitoring of individuals' progress in CT, and the need to investigate long-term outcomes of patients with differing patterns of symptom change. PsycINFO Database Record

  12. variations in dimensions and shape of thoracic cage with aging

    African Journals Online (AJOL)

    ABSTRACT. The thoracic cage variations in dimensions and proportions are influenced by age, sex and race. The objective of the present review was to describe the age related changes occurring in thoracic wall and its influence on the pattern of respiration in infants, adult and elderly. We had systematically reviewed, ...

  13. Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision.

    Science.gov (United States)

    Khurana, A; Brousil, J; Russo, A; Evans, A; Quraishi, N A; Boszczyk, Bronek M

    2013-09-01

    Thoracic cerebrospinal fluid (CSF) hygroma is a rare and potentially devastating complication of the anterior thoracic approach to the spine. We present two cases in which this complication resulted in acute cranial nerve palsy and discuss the pathoanatomy and management options in this scenario. Two male patients presented to our department with neurological deterioration due to a giant herniated thoracic disc. The extruded disc fragment was noted pre-operatively to be calcified in both patients. A durotomy was performed at primary disc prolapse resection in the first patient, whereas an incidental durotomy during the procedure caused complication in the second patient. These were repaired primarily or sealed with Tachosil(®). Both patients re-presented with acute diplopia. Imaging of both patients confirmed a massive thoracic cerebrospinal fluid hygroma and evidence of intracranial changes in keeping with intracranial hypotension, but no obvious brain stem shift. The hemithorax was re-explored and the dural repair was revised. The first patient made a full recovery within 3 months. The second patient was managed conservatively and took 5 months for improvement in his ophthalmic symptoms. The risk of CSF leakage post-dural repair into the thoracic cavity is raised due to local factors related to the chest cavity. Dural repairs can fail in the presence of an acute increase in CSF pressure, for example whilst sneezing. Intracranial hypotension can result in subsequent hygroma and possibly haematoma formation. The resultant cranial nerve palsy may be managed expectantly except in the setting of symptomatic subdural haematoma or compressive pneumocephaly.

  14. Does change in definition of psychotic symptoms in diagnosis of schizophrenia in DSM-5 affect caseness?

    Science.gov (United States)

    Tandon, Rajiv; Bruijnzeel, Dawn; Rankupalli, Babu

    2013-08-01

    Psychotic symptoms are a central element in the diagnosis of schizophrenia, although their precise definition has varied through the multiple iterations of DSM and the ICD. Schneiderian first-rank symptoms (FRS) have received a particularly prominent position in the diagnostic criteria of schizophrenia since ICD-9 and DSM-III. In the current iteration of DSM (DSM-IV-TR), whereas two characteristic symptoms are ordinarily required to meet criterion A, only a single symptom is necessary if the psychotic symptom happens to be a FRS, notably a bizarre delusion or auditory hallucination of a running commentary or 'conversing voices'. Because of limited data in support of the special treatment of FRS, DSM-5 has made changes to criterion A, requiring that at least two psychotic symptoms be present in all cases with at least one of these symptoms being a delusion, hallucination, or disorganized speech. To assess the impact of these changes on the prevalence of schizophrenia, we examined a research dataset of 221 individuals with DSM-IV schizophrenia to study the prevalence and co-occurrence of various criterion A symptoms. Although bizarre delusions and/or Schneiderian hallucinations were present in 124 patients (56.1%), they were singly determinative of diagnosis in only one patient (0.46%). Additionally, only three of the 221 patients (1.4%) with DSM-IV schizophrenia did not have a delusion, hallucination, or disorganized speech. DSM-5 changes in criteria A should have a negligible effect on the prevalence of schizophrenia, with over 98% of individuals with DSM-IV schizophrenia continuing to receive a DSM-5 diagnosis of schizophrenia in this dataset. Copyright © 2013 Elsevier B.V. All rights reserved.

  15. The impact of accepting biological changes during adolescence on the severity of depression symptoms

    Directory of Open Access Journals (Sweden)

    Radziwiłłowicz Wioletta

    2016-12-01

    Full Text Available The aim of the study was to establish whether any relation exists between depression symptoms and the extent to which adolescents accept the changes their bodies undergo (the physical changes they experience at different stages of growing up, and if the connection does exist - is it gender-related. Method: Data were collected from four sub-groups: younger girls (aged 12-13, older girls (aged 17-18, younger boys (aged 12-13, and older boys (aged 17-18. The participants were asked to complete questionnaires that allow to measure the subjective intensity of depression symptoms (BDI, the current stage of biological changes (the Tanner scale and whether these changes are accepted by the individual who experiences them (the original Feelings Towards the Body questionnaire. Results: The less adolescents accept the changes in their bodies, the higher depression symptoms they demonstrate. For younger girls, older girls and older boys, no links were established between levels of accepting bodily changes and early/late maturation (in comparison with the population of their peers. For younger boys, the later the stage of their development, the less likely they are to accept the changes in their bodies. Girls report more intense depression symptoms than boys do, but their levels of accepting changes that occur around puberty are significantly lower only when compared to those of older boys. Conclusions: Whether biological changes during puberty (mainly feelings of anxiety and shame related to the body are accepted or not, was proven to be a significant predictor of more intense depression symptoms.

  16. Mood changes after indoor tanning among college women: associations with psychiatric/addictive symptoms

    Directory of Open Access Journals (Sweden)

    Carolyn Heckman

    2016-06-01

    Full Text Available Indoor tanning (IT has been linked with psychiatric and addictive symptoms, and frequent tanning may indicate tanning dependence (addiction. The current study evaluated the effects of an IT episode on mood states and the association of these effects with psychiatric and addictive symptoms among young adult female indoor tanners. One-hundred thirty-nine female university students aged 18-25 years who had indoor tanned completed an online survey including the Positive and Negative Affects Scales and a standardized psychiatric interview (the MINI International Neuropsychiatric Interview via telephone. Psychiatric and addictive symptoms were relatively common among these young adult female indoor tanners. Overall, participants reported significant decreases in both negative (upset, scared, irritable, nervous, jittery, afraid and positive (feeling interested mood states after their most recent tanning episode. Multivariable linear regression analyses showed that more frequent indoor tanning in the past month and symptoms of illicit drug use disorders were associated with decreases in negative mood, and symptoms of generalized anxiety disorder were associated with a decrease in feeling interested. In summary, indoor tanners report relatively high rates of psychiatric and substance use symptoms, including symptoms of tanning dependence, and indoor tanning appears to alter mood. Women with certain substance use and psychiatric characteristics may be more vulnerable to such mood changes after tanning indoors. Further research is needed to clarify the relationships among these variables.

  17. Affective symptoms and change in diabetes self-efficacy and glycaemic control

    Science.gov (United States)

    Robertson, S. M.; Amspoker, A. B.; Cully, J. A.; Ross, E. L.; Naik, A. D.

    2013-01-01

    Aims To examine the role of baseline depression, anxiety and stress symptoms on post-intervention diabetes self-efficacy and glycaemic control (HbA1c). Methods The current study analysed data from patients (n = 85) with treated but uncontrolled Type 2 diabetes who participated in a comparative effectiveness study of two diabetes self-management interventions. Hierarchical linear regression was used to examine the relationships between baseline affective symptoms and post-intervention diabetes self-efficacy and the moderating effects of baseline affective symptoms on the relationship between changes in diabetes self-efficacy and post-intervention HbA1c. Results Baseline depression was inversely associated with post-intervention diabetes self-efficacy (P = 0.0001) after adjusting for baseline characteristics including diabetes self-efficacy. In contrast, normal–mild levels of stress were associated with higher post-intervention diabetes self-efficacy (P = 0.04). Anxiety and stress symptoms significantly and independently moderated the relationship between changes in diabetes self-efficacy and post-intervention HbA1c (P = 0.02 and P = 0.03, respectively). Further evaluation of these interactions demonstrated that changes in diabetes self-efficacy were associated with lower post-intervention HbA1c, but only among those with higher baseline affective symptoms. Conclusions We found a moderating effect across affective symptoms on the relationship between diabetes self-efficacy changes and post-intervention HbA1c in the context of a self-management intervention. Results suggest that patients with poorly controlled diabetes who have higher levels of depression, anxiety and stress symptoms may derive greater benefits from self-management interventions known to improve diabetes self-efficacy. PMID:23350920

  18. Stability and Change in Personality Disorder Symptoms in 1-Year Follow-up of Depressed Adolescent Outpatients.

    Science.gov (United States)

    Strandholm, Thea; Kiviruusu, Olli; Karlsson, Linnea; Pankakoski, Maiju; Pelkonen, Mirjami; Marttunen, Mauri

    2017-01-01

    We investigated stability and change in personality disorder (PD) symptoms and whether depression severity, comorbid clinical psychiatric disorders, and social support predict changes in personality pathology among adolescent outpatients. The 1-year outcome of PD symptoms among consecutive adolescent psychiatric outpatients with depressive disorders (N = 189) was investigated with symptom count of depression, comorbid psychiatric disorders, and perceived social support as predictors. An overall decrease in PD symptoms in most PD categories was observed. Decreases in depression severity and in number of comorbid diagnoses correlated positively with decreases in PD symptoms of most PD categories. Social support from close friends predicted a decrease in schizotypal and narcissistic, whereas support from family predicted a decrease in paranoid symptoms. Our results suggest that among depressed adolescent outpatients, PD symptoms are relatively unstable, changes co-occuring with changes/improvement in overall psychopathology. Social support seems a possibly effective point for intervention efforts regarding positive outcome of PD symptoms.

  19. The Association Between Insomnia Symptoms and Mood Changes During Exercise Among Patients Enrolled in Cardiac Rehabilitation.

    Science.gov (United States)

    Rouleau, Codie R; Horsley, Kristin J; Morse, Erin; Aggarwal, Sandeep; Bacon, Simon L; Campbell, Tavis S

    2015-01-01

    Insomnia symptoms (ie, difficulty falling asleep, difficulty staying asleep, and early awakenings) are common among patients with cardiovascular disease and may interfere with the beneficial impact of exercise on mood state. This study investigated the association of insomnia symptom severity with mood disturbance and with changes in mood state during exercise in a cardiac rehabilitation (CR) population. Insomnia symptom severity was measured using the Insomnia Severity Index upon admission to a 12-week CR program (n = 57). The Physical Activity Affect Scale was administered before and during a single bout of moderate intensity exercise to measure changes in mood state. Indices of mood disturbance included depressive symptoms (Hospital Anxiety and Depression Scale) and pre-exercise mood state (Physical Activity Affect Scale). Greater severity of insomnia symptoms was associated with less pleasant mood overall (r = -0.45, P mood state (b = 0.26, standard error = 0.10, P = .009) and tranquility (b = 0.09, standard error = 0.04, P = .04), following statistical adjustment for demographic variables and pre-exercise mood state. Although CR patients reporting insomnia symptoms tend to experience daytime mood disturbance, they may benefit from mood-elevating properties of exercise. Future research is needed to help optimize mood during exercise, which may have implications for improving psychological distress and CR adherence.

  20. TU-G-BRA-04: Changes in Regional Lung Function Measured by 4D-CT Ventilation Imaging for Thoracic Radiotherapy

    International Nuclear Information System (INIS)

    Nakajima, Y; Kadoya, N; Kabus, S; Loo, B; Keall, P; Yamamoto, T

    2015-01-01

    Purpose: To test the hypothesis: 4D-CT ventilation imaging can show the known effects of radiotherapy on lung function: (1) radiation-induced ventilation reductions, and (2) ventilation increases caused by tumor regression. Methods: Repeat 4D-CT scans (pre-, mid- and/or post-treatment) were acquired prospectively for 11 thoracic cancer patients in an IRB-approved clinical trial. A ventilation image for each time point was created using deformable image registration and the Hounsfield unit (HU)-based or Jacobian-based metric. The 11 patients were divided into two subgroups based on tumor volume reduction using a threshold of 5 cm 3 . To quantify radiation-induced ventilation reduction, six patients who showed a small tumor volume reduction (<5 cm 3 ) were analyzed for dose-response relationships. To investigate ventilation increase caused by tumor regression, two of the other five patients were analyzed to compare ventilation changes in the lung lobes affected and unaffected by the tumor. The remaining three patients were excluded because there were no unaffected lobes. Results: Dose-dependent reductions of HU-based ventilation were observed in a majority of the patient-specific dose-response curves and in the population-based dose-response curve, whereas no clear relationship was seen for Jacobian-based ventilation. The post-treatment population-based dose-response curve of HU-based ventilation demonstrated the average ventilation reductions of 20.9±7.0% at 35–40 Gy (equivalent dose in 2-Gy fractions, EQD2), and 40.6±22.9% at 75–80 Gy EQD2. Remarkable ventilation increases in the affected lobes were observed for the two patients who showed an average tumor volume reduction of 37.1 cm 3 and re-opening airways. The mid-treatment increase in HU-based ventilation of patient 3 was 100.4% in the affected lobes, which was considerably greater than 7.8% in the unaffected lobes. Conclusion: This study has demonstrated that 4D-CT ventilation imaging shows the known

  1. The associations of anxiety and depression symptoms with weight change and incident obesity: The HUNT Study.

    Science.gov (United States)

    Brumpton, B; Langhammer, A; Romundstad, P; Chen, Y; Mai, X-M

    2013-09-01

    To investigate the associations of anxiety and depression symptoms with weight change and incident obesity in men and women. We conducted a prospective cohort study using the Norwegian Nord-Trøndelag Health Study (HUNT). The study cohort included 25 180 men and women, 19-55 years of age from the second survey of the HUNT (1995-1997). Anxiety and depression symptoms were measured using the Hospital Anxiety and Depression Scale. Weight change was determined for the study period of an average 11 years. Incident obesity was new-onset obesity classified as having a body mass index of 30.0 kg m(2) at follow-up. The associations of anxiety or depression with weight change in kilograms (kg) was estimated using linear regression models. Risk ratios (RRs) for incident obesity associated with anxiety or depression were estimated using log-binomial regression. In men, any anxiety or depression was associated with an average 0.81 kg (95% confidence interval (CI) 0.27-1.34) larger weight change after 11 years compared with those without such symptoms (mean weight change: 5.04 versus 4.24 kg). Women with any anxiety or depression had an average 0.98 kg (95% confidence interval (CI) 0.49-1.47) larger weight change compared with those without such symptoms (mean weight change: 5.02 versus 4.04 kg). Participants with any anxiety or depression had a significantly elevated cumulative incidence of obesity (men: RR 1.37, 95% CI 1.13-1.65; women: RR 1.18, 95% CI 1.00-1.40). We found that symptoms of anxiety and depression were associated with larger weight change and an increased cumulative incidence of obesity in both men and women.

  2. Non-specific symptoms as clues to changes in emotional well-being

    Directory of Open Access Journals (Sweden)

    Blumberg Gari

    2011-07-01

    Full Text Available Abstract Background - Somatic symptoms are a common reason for visits to the family physician. The aim of this study was to examine the relation between non-specific symptoms and changes in emotional well-being and the degree to which the physician considers the possibility of mental distress when faced with such patients. Methods - Patients who complained of two or more symptoms including headache, dizziness, fatigue or weakness, palpitations and sleep disorders over one year were identified from the medical records of a random sample of 45 primary care physicians. A control group matched for gender and age was selected from the same population. Emotional well-being was assessed using the MOS-SF 36 in both groups. Results - The study group and the control group each contained 110 patients. Completed MOS questionnaires were obtained from 92 patients, 48 patients with somatic symptoms and 44 controls. Sixty percent of the patients with somatic symptoms experienced decreased emotional well being compared to 25% in the control group (p = 0.00005. Symptoms of dizziness, fatigue and sleep disturbances were significantly linked with mental health impairments. Primary care physicians identified only 6 of 29 patients (21% whose responses revealed functional limitations due to emotional problems as suffering from an emotional disorder and only 6 of 23 patients (26% with a lack of emotional well being were diagnosed with an emotional disorder. Conclusions - Non-specific somatic symptoms may be clues to changes in emotional well-being. Improved recognition and recording of mental distress among patients who complain of these symptoms may enable better follow up and treatment.

  3. Concurrent Trajectories of Change in Adolescent and Maternal Depressive Symptoms in the TORDIA Study

    Science.gov (United States)

    Esposito-Smythers, Christianne; Curby, Timothy W.; Renshaw, Keith D.

    2013-01-01

    Depression has a heightened prevalence in adolescence, with approximately 15 % of adolescents experiencing a major depressive episode by age 18. Depression in adolescence also poses a risk for future distress and impairment. Despite treatment advances, many adolescents relapse after initial remission. Family context may be an important factor in the developmental trajectory of adolescent depression, and thus in enhancing treatment. This study examined concurrent change over time in adolescent and maternal depressive symptoms in the context of the Treatment of Resistant Depression in Adolescents study. Participants were 334 adolescents (mean age: 16; SD: 1.6; 70 % female, 84 % Caucasian), and their mothers (n = 241). All adolescents were clinically depressed when they entered the study and had received previous selective serotonin reuptake inhibitor (SSRI) treatment. Adolescents received acute treatment for 12 weeks and additional treatment for 12 more weeks. Adolescent depression and suicidal ideation were assessed at 0, 6, 12, 24, 48 and 72 weeks, while maternal depressive symptoms were assessed at 0, 12, 24, 48 and 72 weeks. Latent basis growth curve analyses showed a significant correlation over 72 weeks between trajectories of maternal and adolescent depressive symptoms, supporting the hypothesis of concurrent patterns of change in these variables. The trajectories were correlated more strongly in a subsample that included only dyads in which mothers reported at least one depressive symptom at baseline. Results did not show a correlation between trajectories of maternal depressive symptoms and adolescent suicidal ideation. These findings suggest that adolescent and maternal depressive symptoms change in tandem, and that treatment for adolescent depression can benefit the wider family system. Notably, most mothers in this sample had subclinical depressive symptoms. Future research might explore these trajectories in dyads with more severely depressed mothers

  4. Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

    Science.gov (United States)

    Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

    2014-06-01

    Case report. Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

  5. The nature and correlates of change in depressive symptoms with cancer diagnosis: reaction and adaptation.

    Science.gov (United States)

    Infurna, Frank J; Gerstorf, Denis; Ram, Nilam

    2013-06-01

    Major life events trigger change processes in mental health. We examined how depressive symptoms change in conjunction with cancer diagnosis during adulthood and old age, and whether sociodemographic variables, cognitive and health resources, and cancer-specific mortality risks moderate event-related reaction and adaptation. Specifically, we applied multiphase growth models to prospective longitudinal data from 2,848 participants (age at diagnosis: M = 69, SD = 9.91; 46% women) in the Health and Retirement Study (HRS) who reported receiving a cancer diagnosis while enrolled in the study. On average, individuals experienced a significant increase in depressive symptoms within 2 years of cancer diagnosis, still-elevated levels 2 years postdiagnosis, and smaller increases in depressive symptoms postdiagnosis relative to the increases observed prediagnosis. Better memory and lower cancer-specific mortality risks were protective against increases in depressive symptoms within 2 years of diagnosis and were associated with reporting fewer depressive symptoms 2 years postdiagnosis. Findings suggest that diagnosis-related changes in depressive symptoms are typically characterized by a multiphase pattern, but tremendous between-person differences also emerged within each phase. Follow-up analyses comparing a matched group (N = 2,272) who did not experience cancer provided an additional layer of evidence supporting our inferences. Results indicate that, on average, people adapt and adjust to the challenges accompanying a cancer diagnosis, and illustrate the utility of using natural experiments such as major life events as a paradigm for studying developmental change processes. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  6. Narrative Changes Predict a Decrease in Symptoms in CBT for Depression: An Exploratory Study.

    Science.gov (United States)

    Gonçalves, Miguel M; Silva, Joana Ribeiro; Mendes, Inês; Rosa, Catarina; Ribeiro, António P; Batista, João; Sousa, Inês; Fernandes, Carlos F

    2017-07-01

    Innovative moments (IMs) are new and more adjusted ways of thinking, acting, feeling and relating that emerge during psychotherapy. Previous research on IMs has provided sustainable evidence that IMs differentiate recovered from unchanged psychotherapy cases. However, studies with cognitive behavioural therapy (CBT) are so far absent. The present study tests whether IMs can be reliably identified in CBT and examines if IMs and symptoms' improvement are associated. The following variables were assessed in each session from a sample of six cases of CBT for depression (a total of 111 sessions): (a) symptomatology outcomes (Outcome Questionnaire-OQ-10) and (b) IMs. Two hierarchical linear models were used: one to test whether IMs predicted a symptom decrease in the next session and a second one to test whether symptoms in one session predicted the emergence of IMs in the next session. Innovative moments were better predictors of symptom decrease than the reverse. A higher proportion of a specific type of IMs-reflection 2-in one session predicted a decrease in symptoms in the next session. Thus, when clients further elaborated this type of IM (in which clients describe positive contrasts or elaborate on changes processes), a reduction in symptoms was observed in the next session. A higher expression and elaboration of reflection 2 IMs appear to have a facilitative function in the reduction of depressive symptoms in this sample of CBT. Copyright © 2016 John Wiley & Sons, Ltd. Elaborating innovative moments (IMs) that are new ways of thinking, feeling, behaving and relating, in the therapeutic dialogue, may facilitate change. IMs that are more predictive of amelioration of symptoms in CBT are the ones focused on contrasts between former problematic patterns and new adjusted ones; and the ones in which the clients elaborate on processes of change. Therapists may integrate these kinds of questions (centred on contrasts and centred on what allowed change from the client

  7. Neurometabolic changes in the acute phase after sports concussions correlate with symptom severity.

    Science.gov (United States)

    Henry, Luke C; Tremblay, Sébastien; Boulanger, Yvan; Ellemberg, Dave; Lassonde, Maryse

    2010-01-01

    Sports concussion is a major problem that affects thousands of people in North America every year. Despite negative neuroimaging findings, many athletes display neurophysiological alterations and post-concussion symptoms such as headaches and sensitivity to light and noise. It is suspected that neurometabolic changes may underlie these changes. In this study we investigated the effects of sports concussion on brain metabolism using (1)H-MR spectroscopy by comparing a group of 12 non-concussed athletes with a group of 12 concussed athletes of the same age (mean 22.5 years) and education (mean 16 years). All athletes were scanned 1-6 days post-concussion in a 3T Siemens MRI, and were administered a symptom scale to evaluate post-concussion symptomatology. Participants also completed a neuropsychological test battery to assess verbal memory, visual memory, information processing speed, and reaction time, and no group differences were detected relative to controls. Concussed athletes showed a higher number of symptoms than non-concussed athletes, and they also showed a significant decrease in glutamate in the primary motor cortex (M1), as well as significant decreases in N-acetylaspartate in the prefrontal and primary motor cortices. No changes were observed in the hippocampus. Furthermore, the metabolic changes in M1 correlated with self-reported symptom severity despite equivalent neuropsychological performance. These results confirm cortical neurometabolic changes in the acute post-concussion phase, and demonstrate for the first time a correlation between subjective self-reported symptoms and objective physical changes that may be related to increased vulnerability of the concussed brain.

  8. Insight change in psychosis : relationship with neurocognition, social cognition, clinical symptoms and phase of illness

    NARCIS (Netherlands)

    Quee, P. J.; van der Meer, L.; Krabbendam, L.; de Haan, L.; Cahn, W.; Wiersma, D.; van Beveren, N.; Pijnenborg, G. H. M.; Mulder, C. L.; Bruggeman, R.; Aleman, A.

    Objective: Impaired insight is an important and prevalent symptom of psychosis. It remains unclear whether cognitive disturbances hamper improvements in insight. We investigated the neurocognitive, social cognitive, and clinical correlates of changes in insight. Method: One hundred and fifty-four

  9. Perceived Demands of Social Change and Depressive Symptoms in Adolescents from Different Educational Tracks

    Science.gov (United States)

    Pinquart, Martin; Silbereisen, Rainer K.; Grümer, Sebastian

    2014-01-01

    We analyzed whether perceived demands associated with social change and coping with these demands are related to depressive symptoms in German adolescents from the highest versus middle/lowest educational track. Demands reflected an increase in uncertainty (e.g., risk for getting no job). Adolescents on the highest educational track perceived…

  10. Insight change in psychosis: relationship with neurocognition, social cognition, clinical symptoms and phase of illness

    NARCIS (Netherlands)

    Quee, P. J.; Van der Meer, L.; Krabbendam, L.; de Haan, L.; Cahn, W.; Wiersma, D.; van Beveren, N.; Pijnenborg, G. H. M.; Mulder, C. L.; Bruggeman, R.; Aleman, A.

    2014-01-01

    Objective: Impaired insight is an important and prevalent symptom of psychosis. It remains unclear whether cognitive disturbances hamper improvements in insight. We investigated the neurocognitive, social cognitive, and clinical correlates of changes in insight. Method: One hundred and fifty-four

  11. [Hypothyroidism associated to menopause symptoms worsening change with thyroid substitution therapy].

    Science.gov (United States)

    Hernández Valencia, Marcelino; Córdova Pérez, Nydia; Zárate, Arturo; Basurto, Lourdes; Manuel Apolinar, Leticia; Ruiz, Miriam; Vargas, Carlos; Vargas, Antonio

    2008-10-01

    Hypothyroidism is more frequent in woman and raises with age. It is not clear why do they have greater susceptibility, but it seems to be related with levels of estrogens and hormonal changes. To evaluate changes in symptoms of women with menopause and hypothyroidism after receiving hypothyroidism therapy and later hormonal therapy. Longitudinal, descriptive and comparative study. Two groups were formed: one with 27 patients with hypothyroidism diagnoses and menopause, and the other with 27 menopausal patients matched by age. Appraisal criterion of hormonal therapy efficacy was Greene scale. Levotiroxine was employed as hypothyroidism therapy, at doses required to get euthyroidism in each patient. Basal climacteric symptoms' intensity was higher in patients with menopause and hypothyroidism, which decrease significantly (p changes in thyroid function can be associated to changes in estrogens concentrations, and therefore in direct relation to TRH neurohormone (thyroid releasing hormones).

  12. Do symptom-specific stages of change predict eating disorder treatment outcome?

    Science.gov (United States)

    Ackard, Diann M; Cronemeyer, Catherine L; Richter, Sara; Egan, Amber

    2015-03-01

    Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome. Participants [N = 182; age 13-58 years; 92% Caucasian; 96% female; average BMI 21.7 (SD = 5.9); 50% ED not otherwise specified (EDNOS), 30.8% bulimia nervosa (BN), 19.2% anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal-Wallis (continuous) and χ (2) (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome. At intake assessment, 53.3% of AN, 34.0% of BN and 18.1% of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8%) and vomiting (56.5%). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up. Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages

  13. Identifying Latent Trajectories of Personality Disorder Symptom Change: Growth Mixture Modeling in the Longitudinal Study of Personality Disorders

    Science.gov (United States)

    Hallquist, Michael N.; Lenzenweger, Mark F.

    2013-01-01

    Although previous reports have documented mean-level declines in personality disorder (PD) symptoms over time, little is known about whether personality pathology sometimes emerges among nonsymptomatic adults, or whether rates of change differ qualitatively among symptomatic persons. Our study sought to characterize heterogeneity in the longitudinal course of PD symptoms with the goal of testing for and describing latent trajectories. Participants were 250 young adults selected into two groups using a PD screening measure: those who met diagnostic criteria for a DSM-III-R PD (PPD, n = 129), and those with few PD symptoms (NoPD, n = 121). PD symptoms were assessed three times over a four-year study using semistructured interviews. Total PD symptom counts and symptoms of each DSM-III-R PD were analyzed using growth mixture modeling. In the NoPD group, latent trajectories were characterized by stable, minor symptoms; the rapid or gradual remission of subclinical symptoms; or the emergence of symptoms of Avoidant, Obsessive-Compulsive, or Paranoid PD. In the PPD group, three latent trajectories were evident: rapid symptom remission, slow symptom decline, or a relative absence of symptoms. Rapid remission of PD symptoms was associated with fewer comorbid disorders, lower negative emotionality, and greater positive emotionality and constraint, whereas emergent personality dysfunction was associated with comorbid PD symptoms and lower positive emotionality. In most cases, symptom change for one PD was associated with concomitant changes in other PDs, depressive symptoms, and anxiety. These results indicate that the longitudinal course of PD symptoms is heterogeneous, with distinct trajectories evident for both symptomatic and nonsymptomatic individuals. The prognosis of PD symptoms may be informed by an assessment of personality and comorbid psychopathology. PMID:23231459

  14. Case report: the effects of massage therapy on a woman with thoracic outlet syndrome.

    Science.gov (United States)

    Wakefield, Mary Lillias

    2014-12-01

    Thoracic outlet syndrome (TOS) refers to a group of conditions resulting from compression of the neurovascular structures of the thoracic outlet. The parameters for physical therapy include myofascial release (MFR), neuromuscular therapy (NMT), muscle strengthening, and stretching. This case study examined the effects of neuromuscular therapy, massage, and other manual therapies on a 56-year-old female presenting with bilateral numbness over the forearms and hands on waking. Numbness occurred most days, progressing to "dead rubbery" forearms and hands once or twice a month. The treatment plan was implemented over eight weeks and consisted of six, 50-minute bodywork sessions. Several nonbodywork strategies were also employed to address potential contributing factors to the TOS symptomology experienced by the client. Objective measurements included posture analysis (PA), range of movement (ROM), and Roos and Adson's tests. The Measure Your Own Medical Outcome Profile (MYMOP2), a client-generated measure of clinical outcome, was used to measure clinical change. MYMOP2 overall profile score results demonstrated an improvement of 2.25 from pretreatment to post-treatment measurement. Clinically meaningful change was measured by the individual and was indicative of substantial symptom improvement where a score change of over one was considered as meaningful. A course of massage was effective for numbness symptoms in an individual with TOS, and results lasted over a year without additional treatments. Further research is needed to fully understand the effects of massage for TOS symptoms.

  15. Effects of changes in depressive symptoms and cognitive functioning on physical disability in home care elders.

    Science.gov (United States)

    Li, Lydia W; Conwell, Yeates

    2009-02-01

    This study sought to investigate the effect of changes in depression status on physical disability in older persons receiving home care, examine whether the effect is due to concomitant changes in cognitive status, and test whether affective state and cognitive ability interact to influence physical disability. Multilevel analyses were conducted using longitudinal data collected about every 3 months from older participants in Michigan's community-based long-term care programs (N = 13,129). The data set provided an average of nine repeated measures of depressive symptoms, cognitive functioning, and physical disability. We estimated the lag effects of within-person changes in depression and cognitive status, and their interaction, on physical disability measured by activities of daily living (ADL) and instrumental activities of daily living (IADL), controlling for health-related events that occurred in the interim. Changes between not having and having depressive symptoms, including subsyndromal symptoms, are critical to physical disability for home care elders. The effects are independent of concomitant changes in cognitive status, which also have significant adverse effects on physical disability. There is some evidence that improvement of depression buffers the adverse effect of cognitive decline on IADL disability. Providers should monitor changes in depression and cognitive status in home care elders. Early detection and treatment of subthreshold depression, as well as efforts to prevent worsening of cognitive status in home care elders, may have a meaningful impact on their ability to live at home.

  16. Breast size, thoracic kyphosis & thoracic spine pain - association & relevance of bra fitting in post-menopausal women: a correlational study.

    Science.gov (United States)

    Spencer, Linda; Briffa, Kathy

    2013-07-01

    Menopause would seem to exist as a period of accelerated changes for women and their upper torso mechanics. Whether these anthropometric changes reflect changes in pain states remains unclear. Plausible mechanisms of pain exist for the independent and combined effect of increasing breast size and thoracic kyphosis. Bra fit has the potential to change when the anthropometric measures (chest circumference and bust circumference) used to determine bra size change, such as postmenopausally.Identifying an association between breast size, thoracic kyphosis and thoracic spine pain in postmenopausal women and identifying the relevance of bra fit to this association may be of importance to the future management and education of post-menopausal women presenting clinically with thoracic spine pain. A cross-sectional study design. Fifty-one postmenopausal bra-wearing women were recruited. Measures included breast size (Triumph International), thoracic kyphosis (flexible curve), bra fitted (Y/N) and pain (Short Form McGill Pain Questionnaire) and tenderness on palpation (posteroanterior pressure testing). These measures were collected in one session at a physiotherapy clinic. The majority of the women in this study were overweight or obese and wearing an incorrect sized bra. Pain was significantly related to breast size, body weight and BMI at mid thoracic levels (T7-8). In contrast self-reported thoracic pain was not correlated with age or index of kyphosis (thoracic kyphosis). Women with thoracic pain were no more likely to have their bra professionally fitted whereas women with a higher BMI and larger breasts were more likely to have their bra professionally fitted. The findings of this study show that larger breasts and increased BMI are associated with thoracic pain in postmenopausal women. This is unrelated to thoracic kyphosis. Increasing breast size and how a bra is worn may have biomechanical implications for the loaded thoracic spine and surrounding musculature. Post

  17. Generalized Anxiety Disorder: A Comparison of Symptom Change in Adults Receiving Cognitive-Behavioral Therapy or Applied Relaxation

    Science.gov (United States)

    Donegan, Eleanor; Dugas, Michel J.

    2012-01-01

    Objective: Generalized anxiety disorder (GAD) is characterized by excessive worry and somatic symptoms of anxiety (e.g., restlessness, muscle tension). Several psychological treatments lead to significant reductions in GAD symptoms by posttreatment. However, little is known about how GAD symptoms change over time. Our main goal was to examine how…

  18. Symptom burden and its association with change in glucose metabolism status over a 7-year period: the Hoorn Study.

    NARCIS (Netherlands)

    van der Pols-Vijlbrief, R.; Dekker, J.M.; Stehouwer, C.D.A.; de Boer, M.R.; Nijpels, G.; Snoek, F.J.; Adriaanse, M.C.

    2014-01-01

    Aims: To study symptom burden among older people and its associations with change in glucose metabolism status over a 7-year period. Methods: We conducted a prospective population-based cohort study among 397 older people. We used the revised Diabetes Symptom Checklist to assess symptom burden.

  19. Chylothorax complicating thoracic aortic surgery.

    Science.gov (United States)

    Kanakis, Meletios A; Misthos, Panagiotis; Kokotsakis, John N; Lioulias, Achilleas G

    2011-07-01

    Chylothorax is a very rare complication of patients undergoing thoracic aortic aneurysm repair. Possible mechanisms of this condition during thoracic aorta operations and current therapeutic strategies are analyzed according to our experience and thorough search of the English literature. Current experience with chylothorax occurring during thoracic aortic surgery is analyzed in this review by collecting data retrieved from English literature research. Significant risk factors for postoperative chylothorax development after thoracic aorta surgical procedures are thoracic aortic reoperations and descending thoracic repairs. Various treatment modalities from conservative to operative intervention have been proposed. Currently, the morbidity and mortality have improved due to prompt management. Surgical intervention is needed when response to conservative treatment has failed.  © 2011 Wiley Periodicals, Inc.

  20. Perceived Social Support Mediates Anxiety and Depressive Symptom Changes Following Primary Care Intervention

    Science.gov (United States)

    Dour, Halina J.; Wiley, Joshua F.; Roy-Byrne, Peter; Stein, Murray B.; Sullivan, Greer; Sherbourne, Cathy D.; Bystritsky, Alexander; Rose, Raphael D.; Craske, Michelle G.

    2014-01-01

    Background The current study tested whether perceived social support serves as a mediator of anxiety and depressive symptom change following evidence-based anxiety treatment in the primary care setting. Gender, age, and race were tested as moderators. Methods Data were obtained from 1004 adult patients (age M=43, SD=13; 71% female; 56% White, 20% Hispanic, 12% Black) who participated in a randomized effectiveness trial (CALM Study) comparing evidence-based intervention (cognitive-behavioral therapy and/or psychopharmacology) to usual care in the primary care setting. Patients were assessed with a battery of questionnaires at baseline, as well as at 6-, 12-, and 18-months following baseline. Measures utilized in the mediation analyses included the Abbreviated Medical Outcomes (MOS) Social Support Survey, the Brief Symptom Index (BSI) – Somatic and Anxiety subscales, and the Patient Health Questionnaire (PHQ-9). Results There was a mediating effect over time of perceived social support on symptom change following treatment, with stronger effects for 18-month depression than anxiety. None of the mediating pathways were moderated by gender, age, or race. Conclusions Perceived social support may be central to anxiety and depressive symptom changes over time with evidence-based intervention in the primary care setting. These findings possibly have important implications for development of anxiety interventions. PMID:24338947

  1. Thoracic Idiopathic Scoliosis Severity Is Highly Correlated with 3D Measures of Thoracic Kyphosis.

    Science.gov (United States)

    Sullivan, T Barrett; Reighard, Fredrick G; Osborn, Emily J; Parvaresh, Kevin C; Newton, Peter O

    2017-06-07

    Loss of thoracic kyphosis has been associated with thoracic idiopathic scoliosis. Modern 3-dimensional (3D) imaging systems allow more accurate characterization of the scoliotic deformity than traditional radiographs. In this study, we utilized 3D calculations to characterize the association between increasing scoliosis severity and changes in the sagittal and axial planes. Patients evaluated in a scoliosis clinic and determined to have either a normal spine or idiopathic scoliosis were included in the analysis. All underwent upright, biplanar radiography with 3D reconstructions. Two-dimensional (2D) measurements of the magnitude of the thoracic major curve and the thoracic kyphosis were recorded. Image processing and MATLAB analysis were utilized to produce a 3D calculation of thoracic kyphosis and apical vertebral axial rotation. Regression analysis was performed to determine the correlation of 2D kyphosis, 3D kyphosis, and apical axial rotation with the magnitude of the thoracic major curve. The 442 patients for whom 2D and 3D data were collected had a main thoracic curve magnitude ranging from 1° to 118°. Linear regression analysis of the 2D and 3D T5-T12 kyphosis versus main thoracic curve magnitude yielded significant models (p scoliosis magnitude increased, at a rate of more than half the increase in the main thoracic curve magnitude. Analysis confirmed a surprisingly strong correlation between scoliosis severity and loss of 3D kyphosis that was absent in the 2D analysis. A similarly strong correlation between curve magnitude and apical axial rotation was evident. These findings lend further credence to the concept that scoliosis progresses in the coronal, sagittal, and axial planes simultaneously. The findings of this study suggest that 3D assessment is critical for adequate characterization of the multiplanar deformity of idiopathic scoliosis and deformity in the sagittal plane is linked to deformity in the coronal plane. Increasing severity of coronal

  2. Neurogenic thoracic outlet syndrome treatment by the supraclavicular approach.

    Science.gov (United States)

    Yaseen, Ziyad; Baram, Aram

    2014-02-01

    Thoracic outlet syndrome refers to compression of one or more of the neurovascular structures traversing the superior aperture of the thoracic cavity. A symptom-based patient-directed questionnaire was used to evaluate the outcome of the supraclavicular approach for treatment of neurogenic thoracic outlet syndrome. A prospective study was performed between April 2007 and October 2010. During this period, 97 patients in different age groups, with signs and symptoms of thoracic outlet syndrome, were surgically treated by the supraclavicular approach. The patients were aged between 14 and 60 years (mean 32.5 years), and the majority were female (89.69%). Surgery was performed on the left side in 52 patients and on the right side in 48, including 3 who had bilateral operations. The median follow-up was 11.2 months. In 78% of the 100 operations, excellent improvement in symptoms was noted, there was partial improvement in 18%, and 4% resulted in no response. First rib resection remains an important and essential step in the management of the thoracic outlet syndrome, in the absence of bony abnormalities. The supraclavicular approach can be employed with minimal morbidity and an excellent outcome.

  3. The MMPI-2 as a predictor of symptom change following treatment for posttraumatic stress disorder.

    Science.gov (United States)

    Forbes, David; Creamer, Mark; Allen, Nicholas; Elliott, Peter; McHugh, Tony; Debenham, Paul; Hopwood, Malcolm

    2002-10-01

    This study sought to examine the impact of personality factors on symptom change following treatment for 141 Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) using the Minnesota Multiphasic Personality Inventory-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). A series of partial correlation and linear multivariate regression analyses identified social alienation, associated with anger and substance use, as the most potent negative predictor of symptom change. Of the scales assessing personality disorder, Borderline Personality was identified as the strongest negative predictor of outcome. Regression analyses examining the most salient scales identified 5 items that contributed 14% of the variance in the prediction of change scores independently of the 21% accounted for by pretreatment PTSD severity.

  4. Determination of Effective Thoracic Mass

    Directory of Open Access Journals (Sweden)

    Jeffrey H. Marcus

    1996-01-01

    Full Text Available Effective thoracic mass is an important parameter in specifying mathematical and mechanical models (such as crash dummies of humans exposed to impact conditions. A method is developed using a numerical optimizer to determine effective thoracic mass (and mass distribution given a number of acceleration signals and a force signal response. Utilizing previously reported lateral and frontal impact tests with human cadaveric test specimens in a number of different conditions, the effective thoracic mass is computed. The effective thoracic masses are then computed for a variety of crash dummies exposed to identical test conditions.

  5. Longitudinal changes in prevalence of respiratory symptoms among Canadian grain elevator workers.

    Science.gov (United States)

    Pahwa, Punam; McDuffie, Helen H; Dosman, James A

    2006-06-01

    To determine longitudinal changes in the prevalence of chronic respiratory symptoms among Canadian grain workers. Data on respiratory symptoms, smoking status, and pulmonary function were obtained approximately every 3 years (termed cycle) over 15 years beginning in 1978 from five regions of Canada. The number of grain workers participating in each cycle were as follows: cycle 1 (n = 5,702); cycle 2 (n = 5,491); cycle 3 (n = 3,713); cycle 4 (n = 2,847); and cycle 5 (n = 3,079). A procedure based on generalized estimating equations (PROC GENMOD; SAS Institute; Cary, NC) was used to fit marginal models to determine risk factors influencing the prevalence of chronic respiratory symptoms (wheeze, dyspnea, sputum, and cough). The prevalence (predicted probability based on the final model) of chronic respiratory symptoms had an increasing trend with increasing number of years in the grain industry from cycle 1 to cycle 3 (before dust control) for all three smoking categories (current smokers, ex-smokers, and nonsmokers). For cycle 4 and cycle 5 (after dust control), there was a reduction in the prevalence of these respiratory symptoms. For example, in cycle 1, the prevalence of chronic wheeze among current smoking grain workers increased from 12% (for those in the industry for 35 years); in cycle 5, the prevalence of chronic wheeze among current smoking grain workers increased from 9% (for those in the industry for 35 years). Similar trends were observed for ex-smokers and nonsmokers and for other chronic respiratory symptoms. Our results indicate that grain dust control was effective in reducing the prevalence of chronic respiratory symptoms among grain workers in all smoking and exposure categories.

  6. Pain moderates changes in psychological flexibility but not substance use symptoms during substance use disorder treatment.

    Science.gov (United States)

    Foster, Katherine T; Ehrnstrom, Colleen; Chermack, Stephen; Hosanagar, Avinash

    2016-11-30

    Pain-related problems frequently complicate substance use disorder (SUD) course and prognosis. However, it is unclear if the negative outcomes associated with co-occurring pain are due to its link with greater SUD severity, disruption of SUD treatment processes, or connection to a third psychological process. The current study modeled the longitudinal effects of pain during a 4-week intensive outpatient treatment (IOP) on SUD symptoms and limited psychological flexibility (PF), a common feature of psychological well being that is commonly restricted in both SUD and pain patients. After controlling for initial severity of SUD symptoms, current pain level at treatment intake moderated change in a sub-component of PF, values commitment, but not SUD symptoms during the IOP. During the treatment, pain level also limited improvement in PF but not self-reported SUD symptoms. Targeting additional increases in psychological flexibility surrounding commitment to values during SUD treatment may help improve outcomes among patients who began treatment with significant pain symptoms. Copyright © 2016. Published by Elsevier Ireland Ltd.

  7. Thoracic damage control surgery.

    Science.gov (United States)

    Gonçalves, Roberto; Saad, Roberto

    2016-01-01

    The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

  8. Effect of thoracic stretching, thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain.

    Science.gov (United States)

    Yoo, Won-Gyu

    2013-11-01

    [Purpose] The purpose of this study was to investigate the effect of thoracic stretching, a thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain. [Subject] A 36-year-old male, who complained of upper thoracic pain at the T1-4 level with forward head and round shoulders, was the subject. [Methods] He performed thoracic stretching (session 1), a thoracic extension exercise (session 2), and muscle exercises for cervical and scapular posture (session 3). [Results] The upper thoracic pressure pain threshold increased after session 1, session 2, and session 3. The thoracic kyphosis angle decreased after session 1, session 2, and session 3. [Conclusion] We suggest that intervention for thoracic pain or kyphotic thoracic correction should use not only an approach for extending the thoracic muscles, but also an approach treating muscles in the cervical and scapular region.

  9. Thoracic spine x-ray

    Science.gov (United States)

    Vertebral radiography; X-ray - spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films ... There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most ...

  10. Association of change in depression and anxiety symptoms with functional outcomes in pulmonary rehabilitation patients.

    Science.gov (United States)

    Pirraglia, Paul A; Casserly, Brian; Velasco, Robert; Borgia, Matthew L; Nici, Linda

    2011-07-01

    Pulmonary rehabilitation (PR) has emerged over the last decade as an essential component of an integrated approach to managing patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). We sought to examine how depression and anxiety symptom changes relate to disease-specific quality of life outcomes following PR. We performed a cohort study of 81 patients with COPD who completed PR at a Veterans Administration Medical Center. Pulmonary rehabilitation consisted of supervised exercise training and education twice weekly for 8 weeks. Beck Depression and Anxiety Inventories (BDI and BAI) assessed symptom burden at baseline and completion of PR. We measured change in disease-specific quality of life using the dyspnea, mastery, emotion and fatigue domains of the Chronic Respiratory Questionnaire Self-Reported (CRQ-SR) from baseline to completion of PR. Participants were 69.8±9.1 years old and all male. Forced expiratory volume in 1 s (FEV1) was 1.23±0.39 L. The CRQ-SR scores improved significantly: dyspnea (Pchange was not significantly associated with change in disease-specific quality of life domains. Addressing anxiety symptoms in PR patients may be indicated because disease-specific quality of life improvement appears to be associated with mood. Published by Elsevier Inc.

  11. Spontaneous and complete regression of a thoracic disc herniation

    International Nuclear Information System (INIS)

    Coevoet, V.; Benoudiba, F.; Doyon, D.; Lignieres, C.; Said, G.

    1997-01-01

    Spontaneous regression of disc herniation is well known but the mechanism is not clear. Some hypotheses have been made. We present here a large thoracic disc herniation diagnosed by MRI which completely regressed one year after a medical treatment with complete amendment of symptoms. (authors)

  12. Predictors of change in depressive symptoms from preschool to first grade.

    Science.gov (United States)

    Reinfjell, Trude; Kårstad, Silja Berg; Berg-Nielsen, Turid Suzanne; Luby, Joan L; Wichstrøm, Lars

    2016-11-01

    Children's depressive symptoms in the transition from preschool to school are rarely investigated. We therefore tested whether children's temperament (effortful control and negative affect), social skills, child psychopathology, environmental stressors (life events), parental accuracy of predicting their child's emotion understanding (parental accuracy), parental emotional availability, and parental depression predict changes in depressive symptoms from preschool to first grade. Parents of a community sample of 995 4-year-olds were interviewed using the Preschool Age Psychiatric Assessment. The children and parents were reassessed when the children started first grade (n = 795). The results showed that DSM-5 defined depressive symptoms increased. Child temperamental negative affect and parental depression predicted increased, whereas social skills predicted decreased, depressive symptoms. However, such social skills were only protective among children with low and medium effortful control. Further, high parental accuracy proved protective among children with low effortful control and high negative affect. Thus, interventions that treat parental depression may be important for young children. Children with low effortful control and high negative affect may especially benefit from having parents who accurately perceive their emotional understanding. Efforts to enhance social skills may prove particularly important for children with low or medium effortful control.

  13. Vascular Thoracic Outlet Syndrome.

    Science.gov (United States)

    Hussain, Mohamad Anas; Aljabri, Badr; Al-Omran, Mohammed

    2016-01-01

    Two distinct terms are used to describe vascular thoracic outlet syndrome (TOS) depending on which structure is predominantly affected: venous TOS (due to subclavian vein compression) and arterial TOS (due to subclavian artery compression). Although the venous and arterial subtypes of TOS affect only 3% and <1% of all TOS patients respectively, the diagnostic and management approaches to venous and arterial TOS have undergone considerable evolution due to the recent emergence of minimally invasive endovascular techniques such as catheter-directed arterial and venous thrombolysis, and balloon angioplasty. In this review, we discuss the anatomical factors, etiology, pathogenesis and clinical presentation of vascular TOS patients. In addition, we use the most up to date observational evidence available to provide a contemporary approach to the diagnosis and management of venous TOS and arterial TOS patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Treatment of nonspecific thoracic spine pain with trigger point dry needling and intramuscular electrical stimulation: a case series.

    Science.gov (United States)

    Rock, Jodie M; Rainey, Charles E

    2014-10-01

    Case Series. Myofascial trigger points (MTrPs) are a common occurrence in many musculoskeletal issues and have been shown to be prevalent in both subjects with nonspecific low back pain and whiplash associated disorder. Trigger point dry needling (DN) has been shown to reduce pain and improve function in areas such as the cervical and lumbar spine, shoulder, hip, and knee, but has not been investigated in the thoracic spine. The purpose of this case series was to document the use of DN with intramuscular electrical stimulation (IES) in subjects with nonspecific thoracic spine pain. The subjects were both active duty military males aged 31 and 27 years who self-referred to physical therapy for thoracic spinal pain. Physical examination demonstrated thoracic motor control dysfunction, tissue hypertonicity, and tenderness to palpation of bilateral thoracic paraspinal musculature in both subjects. This indicated the presence of possible MrTPs. Objective findings in the first subject included painful thoracic flexion and bilateral rotation in each of these planes of movement. Pain reduction was observed when postural demands of the spine and trunk musculature were reduced through positional changes. Patient 1 demonstrated pain with posterior to anterior (P/A) pressure at T9 to T12. The second subject had bilaterally limited and painful thoracic rotation actively with normal passive rotation and demonstrated pain with P/A pressure at T4 to T7. The subjects were treated with DN and IES for a total of two visits each. DN was performed to paraspinal and multifidus musculature at the levels of elicited pain with P/A testing and IES set at a frequency level of 4 (1.5Hz) for 20 minutes. Subject 1 reported reduced pain with standing flexion from a 62mm VAS score on initial evaluation to 26mm at his second visit. Subject 2 reported being "quite a bit better" in symptoms on the GROC following his second treatment. His VAS score reported following weightlifting activities changed

  15. Automated assessment of symptom severity changes during deep brain stimulation (DBS) therapy for Parkinson's disease.

    Science.gov (United States)

    Angeles, Paolo; Tai, Yen; Pavese, Nicola; Wilson, Samuel; Vaidyanathan, Ravi

    2017-07-01

    Deep brain stimulation (DBS) is currently being used as a treatment for symptoms of Parkinson's disease (PD). Tracking symptom severity progression and deciding the optimal stimulation parameters for people with PD is extremely difficult. This study presents a sensor system that can quantify the three cardinal motor symptoms of PD - rigidity, bradykinesia and tremor. The first phase of this study assesses whether data recorded from the system during physical examinations can be used to correlate to clinician's severity score using supervised machine learning (ML) models. The second phase concludes whether the sensor system can distinguish differences before and after DBS optimisation by a clinician when Unified Parkinson's Disease Rating Scale (UPDRS) scores did not change. An average accuracy of 90.9 % was achieved by the best ML models in the first phase, when correlating sensor data to clinician's scores. Adding on to this, in the second phase of the study, the sensor system was able to pick up discernible differences before and after DBS optimisation sessions in instances where UPDRS scores did not change.

  16. [Treatment of thoracic disc herniation. Case report].

    Science.gov (United States)

    Picado-Baca, Mauricio Leonardo; Mireles-Cano, José Nicolás; León-Meza, Víctor Manuel; García-González, Oscar Guillermo; Ramos-Trujillo, Alejandro

    2016-01-01

    Herniated thoracic intervertebral disc is a rare cause of spinal cord compression. Its frequency varies from 0.15% to 1.7% of all disc herniations, and produces symptoms in 0.5% to 0.8%. Case 1. A 50-year-old woman, with pain and burning sensation in left hemithorax of four months of onset. It was treated as a herpetic syndrome, with no improvement. She was seen after thirteen days of exacerbation of clinical symptoms. The physical examination showed asymmetric paraparesis, lower left pelvic limb 1/5, and right pelvic limb 3/5¸ sensory level T8, with left Babinski positive. A thoracic disc herniation in space T8-T9 was diagnosed. A 55-year-old patient with a history of presenting pain in lumbar area of 5 years onset. She also had radicular pain that radiated to the right pelvic limb, with intensity 10/10 on a Visual Analogue Scale. Her physical examination showed muscle strength 5/5, with normal sensitivity in all dermatomes and tendon reflexes, and a positive right Babinski. Thoracic disc herniation T7-T8 level was diagnosed. Due to anatomical conditions that define this type of hernia, the extracavitary posterolateral approach should be the recommended surgical procedure when the simultaneously performed anterior decompression and fixation with posterior instrumentation are the treatments proposed. Despite the different anatomical structures of this special area, it was possible to obtain satisfactory results for both clinical cases. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  17. Relationships among participant international prostate symptom score, benign prostatic hyperplasia impact index changes and global ratings of change in a trial of phytotherapy in men with lower urinary tract symptoms.

    Science.gov (United States)

    Barry, Michael J; Cantor, Alan; Roehrborn, Claus G

    2013-03-01

    We related changes in American Urological Association symptom index scores with bother measures and global ratings of change in men with lower urinary tract symptoms who were enrolled in a saw palmetto trial. To be eligible for study men were 45 years old or older, and had a peak uroflow of 4 ml per second or greater and an American Urological Association symptom index score of 8 to 24. Participants self-administered the American Urological Association symptom index, International Prostate Symptom Score quality of life item, Benign Prostatic Hyperplasia Impact Index and 2 global change questions at baseline, and at 24, 48 and 72 weeks. In 357 participants global ratings of a little better were associated with a mean decrease in American Urological Association symptom index scores from 2.8 to 4.1 points across 3 time points. The analogous range for mean decreases in Benign Prostatic Hyperplasia Impact Index scores was 1.0 to 1.7 points and for the International Prostate Symptom Score quality of life item it was 0.5 to 0.8 points. At 72 weeks for the first global change question each change measure discriminated between participants who rated themselves at least a little better vs unchanged or worse 70% to 72% of the time. A multivariate model increased discrimination to 77%. For the second global change question each change measure correctly discriminated ratings of at least a little better vs unchanged or worse 69% to 74% of the time and a multivariate model increased discrimination to 79%. Changes in American Urological Association symptom index scores could discriminate between participants rating themselves at least a little better vs unchanged or worse. Our findings support the practice of powering studies to detect group mean differences in American Urological Association symptom index scores of at least 3 points. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. Synchrony of change in depressive symptoms, health status, and quality of life in persons with clinical depression

    OpenAIRE

    Diehr, Paula H; Derleth, Ann M; McKenna, Stephen P; Martin, Mona L; Bushnell, Donald M; Simon, Gregory; Patrick, Donald L

    2006-01-01

    Abstract Background Little is known about longitudinal associations among measures of depression, mental and physical health, and quality of life (QOL). We followed 982 clinically depressed persons to determine which measures changed and whether the change was synchronous with change in depressive symptoms. Methods Data were from the Longitudinal Investigation of Depression Outcomes (LIDO). Depressive symptoms, physical and mental health, and quality of life were measured at baseline, 6 weeks...

  19. Thoracic aortic aneurysm

    Science.gov (United States)

    ... of the aorta Injury from falls or motor vehicle accidents Syphilis Symptoms Aneurysms develop slowly over many ... rupture) if you do not have surgery to repair it. The treatment depends on the location of ...

  20. Identification of symptom domains in ulcerative colitis that occur frequently during flares and are responsive to changes in disease activity

    Directory of Open Access Journals (Sweden)

    Wang Sijian

    2008-09-01

    Full Text Available Abstract Background Ulcerative colitis disease activity is determined by measuring symptoms and signs. Our aim was to determine which symptom domains are frequent and responsive to change in the evaluation of disease activity, which are those defined by three criteria: 1 they occur frequently during flares; 2 they improve during effective therapy for ulcerative colitis; and 3 they resolve during remission. Methods Twenty-eight symptom domains, 16 from standard indices and 12 novel domains identified by ulcerative colitis patient focus groups, were evaluated. Sixty subjects with ulcerative colitis were surveyed, rating each symptom on the three criteria with a 100 mm Visual Analogue Scale. Frequent and responsive symptoms were defined a priori as those whose median Visual Analogue Scale rating for all 3 criteria was significantly greater than 50. Results Thirteen of the 28 symptom domains were identified as both frequent in ulcerative colitis flares and responsive to changes in disease activity. Seven of these 13 symptom domains were novel symptoms derived from ulcerative colitis patient focus groups including stool mucus, tenesmus, fatigue, rapid postprandial bowel movements, and inability to differentiate liquid or gas from solid stool when rectal urgency occurs. Ten of the 16 symptom domains from standard indices were either infrequent or unresponsive to changes in disease activity. Conclusion Only some of the symptoms of ulcerative colitis that are important to patients are included in standard indices, and several symptoms currently measured are not frequent or responsive to change in ulcerative colitis patients. Development of survey measures of these symptom domains could significantly improve the assessment of disease activity in ulcerative colitis.

  1. Patients with extreme obesity: change in mental symptoms three years after gastric banding.

    Science.gov (United States)

    Nickel, C; Widermann, C; Harms, D; Leiberich, P L; Tritt, K; Kettler, C; Lahmann, C; Rother, W K; Loew, T H; Nickel, M K

    2005-01-01

    Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volume. The aim of this study was to investigate whether gastric banding leads to lasting change in: 1) the Body Mass Index (BMI); 2) social factors such as work and partnerships, eating behavior, anxiety and depression symptoms; and 3) health related quality of life. We surveyed a sample of 50 adipose women (BMI > 40 kg/m2). Primary outcome measures were self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), the Hospital Anxiety and Depression Scale (HADS-D), and the Health Survey (SF-36). In comparison with the control group, we observed significant changes in BMI (p PSYC), and vitality (VITA).

  2. Changes in Emotion Processing following Brief Augmented Psychodynamic Interpersonal Therapy for Functional Neurological Symptoms.

    Science.gov (United States)

    Williams, Isobel Anne; Howlett, Stephanie; Levita, Liat; Reuber, Markus

    2018-01-25

    Functional neurological symptoms (FNS) are considered non-volitional and often very disabling, but are not explainable by neurological disease or structural abnormalities. Brief Augmented Psychodynamic Interpersonal Therapy (BAPIT) was adapted to treat the putative emotion processing deficits thought to be central to FNS aetiology and maintenance. BAPIT for FNS has previously been shown to improve levels of distress and functioning, but it is unknown whether improvements on such measures correlate with changes in emotion processing ‒ which this treatment focuses on. To determine (a) whether the recently developed Emotional Processing Scale-25 can be used to demonstrate BAPIT-associated changes in patients with FNS, and (b) whether changes in the EPS-25 are associated with changes in previously validated outcome measures. 44 patients with FNS completed questionnaires including the EPS-25 and measures of clinical symptomology (health-related quality of life (SF-36), somatic symptoms (PHQ-15), psychological distress (CORE-10) and illness understanding (BIPQ)) pre- and post-therapy. At group level, emotion processing improved following therapy (p = .049). Some measures of clinical symptomology also improved, namely health-related quality of life (p = .02) and illness understanding (p = .01). Improvements in the EPS-25 correlated with improvements in mental health-related quality of life and psychological distress. Emotion processing and some measures of clinical symptomology improved in patients with FNS following BAPIT. The EPS-25 demonstrated changes that correlated with previously validated outcome measures. The EPS-25 is a suitable measure of psychotherapy-associated change in the FNS patient population.

  3. Change and predictors of symptom distress in breast cancer patients following the first 4 months after diagnosis

    Directory of Open Access Journals (Sweden)

    Mei-Nan Liao

    2015-03-01

    Conclusion: Change in symptom distress following the first 4 months after diagnosis was predicted by state anxiety, health professional support, and time. Patients should receive social support and be trained in problem-solving skills to relieve distressful symptoms from diagnosis through treatment.

  4. A randomized, comparative trial: does pillow type alter cervico-thoracic spinal posture when side lying?

    Directory of Open Access Journals (Sweden)

    Gordon SJ

    2011-08-01

    Full Text Available Susan J Gordon1, Karen A Grimmer-Somers2, Patricia H Trott31School of Public Health, Tropical Medicine and Rehabilitation Science, James Cook University, Townsville, QLD; 2Centre for Allied Health Sciences, 3School of Health Sciences, University of South Australia, Adelaide, SA, AustraliaBackground: Many patients ask for advice about choosing a pillow. This research was undertaken to determine if pillow type alters cervico-thoracic spine position when resting in the side-lying position.Aim: To investigate the effect of different pillow shape and content on the slope of cervico-thoracic spine segments when side lying.Materials and methods: The study was a randomized blinded comparative trial set in a laboratory that replicated a bedroom. The subjects were side sleepers aged over 18 years. Exclusion criteria were history of surgery to the cervico-thoracic spine, an injury or accident to the cervico-thoracic spine in the preceding year, or currently receiving treatment for neck symptoms. Each participant rested in a standardized side-lying position for 10 minutes on each of the trial pillows: regular shaped polyester, foam, feather, and latex pillows, and a contour shaped foam pillow. Reflective markers were placed on external occipital protuberance (EOP, C2, C4, C7, and T3, and digital images were recorded of subjects at 0 and 10 minutes on each pillow. Images were digitized using each reflective marker and the slope of each spinal segment calculated. Univariate analysis of variance models were used to investigate slope differences between pillows at 0 and 10 minutes. Significance was established at P < 0.01 to take account of chance effects from repeated measures and multiple comparisons.Results: At 0 and 10 minutes, the EOP-C2, C2-C4, and C4-C7 segmental slopes were significantly different across all pillows. Significant differences were identified when comparing the feather pillow with the latex, regular and contour foam pillows, and when

  5. The evolution of thoracic anesthesia.

    Science.gov (United States)

    Brodsky, Jay B

    2005-02-01

    The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients.

  6. Time patterns of changes in biomarkers, symptoms and histopathology during pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Larsen, Annette; Dahl, Olav [Section of Oncology, Institute of Medicine, Univ. of Bergen, and Dept. of Oncology, Haukeland Univ. Hospital, Bergen (Norway); Bjoerge, Benedikte; Klementsen, Beate [National Institute of Nutrition and Seafood Research, Bergen (Norway); Helgeland, Lars [Dept. of Pathology, Haukeland Univ. Hospital, Bergen (Norway); Wentzel-Larsen, Tore [Centre for Clinical Research, Haukeland Univ. Hospital, Bergen (Norway); Fagerhol, Magne K. [Dept. of Immunology and Transfusion Medicine, Ullevaal Univ. Hospital, Oslo (Norway); Hovdenak, Nils [Dept. of Medicine, Haukeland Univ. Hospital, Bergen (Norway)

    2007-07-15

    Acute radiation proctitis was evaluated before, during and after radiotherapy (RT) for prostate cancer. The main aims of the study were to examine changes related to the increasing radiation dose, and identify surrogate markers of gastrointestinal (GI) reaction to radiation. Twenty consecutive prostate cancer patients scheduled for 7 weeks of conformal RT were prospectively included in a longitudinal study assessing symptoms, inflammation in rectal mucosa biopsies, and blood and stool samples at four time points (before RT and 2, 6 and 11 weeks after start of RT). Blood samples were examined for acute phase response-related markers, fatty acids (FAs), vitamin E and leukotriene B4 (LTB4). Lactoferrin, calprotectin and S100A12 were measured in stool samples and FAs in biopsies from rectal mucosa. The increase in histopathological inflammation reached a maximum 2 weeks after start of RT. Symptoms of GI toxicity increased with higher radiation dose and had not returned to pre-treatment level 4 weeks after RT. Lactoferrin concentrations in stool increased significantly at week 6. Significant decreases of vitamin E, leukocyte count, hemoglobin and some groups of FAs were discovered, while a few FAs increased significantly during the study period. Time courses vary between the selected indicators of acute radiation proctitis. The biopsy grading of inflammatory changes were most intense 2 weeks into the treatment period while symptoms continued to increase until week 6. Lactoferrin in stool samples could be a non-invasive marker of GI inflammation during RT. A transient decrease in vitamin E and some FAs during RT warrants further studies.

  7. Changes in psychiatric symptoms and psychological processes among veterans participating in a therapeutic adventure program.

    Science.gov (United States)

    Bettmann, Joanna E; Scheinfeld, David E; Prince, Kort C; Garland, Eric L; Ovrom, Katherine V

    2018-02-08

    When veterans need effective mental health treatment, many are reluctant to engage in traditional treatment modalities because of stigma. Therapeutic adventure shows promise as a way to engage veterans and enact positive changes in functioning, but little is known about how therapeutic adventure impacts mental health symptoms among veterans. This study examined changes in mental health symptoms and related psychological processes over the course of a 6-day Outward Bound for Veterans (OB4V) program and at a 1-month follow-up. This study examined data from 77 U.S. military veterans with psychiatric diagnoses. The authors hypothesized that participants would report significant reductions in mental health symptoms over the course of the program and following its completion, as well as significant improvements in psychological processes that included initiative for psychological growth, psychological attitudes, attitudes toward help-seeking, psychological mindedness, and emotional suppression. A repeated-measures analysis of variance was performed on each of the dependent variables. Results showed that, from pre- to postprogram, participants reported significant improvement in life purpose satisfaction and self-confidence during stressful situations. Further, from preprogram to 1-month postprogram, veterans reported increased psychological mindedness, increased engagement to promote personal growth, decreased mental health symptomology, decreased emotional suppression, and an increase in positive attitude toward seeking professional psychological help. These improvements were significant during the OB4V program and even continued to improve after the program ended, showing the promise of therapeutic adventure as a modality to address veterans' mental health issues. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  8. Change in self-esteem predicts depressive symptoms at follow-up after intensive multimodal psychotherapy for major depression.

    Science.gov (United States)

    Dinger, Ulrike; Ehrenthal, Johannes C; Nikendei, Christoph; Schauenburg, Henning

    2017-09-01

    Reduced self-esteem is a core symptom of depression, but few studies have investigated within-treatment change of self-esteem as a predictor of long-term outcome in depression. This study investigated change in self-esteem during 8 weeks of multimodal, psychodynamically oriented psychotherapy for 40 depressed patients and tested whether it would predict outcome 6 months after termination. Data was drawn from a randomized clinical pilot trial on day-clinic versus inpatient psychotherapy for depression. Findings supported the association between change in self-esteem and follow-up depression severity, even when controlling for within-treatment symptom change. Change in self-esteem was not related to overall symptoms and interpersonal problems at follow-up. Thus, change in self-esteem may be an important variable in preventing relapse for depression. Self-esteem is related to depressive symptoms and interpersonal problems. Improvement of self-esteem during psychotherapy correlates with improvements of symptoms and interpersonal problems. Change of self-esteem during psychotherapy predicts depressive symptoms 6 months after termination of therapy. When treating depressed patients, psychotherapists should work towards an improvement of self-esteem in order to prevent relapse. Copyright © 2017 John Wiley & Sons, Ltd.

  9. Temporal change in bimanual interkeypress intervals and self-reported symptoms during continuous typing.

    Science.gov (United States)

    Liang, Huey-Wen; Hwang, Yaw-Huei; Chang, Fu-Han

    2008-12-01

    Continuous typing is likely to induce mental and/or muscular fatigue, which contributes to musculoskeletal discomfort. Our goals were to describe the temporal changes in symptoms and interkeypress intervals (IKIs) of each hand during continuous typing. The effects of demographic characteristics and time on the IKI were examined. Twenty-four healthy and skilled typists volunteered to participate in this repeated-measurement study. All the subjects typed an English text for 90 min in the laboratory. The outcomes included self-reported pain and fatigue, average typing speed, accuracy rate, finger tapping speed, and IKIs as recorded by electronic activity monitoring software (VDTlog). The changes in self-reported symptoms, average typing speed and accuracy rate after 90 min of typing were compared with baseline data by paired testing. The effects of demographic characteristics and time on IKIs of both hands were explored by generalized estimate equation (GEE) analysis. The pain and fatigue ratings of the study subjects were significantly higher after 60 and 90 min of typing, but the average typing speed of every 30 min remained similar. The most common complaints were associated with the eyes, upper back and wrists. The IKIs as recorded by VDTlog was associated with typing speed. Furthermore, GEE analysis showed that the IKI of the right hand was the shortest in the last 10 min throughout the experiment, while left-hand typing exhibited the longest IKI during the last 10 min of each 30-min typing session. Time has different effect on the temporal changes of IKI during continuous typing for the left and right hands. Right-hand IKI tends to be shorter by time, especially at the last 10 min of typing, while left-hand IKI prolongs as typing continues for 30 min. Perceived pain and fatigue is apparent after continuous typing, though no change in average typing speed is observed.

  10. The role of symptoms and self-efficacy in predicting physical activity change among older adults with arthritis.

    Science.gov (United States)

    Sperber, Nina; Hall, Katherine S; Allen, Kelli; DeVellis, Brenda M; Lewis, Megan; Callahan, Leigh F

    2014-03-01

    Physical and psychological symptoms limit physical activity for people with arthritis. This study examined if self-efficacy mediated a relationship between symptom and physical activity (PA) frequency change. This was a secondary analysis of older adults with arthritis and joint pain in a trial of a lifestyle PA program (n = 339). Measures were depressive symptoms, pain, fatigue, arthritis self-efficacy, PA self-efficacy, and PA frequency. A panel model was used to analyze relationships at baseline and changes at 20 weeks. The mean age was 68.8 years. At baseline, depression and fatigue were associated with arthritis self-efficacy (β = -.34 and -.24) and, in turn, PA self-efficacy (β = .63); PA self-efficacy was associated with PA (β = .15). Pain and depression changes were associated with arthritis self-efficacy change (β = -.20 and -.21) and, in turn, PA self-efficacy (β = .32) change; PA self-efficacy change was associated with PA change (β = .36). Change in symptom severity affected change in PA frequency. These relationships appeared to operate through self-efficacy. Over time, pain appeared to have a stronger relationship than fatigue with self-efficacy and PA. These findings support strategies to help people with arthritis strengthen their confidence for symptom coping and PA participation.

  11. A conservative approach to a thoracic duct injury caused by left subclavian vein catheterization

    Directory of Open Access Journals (Sweden)

    Vedran Premuzic

    2018-01-01

    Full Text Available Thoracic duct injury is a rare complication of left subclavian vein catheterization. A significant injury could lead to chylothorax, a condition with high mortality rate if not treated. It is diagnosed with lymphography or by laboratory tests of pleural fluid aspirate. A 51 year old Caucasian male with a history of unregulated hypertension presented to our Emergency department (ED with anginous symptoms and increased serum creatinine level. After the placement of a temporary central venous catheter for hemodialysis in left subclavian vein, he developed lymph leakage on puncture site beside the catheter, at drainage rate of 75 ml/h. In the absence of more serious clinical symptoms, conservative treatment with close patient monitoring and diet changes was chosen, rather than more invasive treatment options.

  12. The reported thoracic injuries in Homer's Iliad.

    Science.gov (United States)

    Apostolakis, Efstratios; Apostolaki, Georgia; Apostolaki, Mary; Chorti, Maria

    2010-11-19

    Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield.

  13. State of the art thoracic ultrasound: intervention and therapeutics.

    Science.gov (United States)

    Corcoran, John P; Tazi-Mezalek, Rachid; Maldonado, Fabien; Yarmus, Lonny B; Annema, Jouke T; Koegelenberg, Coenraad F N; St Noble, Victoria; Rahman, Najib M

    2017-09-01

    The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will be in its use as an adjunct to pleural and thoracic interventions, owing to the widely recognised benefits for patient safety and risk reduction. However, as clinicians become increasingly familiar with the capabilities of thoracic ultrasound, new directions for its use are being sought which might enhance practice and patient care. This article reviews the ways in which the advent of thoracic ultrasound is changing the approach to the investigation and treatment of respiratory disease from an interventional perspective. This will include the impact of thoracic ultrasound on areas including patient safety, diagnostic and therapeutic procedures, and outcome prediction; and will also consider potential future research and clinical directions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Early patterns of symptom change signal remission with interpersonal psychotherapy for depressed adolescents.

    Science.gov (United States)

    Gunlicks-Stoessel, Meredith; Mufson, Laura

    2011-07-01

    This study examined whether reductions in depression symptoms at different time points over the course of therapy predict remission for depressed adolescents treated with interpersonal psychotherapy (IPT-A) or treatment as usual (TAU) delivered in school-based health clinics. Participants were 63 adolescents (ages 12-18) drawn from a randomized controlled clinical trial examining the effectiveness of IPT-A Mufson et al. [2004; Archives of General Psychiatry 61:577-584]. Adolescents were randomized to receive IPT-A or TAU delivered by school-based mental health clinicians. Assessments were completed at baseline and weeks 4, 8, 12, and 16 (or at early termination) and included the Hamilton Rating Scale for Depression (HRSD; Hamilton [1967; British Journal of Social and Clinical Psychology 6:278-2962]). Receiver operating characteristic analysis was used to identify the time point and degree of reduction in HRSD that best predicted remission (HRSD <7) at the end of the trial (week 16). Week 4 was the best time point for classifying adolescents as likely to remit or not likely to remit for both IPT-A and TAU. A 16.2% reduction in HRSD from baseline represented the best combined sensitivity and specificity in predicting week 16 remission status for adolescents treated with IPT-A. A 24.4% reduction in depressive symptoms represented the best combined sensitivity and specificity in predicting remission status for TAU. These findings provide preliminary evidence of one early marker of remission with IPT-A. Replication with larger samples would suggest that depressed adolescents who have not demonstrated at least a 16.2% reduction in their depressive symptoms after 4 weeks of IPT-A may benefit from a change in the treatment plan. © 2011 Wiley-Liss, Inc.

  15. The cervical spine of professional front-row rugby players: correlation between degenerative changes and symptoms.

    Science.gov (United States)

    Hogan, B A; Hogan, N A; Vos, P M; Eustace, S J; Kenny, P J

    2010-06-01

    Injuries to the cervical spine (C-spine) are among the most serious in rugby and are well documented. Front-row players are particularly at risk due to repetitive high-intensity collisions in the scrum. This study evaluates degenerative changes of the C-spine and associated symptomatology in front-row rugby players. C-spine radiographs from 14 professional rugby players and controls were compared. Players averaged 23 years of playing competitive rugby. Two consultant radiologists performed a blind review of radiographs evaluating degeneration of disc spaces and apophyseal joints. Clinical status was assessed using a modified AAOS/NASS/COSS cervical spine outcomes questionnaire. Front-row rugby players exhibited significant radiographic evidence of C-spine degenerative changes compared to the non-rugby playing controls (P < 0.005). Despite these findings the rugby players did not exhibit increased symptoms. This highlights the radiologic degenerative changes of the C-spine of front-row rugby players. However, these changes do not manifest themselves clinically or affect activities of daily living.

  16. Mood and Global Symptom Changes among Psychotherapy Clients with Depressive Personality

    Directory of Open Access Journals (Sweden)

    Rachel E. Maddux

    2012-01-01

    Full Text Available The present study assessed the rate of depressive personality (DP, as measured by the self-report instrument depressive personality disorder inventory (DPDI, among 159 clients entering psychotherapy at an outpatient university clinic. The presenting clinical profile was evaluated for those with and without DP, including levels of depressed mood, other psychological symptoms, and global severity of psychopathology. Clients were followed naturalistically over the course of therapy, up to 40 weeks, and reassessed on these variables again after treatment. Results indicated that 44 percent of the sample qualified for DP prior to treatment, and these individuals had a comparatively more severe and complex presenting disposition than those without DP. Mixed-model repeated-measures analysis of variance was used to examine between-groups changes on mood and global severity over time, with those with DP demonstrating larger reductions on both outcome variables, although still showing more symptoms after treatment, than those without DP. Only eleven percent of the sample continued to endorse DP following treatment. These findings suggest that in routine clinical situations, psychotherapy may benefit individuals with DP.

  17. THE UTILIZATION OF MULLIGAN CONCEPT THORACIC SUSTAINED NATURAL APOPHYSEAL GLIDES ON PATIENTS CLASSIFIED WITH SECONDARY IMPINGEMENT SYNDROME: A MULTI-SITE CASE SERIES.

    Science.gov (United States)

    Andrews, Dawn P; Odland-Wolf, Kari B; May, James; Baker, Russell; Nasypany, Alan

    2018-02-01

    Secondary impingement syndrome (SIS) is a common complaint in the sporting population particularly among athletes engaging in overhead activities. While symptoms may be present at the shoulder with patients complaining of SIS, spinal alignment or dysfunction can influence scapular positioning and overall shoulder girdle function. As an adjunct therapy to traditional interventions for SIS, thoracic high-velocity low-amplitude (HVLA) thrusts have been utilized and correlated with patient reported decreases in pain. Mulligan Concept (MC) thoracic sustained natural apophyseal glides (SNAGs) are an emerging treatment intervention utilized to treat patients with shoulder pain and dysfunction as the evidence supporting an interdependent relationship between the thoracic spine and the shoulder is growing. The purpose of this case series was to investigate the effects of one MC thoracic SNAG treatment session on subjects classified with SIS, while utilizing a classification-based treatment protocol. Seven subjects classified with SIS were treated utilizing a MC thoracic SNAG. The Numeric Rating Scale (NRS) was administered at initial evaluation, immediately following intervention, and at the 48-h follow-up to identify patient-reported pain during range of motion, manual strength testing, and special tests of the shoulder. Investigators collected the Shoulder Pain and Disability Index (SPADI) at initial evaluation and the 48-h follow-up to identify patient-reported dysfunction. Following one MC thoracic SNAG treatment (3 sets of 10 repetitions), minimal clinically important differences (MCIDs) were reported utilizing the NRS. A decrease in pain during active shoulder abduction (ABD) was detected immediately post-treatment, and the NRS change scores for resisted external rotation (RER) and active ABD were statistically different and clinically important at the 48-h follow-up. Based on the results of this case series, thoracic SNAGs may influence short-term pain levels and

  18. THE UTILIZATION OF MULLIGAN CONCEPT THORACIC SUSTAINED NATURAL APOPHYSEAL GLIDES ON PATIENTS CLASSIFIED WITH SECONDARY IMPINGEMENT SYNDROME: A MULTI-SITE CASE SERIES

    Science.gov (United States)

    Odland-Wolf, Kari B.; May, James; Baker, Russell; Nasypany, Alan

    2018-01-01

    Background and Purpose Secondary impingement syndrome (SIS) is a common complaint in the sporting population particularly among athletes engaging in overhead activities. While symptoms may be present at the shoulder with patients complaining of SIS, spinal alignment or dysfunction can influence scapular positioning and overall shoulder girdle function. As an adjunct therapy to traditional interventions for SIS, thoracic high-velocity low-amplitude (HVLA) thrusts have been utilized and correlated with patient reported decreases in pain. Mulligan Concept (MC) thoracic sustained natural apophyseal glides (SNAGs) are an emerging treatment intervention utilized to treat patients with shoulder pain and dysfunction as the evidence supporting an interdependent relationship between the thoracic spine and the shoulder is growing. The purpose of this case series was to investigate the effects of one MC thoracic SNAG treatment session on subjects classified with SIS, while utilizing a classification-based treatment protocol. Case Descriptions Seven subjects classified with SIS were treated utilizing a MC thoracic SNAG. The Numeric Rating Scale (NRS) was administered at initial evaluation, immediately following intervention, and at the 48-h follow-up to identify patient-reported pain during range of motion, manual strength testing, and special tests of the shoulder. Investigators collected the Shoulder Pain and Disability Index (SPADI) at initial evaluation and the 48-h follow-up to identify patient-reported dysfunction. Outcomes Following one MC thoracic SNAG treatment (3 sets of 10 repetitions), minimal clinically important differences (MCIDs) were reported utilizing the NRS. A decrease in pain during active shoulder abduction (ABD) was detected immediately post-treatment, and the NRS change scores for resisted external rotation (RER) and active ABD were statistically different and clinically important at the 48-h follow-up. Discussion Based on the results of this case series

  19. Medical image of the week: tortuosity of thoracic aorta mimicking a lung mass

    Directory of Open Access Journals (Sweden)

    Park JS

    2017-08-01

    Full Text Available No abstract available. Article truncated at 150 words. An 83-year-old female presented with epigastric discomfort and nausea for 1 month. Her past medical history included hypertension and osteoarthritis. Her vital signs at were unremarkable. Her electrocardiogram revealed only atrial premature beats. Laboratory examination, including complete blood count, liver function test, blood urea nitrogen, creatinine, and electrolytes were normal. Esophagogastroduodenoscopy revealed minimal changes of reflux esophagitis, erosive gastritis, and extrinsic compression of lower esophagus. Her chest x-ray (Figure 1 showed a 5x4 cm sized round retrocardiac mass with sharp margin. Chest CT was ordered to evaluate the lung mass and it revealed that acutely angulated lower thoracic aorta which crossed from left to right above the left diaphragm (Figure 2. After treatment with a proton pump inhibitor and a gastrointestinal pro-motility agent, her symptoms gradually decreased. Follow-up CT after 2 years shows saccular dilatation of the transverse area of thoracic aorta (Figure 2D, however, she has no specific symptoms. …

  20. Intubation in two patients with difficult airway management and tracheal stenosis after tracheostomy in thoracic surgery.

    Science.gov (United States)

    Granell Gil, M; Solís Albamonte, P; Córdova Hernández, C; Cobo, I; Guijarro, R; de Andrés Ibañez, J A

    2018-02-08

    Lung isolation in thoracic surgery is a challenge, this is even more complex in the presence of unknown tracheal stenosis (TS). We report two cases of unknown TS and its airway management. TS appears most frequently after long term intubation close to the endotracheal tube cuff or in the stoma of tracheostomy that appears as a consequence of the granulation tissue after the surgical opening of the trachea. Clinical history, physical examination, difficult intubating predictors and imaging tests (CT scans) are crucial, however most of tracheal stenosis may be unnoticed and symptoms depend on the degree of obstruction. In our cases, the patients presented anatomical changes due to surgery and previous tracheostomy that led to a TS without symptoms. There is scarce literature about the intubation in patients with previous tracheostomy in thoracic surgery. In the first case, a Univent ® tube was used using a flexible fiberscope but an acute tracheal hemorrhage occurred. In the second case, after intubation with VivaSight SL ® in an awake patient, the insertion of a bronchial blocker was performed through an endotracheal tube guided by its integrated camera without using flexible fiberscopy. Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Thoracic Ganglioneuromas Resulting in Nonimmune Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Paul Singh

    2014-05-01

    Full Text Available Introduction - Most often, ganglioneuromas affect older pediatric and adult patients. They are typically slow growing tumors that remain clinically silent until they become large enough to cause symptoms by compression of adjacent structures. Case - We report a case of a 22-year-old Hispanic gravida 2 para 1 female patient who was found to have massive hydrops fetalis at 20 completed gestational weeks. Fetal echocardiography revealed a narrowed distal ductal arch and proximal descending aorta. Cesarean delivery was undertaken at 29 completed gestational weeks for refractory labor and nonreassuring fetal status. The neonate expired at 47 minutes of life despite aggressive resuscitation. At autopsy, multiple thoracic masses were found adjacent to a compressed proximal descending aorta. Histological and immunohistochemical analysis confirmed the diagnosis of a ganglioneuroma, a rare type of neural crest tumor. Discussion - A variety of intrathoracic masses have previously been reported to cause hydrops fetalis including teratomas, fibrosarcomas, and lymphangiomas. To our knowledge, this case is the first description of hydrops fetalis caused by ganglioneuromas. We propose that multiple thoracic ganglioneuromas led to biventricular distal outflow tract obstruction and hydrops fetalis.

  2. Acute chest pain in a top soccer player due to thoracic disc herniation.

    Science.gov (United States)

    Baranto, Adad; Börjesson, Mats; Danielsson, Barbro; Hellström, Mikael; Swärd, Leif

    2009-05-01

    Case report. An unusual and previously not reported case of upper thoracic disc herniation combined with acute chest pain, is presented. Disc herniation in the thoracic spine is rare. There are only a few cases of thoracic disc herniation in top athletes presented in the literature. The clinical presentation of a thoracic disc herniation can vary widely depending on its location and morphologic characteristics. Clinically, the acute symptoms may be severe. A 24-year-old soccer player with acute left-sided chest pain that started in the middle of a soccer game has been followed clinically and with MRI examinations for 3 years. MRI of the thoracic spine showed a left-sided paramedial disc herniation at T2-T3 level and the right-sided paramedial disc herniation at T3-T4 level. The player was prescribed initial rest and subsequent physical rehabilitation. He had no further symptoms during rehabilitation to full training, and could resume play and remained symptom free for the rest of the season.The following season, the player experienced a similar sudden thoracic pain episode during training. This time the chest pain was right-sided. A new MRI of the thoracic spine showed unchanged findings. The initial rehabilitation was similar to the one used in the first episode. After 15 months with no symptoms during normal life the player was allowed to increase the intensity of training gradually and after 2 years the patient played soccer at elite level again. However, 3 years later the symptoms relapsed and the player ended his career after another rehabilitation period. In conclusion, it is important to consider thoracic disc herniation as acute chest pain in athletes and that the long-term prognosis of this entity is not always good.

  3. Attention Bias Modification for Major Depressive Disorder: Effects on Attention Bias, Resting State Connectivity, and Symptom Change

    Science.gov (United States)

    Beevers, Christopher G.; Clasen, Peter C.; Enock, Philip M.; Schnyer, David M.

    2015-01-01

    Cognitive theories of depression posit that selective attention for negative information contributes to the maintenance of depression. The current study experimentally tested this idea by randomly assigning adults with Major Depressive Disorder (MDD) to four weeks of computer-based attention bias modification designed to reduce negative attention bias or four weeks of placebo attention training. Findings indicate that compared to placebo training, attention bias modification reduced negative attention bias and increased resting-state connectivity within a neural circuit (i.e., middle frontal gyrus and dorsal anterior cingulate cortex) that supports control over emotional information. Further, pre- to post-training change in negative attention bias was significantly correlated with depression symptom change only in the active training condition. Exploratory analyses indicated that pre- to post-training changes in resting state connectivity within a circuit associated with sustained attention to visual information (i.e., precuenus and middle frontal gyrus) contributed to symptom improvement in the placebo condition. Importantly, depression symptoms did not change differentially between the training groups—overall, a 40% decrease in symptoms was observed across attention training conditions. Findings suggest that negative attention bias is associated with the maintenance of depression; however, general attentional control may also maintain depression symptoms, as evidenced by resting state connectivity and depression symptom improvement in the placebo training condition. PMID:25894440

  4. The clinical significance of adjacent rib involvement on MRI in patients with acute osteoporotic compression fractures of the thoracic spine

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Joo; Kim, Jae Hyun; Kwon, Kui Hyang; Choi, Deuk Lin; Goo, Dong Erk; Suh, You Sung [Soonchunhyang Univ. Seoul Hospital/Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of); Bae, Won Kyung [Soonchunhyang Univ. Cheonan Hospital/Soonchunhyang Univ. College of Medicine, Cheonan (Korea, Republic of)

    2012-05-15

    The purpose of this study was to evaluate the significance of the presence of adjacent rib involvement in osteoporotic compression fractures. All the patients with acute osteoporotic compression fractures of the thoracic spine on thoracic spine MRI that presented to our clinic between September 2003 and January 2010 were retrospectively reviewed. All the vertebrae were divided into two groups: those that showed signal intensity change in the rib adjacent to the compression fracture and those that did not. We compared the results between the two groups to determine if there were differences in the degree of osteoporosis, the compression fracture level and the age of patients between the two groups. We calculated the degree of correlation between the MRI and the bone scan images of these patients. We also reviewed whether percutaneous vertebroplasty relieved symptoms or not. Signal intensity changes were found in the adjacent rib(s) in 12 of the 60 patients and in 14 of the 94 levels (the total number of levels). The MRI and bone scan showed significant correlation (p < 0.001). There was a statistically significant difference in the incidence of pain at the one month outpatient follow up between the two groups (p = 0.0215). The radiologist should comment on the presence or absence of adjacent rib involvement when reporting on the thoracic spine MRI of patients suffering from osteoporotic compression fractures in order to more accurately determine prognosis.

  5. Concomitant Thoracic Aortobifemoral Bypass With Left Ventricular Assist Device Implantation.

    Science.gov (United States)

    Bishawi, Muath; Shah, Asad A; McCann, Richard L; Milano, Carmelo A

    2016-11-01

    Improved quality of life for patients after left ventricular assist device (LVAD) implantation can be greatly limited by peripheral vascular disease even if heart failure symptoms are resolved by LVAD support. We present a case of concomitant thoracic aortobifemoral bypass and LVAD implantation in a patient with ischemic cardiomyopathy, severe peripheral vascular disease, and multiple previous failed revascularization attempts. In this patient, we used the LVAD outflow to provide the inflow to the femoral artery bypass graft. This graft has remained patent at a 2-year follow-up, without claudication symptoms. Performing concomitant major vascular operations safely and successfully is feasible in patients with LVADs. Quality of life after ventricular assist device placement can be limited by vascular disease, but it can be markedly improved after vascular surgical intervention. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Variations in Dimensions and Shape of Thoracic Cage with Aging ...

    African Journals Online (AJOL)

    We had systematically reviewed, compared and analysed many original and review articles related to aging changes in chest wall images and with the aid of radiological findings recorded in a span of four years. We have concluded that alterations in the geometric dimensions of thoracic wall, change in the pattern and ...

  7. Thoracic complications of rheumatoid disease

    International Nuclear Information System (INIS)

    Massey, H.; Darby, M.; Edey, A.

    2013-01-01

    Rheumatoid arthritis is a relatively common multisystem disease associated with significant mortality and morbidity. Thoracic disease, both pleural and pulmonary, is a frequent extra-articular manifestation of rheumatoid arthritis and responsible for approximately 20% of rheumatoid-associated mortality. Rheumatoid disease and its associated therapies can affect all compartments of the lung inciting a range of stereotyped pathological responses and it is not infrequent for multiple disease entities to co-exist. In some instances, development of pulmonary complications may precede typical rheumatological presentation of the disease and be the first indication of an underlying connective tissue disease. The spectrum of thoracic disease related to rheumatoid arthritis is reviewed

  8. Impedance plethysmographic observations in thoracic outlet syndrome.

    Directory of Open Access Journals (Sweden)

    Nerurkar S

    1990-07-01

    Full Text Available Forty patients with symptoms of neuro-vascular compression in the upper extremities were subjected to impedance plethysmographic study using Parulkar′s method. Two patients recorded decreased blood flow (BFI in supine position and were diagnosed as having partial occlusion at subclavian level. Sixteen of the patients recorded decreased BFI on 90 degrees abduction and hyper-abduction. Twelve of these patients had radiological evidence of anomalous cervicle ribs. In remaining four patients extrinsic impression on the subclavian artery due to fibrous deposits was confirmed by arteriography. Remaining 22 patients recorded normal impedance plethysmograms. Impedance plethysmography thus provided a non-invasive modality for confirmation of vascular compression in thoracic outlet syndrome.

  9. Employment status, depressive symptoms, and waist circumference change in midlife women: the Study of Women's Health Across the Nation (SWAN).

    Science.gov (United States)

    Appelhans, Bradley M; Segawa, Eisuke; Janssen, Imke; Kazlauskaite, Rasa; Thurston, Rebecca C; Lewis, Tené T; Kravitz, Howard M

    2014-03-01

    Changes in employment status have shown inconsistent associations with adiposity. This study tested whether the presence of elevated depressive symptoms explains variability in the time-varying association between employment status and central adiposity. Employment status, depressive symptoms, and waist circumference (WC) were assessed annually over 10 years in a multiethnic sample of 3220 midlife women enrolled in the Study of Women's Health Across the Nation. Linear mixed-effects models tested time-varying associations of employment status, depressive symptoms, and their interaction with WC. WC increases were greatest during the years of combined nonemployment and elevated depressive symptoms (1.00 cm/y) and lowest in the years of full-time employment and elevated depressive symptoms (0.25 cm/y), compared with the years of full-time employment and nonelevated depressive symptoms (0.51 cm/y). Employment status was unrelated to WC in years without elevated depressive symptoms. The pattern of results was unchanged when analyses were restricted to preretirement observations and did not vary according to WC at baseline or ethnicity/race. Identifying and managing depressive symptoms in midlife women who are not working may help prevent increases in central adiposity. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Endovascular treatment of thoracic aortic pseudoaneurysm due to brucellosis: a rare case report.

    Science.gov (United States)

    Wang, Shuai; Wang, Qi; Liu, Han; Sun, Siqiao; Sun, Xiwei; Zhang, Yang; Wang, Zhongying; Cheng, Zhihua

    2017-06-02

    Arterial damage is a known complication of brucellosis, but the occurrence of a thoracic aortic pseudoaneurysm secondary to brucellosis has not been previously reported. A 65-year-old Chinese man presented with a pseudoaneurysm in the descending segment of the thoracic aorta that caused symptoms of chest pain and intermittent fever. He was diagnosed with a thoracic aortic pseudoaneurysm secondary to brucellosis based on a positive brucella serology test (standard-tube agglutination test) and imaging examination (computed tomography angiography). Anti-brucellosis treatment and covered stent graft implantation were attempted to eliminate the brucellosis and pseudoaneurysm, respectively, and were ultimately successful, with no symptoms after 6 months of follow-up. Endovascular repair may be effective and safe for treating a thoracic aortic pseudoaneurysm resulting from brucellosis.

  11. Imaging of thoracic and lumbar spinal extradural arachnoid cysts: report of two cases

    International Nuclear Information System (INIS)

    Rimmelin, A.; Clouet, P.L.; Salatino, S.; Kehrli, P.; Maitrot, D.; Stephan, M.; Dietemann, J.L.

    1997-01-01

    Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal which may communicate with the subarachnoid space. Usually in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report cases of thoracic and lumbar arachnoid cysts studied by cystography, myelography, CT and MRI. These techniques showed extradural cystic lesions containing cerebrospinal fluid, with variable communication with the subarachnoid space, causing anterior displacement and flattening of the spinal cord. (orig.)

  12. Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety.

    Science.gov (United States)

    Makovac, Elena; Watson, David R; Meeten, Frances; Garfinkel, Sarah N; Cercignani, Mara; Critchley, Hugo D; Ottaviani, Cristina

    2016-11-01

    Generalized anxiety disorder (GAD) is characterized by excessive worry, autonomic dysregulation and functional amygdala dysconnectivity, yet these illness markers have rarely been considered together, nor their interrelationship tested longitudinally. We hypothesized that an individual's capacity for emotion regulation predicts longer-term changes in amygdala functional connectivity, supporting the modification of GAD core symptoms. Sixteen patients with GAD (14 women) and individually matched controls were studied at two time points separated by 1 year. Resting-state fMRI data and concurrent measurement of vagally mediated heart rate variability were obtained before and after the induction of perseverative cognition. A greater rise in levels of worry following the induction predicted a stronger reduction in connectivity between right amygdala and ventromedial prefrontal cortex, and enhanced coupling between left amygdala and ventral tegmental area at follow-up. Similarly, amplified physiological responses to the induction predicted increased connectivity between right amygdala and thalamus. Longitudinal shifts in a distinct set of functional connectivity scores were associated with concomitant changes in GAD symptomatology over the course of the year. Results highlight the prognostic value of indices of emotional dysregulation and emphasize the integral role of the amygdala as a critical hub in functional neural circuitry underlying the progression of GAD symptomatology. © The Author (2016). Published by Oxford University Press.

  13. Lower thoracic degenerative spondylithesis with concomitant lumbar spondylosis.

    Science.gov (United States)

    Hsieh, Po-Chuan; Lee, Shih-Tseng; Chen, Jyi-Feng

    2014-03-01

    Degenerative spondylolisthesis of the spine is less common in the lower thoracic region than in the lumbar and cervical regions. However, lower thoracic degenerative spondylolisthesis may develop secondary to intervertebral disc degeneration. Most of our patients are found to have concomitant lumbar spondylosis. By retrospective review of our cases, current diagnosis and treatments for this rare disease were discussed. We present a series of 5 patients who experienced low back pain, progressive numbness, weakness and even paraparesis. Initially, all of them were diagnosed with lumbar spondylosis at other clinics, and 1 patient had even received prior decompressive lumbar surgery. However, their symptoms continued to progress, even after conservative treatments or lumbar surgeries. These patients also showed wide-based gait, increased deep tendon reflex (DTR), and urinary difficulty. All these clinical presentations could not be explained solely by lumbar spondylosis. Thoracolumbar spinal magnetic resonance imaging (MRI), neurophysiologic studies such as motor evoked potential (MEP) or somatosensory evoked potential (SSEP), and dynamic thoracolumbar lateral radiography were performed, and a final diagnosis of lower thoracic degenerative spondylolisthesis was made. Bilateral facet effusions, shown by hyperintense signals in T2 MRI sequence, were observed in all patients. Neurophysiologic studies revealed conduction defect of either MEP or SSEP. One patient refused surgical management because of personal reasons. However, with the use of thoracolumbar orthosis, his symptoms/signs stabilized, although partial lower leg myelopathy was present. The other patients received surgical decompression in association with fixation/fusion procedures performed for managing the thoracolumbar lesions. Three patients became symptom-free, whereas in 1 patient, paralysis set in before the operation; this patient was able to walk with assistance 6 months after surgical decompression

  14. Change in Job Strain as a Predictor of Change in Insomnia Symptoms: Analyzing Observational Data as a Non-randomized Pseudo-Trial

    Science.gov (United States)

    Lallukka, Tea; Pentti, Jaana; Stenholm, Sari; Rod, Naja H.; Virtanen, Marianna; Salo, Paula; Kivimäki, Mika; Vahtera, Jussi

    2017-01-01

    Abstract Study objectives: To examine whether change in job strain leads to change in insomnia symptoms. Methods: Among 24873 adults (82% women, mean age 44 years) who participated in a minimum of three consecutive study waves (2000–2012), job strain was assessed at the first and second wave and insomnia symptoms at all three waves. We analyzed observational data as a “pseudo-trial” including participants with no job strain in the first wave and no insomnia symptoms in the first and second wave (n = 7354) to examine whether the onset of job strain between the first and second waves predicted the onset of insomnia symptoms in the third wave. We used a corresponding approach, including those with job strain in the first wave and insomnia symptoms in the first and second wave (n = 2332), to examine whether the disappearance of job strain between the first two waves predicted remission of insomnia symptoms in the third wave. Results: The onset of job strain predicted the onset of subsequent insomnia symptoms after adjustment for sex, age, marital status, education, smoking, physical activity, alcohol consumption, body mass index, and comorbidities (odds ratio compared to no onset of job strain 1.32, 95% CI 1.16–1.51). The disappearance of job strain was associated with lower odds of repeated insomnia symptoms (odds ratio compared to no disappearance of job strain 0.78, 95% CI 0.65–0.94). Further adjustment for shift work or sleep apnea did not change these associations. Conclusions: These results suggest that job strain is a modifiable risk factor for insomnia symptoms. PMID:28364463

  15. Thoracic aortic catastrophes : towards the endovascular solution

    NARCIS (Netherlands)

    Jonker, F.H.W.

    2010-01-01

    Descending thoracic aortic catastrophes include a variety of acute pathologies of the descending thoracic aorta, which are all associated with high morbidity and mortality rates, requiring immediate intervention. For this thesis, we explored the management and outcomes of several thoracic aortic

  16. Thoracic periaortal fibrosis and Ormond's disease

    International Nuclear Information System (INIS)

    Kacl, G.M.; Bino, M.; Salomon, F.; Risti, B.; Marincek, B.

    1995-01-01

    Two cases of thoracic periaortal fibrosis as a manifestation of retroperitoneal fibrosis (Ormond's disease) are shown on CT and MRI. Thoracic periaortal fibrosis can result in an inflammatory aneurysmo with chronic dissection. Manifestation of thoracic periaortal fibrosis may typically occur intermittently over decades. (orig.) [de

  17. MDCT angiography of thoracic aorta endovascular stent-grafts: pearls and pitfalls.

    Science.gov (United States)

    Hoang, Jenny K; Martinez, Santiago; Hurwitz, Lynne M

    2009-02-01

    The objective of our study was to review expected findings and complications after thoracic endovascular aortic repair on CT angiography (CTA). Luminal and extraluminal changes to the thoracic aorta occur after endovascular stent-grafting. The radiologist can facilitate appropriate management by detecting and differentiating expected CTA findings from complications.

  18. Quantitative Assessment of Scalene Muscle Block for the Diagnosis of Suspected Thoracic Outlet Syndrome.

    Science.gov (United States)

    Braun, Richard M; Shah, Kalpit N; Rechnic, Mark; Doehr, Sandra; Woods, Nancy

    2015-11-01

    To measure changes in upper limb work and power capacity before and after anterior scalene muscle block (ASMB) to suggest thoracic outlet syndrome caused by costoclavicular space compression. We evaluated 34 patients disabled by symptoms suggesting thoracic outlet syndrome. An ASMB was performed via a supraclavicular injection. The sternocleidomastoid muscle was injected as a control. We captured data obtained from work simulator measurements before and after ASMB. Each patient performed a push-pull test with the forearm at waist level (test 1), an overhead bar push-pull test with the arm elevated (test 2), and the extremity abduction stress test with repetitive hand gripping during static arm elevation (test 3). We measured the work product, time to fatigue, and power generation. Sensory testing was performed after ASMB to rule out improved performance associated with possible sensory nerve block. In contrast to sternocleidomastoid injection controls, symptomatic and functional improvement was noted in all patients (n = 34) after ASMB. Work product measurement improved 93%, 108%, and 104% for tests 1, 2, and 3, respectively. Time to fatigue and power output also increased after the block. Temporary symptomatic improvement after ASMB may be anticipated in patients with TOS. This study documents a significant concurrent increase in upper limb motor function after the block. Increased work and power measurements after ASMB may draw diagnostic inference regarding a dynamic change in the scalene muscle and the costoclavicular space associated with symptomatic thoracic outlet syndrome. Diagnostic III. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Thoracic trauma in newborn foals

    International Nuclear Information System (INIS)

    Jean, D.; Laverty, S.; Halley, J.; Hannigan, D.; Leveille, R.

    1999-01-01

    In a report describing life ending fractures (255 horses) from the Livestock Disease Diagnostic Center, Kentucky (1993 and 1994), 32 foals had rib fractures. The purpose of our study was to examine the incidence of rib fractures in newborn foals on a Thoroughbred studfarm by physical and radiographic examination, to determine factors which may contribute to the problem and to document any clinical consequences. All foals (263) included were examined within 3 days of birth. The thoracic cage was palpated externally for abnormalities and all foals were placed in dorsal recumbency to evaluate thoracic cage symmetry. Radiographs were used to diagnose foals with thoraciccage asymmetry (TCA) and rib fracture (RF). A diagnosis of costochondral dislocation (CD) was made when no radiographic evidence of fracture was present but there was severe TCA, Fifty-five foals (20.1%) had TCA (9 RF), One to 5 ribs were fractured on 9 of 40 radiographic studies. No consequences of the thoracic trauma was detected clinically, radiographically or ultrasonographically in this group of foals or at a 2- and 4-week follow-up examination. The percentage of foals with a history of abnormal parturition was higher in the TCA foals (15%) compared to the normal foals (6.8%). There weremore primiparous dams in the TCA group than in the normal foal group. Fillies (56.6%) had a higher incidence of birth trauma than colts (43.4%), Thisstudy demonstrates that thoracic trauma is often present in newborn foals and may not always be of clinical significance. Dystocia foals and foals from primiparous mares should be considered high risk for thoracic trauma

  20. Relationship between changes in vasomotor symptoms and changes in menopause-specific quality of life and sleep parameters.

    Science.gov (United States)

    Pinkerton, JoAnn V; Abraham, Lucy; Bushmakin, Andrew G; Cappelleri, Joseph C; Komm, Barry S

    2016-10-01

    This study characterizes and quantifies the relationship of vasomotor symptoms (VMS) of menopause with menopause-specific quality of life (MSQOL) and sleep parameters to help predict treatment outcomes and inform treatment decision-making. Data were derived from a 12-week randomized, double-blind, placebo-controlled phase 3 trial that evaluated effects of two doses of conjugated estrogens/bazedoxifene on VMS in nonhysterectomized postmenopausal women (N = 318, mean age = 53.39) experiencing at least seven moderate to severe hot flushes (HFs) per day or at least 50 per week. Repeated measures models were used to determine relationships between HF frequency and severity and outcomes on the Menopause-Specific Quality of Life questionnaire and the Medical Outcomes Study sleep scale. Sensitivity analyses were performed to check assumptions of linearity between VMS and outcomes. Frequency and severity of HFs showed approximately linear relationships with MSQOL and sleep parameters. Sensitivity analyses supported assumptions of linearity. The largest changes associated with a reduction of five HFs and a 0.5-point decrease in severity occurred in the Menopause-Specific Quality of Life vasomotor functioning domain (0.78 for number of HFs and 0.98 for severity) and the Medical Outcomes Study sleep disturbance (7.38 and 4.86) and sleep adequacy (-5.60 and -4.66) domains and the two overall sleep problems indices (SPI: 5.17 and 3.63; SPII: 5.82 and 3.83). Frequency and severity of HFs have an approximately linear relationship with MSQOL and sleep parameters-that is, improvements in HFs are associated with improvements in MSQOL and sleep. Such relationships may enable clinicians to predict changes in sleep and MSQOL expected from various VMS treatments.

  1. Evaluation of Self-Perceived Changes in Gastrointestinal Symptoms During Ramadan Fasting.

    Science.gov (United States)

    Keshteli, A H; Sadeghpour, S; Feizi, A; Boyce, P; Adibi, P

    2017-10-01

    Little is known regarding the effects of Ramadan fasting on common gastrointestinal symptoms. The aim of this study was to assess the alterations of these symptoms in a healthy Iranian adult population during Ramadan. In a cross-sectional study, self-administered questionnaires were used to evaluate the alterations in seven groups of gastrointestinal symptoms (esophageal symptoms, dyspeptic symptoms, bloating and abdominal distension, constipation, diarrhea, abdominal pain, and nausea) after Ramadan. A total of 900 individuals participated in the study. Almost 87 % of participants reported to fast for at least 2 weeks during Ramadan. After adjusting for potential confounders, we found no relationship between alteration in frequency of gastrointestinal symptoms and Ramadan fasting, except for constipation which increased significantly after Ramadan fasting (odds ratio 1.99, 95 % confidence interval 1.05-3.80, P fasted for at least 2 weeks reported to experience severe or very severe constipation-related symptoms three times more in comparison with those who fasted for less than 2 weeks (P gastrointestinal symptoms and Ramadan fasting. We found that Ramadan fasting does not increase frequency and severity of common gastrointestinal symptoms in the general population except for constipation that may be experienced more frequently and severely among those who fast for 2 weeks or more.

  2. Expanded level of sympathetic chain removal does not increase the incidence or severity of compensatory hyperhidrosis after endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Gunn, Tyler M; Davis, Diane M; Speicher, James E; Rossi, Nicholas P; Parekh, Kalpaj R; Lynch, William R; Iannettoni, Mark D

    2014-12-01

    Compensatory hyperhidrosis is a common devastating adverse effect after endoscopic thoracic sympathectomy for patients undergoing surgical treatment of primary hyperhidrosis. We sought to determine whether a correlation existed in our patient population between the level and extent of sympathetic chain resection and the subsequent development of compensatory hyperhidrosis. All patients undergoing endoscopic thoracic sympathectomy in the T2-T3, T2-T4, T2-T5, or T2-T6 levels for palmar or axillary hyperhidrosis at the University of Iowa Hospital and Clinics (n = 97) from January 2004 to January 2013 were retrospectively reviewed. Differences in the preoperative patient characteristics were not statistically significant among the patients receiving T2-T3, T2-T4, T2-T5, or T2-T6 level resections. Of the 97 included patients, 28 (29%) experienced transient compensatory hyperhidrosis and 4 (4%) complained of severe compensatory hyperhidrosis and required additional treatment. No operative mortalities occurred, and the morbidity was similar among the groups. Most patients had successful outcomes after undergoing extensive resection without changes in the incidence of compensatory hyperhidrosis. Therefore, we recommend performing complete and adequate resection for relief of symptoms in patients with primary hyperhidrosis. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  3. Depressive Symptoms and Longitudinal Changes in Cognition: Women's Health Initiative Study of Cognitive Aging.

    Science.gov (United States)

    Goveas, Joseph S; Espeland, Mark A; Hogan, Patricia E; Tindle, Hilary A; Shih, Regina A; Kotchen, Jane M; Robinson, Jennifer G; Barnes, Deborah E; Resnick, Susan M

    2014-06-01

    Elevated depressive symptoms (DS) are associated with incident mild cognitive impairment and probable dementia in postmenopausal women. We examined the association of elevated DS with domain-specific cognitive changes and the moderating role of cardiovascular risk factor severity and cardiovascular disease (CVD). A total of 2221 elderly women who participated in the Women's Health Initiative Study of Cognitive Aging were separated into those with (N = 204) and without (N = 2017) elevated DS. The DS and multidomain cognitive outcomes were measured annually for an average follow-up of 5.04 years. Women with elevated DS showed baseline multidomain cognitive deficits but longitudinal declines in global cognition only. Persistent DS was related to greater global cognition, verbal knowledge and fluency, and memory declines. Significant DS-CVD interactions were observed cross-sectionally (but not longitudinally) for figural memory and fine motor speed. Future studies should investigate the role of nonvascular mechanisms linking DS and cognitive decline. © The Author(s) 2014.

  4. Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction.

    Science.gov (United States)

    Stephenson, Kyle R; Simpson, Tracy L; Martinez, Michelle E; Kearney, David J

    2017-03-01

    The current study assessed associations between changes in 5 facets of mindfulness (Acting With Awareness, Observing, Describing, Non-Reactivity, and Nonjudgment) and changes in 4 posttraumatic stress disorder (PTSD) symptom clusters (Re-Experiencing, Avoidance, Emotional Numbing, and Hyperarousal symptoms) among veterans participating in mindfulness-based stress reduction (MBSR). Secondary analyses were performed with a combined data set consisting of 2 published and 2 unpublished trials of MBSR conducted at a large Veterans Affairs hospital. The combined sample included 113 veterans enrolled in MBSR who screened positive for PTSD and completed measures of mindfulness and PTSD symptoms before and after the 8-week intervention. Increases in mindfulness were significantly associated with reduced PTSD symptoms. Increases in Acting With Awareness and Non-Reactivity were the facets of mindfulness most strongly and consistently associated with reduced PTSD symptoms. Increases in mindfulness were most strongly related to decreases in Hyperarousal and Emotional Numbing. These results extend previous research, provide preliminary support for changes in mindfulness as a viable mechanism of treatment, and have a number of potential practical and theoretical implications. © 2016 Wiley Periodicals, Inc.

  5. Thoracic imaging in AIDS

    International Nuclear Information System (INIS)

    Barneveld Binkhuysen, F.H.

    1995-01-01

    The contents are infectious diseases i.e. pneumocystis carinii, mycobacterium tuberculosis, atypical mycobacteria, fungal infections, viral infections ; Malignant diseases : kaposi's sarcoma (KS), malignant lymphoma and other disorders i.e. lymphocytic interstitial pneumonitis, hypersensitivity reactions, bullous changes, pericardial abnormalities (15 refs.)

  6. The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders.

    Science.gov (United States)

    Turner, Hannah; Bryant-Waugh, Rachel; Marshall, Emily

    2015-10-01

    The present study explored the impact of early symptom change (cognitive and behavioural) and the early therapeutic alliance on treatment outcome in cognitive-behavioural therapy (CBT) for the eating disorders. Participants were 94 adults with diagnosed eating disorders who completed a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment, following the 6th session and at the end of treatment. They also completed a measure of therapeutic alliance following the 6th session. Greater early reduction in dietary restraint and eating concerns, and smaller levels of change in shape concern, significantly predicted later reduction in global eating pathology. The early therapeutic alliance was strong across the three domains of tasks, goals and bond. Early symptom reduction was a stronger predictor of later reduction in eating pathology than early therapeutic alliance. The early therapeutic alliance did not mediate the relationship between early symptom reduction and later reduction in global eating pathology. Instead, greater early symptom reduction predicted a strong early therapeutic alliance. Early clinical change was the strongest predictor of treatment outcome and this also facilitated the development of a strong early alliance. Clinicians should be encouraged to deliver all aspects of evidence-based CBT, including behavioural change. The findings suggest that this will have a positive impact on both the early therapeutic alliance and later change in eating pathology. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Behavioral problem trajectories and self-esteem changes in relation with adolescent depressive symptoms: a longitudinal study.

    Science.gov (United States)

    Leung, Cherry Y; Leung, Gabriel M; Schooling, C Mary

    2018-04-04

    Prospectively childhood behavioral problems and low self-esteem are associated with depression. However, these mental health changes over time have never been examined. This study assessed the association of childhood behavioral trajectories and self-esteem changes over time with adolescent depressive symptoms. Parent-reported Rutter behavioral assessments and self-reported Culture-Free Self-Esteem Inventories (SEI) were obtained via record linkage from the Student Health Service, Department of Health (Hong Kong), and the Patient Health Questionnaire-9 (PHQ-9) depressive symptom scores were obtained via active follow-up of the Hong Kong's Children of 1997" Chinese birth cohort. Partitional clustering was used to generate homogenous trajectories between ~ 7 and ~ 11 years for Rutter scores. Changes in low self-esteem between ~ 10 and ~ 12 years were obtained from the SEI. Multiple linear regression was used to estimate their associations with depressive symptom scores at ~ 13 years. Four trajectories/groups (stable low, declining, rising, and stable high) of Rutter score and self-esteem groups were created. The stable low behavioral trajectory was associated with the fewest depressive symptoms while the stable high trajectory had 1.23 more depressive symptoms [95% confidence interval (CI) 0.84 to 1.61] than the stable low trajectory. Consistently low self-esteem (stable low) was associated with 2.96 more depressive symptoms (95% CI 2.35-3.57) compared to consistently high self-esteem (stable high). Sustained or worsening childhood behavioral problems and low self-esteem were precursors of adolescent depressive symptoms, and as such could be an early indicator of the need for intervention.

  8. Changes in Depressive Self-Schemata and Depressive Symptoms Following Cognitive Therapy.

    Science.gov (United States)

    Pace, Terry M.; Dixon, David N.

    1993-01-01

    Examined effects of 6-8 sessions of Beck's cognitive therapy on mildly and moderately depressed college students' (n=31) depressive symptoms and depressive self-schemata compared to no-treatment controls (n=43). Results supported efficacy of cognitive therapy in reducing depressive symptoms and depressive self-schemata, as measured by…

  9. The thoracic outlet syndromes: Part 1. Overview of the thoracic outlet syndromes and review of true neurogenic thoracic outlet syndrome.

    Science.gov (United States)

    Ferrante, Mark A; Ferrante, Nicole D

    2017-06-01

    The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Thus, some categorize disputed TOS as a cervicoscapular pain syndrome rather than as a type of TOS. To better understand these disorders, their distinctions, and the reasoning underlying the categorical change of disputed TOS from a form of TOS to a cervicoscapular pain syndrome, a thorough understanding of the pertinent anatomy, pathology, pathophysiology, and the electrodiagnostic manifestations of their pathophysiologies is required. This review of the TOSs is provided in 2 parts. In this first part we address information pertinent to all 5 TOSs and reviews true neurogenic TOS. In part 2 we review the other 4 TOSs. Muscle Nerve 55: 782-793, 2017. © 2017 Wiley Periodicals, Inc.

  10. Interactions between MAOA Genotype and Receipt of Public Assistance: Predicting Change in Depressive Symptoms and Body Mass Index

    Science.gov (United States)

    Marmorstein, Naomi R.; Hart, Daniel

    2011-01-01

    Response to stress is determined in part by genetically influenced regulation of the monoamine system (MAOA). We examined the interaction of a stressor (receipt of public assistance) and a gene regulating MAOA in the prediction of change in adolescent depressive symptoms and body mass index (BMI). Participants were drawn from the National…

  11. Association between insomnia symptoms and weight change in older women: caregiver--study of osteoporotic fractures study.

    Science.gov (United States)

    Ross, Craig; Ancoli-Israel, Sonia; Redline, Susan; Stone, Katie; Fredman, Lisa

    2011-09-01

    To determine whether self-reported insomnia symptoms were associated with weight change in older women and whether caregiving, comorbidities, sleep medication, or stress modified this association. One-year prospective study conducted in four communities from 1999 to 2003 nested within a larger cohort study. Home-based interviews. Nine hundred eighty-eight participants (354 caregivers and 634 noncaregivers) from the Caregiver--Study of Osteoporotic Fractures. Self-reported insomnia symptoms in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble getting back to sleep. Weight was measured at baseline and 12 months. The average weight change was -1.9 ± 7.8 pounds. Trouble staying asleep was significantly associated with an average weight loss of 1.3 pounds (P = .03) in multivariable analyses. Neither of the other insomnia symptoms was associated with weight change. Use of sleep medications modified the association between trouble falling asleep (interaction term P = .03) and weight change. Insomnia symptoms were associated with weight loss only in women not taking sleep medications. Neither caregiving status, presence of multiple comorbidities, nor stress modified the association. Trouble staying asleep was associated with weight loss over 12 months in older women. Practitioners should inquire about sleep habits of patients presenting with weight loss, because this may identify a marker of declining health and may be a factor that can be modified. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

  12. The Process of Change in Cognitive Therapy for Depression when Combined with Antidepressant Medication: Predictors of Early Intersession Symptom Gains

    Science.gov (United States)

    Strunk, Daniel R.; Cooper, Andrew A.; Ryan, Elizabeth T.; DeRubeis, Robert J.; Hollon, Steven D.

    2012-01-01

    Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed…

  13. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark....... PARTICIPANTS: Sixty patients for major lung resection. INTERVENTIONS: Postoperative observation of ipsilateral shoulder pain. MEASUREMENTS AND MAIN RESULTS: Postoperative numeric rating scale score of shoulder pain and thoracic pain and postoperative examination of the sites of shoulder pain...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...

  14. Patients Older Than 40 Years With Unilateral Occupational Claims for New Shoulder and Knee Symptoms Have Bilateral MRI Changes.

    Science.gov (United States)

    Liu, Tiffany C; Leung, Nina; Edwards, Leonard; Ring, David; Bernacki, Edward; Tonn, Melissa D

    2017-10-01

    Minor events that occur in the workplace sometimes are evaluated with MRI, which may reveal age-related changes in the symptomatic body part. These age-related changes are often ascribed to the event. However, evidence of similar or worse pathophysiology in the contralateral joint would suggest that the symptoms might be new, but the pathophysiology is not. Using a convenience sample of occupational injury claimants with bilateral MRI to evaluate unilateral knee or shoulder symptoms ascribed to a single event at work, we sought to determine whether MRI findings of the shoulder and knee are more often congruent or incongruent with new unilateral symptoms. Two hundred ninety-four occupational injury claimants employed at companies throughout Texas that do not subscribe to workers' compensation insurance, who were older than 40 years, and with unilateral shoulder or knee symptoms, were studied. Starting in 2012, all patients seen by OccMD Group PA who present with unilateral symptoms ascribed to work undergo bilateral MRI, based on several previous occasions where bilateral MRI proved to be a compelling demonstration that perceived injuries are more likely age-related, previously well-adapted pathophysiology. MRI findings (anything described as abnormal by the radiologist; eg, defect size or signal change) was considered congruent if the abnormality of one or more structures on the symptomatic side was greater than that of the corresponding structures in the asymptomatic joint. Bivariate analysis was used to compare the frequency of MRI findings congruent and incongruent with symptoms. Logistic regression was used to evaluate factors associated with MRI findings of the shoulder or knee. Less than half of the patients with shoulder (90 of 189; 48%; p = 0.36) or knee (45 of 105; 43%; p = 0.038) symptoms had worse pathologic features on the symptomatic side. Older age was associated with disorders in the infraspinatus tendon (59 ± 8 versus 56 ± 8 years; p = 0

  15. Changes in symptoms and interpersonal problems during the first 2 years of long-term psychoanalytic psychotherapy and psychoanalysis.

    Science.gov (United States)

    Berghout, Caspar C; Zevalkink, Jolien; Katzko, Michael W; de Jong, Joop T

    2012-06-01

    Longitudinal measurements can provide important information regarding variations in developmental trajectories of patients in long-term treatment. The present study investigated changes in general symptoms, depression, anxiety, and interpersonal problems during the first 2 years of long-term psychoanalytic psychotherapy (PP) and psychoanalysis (PA). It was expected that interpersonal problems would diminish more slowly compared to symptomatic dysfunction. An accelerated longitudinal design with five consecutive measurement points across two cohorts of patients was used. Changes on the Symptom Checklist-90-R (SCL-90-R), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), and Inventory of Interpersonal Problems-64 (IIP-64) were investigated during the first 2 years of long-term PP (n = 73) and PA (n = 40). Linear regression analysis was performed to model the different courses of improvement. After 2 years of treatment, patients in both groups still presented moderate to high levels of symptoms and interpersonal problems compared to non-clinical populations. As expected, interpersonal problems changed less rapidly. PP patients changed both with regard to symptomatic and interpersonal problems, whereas the only significant change in the PA group was on one of the symptomatic subscales. Slopes in the PA group and in PP group did not differ significantly from each other, except for the IIP-64 scale intrusive, with PP patients showing significantly more improvement than PA patients. The height of intake values of the outcome variables appeared to predict the speed of symptomatic recovery. Symptoms and interpersonal problems did not decrease notably within the first 2 years of psychoanalytic treatment. This is consistent with the idea that significant change takes time for patients with chronic mental disorders and personality pathology. In regular practice, it is advisable to monitor changes routinely in order to identify slow responders more

  16. Efficacy of Conical Laminoplasty After Thoracic Laminectomy.

    Science.gov (United States)

    Kobayashi, Kazuyoshi; Imagama, Shiro; Ando, Kei; Nishida, Yoshihiro; Ishiguro, Naoki

    2017-07-07

    Retrospective clinical study. To evaluate the results of a new method of laminoplasty, referred to as conical laminoplasty. In surgery for a thoracic intradural tumor, laminectomy is frequently used for tumor resection. However, laminoplasty may be more effective due to prevention of damage to the posterior elements. This method can be performed as recapping T-saw laminoplasty and conical laminoplasty which we refer. After en bloc laminectomy, conical laminoplasty (group C; 21 cases) or recapping T-saw laminoplasty (group R; 17 cases) was performed for patients with thoracic spinal cord tumors. If neither was possible, laminectomy (group L; 16 cases) was performed. The number of laminae removed and Japanese Orthopedic Association recovery rates did not differ significantly among the 3 groups. Sagittal kyphosis significantly worsened at final follow-up in group L, but did not change significantly in groups C and R. Conical laminoplasty is particularly useful in a case in which T-saw laminoplasty cannot be performed due to tumor expansion in the canal and ossification of the ligamentum flavum. Conical laminoplasty also preserves the posterior elements, which reduces the risk of worsening of kyphosis postoperatively.

  17. October 2013 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-10-01

    Full Text Available No abstract available. Article truncated after 150 words. The October Arizona Thoracic Society meeting was held on Wednesday, 10/23/2013 at Shea Hospital beginning at 6:30 PM. There were 21 in attendance representing the pulmonary, critical care, sleep, and thoracic surgery communities. A proposal was made to decrease the number of meetings from 10 to 8 per year. After a brief discussion, this was adopted. Dr. Parides will try and coordinate these changes with Tucson. Meetings were announced for December in Tucson, January in Carmel, February in Albuquerque, and April in Phoenix. A suggestion was made to have a separate area for meetings on the SWJPCC website. There were 2 cases presented-both by Nick Sparacino, a first year fellow at Good Samaritan/VA. 1. The first case was a 48 year old man admitted to podiatry for chronic diabetic foot ulcers. His preoperative chest x-ray revealed multiple pulmonary nodules. Importantly, he had a history of working in a brake pad …

  18. Symptom changes in multiple sclerosis following psychological interventions: a systematic review.

    Science.gov (United States)

    Pagnini, Francesco; Bosma, Colin M; Phillips, Deborah; Langer, Ellen

    2014-11-30

    Multiple Sclerosis is a disease of the central nervous system involving a variety of debilitating physical, sensory, cognitive and emotional symptoms. This literature review evaluated the impact of psychological interventions on the physiological symptoms associated with the illness. A systematic literature search was conducted using Medline, PsycINFO, Scopus, and the Cochrane Library databases, as well as reference lists. Relevant studies were selected and assessed according to a preset protocol. The search produced 220 articles, with 22 meeting inclusion criteria for the review. A total of 5,705 subjects with Multiple Sclerosis were analyzed. Results from the included studies indicate a general improvement in both psychological and physiological outcomes following psychological treatment. The most highly influenced physical symptoms include fatigue, sleep disturbances, pain, and physical vitality. Findings from the review suggest a positive relationship between psychological interventions and physiological Multiple Sclerosis symptoms. Implications for future research are discussed.

  19. Specificity of the Association between Marital Discord and Longitudinal Changes in Symptoms of Depression and Generalized Anxiety Disorder in the Irish Longitudinal Study on Ageing.

    Science.gov (United States)

    Whisman, Mark A; Robustelli, Briana L; Labrecque, Lindsay T

    2018-03-25

    This longitudinal study was conducted to evaluate actor and partner effects of marital discord on changes in symptoms of depression and generalized anxiety disorder (GAD) in a large population sample of Irish adults (N = 1,445 couples), adjusting for the potential confounds of quality of other social relationships and other psychopathology symptoms. The Actor-Partner Interdependence Model was used to examine actor and partner effects of marital discord on changes in symptoms of depression and GAD at a 2-year follow-up. Additional models examined these associations adjusting for family and friend discord and symptoms of the other type of psychopathology (depressive or GAD symptoms). Actor effects of marital discord on depressive and anxiety symptoms were greater for men than for women. There were significant, positive actor effects of marital discord on depressive symptoms for husbands and wives, which remained significant when adjusting for family and friend discord and GAD symptoms. There were significant, positive actor effects of marital discord on GAD symptoms for husbands, which remained significant when adjusting for family and friend discord and depressive symptoms. Results demonstrate that longitudinal associations between marital discord and depressive symptoms (for wives and husbands) and GAD symptoms (for husbands) are incremental to other rival explanations (family and friend discord and the other set of symptoms). Findings provide evidence for a potential causal association leading from marital discord to symptoms of depression and GAD. © 2018 Family Process Institute.

  20. Prospective Changes in Healthy Lifestyle Among Midlife Women: When Psychological Symptoms Get in the Way.

    Science.gov (United States)

    Trudel-Fitzgerald, Claudia; Tworoger, Shelley S; Poole, Elizabeth M; Williams, David R; Kubzansky, Laura D

    2016-09-01

    Anxiety and depression are linked to increased risk of cardiometabolic disease and mortality, and unhealthy behaviors may be the key mechanisms underlying these associations. Although higher levels of psychological symptoms are associated with individual unhealthy behaviors (e.g., physical activity, smoking), their roles in overall lifestyle remain understudied. Midlife women (n=55,395) from the cohort Nurses' Health Study reported anxiety and depression symptoms in 1988 and 1992, respectively. Health behaviors (i.e., physical inactivity, BMI, diet, and alcohol and tobacco consumption) were measured in self-administered questionnaires in 1988 or 1992, and every 4 years until the last assessment available (2010; follow-up, 18-22 years). Data were analyzed in 2014-2015. Women were categorized according to initial level of psychological symptoms (e.g., lower versus higher anxiety symptoms). Despite slight improvements in healthy lifestyle over time among women with higher versus lower anxiety (βinteraction=0.002, 95% CI=0.001, 0.003), those experiencing more severe symptoms had a consistently less healthy lifestyle over time (ppsychological symptoms may promote healthier lifestyles. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Ancient schwannoma of thoracic spine in a schizophrenic patient with somatic delusion

    Directory of Open Access Journals (Sweden)

    Ya-Ting Wen

    2016-03-01

    Full Text Available Ancient schwannoma is a rare variant of schwannoma characterized by histopathologic degenerative changes, which are thought to be the result of long-term tumor growth and aging. However, ancient schwannoma in the spinal canal is particularly rare. We report a case of thoracic spine intradural extramedullary ancient schwannoma in a schizophrenic patient, who kept saying that “something in his back was giving him electric shock” for a long time. Unfortunately, this complaint was misinterpreted as somatic delusion symptoms. A spinal cord tumor was taken into consideration only after paraparesis developed. We have highlighted this case to remind every clinician to remain alert about the possibility of organic disease while treating patients with psychotic disorder history. Thorough neurological examination is required to avoid misdiagnosis. Spinal canal schwannoma can be totally removed successfully with good functional outcome and prognosis.

  2. Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy

    Science.gov (United States)

    Oh, In-Soo; Seo, Jun-Yeong; Kim, Yoon-Chung

    2010-01-01

    We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment. PMID:20622956

  3. [Thoracic aortic dissection revealed by systemic cholesterol embolism].

    Science.gov (United States)

    Braem, L; Paule, P; Héno, P; Morand, J J; Mafart, B; La Folie, T; Varlet, P; Mioulet, D; Fourcade, L

    2006-10-01

    Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

  4. Sleep-wake profiles predict longitudinal changes in manic symptoms and memory in young people with mood disorders.

    Science.gov (United States)

    Robillard, Rébecca; Hermens, Daniel F; Lee, Rico S C; Jones, Andrew; Carpenter, Joanne S; White, Django; Naismith, Sharon L; Southan, James; Whitwell, Bradley; Scott, Elizabeth M; Hickie, Ian B

    2016-10-01

    Mood disorders are characterized by disabling symptoms and cognitive difficulties which may vary in intensity throughout the course of the illness. Sleep-wake cycles and circadian rhythms influence emotional regulation and cognitive functions. However, the relationships between the sleep-wake disturbances experienced commonly by people with mood disorders and the longitudinal changes in their clinical and cognitive profile are not well characterized. This study investigated associations between initial sleep-wake patterns and longitudinal changes in mood symptoms and cognitive functions in 50 young people (aged 13-33 years) with depression or bipolar disorder. Data were based on actigraphy monitoring conducted over approximately 2 weeks and clinical and neuropsychological assessment. As part of a longitudinal cohort study, these assessments were repeated after a mean follow-up interval of 18.9 months. No significant differences in longitudinal clinical changes were found between the participants with depression and those with bipolar disorder. Lower sleep efficiency was predictive of longitudinal worsening in manic symptoms (P = 0.007). Shorter total sleep time (P = 0.043) and poorer circadian rhythmicity (P = 0.045) were predictive of worsening in verbal memory. These findings suggest that some sleep-wake and circadian disturbances in young people with mood disorders may be associated with less favourable longitudinal outcomes, notably for subsequent manic symptoms and memory difficulties. © 2016 European Sleep Research Society.

  5. A mixed methods study of symptom perception in patients with chronic heart failure.

    Science.gov (United States)

    Riegel, Barbara; Dickson, Victoria Vaughan; Lee, Christopher S; Daus, Marguerite; Hill, Julia; Irani, Elliane; Lee, Solim; Wald, Joyce W; Moelter, Stephen T; Rathman, Lisa; Streur, Megan; Baah, Foster Osei; Ruppert, Linda; Schwartz, Daniel R; Bove, Alfred

    2018-01-03

    Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received. Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. The Diagnostic Accuracy of Clinical Diagnostic Tests for Thoracic Outlet Syndrome.

    Science.gov (United States)

    Hixson, Krista M; Horris, Hannah B; McLeod, Tamara C Valovich; Bacon, Cailee E Welch

    2017-09-01

    Clinical Scenario: Thoracic outlet syndrome is quite challenging to diagnose. Currently, there are myriad diagnostic procedures used in the diagnosis of all types of thoracic outlet syndrome. However, controversy exists over which diagnostic procedures produce accurate findings. Can clinical diagnostic tests accurately diagnose patients presenting with symptoms of thoracic outlet syndrome? Summary of Key Findings: A thorough literature search returned 6 possible studies; 3 studies met the inclusion criteria and were included. Two studies supported the use of clinical diagnostic tests for the diagnosis of thoracic outlet syndrome. One study reported high false-positive rates among clinical diagnostic tests for thoracic outlet syndrome. One study reported that clinical diagnostic test findings correlate to provocative positioned magnetic resonance imaging findings. Clinical Bottom Line: There is moderate evidence to support the use of the Halstead maneuver (also known as the costoclavicular maneuver or exaggerated military brace test), Wright's test, Cyriax Release test, and supraclavicular pressure test to have good diagnostic accuracy for the provocation of symptoms in patients presenting with upper extremity pathology. However, these clinical diagnostic tests do not appear to allow for the differential diagnosis of thoracic outlet syndrome exclusively. The use of the Adson's test and Roos test should be discontinued for the differential diagnosis of thoracic outlet syndrome. Strength of Recommendation: Grade B evidence exists to support the accuracy of the Halstead maneuver, Wright's test, Cyriax Release test, and supraclavicular pressure test for the diagnosis of upper extremity pathology in general. Grade C evidence exists for the use of these clinical diagnostic tests to exclusively diagnose thoracic outlet syndrome.

  7. Symptoms of depression and anxiety, and change in body mass index from adolescence to adulthood: results from a British birth cohort.

    Science.gov (United States)

    Gaysina, D; Hotopf, M; Richards, M; Colman, I; Kuh, D; Hardy, R

    2011-01-01

    Depression and anxiety have been shown to be associated with obesity and underweight, but little is known about how the relationship varies across the life course, from adolescence through adulthood. We aimed to investigate the association between adolescent- and adult-onset affective symptoms and body mass index (BMI) change from age 15 to 53 years. We used data from a British birth cohort born in 1946 and followed up ever since. The relationship between affective symptom profiles, distinguishing adolescent-onset and adult-onset symptoms, and BMI change from adolescence to age 53 years was investigated using multilevel models. Women with adolescent-onset symptoms had lower mean BMI at age 15 years, faster rates of increase across adulthood, and higher BMI at age 53 years than those with no symptoms. Men with adolescent-onset symptoms had lower BMI at all ages from 15 to 53 years. The BMI trajectories of men and women with adult-onset symptoms did not differ from those with absence of symptoms at all ages. The relationship between affective symptoms and change in BMI varies by sex and age at onset of symptoms. Adolescence may be an important period for the development of the association between affective symptoms and weight gain in girls. Intervention to prevent increases in BMI across adult life in women with adolescent-onset symptoms, even if they are not overweight at this age, should be considered.

  8. Changes in anxiety and depression symptoms associated to the outcome of MOH

    DEFF Research Database (Denmark)

    Bottiroli, Sara; Allena, Marta; Sances, Grazia

    2018-01-01

    ( p = 0.69). At the multivariate analysis, intake of a prophylactic drug and absence of symptoms of depression at six months emerged as prognostic factors for being a responder (OR 2.406; p = 0.002 and OR 1.989; p = 0.019 respectively), while lack of antidepressant drugs and presence of symptoms......Aims To evaluate the impact of treatment success on depression and anxiety symptoms in medication-overuse headache (MOH) and whether depression and anxiety can be predictors of treatment outcome. Methods All consecutive patients entering the detoxification program were analysed in a prospective......, non-randomised fashion over a six-month period. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. Results A total of 663 MOH patients were evaluated, and 492 completed the entire protocol. Of these, 287 ceased overuse and reverted to an episodic pattern (responders...

  9. Sleep in Adolescents With Bipolar I Disorder: Stability and Relation to Symptom Change.

    Science.gov (United States)

    Gershon, Anda; Singh, Manpreet K

    2017-01-01

    Sleep disturbances are common features of bipolar disorder (BD), yet little is known about trajectories of sleep disturbances in youth with BD. Using longitudinal data, this study assessed the stability of sleep disturbances and their ability to predict symptom progression in adolescents diagnosed with BD compared to controls. Thirteen- to 19-year-olds meeting diagnostic criteria for BD I (n = 19, 16.2 ± 1.75 years, 57.9 % female, 68.4% Caucasian) and psychiatrically healthy age-comparable controls (n = 21, 15.7 ± 1.48 years. 52.4% female, 57.1% Caucasian) were assessed for sleep onset latency, number of awakenings, and wake time, separately for weekdays and weekends using a self-report questionnaire. Sleep indices and symptoms of mania (Young Mania Rating Scale) and depression (Children's Depression Rating Scale) were assessed at two time points, T1 and T2, approximately 12 months apart. Correlations were used to examine stability of sleep indices across time points and regression models to examine the effects of T1 sleep on T2 symptoms. Adolescents with BD showed low stability on most sleep indices, whereas controls showed high stability on all sleep indices. After controlling for T1 depression symptoms, more T1 weekend awakenings and weekend wake time predicted significantly greater T2 depression symptoms in youth with BD but not in controls. No significant associations were found between T1 sleep and T2 mania symptoms. These findings suggest that increased awakenings and wakefulness on weekends may represent an important therapeutic target for reducing depression in adolescents with BD.

  10. Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management

    Science.gov (United States)

    DeConde, Adam S.; Mace, Jess C.; Alt, Jeremiah A.; Soler, Zachary M.; Orlandi, Richard R.; Smith, Timothy L.

    2014-01-01

    Background Chronic rhinosinusitis (CRS) has been defined as inflammation of the paranasal sinuses lasting at least 12-weeks with corresponding two or more “cardinal symptoms” that includes: 1) nasal obstruction, 2) thick nasal discharge, 3) facial pain/pressure, and 4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS after sinus surgery, none have compared the outcomes of these specific symptoms to on-going medical therapy. Methods Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical management or endoscopic sinus surgery (ESS). Baseline characteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by four questions on the 22-item SinoNasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up. Results 342 subjects were enrolled with 69 (20.2%) electing continued medical management while 273 (79.8%) elected ESS. Subjects electing surgical therapy were more likely to have a higher baseline aggregate SNOT-22 score (44.3(18.9) vs. 53.6(18.8); p<0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely (p<0.013) to experience improvement in thick nasal discharge (OR=4.36), facial pain/pressure (OR=3.56), and blockage/congestion of nose (OR=2.76). Subjects with nasal polyposis were significantly more likely to report complete resolution of smell/taste following ESS compare to medical management (23.8% vs. 4.0%; p=0.026). Conclusions Across a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste. PMID:25236780

  11. Impact of alcohol use motives and internalizing symptoms on mood changes in response to drinking: An ecological momentary assessment investigation.

    Science.gov (United States)

    Gorka, Stephanie M; Hedeker, Donald; Piasecki, Thomas M; Mermelstein, Robin

    2017-04-01

    Theory implies that individuals who use alcohol to cope with negative emotions experience the acute mood-altering effects they desire. However, no study to date has directly tested whether alcohol coping motives map onto alcohol-induced changes in mood in real-time or how co-occurring internalizing symptoms (i.e., depression and anxiety) impact the relation between coping motives and alcohol-induced changes in mood. The current study tested the unique and interactive effects of alcohol coping motives and internalizing symptoms on mood changes during drinking using ecological momentary assessment (EMA) in a sample of young adults (n=257). Participants completed a battery of questionnaires and a 7-day EMA assessment protocol. In general, alcohol use was associated with greater positive mood and reduced negative mood while drinking. However, individuals who reported that they use alcohol to cope with anxiety, but not depression, experienced less mood benefits from alcohol relative to those without mood coping motives. In contrast, individuals with high internalizing symptoms experienced greater mood benefits while drinking relative to those with low levels of internalizing symptoms; and at high levels of anxiety, alcohol consumption was reinforcing for everyone regardless of coping motives. Only at low levels of anxiety symptoms, did coping with anxiety motives attenuate alcohol's acute reinforcing effects. These results together confirm that alcohol has a robust impact on real-time mood in young adults and sheds light on the processes that may contribute to repeated alcohol use within individuals who do, and do not, use alcohol as a means of coping. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Cognitive processes as mediators of the relation between mindfulness and change in social anxiety symptoms following cognitive behavioral treatment.

    Science.gov (United States)

    Morgan, Jessica R; Price, Matthew; Schmertz, Stefan K; Johnson, Suzanne B; Masuda, Akihiko; Calamaras, Martha; Anderson, Page L

    2014-05-01

    The present study examined whether pretreatment mindfulness exerts an indirect effect on outcomes following cognitive-behavioral therapy (CBT). Cognitive processes of probability and cost bias (i.e., overestimations of the likelihood that negative social events will occur, and that these events will have negative consequences when they do occur) were explored as potential mediators of the relation between mindfulness and social anxiety symptom change. People with higher levels of mindfulness may be better able to benefit from treatments that reduce biases because mindfulness may aid in regulation of attention. Sixty-seven individuals with a primary diagnosis of social phobia identifying public speaking as their greatest fear received eight sessions of one of two types of exposure-based CBT delivered according to treatment manuals. Participants completed self-report measures of mindfulness, probability bias, cost bias, and social anxiety symptoms. Mediation hypotheses were assessed by a bootstrapped regression using treatment outcome data. Pretreatment mindfulness was not related to change in social anxiety symptoms from pre- to posttreatment. However, mindfulness had an indirect effect on treatment outcome via its association with probability bias, but not cost bias, at midtreatment. These findings were consistent across three metrics of social anxiety symptoms. Mindfulness may play a role in response to CBT among individuals with social phobia through its relation with probability bias--even when the treatment does not target mindfulness.

  13. Changes in depressive symptoms and correlates in HIV+ people at An Hoa Clinic in Ho Chi Minh City, Vietnam.

    Science.gov (United States)

    Huynh, Van-Anh N; To, Kien G; Do, Dung Van; To, Quyen G; Nguyen, Mai T H

    2017-01-21

    Understanding of depression among Vietnamese people living with HIV (PLWH) is limited. This longitudinal study examines changes in depressive symptoms and identifies its correlates among people living with HIV under antiretroviral therapy at An Hoa Clinic. People living with HIV ≥18 years and undergoing antiretroviral therapy for ≥3 months were eligible. Those at final AIDS stage, too ill, or illiterate were excluded due to their inability to complete the self-administered questionnaire. One researcher was present in the clinic for a month inviting PLWH to participate. Data were collected from 242 PLWH at baseline (T1) and 234 after three months (T2). Depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale (CESD). Social relationship was measured using questions created by World Health Organization. Generalized Estimating Equations were used examining changes in depressive symptoms with CESD cut-off  0.05). Those with a co-morbidity were more likely to have depressive symptoms than those without a co-morbidity (OR = 1.76, p economy, and adherence were not correlates.

  14. Treatment progress in medium security hospital settings for women: changes in symptoms, personality and service need from admission to discharge.

    Science.gov (United States)

    Long, Clive G; Dolley, O; Hollin, Clive R

    2015-04-01

    Service evaluations of medium secure hospital facilities for women are underrepresented in the extant literature. That positive changes in symptoms, personality traits and service need would be evident between admission and discharge among women in a medium security hospital service. A pre-test/post-test design was used, with comparisons made between admission and pre-discharge points on a variety of measures of psychiatric symptoms and personality traits. There were significant improvements in mood according to Beck Depression Inventory scores, mood and other symptoms of mental disorder and distress as measured by the Brief Psychiatric Rating Scale and the Modified Post Traumatic Stress Disorder Symptom Scale, personality traits recorded using the Millon Clinical Multiaxial Inventory III and service need as measured by the Camberwell Assessment of Need, Forensic Version. Significant positive change during treatment, in all clinical areas, is encouraging given poor outcomes for women reported in other research. Findings cannot, however, be unequivocally attributed to the treatments given. Further work is needed to improve early engagement and tailor treatment more specifically to the needs of a heterogeneous population. Copyright © 2014 John Wiley & Sons, Ltd.

  15. Within-person Changes in Individual Symptoms of Depression Predict Subsequent Depressive Episodes in Adolescents: A Prospective Study

    Science.gov (United States)

    Kouros, Chrystyna D.; Morris, Matthew C.; Garber, Judy

    2015-01-01

    The current longitudinal study examined which individual symptoms of depression uniquely predicted a subsequent Major Depressive Episode (MDE) in adolescents, and whether these relations differed by sex. Adolescents (N=240) were first interviewed in grade 6 (M=11.86 years old; SD = 0.56; 54% female; 81.5% Caucasian) and then annually through grade 12 regarding their individual symptoms of depression as well as the occurrence of MDEs. Individual symptoms of depression were assessed with the Children’s Depression Rating Scale-Revised (CDRS-R) and depressive episodes were assessed with the Longitudinal Interval Follow-up Evaluation (LIFE). Results showed that within-person changes in sleep problems and low self-esteem/excessive guilt positively predicted an increased likelihood of an MDE for both boys and girls. Significant sex differences also were found. Within-person changes in anhedonia predicted an increased likelihood of a subsequent MDE among boys, whereas irritability predicted a decreased likelihood of a future MDE among boys, and concentration difficulties predicted a decreased likelihood of an MDE in girls. These results identified individual depressive symptoms that predicted subsequent depressive episodes in male and female adolescents, and may be used to guide the early detection, treatment, and prevention of depressive disorders in youth. PMID:26105209

  16. MMPI-2 as a predictor of change in PTSD symptom clusters: a further analysis of the Forbes et al. (2002) data set.

    Science.gov (United States)

    Forbes, David; Creamer, Mark; Allen, Nicholas; McHugh, Tony; Debenham, Paul; Hopwood, Malcolm

    2003-10-01

    In this study, we reanalyzed the Forbes et al. (2002) data set to examine the Minnesota Multiphasic Personality Inventory (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) as a differential predictor of change across posttraumatic stress disorder symptom clusters following treatment in 141 Vietnam veterans. A series of partial correlation and linear multivariate regression analyses, controlling for initial symptom severity, identified several scales predictive of symptom change. None of the MMPI-2 scales, however, emerged as predictors of change in reexperiencing symptoms. Social alienation and marital distress were the most potent predictors for avoidance symptoms. Anger, alcohol use, and hypomania were the most potent predictors for the hyperarousal symptoms. Of the personality disorders, borderline personality was the strongest predictor of change in the avoidance and hyperarousal clusters. Further replication of the findings of this article and those reported by Forbes et al. (2002) is required.

  17. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    Camassa, N.W.; Boccuzzi, F.; Diettorre, E.; Troilo, A.

    1988-01-01

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  18. Impedance plethysmography of thoracic region: impedance cardiography.

    Directory of Open Access Journals (Sweden)

    Deshpande A

    1990-10-01

    Full Text Available Impedance plethysmograms were recorded from thoracic region in 254 normal subjects, 183 patients with coronary artery disease, 391 patients with valvular heart disease and 107 patients with congenital septal disorder. The data in 18 normal subjects and 55 patients showed that basal impedance decreases markedly during exercise in patients with ischaemic heart disease. Estimation of cardiac index by this technique in a group of 99 normal subjects has been observed to be more consistent than that of the stroke volume. Estimation of systolic time index from impedance plethysmograms in 34 normal subjects has been shown to be as reliable as that from electrocardiogram, phonocardiogram and carotid pulse tracing. Changes in the shape of plethysmographic waveform produced by valvular and congenital heart diseases are briefly described and the role of this technique in screening cardiac patients has been highlighted.

  19. Changes in Depressive Symptoms among Adolescents with ASD Completing the PEERS® Social Skills Intervention

    Science.gov (United States)

    Schiltz, Hillary K.; McVey, Alana J.; Dolan, Bridget K.; Willar, Kirsten S.; Pleiss, Sheryl; Karst, Jeffrey S.; Carson, Audrey M.; Caiozzo, Christina; Vogt, Elisabeth M.; Yund, Brianna D.; Van Hecke, Amy Vaughan

    2018-01-01

    Depression is a common concern among people with autism spectrum disorder (ASD) and is often associated with social skills and relationship challenges. The present data, from a randomized controlled trial, examined the effect of PEERS® on self-reported depressive symptoms via the Children's Depression Inventory (CDI) among 49 adolescents with ASD.…

  20. Health-seeking norms for tuberculosis symptoms in southern Angola: implications for behaviour change communications

    NARCIS (Netherlands)

    Luis, S. F.; Kamp, N.; Mitchell, E. M. H.; Henriksen, K.; van Leth, F.

    2011-01-01

    A passive case-finding strategy as present in the DOTS strategy presupposes a patient's willingness to seek care. This requires awareness of tuberculosis (TB) symptoms and the diagnostic process, and positive attitudes towards access and probability of cure. To measure parameters of health-seeking

  1. Parental Behaviors during Family Interactions Predict Changes in Depression and Anxiety Symptoms during Adolescence

    Science.gov (United States)

    Schwartz, Orli S.; Dudgeon, Paul; Sheeber, Lisa B.; Yap, Marie B. H.; Simmons, Julian G.; Allen, Nicholas B.

    2012-01-01

    This study investigated the prospective, longitudinal relations between parental behaviors observed during parent-adolescent interactions, and the development of depression and anxiety symptoms in a community-based sample of 194 adolescents. Positive and negative parental behaviors were examined, with negative behaviors operationalized to…

  2. Results from a community-based program evaluating the effect of changing smoking status on asthma symptom control

    Directory of Open Access Journals (Sweden)

    To Teresa

    2012-04-01

    Full Text Available Abstract Background Cigarette smoking has been associated with accelerated decline in lung function, increased health services use and asthma severity in patients with asthma. Previous studies have provided insight into how smoking cessation improves lung function among asthma patients, however, fail to provide measurable asthma symptom-specific outcomes after smoking cessation. The objective of this study was to measure the effect of changing smoking status on asthma symptom control and health services use in adults with asthma. Methods The study was conducted in eight primary care practices across Ontario, Canada participating in a community-based, participatory, and evidence-based Asthma Care Program. Patients aged 18 to 55 identified with physician-diagnosed mild to moderate asthma were recruited. In addition to receiving clinical asthma care, participants were administered a questionnaire at baseline and 12-month follow-up visits to collect information on demographics, smoking status, asthma symptoms and routine health services use. The effect of changing smoking status on asthma symptom control was compared between smoking groups using Chi-square and Fisher’s exact tests where appropriate. Mixed effect models were used to measure the impact of the change in smoking status on asthma symptom and health services use while adjusting for covariates. Results This study included 519 patients with asthma; 11% of baseline smokers quit smoking while 4% of baseline non-smokers started smoking by follow-up. Individuals who quit smoking had 80% lower odds of having tightness in the chest (Odds ratio (OR = 0.21, 95% CI: 0.06, 0.82 and 76% lower odds of night-time symptoms (OR = 0.24, 95% CI: 0.07, 0.85 compared to smokers who continued to smoke. Compared to those who remained non-smokers, those who had not been smoking at baseline but self-reported as current smoker at follow-up had significantly higher odds of chest tightness (OR = 1

  3. Thoracic spine disc-related abnormalities: longitudinal MR imaging assessment

    Energy Technology Data Exchange (ETDEWEB)

    Girard, Charles J.; Schweitzer, Mark E.; Morrison, William B.; Parellada, Joan A. [TJUH Radiology, Philadelphia, Pennsylvania (United States); Carrino, J.A. [Department of Radiology ASB-1, Harvard Medical School, Brigham and Women' s Hospital, L1, Room 002B, 75 Francis Street, MA 02115, Boston (United States)

    2004-04-01

    To describe and characterize the temporal changes in disc-related disorders of the thoracic spine using MR imaging. A retrospective longitudinal cohort study was carried out of 40 patients with two sequential thoracic spine MR images at variable intervals. The images were assessed for baseline presence of, new incidence of and changes in disc herniation, degenerative disc disease, endplate marrow signal alteration and Schmorl nodes. The range of follow-up was 4-149 weeks. Baseline presence was: disc herniation, 10% (49/480); degenerative disc disease, 14% (66/480); endplate marrow signal alteration, 2.3% (11/480); Schmorl nodes 9.6% (46/480). Most pre-existing lesions tended to remain unchanged. Herniations showed the most change, tending to improve in 27%. New incidence was: disc herniation, 1.5% (7/480), degenerative disc disease, 2% (10/480); endplate marrow signal alteration, 1.6% (8/480); Schmorl nodes, 2.1% (10/480). Disc degeneration was first visible at an 11-week interval and once established almost never changed over many weeks to months. Endplate signal alterations (Modic changes) were uncommon. Schmorl nodes show no change from baseline for up to 2 1/2 years. All findings predominated in the lower intervertebral levels from T6 to T10. The most prevalent thoracic spine disc-related findings are degeneration and herniation. Disc herniations predominate in the lower segments and are a dynamic phenomenon. Disc degeneration can be rapidly evolving but tends to remain unchanged after occurrence. Endplate marrow signal changes were an uncommon manifestation of thoracic disc disease. Schmorl nodes showed the least change over time. (orig.)

  4. Changes in blink rate and ocular symptoms during different reading tasks

    Directory of Open Access Journals (Sweden)

    Abusharha AA

    2017-11-01

    Full Text Available Ali A Abusharha Department of Optometry and Vision Sciences, King Saud University, Riyadh, Saudi Arabia Background: Reading from tablets is fundamental to modern culture. This study measured differences in the blink rate and symptoms of ocular discomfort in healthy participants during reading from a tablet and a paper book.Methods: Forty healthy, normal males subjects were recruited for this study. Subjects were video recorded during reading a text presented on an electronic device (9.7 inch tablet and a hard copy format, for 15 min. Ocular discomfort experienced during reading was scored using a visual analog scale. Each participant was examined performing one of the two tasks (randomized on one visit and the other on a separate visit (crossover design. All subjects were evaluated before the reading tasks and every 5 min during 15 min of reading.Results: The mean ± standard deviation blink rate was 19.74 ± 9.12/min at baseline. The blink rate decreased significantly under both reading conditions (to 11.35 ± 10.20 and 14.93 ± 10.90/min when reading from a book and a tablet, respectively. There was no significant difference in the blink rate over 15 min during either type of reading. The mean discomfort symptom scores were 148 for the book and 134 for the tablet; both were significantly higher than baseline. A gradual increase in symptoms was found every 5 min during both types of reading.Conclusion: The study confirmed that both the blink rate and ocular discomfort symptoms were strongly affected during performance of close visual tasks. Both reading conditions affected blinking; this may interfere with tear film dynamics. Such effects were reflected in the immediate development of ocular symptoms, which increased significantly during both types of reading. Keywords: blink rate, tear film, reading tasks

  5. Percutaneous thoracic intervertebral disc nucleoplasty: technical notes from 3 patients with painful thoracic disc herniations

    NARCIS (Netherlands)

    Chua Hai Liang, N.; Gultuna, I.; Riezebos, P.; Beems, T.; Vissers, K.C.P.

    2011-01-01

    Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic

  6. Changes in respiratory and non-respiratory symptoms in occupants of a large office building over a period of moisture damage remediation attempts.

    Science.gov (United States)

    Park, Ju-Hyeong; Cho, Sook Ja; White, Sandra K; Cox-Ganser, Jean M

    2018-01-01

    There is limited information on the natural history of building occupants' health in relation to attempts to remediate moisture damage. We examined changes in respiratory and non-respiratory symptoms in 1,175 office building occupants over seven years with multiple remediation attempts. During each of four surveys, we categorized participants using a severity score: 0 = asymptomatic; 1 = mild, symptomatic in the last 12 months, but not frequently in the last 4 weeks; 2 = severe, symptomatic at least once weekly in the last 4 weeks. Building-related symptoms were defined as improving away from the building. We used random intercept models adjusted for demographics, smoking, building tenure, and microbial exposures to estimate temporal changes in the odds of building-related symptoms or severity scores independent of the effect of microbial exposures. Trend analyses of combined mild/severe symptoms showed no changes in the odds of respiratory symptoms but significant improvement in non-respiratory symptoms over time. Separate analyses showed increases in the odds of severe respiratory symptoms (odds ratio/year = 1.15‒1.16, p-valuesrespiratory symptoms, we found no changes in the odds of severe symptoms but improvement in severity scores (-0.04‒-0.01/year, p-valuesrespiratory and severe non-respiratory symptoms associated with dampness/mold, remediation efforts might not be effective in improving occupants' health.

  7. Exposure latitude for thoracic radiography

    Science.gov (United States)

    Van Metter, Richard L.; Lemmers, Henri E. A. S. J.; Schultze Kool, Leo J.

    1992-06-01

    The chest PA examination is one of the single most performed studies in radiology today. It can provide a wealth of information in a single examination. As in many other areas of radiology there is a conflict between high contrast, which enables subtle structures to be visualized, and wide latitude, which allows all areas of interest in the chest to be displayed in a single image. In order to optimize the design of receptor systems it is useful to establish and understand the latitude required for thoracic imaging. We have measured the distributions of x-ray transmittance within the lungs, heart, and abdomen for a population of 868 out-patients. The measurements were made with a resolution element approximately 2 X 2 cm, at a single x-ray beam quality, and with a low-scatter slot-beam geometry. Under these conditions, the required receptor latitude for capturing each area of interest in the thorax is derived as a function of body habitus. To capture all three regions the required receptor latitude for the PA examination varies from 11:1 to 81:1 with increasing patient size. The implications of these results for thoracic image-receptor design is discussed.

  8. Radiological Changes After Resection Rectopexy in Patients with Rectal Prolapse-Influence on Clinical Symptoms and Quality of Life.

    Science.gov (United States)

    Otto, Susanne; Dizer, A M; Kreis, M E; Gröne, J

    2018-04-01

    Resection rectopexy is performed to correct the anatomic defect associated with rectal prolapse. The aim of the study was to determine whether the change in the radiological prolapse grade has an influence on patients' symptoms and quality of life. The study investigated 40 patients who underwent resection rectopexy for rectal prolapse. The following were determined before and after surgery: radiological prolapse grade, anorectal angle and pelvic floor position in defecography, clinical symptoms (Cleveland Clinic Incontinence and Constipation Scores, Kelly-Hohlschneider Score), quality of life. Defecography revealed postoperative improvement in the prolapse grade and pelvic floor position (p quality of life improved in both, the total population (n = 40) and in patients with improved radiological prolapse grade (n = 30): all clinical scores (p Quality of Life Scale (lifestyle, coping, embarrassment p quality of life. Our study demonstrates that the radiological prolapse grade is improved by resection rectopexy. Correction of the anatomic defect was associated with improvement in symptoms and quality of life. Defecography may therefore be useful in the postoperative assessment of persistent symptoms or reduced quality of life.

  9. Changes in blink rate and ocular symptoms during different reading tasks

    OpenAIRE

    Abusharha,Ali

    2017-01-01

    Ali A Abusharha Department of Optometry and Vision Sciences, King Saud University, Riyadh, Saudi Arabia Background: Reading from tablets is fundamental to modern culture. This study measured differences in the blink rate and symptoms of ocular discomfort in healthy participants during reading from a tablet and a paper book.Methods: Forty healthy, normal males subjects were recruited for this study. Subjects were video recorded during reading a text presented on an electronic device (9.7 inch ...

  10. Changes in Life-Quality, a Possible Symptom of Dementia Development

    OpenAIRE

    Dadić-Hero, Elizabeta; Grahovac, Tanja; Kovac, Marina

    2011-01-01

    Dementia is a chronic and irreversible brain impairment characterised by significant cognitive deficits. Severe symptoms of the aforesaid disease interfere with normal life functions and daily activities. Dementia usually develops with advancing age, i.e. after the age of 85, and when it develops in people younger than age 65, it is referred to as early onset dementia. This paper presents a 53-year-old male patient. Provisional diagnosis was established while further diagnostic wo...

  11. Posteriorly migrated thoracic disc herniation: a case report

    Directory of Open Access Journals (Sweden)

    Miyakoshi Naohisa

    2013-02-01

    Full Text Available Abstract Introduction Posterior epidural migration of thoracic disc herniation is extremely rare but may occur in the same manner as in the lumbar spine. Case presentation A 53-year-old Japanese man experienced sudden onset of incomplete paraplegia after lifting a heavy object. Magnetic resonance imaging revealed a posterior epidural mass compressing the spinal cord at the T9-T10 level. The patient underwent emergency surgery consisting of laminectomy at T9-T10 with right medial facetectomy, removal of the mass lesion, and posterior instrumented fusion. Histological examination of the mass lesion yielded findings consistent with sequestered disc material. His symptoms resolved, and he was able to resume walking without a cane 4 weeks after surgery. Conclusions Pre-operative diagnosis of posterior epidural migration of herniated thoracic disc based on magnetic resonance imaging alone may be overlooked, given the rarity of this pathology. However, this entity should be considered among the differential diagnoses for an enhancing posterior thoracic extradural mass.

  12. Bilateral locked facets in the thoracic spine

    NARCIS (Netherlands)

    M.H.A. Willems; Braakman, R. (Reinder); B. van Linge (Bert)

    1984-01-01

    textabstractTwo cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine.

  13. Thoracic duct lymphography by subcutaneous contrast agent ...

    African Journals Online (AJOL)

    A second lymphography revealed a collateral thoracic duct that was not detected during the first lymphography. The collateral duct was ligated and chylothorax was resolved after the second surgery. The lymphography applied in this study was minimally-invasive and easily provided images of the thoracic duct in a dog with ...

  14. Advancements in robotic-assisted thoracic surgery.

    Science.gov (United States)

    Steenwyk, Brad; Lyerly, Ralph

    2012-12-01

    Advancements in robotic-assisted thoracic surgery present potential advantages for patients as well as new challenges for the anesthesia and surgery teams. This article describes the major aspects of the surgical approach for the most commonly performed robotic-assisted thoracic surgical procedures as well as the pertinent preoperative, intraoperative, and postoperative anesthetic concerns. Copyright © 2012. Published by Elsevier Inc.

  15. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  16. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; Zwan, J.M.V.D.; Izarzugaza, I.; Jaal, J.; Treasure, T.; Foschi, R.; Ricardi, U.; Groen, H.; Tavilla, A.; Ardanaz, E.

    2012-01-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  17. Relationship between the change of language symptoms and the change of regional cerebral blood flow in the recovery process of two children with acquired aphasia.

    Science.gov (United States)

    Kozuka, Junko; Uno, Akira; Matsuda, Hiroshi; Toyoshima, Yoshiya; Hamano, Shin-Ichiro

    2017-06-01

    This study aimed to investigate the relationship between the change of language symptoms and the change of regional cerebral blood flow (rCBF) in the recovery process of two children with acquired aphasia caused by infarctions from Moyamoya disease with an onset age of 8years. We compared the results for the Standard Language Test of Aphasia (SLTA) with rCBF changes in 7 language regions in the left hemisphere and their homologous regions in the right hemisphere at 4 time points from 3weeks for up to 5years after the onset of aphasia, while controlling for the effect of age. In both cases, strong correlations were seen within a hemisphere between adjacent regions or regions that are connected by neuronal fibers, and between some language regions in the left hemisphere and their homologous regions in the right hemisphere. Conversely, there were differences between the two cases in the time course of rCBF changes during their recovery process. Consistent with previous studies, the current study suggested that both hemispheres were involved in the long-term recovery of language symptoms in children with acquired aphasia. We suggest that the differences between both cases during their recovery process might be influenced by the brain states before aphasia, by which hemisphere was affected, and by the timing of the surgical revascularization procedure. However, the changes were observed in the data obtained for rCBF with strong correlations with the changes in language performance, so it is possible that rCBF could be used as a biomarker for language symptom changes. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  18. Improved Sleep in Military Personnel is Associated with Changes in the Expression of Inflammatory Genes and Improvement in Depression Symptoms

    Directory of Open Access Journals (Sweden)

    Whitney S. Livingston

    2015-04-01

    Full Text Available Study Objectives: Sleep disturbances are common in military personnel and are associated with increased risk for psychiatric morbidity, including posttraumatic stress disorder and depression, as well as inflammation. Improved sleep quality is linked to reductions in inflammatory bio-markers; however, the underlying mechanisms remain elusive. Methods: In this study we examine whole genome expression changes related to improved sleep in 68 military personnel diagnosed with insomnia. Subjects were classified into the following groups and then compared: improved sleep (n=46, or non-improved sleep (n=22 following three months of standard of care treatment for insomnia. Within subject differential expression was determined from microarray data using the Partek Genomics Suite analysis program and the interactive pathway analysis was used to determine key regulators of observed expression changes. Changes in symptoms of depression and posttraumatic stress disorder were also compared. Results: At baseline both groups were similar in demographics, clinical characteristics, and gene-expression profiles. The microarray data revealed that 217 coding genes were differentially expressed at the follow-up-period compared to baseline in the participants with improved sleep. Expression of inflammatory cytokines were reduced including IL-1β, IL-6, IL-8 and IL-13, with fold changes ranging from -3.19 to -2.1, and there were increases in the expression of inflammatory regulatory genes including toll-like receptors 1, 4, 7, and 8 in the improved sleep group. Interactive pathway analysis revealed 6 gene networks, including ubiquitin which was a major regulator in these gene-expression changes. The improved sleep group also had a significant reduction in the severity of depressive symptoms.Conclusions: Interventions that restore sleep likely reduce the expression of inflammatory genes, which relate to ubiquitin genes and relate to reductions in depressive symptoms.

  19. The stability and change of etiological influences on depression, anxiety symptoms and their co-occurrence across adolescence and young adulthood.

    Science.gov (United States)

    Waszczuk, M A; Zavos, H M S; Gregory, A M; Eley, T C

    2016-01-01

    Depression and anxiety persist within and across diagnostic boundaries. The manner in which common v. disorder-specific genetic and environmental influences operate across development to maintain internalizing disorders and their co-morbidity is unclear. This paper investigates the stability and change of etiological influences on depression, panic, generalized, separation and social anxiety symptoms, and their co-occurrence, across adolescence and young adulthood. A total of 2619 twins/siblings prospectively reported symptoms of depression and anxiety at mean ages 15, 17 and 20 years. Each symptom scale showed a similar pattern of moderate continuity across development, largely underpinned by genetic stability. New genetic influences contributing to change in the developmental course of the symptoms emerged at each time point. All symptom scales correlated moderately with one another over time. Genetic influences, both stable and time-specific, overlapped considerably between the scales. Non-shared environmental influences were largely time- and symptom-specific, but some contributed moderately to the stability of depression and anxiety symptom scales. These stable, longitudinal environmental influences were highly correlated between the symptoms. The results highlight both stable and dynamic etiology of depression and anxiety symptom scales. They provide preliminary evidence that stable as well as newly emerging genes contribute to the co-morbidity between depression and anxiety across adolescence and young adulthood. Conversely, environmental influences are largely time-specific and contribute to change in symptoms over time. The results inform molecular genetics research and transdiagnostic treatment and prevention approaches.

  20. Quantification of the weakness and fatigue in thoracic outlet syndrome with isokinetic measurements

    OpenAIRE

    Ozcakar, L; Inanici, F; Kaymak, B; Abali, G; Cetin, A; Hascelik, Z

    2005-01-01

    Objectives: Patients with thoracic outlet syndrome (TOS) complain of many subjective symptoms that are difficult to measure and quantify. In this study we have tried to assess the weakness (muscle strength) and fatigue (endurance) of these patients with an objective measurement method, isokinetic muscle testing.

  1. Changes in circulating cytokine levels in midlife women with psychological symptoms with selective serotonin reuptake inhibitor and Japanese traditional medicine.

    Science.gov (United States)

    Yasui, Toshiyuki; Yamada, Masayo; Uemura, Hirokazu; Ueno, Shu-Ichi; Numata, Shusuke; Ohmori, Tetsuro; Tsuchiya, Naoko; Noguchi, Masamichi; Yuzurihara, Mitsutoshi; Kase, Yoshio; Irahara, Minoru

    2009-02-20

    The aim of the present study was to compare the effects on serum cytokine concentrations of paroxetine, a selective serotonin re-uptake inhibitor, and kamishoyosan, a Japanese traditional medicine, in midlife women with psychological symptoms. Seventy-six women with psychological symptoms such as anxiety and mild depression as menopausal symptoms were enrolled in this study. Thirty-eight women received oral administration of 10mg paroxetine every day, and 38 women received oral administration of kamshoyosan every day for 6 months. Overall climacteric symptoms were assessed using Greene's climacteric scale. Serum levels of cytokines were measured using a multiplexed human cytokine assay. Greene's total scores in both women treated with paroxetine and in women treated with kamishoyosan decreased significantly. Percentage decreases in Greene's total, psychological and vasomotor scores during the 6-month period in the paroxetine group were significantly greater than those in the kamishoyosan group. Serum IL-6 concentration in women treated with paroxetine decreased significantly. Serum concentrations of IL-8, IL-10, macrophage inflammatory protein (MIP)-1beta and monocyte chemoattractant protein-1 in women treated with paroxetine decreased significantly. On the other hand, serum IL-6 concentration in women treated with kamishoyosan decreased significantly, but other serum concentrations did not change significantly. Decrease in IL-6 concentration may be involved in the mechanism of the actions of both paroxetine and kamishoyosan in women with psychological symptoms, and IL-6 may therefore be useful as a marker of treatment. The action of paroxetine may also be associated with decreases in IL-8, IL-10, MIP-1beta.

  2. Radiologic findings of thoracic trauma

    Directory of Open Access Journals (Sweden)

    Akgul Ozmen C

    2017-08-01

    Full Text Available Cihan Akgul Ozmen,1 Serdar Onat,2 Delal Aycicek3 1Department of Radiology, 2Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir, 3Radiology Unit, Siirt State Hospital, Siirt, Turkey Introduction: Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods: A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3% and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results: MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05. Conclusion: MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by

  3. Stability and change in patterns of eating disorder symptoms from adolescence to young adulthood.

    Science.gov (United States)

    Pearson, Carolyn M; Miller, Jonathan; Ackard, Diann M; Loth, Katie A; Wall, Melanie M; Haynos, Ann F; Neumark-Sztainer, Dianne

    2017-07-01

    Using a community adolescent sample, we aimed to (a) empirically derive eating disorder (ED) symptom groups, (b) examine the longitudinal stability of those groups over 10 years, and (c) identify risk factors associated with ED group stability and transition through young adulthood. Young people (N = 2,287) from the Project EAT cohort participated at baseline (1998-1999) and at 10-year follow-up (2008-2009). Participants completed anthropometric measures at baseline and self-report surveys on disordered eating symptoms and risk factors at both time points. Latent transition modeling was used to test the first two aims and multinomial logistic regression was used for the third aim. Three groups emerged and were labeled as: (a) asymptomatic, (b) dieting, (c) disordered eating (e.g., binge eating, compensatory behaviors). Stability of group membership over 10 years was highest for those in the asymptomatic group, while those in the dieting group showed equal likelihood of transitioning to any group. There was a 75% chance that those in the disordered eating group would continue to belong to a symptomatic group 10 years later. We found that these transitions could be predicted by baseline risk factors. For example, adolescents with one standard deviation higher depressive symptoms than their peers had 53% higher odds (OR = 1.53, 95% CI 1.09-2.16) of transitioning from the asymptomatic group to the disordered eating group. Transition among ED groups is relatively common during adolescence and early adulthood. By targeting risk factors such as self-esteem and familial factors in early adolescence, prevention efforts may be improved. © 2017 Wiley Periodicals, Inc.

  4. Associations between improvement in genitourinary symptoms of menopause and changes in the vaginal ecosystem.

    Science.gov (United States)

    Mitchell, Caroline M; Srinivasan, Sujatha; Plantinga, Anna; Wu, Michael C; Reed, Susan D; Guthrie, Katherine A; LaCroix, Andrea Z; Fiedler, Tina; Munch, Matthew; Liu, Congzhou; Hoffman, Noah G; Blair, Ian A; Newton, Katherine; Freeman, Ellen W; Joffe, Hadine; Cohen, Lee; Fredricks, David N

    2018-05-01

    The aim of the study was to identify associations between improvement in genitourinary symptoms of menopause (GSM) and vaginal microbiota, vaginal glycogen, and serum estrogen. Thirty postmenopausal women enrolled in a hot flash treatment trial (oral estradiol vs venlafaxine vs placebo) who reported GSM and provided vaginal swabs at 0, 4, and 8 weeks were studied. Bacterial communities were characterized using deep sequencing targeting the 16S rRNA gene V3-V4 region. Participants selected a most bothersome genitourinary symptom (dryness, discharge, pain, itch/burn, or inability to have sex) and rated severity on a 10-point scale at baseline and 8 weeks. Vaginal glycogen and serum estradiol and estrone were measured at enrollment and 8 weeks. Comparisons according to improvement in most bothersome symptom (MBS) were made using χ, Wilcoxon signed-rank test, or Hotelling's t test. Of 30 participants, 21 (70%) had improvement in MBS over the 8-week study and 9 (30%) had no improvement or worsening of MBS. A higher proportion of women receiving estradiol or venlafaxine reported improvement in MBS (88%, 78%) compared with placebo (54%; P = 0.28). MBS improvement was associated with Lactobacillus-dominant vaginal microbiota at enrollment (57% vs 22%, P = 0.08). Vaginal glycogen, serum estradiol, and estrone significantly increased in women whose MBS improved. A larger proportion of women whose MBS improved had a Lactobacillus dominant microbiota at enrollment than those who had no improvement during the trial, though this difference was not statistically significant. Larger trials are needed to determine whether vaginal microbiota modify or mediate treatment responses in women with GSM.

  5. Depressive Symptoms and Change in Abdominal Obesity in the Elderly: positive or negative association?

    Science.gov (United States)

    WONG, Samuel YS; LEUNG, Jason C; LEUNG, Ping C; WOO, Jean

    2010-01-01

    Objectives Recent evidence suggests depression could result in abdominal obesity in the elderly. Few longitudinal studies are available and none has been conducted outside of the US. Methods To examine the relationship between depressive symptoms and abdominal obesity, data from 3998 community dwelling Chinese elderly men and women aged 65 years and above with 4-year follow up were analyzed. Depression was defined by a Geriatric Depression Scale score of 8 or higher. At baseline and after 4 years, overall obesity measures included body mass index, percentage of body fat and general adiposity or body fat index (BFI) (expressed by total body fat mass measured by DEXA in kilograms divided by the square of stature in metres). Abdominal obesity measures included waist circumference, waist hip ratio and relative truncal fat (ratio of truncal fat mass to total fat mass measured by DEXA). Results After adjustment for socio-demographics, lifestyle and medical factors, the presence of clinically relevant depressive symptoms at baseline was associated with significant decrease in waist circumference at follow up after adjusting for socio-demographic factors, baseline obesity, lifestyle and medical factors (β=−1.801, t=−2.93, df=1564, p=0.0034) although this relationship disappeared in older aged women in further age stratified analysis. Conclusions This study shows that depressive symptoms may result in a decrease in abdominal obesity, suggesting that more research is needed to further explore this relationship. Similar studies conducted in different cultural groups may help to explain these conflicting findings. PMID:21788923

  6. Exploring mechanisms of change: the relationships between cognitions, symptoms, and quality of life over the course of group cognitive-behaviour therapy.

    Science.gov (United States)

    Oei, Tian Po S; McAlinden, Niamh M; Cruwys, Tegan

    2014-10-01

    This study aimed to explain how quality of life changes during psychotherapy, using a cognitive-behavioural theoretical framework, and examined whether changes in symptoms or changes in cognitions were more influential with regard to quality of life change. Three different hypotheses were tested that might explain the mechanisms by which quality of life changes during group cognitive-behaviour therapy (CBT) for anxiety and depression. 127 outpatients with anxiety and/or depression enrolled in a four-week group CBT programme participated. Measures of anxiety and depression symptoms, cognitive change, and quality of life were administered at baseline and post-treatment. Baseline to post-treatment change scores were calculated and entered into multiple regression analyses. Reductions in anxiety and depression symptoms were related to increases in quality of life, whereas cognitive changes were not consistently related to changes in quality of life. The main limitation was that the study׳s design was not able to assess whether changes in cognitions or symptoms preceded changes in quality of life, as all variables were measured at the same two points in time. These results provided evidence that quality of life changes as a result of or, simultaneously with, symptom change. It appears that group CBT does not improve quality of life through strategies designed to change patients׳ cognitions. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Daily changes of peak expiratory flow and respiratory symptom occurrence around a soy processing factory

    Directory of Open Access Journals (Sweden)

    Dick Heederik

    2014-04-01

    Full Text Available Objectives. To evaluate sensitization and acute respiratory health effects in inhabitants living in the vicinity of a factory producing soy oil. Methods. Two panels of potential responders were created on the basis of a response to a short screening questionnaire sent to random samples of 1,000 exposed and 1,000 non-exposed individuals living around the factory and a control area. Individuals responding to the questionnaire were invited for a medical evaluation, including a respiratory symptom questionnaire and skin prick testing, for a panel of common allergens and a soy allergen extract. This resulted in 53 atopic and/or asthmatic inhabitants from the area surrounding the factory and 30 comparable control subjects. In these subjects, morning and evening Peak Expiratory Flow (PEF, respiratory symptoms and medication use were recorded daily during a 10-week period in the autumn. At the same time, soy allergen and endotoxin concentrations were determined in airborne dust in the exposed and the control area. The wind direction relative to the location of a subjects’ house and the factory was used to determine whether an individual was exposed on a particular day. Results. Only few of the atopic subjects were sensitized to soy. PEF showed a decrease, respiratory symptoms and bronchodilator use, an increase among soy sensitized subjects after having been downwind from the factory. Airborne soy allergen was found more frequently in the area surrounding the factory and levels were higher than in the control area. Highest levels were found on the factory premises. Only a weak association was found with wind direction. Airborne endotoxin concentrations did not show a consistent pattern with distance, but levels were clearly higher on the factory premises. Conclusion. Sensitization to soy allergen was not increased among the population sample living in the vicinity of the factory. Soy sensitized individuals living in the surroundings of the factory

  8. Daily changes of peak expiratory flow and respiratory symptom occurrence around a soy processing factory

    Directory of Open Access Journals (Sweden)

    Dick Heederik

    2014-03-01

    Full Text Available Objectives. To evaluate sensitization and acute respiratory health effects in inhabitants living in the vicinity of a factory producing soy oil. Methods. Two panels of potential responders were created on the basis of a response to a short screening questionnaire sent to random samples of 1,000 exposed and 1,000 non-exposed individuals living around the factory and a control area. Individuals responding to the questionnaire were invited for a medical evaluation, including a respiratory symptom questionnaire and skin prick testing, for a panel of common allergens and a soy allergen extract. This resulted in 53 atopic and/or asthmatic inhabitants from the area surrounding the factory and 30 comparable control subjects. In these subjects, morning and evening Peak Expiratory Flow (PEF, respiratory symptoms and medication use were recorded daily during a 10-week period in the autumn. At the same time, soy allergen and endotoxin concentrations were determined in airborne dust in the exposed and the control area. The wind direction relative to the location of a subjects’ house and the factory was used to determine whether an individual was exposed on a particular day. Results. Only few of the atopic subjects were sensitized to soy. PEF showed a decrease, respiratory symptoms and bronchodilator use, an increase among soy sensitized subjects after having been downwind from the factory. Airborne soy allergen was found more frequently in the area surrounding the factory and levels were higher than in the control area. Highest levels were found on the factory premises. Only a weak association was found with wind direction. Airborne endotoxin concentrations did not show a consistent pattern with distance, but levels were clearly higher on the factory premises. Conclusion. Sensitization to soy allergen was not increased among the population sample living in the vicinity of the factory. Soy sensitized individuals living in the surroundings of the factory

  9. Changes in life-quality, a possible symptom of dementia development.

    Science.gov (United States)

    Dadić-Hero, Elizabeta; Grahovac, Tanja; Kovac, Marina

    2011-09-01

    Dementia is a chronic and irreversible brain impairment characterised by significant cognitive deficits. Severe symptoms of the aforesaid disease interfere with normal life functions and daily activities. Dementia usually develops with advancing age, i.e. after the age of 85, and when it develops in people younger than age 65, it is referred to as early onset dementia. This paper presents a 53-year-old male patient. Provisional diagnosis was established while further diagnostic workup included psycho-diagnostic assessment, neurological exam, and brain CT Such workup confirmed the development of dementia, i.e. early-onset Alzheimer's disease accompanied by depressed mood with impaired vision.

  10. Management of whiplash-associated disorder addressing thoracic and cervical spine impairments: a case report.

    Science.gov (United States)

    Pho, Cuong; Godges, Joe

    2004-09-01

    Clinical case report. To describe a physical therapy program addressing impairments of the upper thoracic and cervical spine region for an individual with a whiplash-associated disorder. A 32-year-old female with complaint of diffuse posterior cervical and upper thoracic region pain was evaluated 2 weeks following a motor vehicle accident. The patient reported that she was unable to sit for longer than 10 minutes or perform household duties for longer than 1 hour. In addition, she was unable to perform her tasks as a postal worker or participate in her customary running and aerobic exercise activities because of pain in the cervical and upper thoracic region. An examination for physical impairments was performed, including the measurement of cervical range of motion using the CROM device, and the assessment of soft tissue and segmental mobility of the upper thoracic and cervical spine regions. The Northwick Park Neck Pain Questionnaire was used to assess functional limitations and disability. Manual therapy and therapeutic exercises were applied to address the identified impairments. Manual therapy techniques included soft tissue mobilization, joint mobilization, and joint manipulation. The patient's cervical range of motion was improved and the disability score improved from 25% to 19.5% 3 days after the initial session addressing the thoracic spine. Following a second session also addressing thoracic spine impairments and the use of therapeutic exercises for 7 days, the disability score improved to 11.1%. At the final visit 17 days following the third visit, which focused on addressing the cervical spine impairments, there was complete resolution of signs and symptoms and disability. Interventions addressing the impairments of the upper thoracic and cervical spine region were associated with reducing pain, increasing cervical range of motion, and facilitating return to work and physical activities in a patient with a whiplash-associated disorder. There is a need

  11. Thoracic radiography and oxidative stress indices in heartworm affected dogs

    Directory of Open Access Journals (Sweden)

    P. K. Rath

    2014-09-01

    Full Text Available Aim: The aim was to study the pathomorphological changes through thoracic radiography and status of oxidative stress parameters in heartworm affected dogs in Odisha. Materials and Methods: A total of 16 dogs with clinically established diagnosis of dirofilariasis by wet blood smear and modified Knott’s test and equal numbers of dogs as control were included in this study. The present study was conducted in heartworm affected dogs to see the pathomorphological changes through thoracic radiography. Similarly, the evaluation was undertaken for observing any alterations in oxidative stress status in affected as well as non-affected, but healthy control dogs by adopting standard procedure. Results: Thoracic radiography revealed cardiac enlargement, round heart appearance suggestive of right ventricular hypertrophy, tortuous pulmonary artery and darkening of lungs. Alterations in oxidative stress indices showed a significant rise of lipid peroxidase activity, non-significant rise of superoxide dismutase and a significant although reverse trend for catalase levels in affected dogs in comparison to Dirofilaria negative control but apparently healthy dogs. Conclusions: Radiographic changes, as well as alterations in oxidative stress parameters, may not be diagnostic for heartworm infection, but useful for detecting heartworm disease, assessing severity and evaluating cardiopulmonary parenchyma changes and gives a fair idea about the degree of severity of the disease. It aids as contributing factors in disease pathogenesis.

  12. Resting state amygdala-prefrontal connectivity predicts symptom change after cognitive behavioral therapy in generalized social anxiety disorder.

    Science.gov (United States)

    Klumpp, Heide; Keutmann, Michael K; Fitzgerald, Daniel A; Shankman, Stewart A; Phan, K Luan

    2014-01-01

    Aberrant amygdala-prefrontal interactions at rest and during emotion processing are implicated in the pathophysiology of generalized social anxiety disorder (gSAD), a common disorder characterized by fears of potential scrutiny. Cognitive behavioral therapy (CBT) is first-line psychotherapy for gSAD and other anxiety disorders. While CBT is generally effective, there is a great deal of heterogeneity in treatment response. To date, predictors of success in CBT for gSAD include reduced amygdala reactivity and increased activity in prefrontal regulatory regions (e.g., anterior cingulate cortex, "ACC") during emotion processing. However, studies have not examined whether tonic (i.e., at rest) coupling of amygdala and these prefrontal regions also predict response to CBT. Twenty-one patients with gSAD participated in resting-state functional magnetic resonance imaging (fMRI) before 12 weeks of CBT. Overall, symptom severity was significantly reduced after completing CBT; however, the patients varied considerably in degree of symptom change. Whole-brain voxel-wise findings showed symptom improvement after CBT was predicted by greater right amygdala-pregenual ACC ("pgACC") connectivity and greater left amygdala-pgACC coupling encompassing medial prefrontal cortex. In support of their predictive value, area under receiver operating characteristic curve was significant for the left and right amygdala-pgACC in relation to treatment responders. Improvement after CBT was predicted by enhanced resting-state bilateral amygdala-prefrontal coupling in gSAD. Preliminary results suggest baseline individual differences in a fundamental circuitry that may underlie emotion regulation contributed to variation in symptom change after CBT. Findings offer a new approach towards using a biological measure to foretell who will most likely benefit from CBT. In particular, the departure from neural predictors based on illness-relevant stimuli (e.g., socio-emotional stimuli in gSAD) permits

  13. Delayed chronic intracranial subdural hematoma complicating resection of a tanycytic thoracic ependymoma

    OpenAIRE

    Maugeri, Rosario; Giugno, Antonella; Graziano, Francesca; Visocchi, Massimiliano; Giller, Cole; Iacopino, Domenico Gerardo

    2016-01-01

    Background: To demonstrate that the diagnosis of an intracranial subdural hematoma should be considered for patients presenting with acute or delayed symptoms of intracranial pathology following resection of a spinal tumor. Case Description: We present a case of a 57-year-old woman found to have a chronic subdural hematoma 1 month following resection of a thoracic extramedullary ependymoma. Evacuation of the hematoma through a burr hole relieved the presenting symptoms and signs. Resoluti...

  14. The thoracic outlet syndromes: Part 2. The arterial, venous, neurovascular, and disputed thoracic outlet syndromes.

    Science.gov (United States)

    Ferrante, Mark A; Ferrante, Nicole D

    2017-10-01

    The thoracic outlet syndromes (TOSs) are a group of etiologically and clinically distinct disorders with 1 feature in common: compression of 1 or more neurovascular elements as they traverse the thoracic outlet. The medical literature reflects 5 TOSs: arterial; venous; traumatic neurovascular; true neurogenic; and disputed. Of these, the first 4 demonstrate all of the features expected of a syndrome, whereas disputed TOS does not, causing many experts to doubt its existence altogether. Thus, some categorize disputed TOSs as cervicoscapular pain syndrome rather than as a type of TOS. To better understand these disorders, their distinctions, and the reasoning underlying the categorical change of disputed TOS from a form of TOS to a cervicoscapular pain syndrome, a thorough understanding of the pertinent anatomy, pathology, pathophysiology, and electrodiagnostic manifestations of these pathophysiologies is required. This review of the TOSs is provided in 2 parts. In part 1 we covered general information pertinent to all 5 TOSs and reviewed true neurogenic TOS in detail. In part 2, we review the arterial, venous, traumatic neurovascular, and disputed forms of TOS. Muscle Nerve 56: 663-673, 2017. © 017 American Association of Neuromuscular & Electrodiagnostic Medicine.

  15. Adult Psychotic Symptoms, Their Associated Risk Factors and Changes in Prevalence in Men and Women Over a Decade in a Poor Rural District of Kenya

    Directory of Open Access Journals (Sweden)

    Rachel Jenkins

    2015-05-01

    Full Text Available There have been no repeat surveys of psychotic symptoms in Kenya or indeed subSaharan Africa. A mental health epidemiological survey was therefore conducted in a demographic surveillance site of a Kenyan household population in 2013 to test the hypothesis that the prevalence of psychotic symptoms would be similar to that found in an earlier sample drawn from the same sample frame in 2004, using the same overall methodology and instruments. This 2013 study found that the prevalence of one or more psychotic symptoms was 13.9% with one or more symptoms and 3.8% with two or more symptoms, while the 2004 study had found that the prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms. This change was accounted for by a striking increase in psychotic symptoms in women (17.8% in 2013 compared with 6.9% in 2004, p < 0.001, whereas there was no significant change in men (10.6% in 2013 compared with 9.4% in 2004, p = 0.582. Potential reasons for this increase in rate of psychotic symptoms in women are explored.

  16. Consensually defined facets of personality as prospective predictors of change in depression symptoms.

    Science.gov (United States)

    Naragon-Gainey, Kristin; Watson, David

    2014-08-01

    Depression has robust associations with personality, showing a strong relation with neuroticism and more moderate associations with extraversion and conscientiousness. In addition, each Big Five domain can be decomposed into narrower facets. However, we currently lack consensus as to the contents of Big Five facets, with idiosyncrasies across instruments; moreover, few studies have examined associations with depression. In the current study, community participants completed six omnibus personality inventories; self-reported depressive symptoms were assessed at baseline and 5 years later. Exploratory factor analyses suggested three to five facets in each domain, and these facets served as prospective predictors of depression in hierarchical regressions, after accounting for baseline and trait depression. In these analyses, high anger (from neuroticism), low positive emotionality (extraversion), low conventionality (conscientiousness), and low culture (openness to experiences) were significant prospective predictors of depression. Results are discussed in regard to personality structure and assessment, as well as personality-psychopathology associations. © The Author(s) 2014.

  17. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2017-01-15

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  18. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    International Nuclear Information System (INIS)

    Kariya, Shuji; Nakatani, Miyuki; Yoshida, Rie; Ueno, Yutaka; Komemushi, Atsushi; Tanigawa, Noboru

    2017-01-01

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  19. [Influence of temperature changes on clinical symptoms in multiple sclerosis: an epidemiologic study].

    Science.gov (United States)

    Petrilli, S; Durufle, A; Nicolas, B; Robineau, S; Kerdoncuff, V; Le Tallec, H; Lassalle, A; Gallien, P

    2004-06-01

    The effects of the modifications of temperature are well known in patients affected by multiple sclerosis (MS). They are variable and can influence daily living. This sensibility can be used in the management of the disabilities. An epidemiological study was realized on a cohort of 191 patients suffering from MS referred to the MS clinic of Rennes (France). All the patients were questioned about the influence of heat and cold on their clinical symptoms (fatigue spasticity, walking disorders, vision, em leader ). Correlations with the main clinical characteristics were studied. One hundred ninety-one patients, 129 women and 62 men with an average age of 47.6 +/- 10 years were interviewed. Average score EDSS was of 5.2 +/- 1.5. The mean duration of MS was 13.5 +/- 10 years. One hundred forty-seven patients (77%) reported a sensibility to the temperature. Heat deteriorated function in 104 cases and 82 patients improved with cold. Paradoxically 20 patients reported to be deteriorated with cold and 19 improved with heat. Fatigue and walking were the most sensitive to temperature fluctuations. No particular clinical profile could be established. Fifty percent of the patients used this sensibility with therapeutic aim in everyday life. The clear influence of temperature fluctuations on the clinical symptom was confirmed in this study. However, there is a great variability from one patient to another. Different hypotheses have been evoked to explain this phenomenon. The most likely is an influence on the nervous specific conductivity. In routine practice cold physiotherapy will be proposed on case by case basis and still has an interesting place in the rehabilitation management.

  20. Cognitive Change Predicts Symptom Reduction with Cognitive Therapy for Posttraumatic Stress Disorder

    Science.gov (United States)

    Kleim, Birgit; Grey, Nick; Wild, Jennifer; Nussbeck, Fridtjof W.; Stott, Richard; Hackmann, Ann; Clark, David M.; Ehlers, Anke

    2013-01-01

    Objective: There is a growing body of evidence for the effectiveness of trauma-focused cognitive behavior therapy (TF-CBT) for posttraumatic stress disorder (PTSD), but few studies to date have investigated the mechanisms by which TF-CBT leads to therapeutic change. Models of PTSD suggest that a core treatment mechanism is the change in…

  1. Change in organizational justice as a predictor of insomnia symptoms: longitudinal study analysing observational data as a non-randomized pseudo-trial.

    Science.gov (United States)

    Lallukka, Tea; Halonen, Jaana I; Sivertsen, Børge; Pentti, Jaana; Stenholm, Sari; Virtanen, Marianna; Salo, Paula; Oksanen, Tuula; Elovainio, Marko; Vahtera, Jussi; Kivimäki, Mika

    2017-08-01

    Despite injustice at the workplace being a potential source of sleep problems, longitudinal evidence remains scarce. We examined whether changes in perceived organizational justice predicted changes in insomnia symptoms. Data on 24 287 Finnish public sector employees (82% women), from three consecutive survey waves between 2000 and 2012, were treated as 'pseudo-trials'. Thus, the analysis of unfavourable changes in organizational justice included participants without insomnia symptoms in Waves 1 and 2, with high organizational justice in Wave 1 and high or low justice in Wave 2 (N = 6307). In the analyses of favourable changes in justice, participants had insomnia symptoms in Waves 1 and 2, low justice in Wave 1 and high or low justice in Wave 2 (N = 2903). In both analyses, the outcome was insomnia symptoms in Wave 3. We used generalized estimating equation models to analyse the data. After adjusting for social and health-related covariates in Wave 1, unfavourable changes in relational organizational justice (i.e. fairness of managerial behaviours) were associated with increased odds of developing insomnia symptoms [odds ratio = 1.15; 95% confidence interval (CI) 1.02-1.30]. A favourable change in relational organizational justice was associated with lower odds of persistent insomnia symptoms (odds ratio = 0.83; 95% CI 0.71-0.96). Changes in procedural justice (i.e. the fairness of decision-making procedures) were not associated with insomnia symptoms. These data suggest that changes in perceived relational justice may affect employees' sleep quality. Decreases in the fairness of managerial behaviours were linked to increases in insomnia symptoms, whereas rises in fairness were associated with reduced insomnia symptoms. © The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association.

  2. The Relation between Maternal ADHD Symptoms & Improvement in Child Behavior Following Brief Behavioral Parent Training Is Mediated by Change in Negative Parenting

    Science.gov (United States)

    Chronis-Tuscano, Andrea; O'Brien, Kelly A.; Johnston, Charlotte; Jones, Heather A.; Clarke, Tana L.; Raggi, Veronica L.; Rooney, Mary E.; Diaz, Yamalis; Pian, Jessica; Seymour, Karen E.

    2011-01-01

    This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy…

  3. Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster.

    Science.gov (United States)

    Osofsky, Howard J; Weems, Carl F; Hansel, Tonya Cross; Speier, Anthony H; Osofsky, Joy D; Graham, Rebecca; King, Lucy; Craft, Timothy K

    2017-06-01

    Addressing life stressors is an important function for integrated care, especially for health care homes located in disaster prone environments. This study evaluated trajectories of change for patients with postdisaster posttraumatic stress disorder (PTSD) who were seen in integrated care. In addition to describing the results, this article provides the methods of subgroup analyses as this may be useful for others working in real-world practice. Patients (N = 340) receiving services at 5 rural health clinics self-reported PTSD symptoms as part of an ongoing evaluation to study the effectiveness of integrated health. Analysis of variance was used to assess differences overtime and trajectories were identified with cluster analyses. Disaster and trauma related factors associated with these trajectories were assessed using logistic regression. Significant overall decreases in PTSD symptoms overtime were found; individual trajectories were identified and include stable low, steep declines, stable high symptoms, and increasing symptoms. Stress related to disaster and the number of other traumas patients experienced correctly classified trajectory membership. Trajectories indicate that patients have differing treatment needs and cluster analysis as an evaluation technique may be useful in identifying what treatment works and for whom. The present study addresses a major concern for health care providers serving disaster prone communities and emphasizes the importance of identifying pre incident and disaster related risk vulnerabilities that contribute to mental health outcomes. Subgroup analyses are a useful tool for developing more targeted treatment within integrated care and may be an accessible research strategy for others working in such settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  4. Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury.

    Science.gov (United States)

    Zariffa, J; Kramer, J L K; Fawcett, J W; Lammertse, D P; Blight, A R; Guest, J; Jones, L; Burns, S; Schubert, M; Bolliger, M; Curt, A; Steeves, J D

    2011-03-01

    Retrospective, longitudinal analysis of sensory, motor and functional outcomes from individuals with thoracic (T2-T12) sensorimotor complete spinal cord injury (SCI). To characterize neurological changes over the first year after traumatic thoracic sensorimotor complete SCI. A dataset of 399 thoracic complete SCI subjects from the European Multi-center study about SCI (EMSCI) was examined for neurological level, sensory levels and sensory scores (pin-prick and light touch), lower extremity motor score (LEMS), ASIA Impairment Scale (AIS) grade, and Spinal Cord Independence Measure (SCIM) over the first year after SCI. AIS grade conversions were limited. Sensory scores exhibited minimal mean change, but high variability in both rostral and caudal directions. Pin-prick and light touch sensory levels, as well as neurological level, exhibited minor changes (improvement or deterioration), but most subjects remained within one segment of their initial injury level after 1 year. Recovery of LEMS occurred predominantly in subjects with low thoracic SCI. The sensory zone of partial preservation (ZPP) had no prognostic value for subsequent recovery of sensory levels or LEMS. However, after mid or low thoracic SCI, ≥3 segments of sensory ZPP correlated with an increased likelihood for AIS grade conversion. The data suggest that a sustained deterioration of three or more thoracic sensory levels or loss of upper extremity motor function are rare events and may be useful for tracking the safety of a therapeutic intervention in early phase acute SCI clinical trials, if a significant proportion of study subjects exhibit such an ascent.

  5. Disappearing large calcified thoracic disc herniation in a patient with thalassaemia

    Science.gov (United States)

    Ahmad, Faiz U; Schallert, Erica; Bregy, Amade; Post, Judith D; Vanni, Steven

    2016-01-01

    Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a case of a 38-year-old patient with thalassaemia who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level and discuss the possible aetiopathogenesis. This is the first such case reported in the thalassaemia population. PMID:26823353

  6. Aneurysmal Bone Cyst Arising from the First Rib: A Rare Cause of Thoracic Outlet Syndrome.

    Science.gov (United States)

    Medina, Manuel; Paul, Subroto

    2016-12-01

    Aneurysmal bone cyst is a rare benign cystic bone lesion with an incidence of only 0.14 per 100,000 individuals and most commonly affects the metaphyses of long bones, spine, and pelvis. We present a very rare case of a 17-year-old boy with a rapidly expanding aneurysmal bone cyst arising from the first rib, resulting in neurogenic thoracic outlet syndrome secondary to its compression of the brachial plexus. The patient's symptoms resolved after en bloc resection. To our knowledge there have been no other reports in the literature of thoracic outlet syndrome due to aneurysmal bone cyst arising from the first rib.

  7. Emergency Anaesthetic Management of Extensive Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    H C Chandola

    2007-01-01

    Full Text Available High speed vehicles, drug abuse, alcohol and easy availability of handguns are the main reasons of increasing number of trauma especially thoracic trauma. Anaesthesiologist plays an important role in the management of extensive thoracic trauma. Thoracic trauma, penetrating or blunt, may cause damage to organs suspended in thorax viz. pleura, lungs, heart, great vessels, trachea and oesophagus. It may lead to pneumothorax, cardiac tamponade or life threatening haemorrhage. With aggressive care and management of these factors, majority of patients can survive and return to normal life.

  8. Thromboembolic stroke associated with thoracic outlet syndrome.

    Science.gov (United States)

    Meumann, Ella M; Chuen, Jason; Fitt, Greg; Perchyonok, Yuliya; Pond, Franklin; Dewey, Helen M

    2014-05-01

    Thoracic outlet syndrome occurs due to compression of the neurovascular structures as they exit the thorax. Subclavian arterial compression is usually due to a cervical rib, and is rarely associated with thromboembolic stroke. The mechanism of cerebral embolisation associated with the thoracic outlet syndrome is poorly understood, but may be due to retrograde propagation of thrombus or transient retrograde flow within the subclavian artery exacerbated by arm abduction. We report an illustrative patient and review the clinical features, imaging findings and management of stroke associated with thoracic outlet syndrome. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Can virtual reality reduce reality distortion? Impact of performance feedback on symptom change in schizophrenia patients.

    Science.gov (United States)

    Moritz, Steffen; Voigt, Miriam; Köther, Ulf; Leighton, Lucy; Kjahili, Besiane; Babur, Zehra; Jungclaussen, David; Veckenstedt, Ruth; Grzella, Karsten

    2014-06-01

    There is emerging evidence that the induction of doubt can reduce positive symptoms in patients with schizophrenia. Based on prior investigations indicating that brief psychological interventions may attenuate core aspects of delusions, we set up a proof of concept study using a virtual reality experiment. We explored whether feedback for false judgments positively influences delusion severity. A total of 33 patients with schizophrenia participated in the experiment. Following a short practice trial, patients were instructed to navigate through a virtual street on two occasions (noise versus no noise), where they met six different pedestrians in each condition. Subsequently, patients were asked to recollect the pedestrians and their corresponding facial affect in a recognition task graded for confidence. Before and after the experiment, the Paranoia Checklist (frequency subscale) was administered. The Paranoia Checklist score declined significantly from pre to post at a medium effect size. We split the sample into those with some improvement versus those that either showed no improvement, or worsened. Improvement was associated with lower confidence ratings (both during the experiment, particularly for incorrect responses, and according to retrospect assessment). No control condition, unclear if improvement is sustained. The study tentatively suggests that a brief virtual reality experiment involving error feedback may ameliorate delusional ideas. Randomized controlled trials and dismantling studies are now needed to substantiate the findings and to pinpoint the underlying therapeutic mechanisms, for example error feedback or fostering attenuation of confidence judgments in the face of incomplete evidence. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Resident training in a new robotic thoracic surgery program.

    Science.gov (United States)

    White, Yasmine N; Dedhia, Priya; Bergeron, Edward J; Lin, Jules; Chang, Andrew A; Reddy, Rishindra M

    2016-03-01

    The volume of robot-assisted operations has drastically increased over the past decade. New programs have focused on training surgeons, whereas resident training has lagged behind. The objective of this study was to evaluate our institutional experience with resident participation in thoracic robotic surgery cases since the initiation of our program. The first 100 robotic thoracic surgery cases at our institution were retrospectively reviewed and categorized into three sequential cohorts. Procedure type, patient and operative characteristics, level of resident participation (primary surgeon [PS] or assistant), and postoperative variables were evaluated. Of the first 100 cases, 38% were lung resections, 23% were esophageal operations, and 20% were sympathectomies. The distribution of cases changed over time with the proportion of pulmonary resections significantly increasing. Patient age (P robotics program. Operative time, estimated blood loss, and length of stay were similar regardless of level of resident participation. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. MRI findings in thoracic outlet syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Aralasmak, Ayse; Sharifov, Rasul; Kilicarslan, Rukiye; Alkan, Alpay [Bezmialem Vakif University, Department of Radiology, Fatih/Istanbul (Turkey); Cevikol, Can; Karaali, Kamil; Senol, Utku [Akdeniz University, Department of Radiology, Antalya (Turkey)

    2012-11-15

    We discuss MRI findings in patients with thoracic outlet syndrome (TOS). A total of 100 neurovascular bundles were evaluated in the interscalene triangle (IS), costoclavicular (CC), and retropectoralis minor (RPM) spaces. To exclude neurogenic abnormality, MRIs of the cervical spine and brachial plexus (BPL) were obtained in neutral. To exclude compression on neurovascular bundles, sagittal T1W images were obtained vertical to the longitudinal axis of BPL from spinal cord to the medial part of the humerus, in abduction and neutral. To exclude vascular TOS, MR angiography (MRA) and venography (MRV) of the subclavian artery (SA) and vein (SV) in abduction were obtained. If there is compression on the vessels, MRA and MRV of the subclavian vessels were repeated in neutral. Seventy-one neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the CC, mostly secondary to position, and very rarely compressed in the RPM. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory. (orig.)

  12. The current status of endovascular repair of thoracic aortic aneurysms (TEVAR).

    Science.gov (United States)

    El-Sayed, Hosam; Ramlawi, Basel

    2011-01-01

    Thoracic endovascular aortic repair (TEVAR) has been one of the most important advances in the management of thoracic aortic disease in the past two decades. The procedure was originally developed by Dake and colleagues in 1994 for the treatment of descending thoracic aortic aneurysm (DTAA), using the same principles as EVAR for the treatment of abdominal aortic aneurysm (AAA). The first device approved for this indication was the TAG device (W.L. Gore & Associated, Inc., Flagstaff, AZ) in 2005. Since then there has been a plethora of changes and new developments related to thoracic endovascular aortic repair. This article will summarize the major updates related to TEVAR, focusing on three main aspects: what is new in device technology and future prospects; the expanding indications of TEVAR for the treatment of other pathologies and the newly developed techniques involved; and a glimpse at the expected future direction in the field.

  13. Relations between Concurrent Longitudinal Changes in Cognition, Depressive Symptoms, Self-Rated Health and Everyday Function in Normally Aging Octogenarians.

    Science.gov (United States)

    Classon, Elisabet; Fällman, Katarina; Wressle, Ewa; Marcusson, Jan

    2016-01-01

    Ability to predict and prevent incipient functional decline in older adults may help prolong independence. Cognition is related to everyday function and easily administered, sensitive cognitive tests may help identify at-risk individuals. Factors like depressive symptoms and self-rated health are also associated with functional ability and may be as important as cognition. The purpose of this study was to investigate the relationship between concurrent longitudinal changes in cognition, depression, self-rated health and everyday function in a well-defined cohort of healthy 85 year olds that were followed-up at the age of 90 in the Elderly in Linköping Screening Assessment 85 study. Regression analyses were used to determine if cognitive decline as assessed by global (the Mini-Mental State Examination) and domain specific (the Cognitive Assessment Battery, CAB) cognitive tests predicted functional decline in the context of changes in depressive symptoms and self-rated health. Results showed deterioration in most variables and as many as 83% of these community-dwelling elders experienced functional difficulties at the age of 90. Slowing-down of processing speed as assessed by the Symbol Digits Modality Test (included in the CAB) accounted for 14% of the variance in functional decline. Worsening self-rated health accounted for an additional 6%, but no other variables reached significance. These results are discussed with an eye to possible preventive interventions that may prolong independence for the steadily growing number of normally aging old-old citizens.

  14. Categorization of the sumptom thoracic pain type isquemic in the woman to the light the theory of unpleasant symptoms Tipificación del síntoma dolor torácico tipo isquémico en la mujer, a la luz de la teoría de los síntomas desagradables

    Directory of Open Access Journals (Sweden)

    CORTÉS CASTRO LUIS ALBERTO

    2007-12-01

    Full Text Available Coronary heart disease is the first cause of mortality among Colombia's female population (1 and constitutes a health problem that implies deterioration of the quality of life of this group. The objective of this study was to categorize the ischemic thoracic pain in women in light of the theory Of Unpleasant Symptoms. The study was designed to be descriptiveexploratory with a qualitativequantitative approach. The information was collected by means of a semistructured interview and samples as gathered with information supplied by 30 women who were diagnosed with unstable heart pain or acute heart attack at San Rafael Hospital and at San Sebastián Clinic in Giradot from July to November 2005. The results showed women between 50 and 95 years of age, the majority classified to be within a low social class and level of education. As to the physiological factor, the most representative pathologic background from cardiovascular origin was high blood pressure, followed by diabetes. Within the psychological factors, the most representative category in frequency was "what women believe and know about the symptoms and the disease" and in the situational factors "heat affects me". In terms of the quality dimension, the outstanding category was "major commitment with being a human being". The symptom was referred to a severe intensity in 93% of the cases, and the average grade was 9,48 in a visual analogue scale. Within the consequences of the symptom, the most representative was "Controlling physical activity". The most frequent secondary symptoms were "vomit", "dizziness" and "headache". A symptomatic profile is observed, which is expressed with a linguistic richness and that shows concatenation processes within her health experience that enables us to understand her situation better and consequently to provide adequate care.La enfermedad coronaria ocupa el primer lugar como causa de mortalidad en la población femenina en Colombia

  15. Tipificación del síntoma dolor torácico tipo isquémico en la mujer, a la luz de la teoría de los síntomas desagradables Categorization of the sumptom thoracic pain type isquemic in the woman to the light the theory of unpleasant symptoms

    Directory of Open Access Journals (Sweden)

    LUIS ALBERTO CORTÉS CASTRO

    2007-12-01

    problem that implies deterioration of the quality of life of this group. The objective of this study was to categorize the ischemic thoracic pain in women in light of the theory Of Unpleasant Symptoms. The study was designed to be descriptive exploratory with a qualitative quantitative approach. The information was collected by means of a semistructured interview and samples as gathered with information supplied by 30 women who were diagnosed with unstable heart pain or acute heart attack at San Rafael Hospital and at San Sebastián Clinic in Giradot from July to November 2005. The results showed women between 50 and 95 years of age, the majority classified to be within a low social class and level of education. As to the physiological factor, the most representative pathologic background from cardiovascular origin was high blood pressure, followed by diabetes. Within the psychological factors, the most representative category in frequency was "what women believe and know about the symptoms and the disease" and in the situational factors "heat affects me". In terms of the quality dimension, the outstanding category was "major commitment with being a human being". The symptom was referred to a severe intensity in 93% of the cases, and the average grade was 9,48 in a visual analogue scale. Within the consequences of the symptom, the most representative was "Controlling physical activity". The most frequent secondary symptoms were "vomit", "dizziness" and "headache". A symptomatic profile is observed, which is expressed with a linguistic richness and that shows concatenation processes within her health experience that enables us to understand her situation better and consequently to provide adequate care.

  16. Integrated Exposure-Based Therapy for Co-Occurring Post Traumatic Stress Disorder (PTSD and Substance Dependence: Predictors of Change in PTSD Symptom Severity

    Directory of Open Access Journals (Sweden)

    Katherine L. Mills

    2016-11-01

    Full Text Available This paper examines factors associated with change in PTSD symptom severity among individuals randomised to receive an integrated exposure-based psychotherapy for PTSD and substance dependence–Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE. Outcomes examined include change in PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS, and the reliability and clinical significance of change in PTSD symptom severity. Factors examined include patient baseline characteristics, treatment characteristics, and events over follow-up. The mean difference in CAPS score was 38.24 (SE 4.81. Approximately half (49.1% demonstrated a reliable and clinically significant improvement in PTSD symptom severity. No one was classified as having demonstrated clinically significant worsening of symptoms. Three independent predictors of reductions in PTSD symptom severity were identified: baseline PTSD symptom severity (β 0.77, SE 0.23, p = 0.001, number of traumas experienced prior to baseline (β −0.30, SE 0.15, p = 0.049, and number of sessions attended (β 2.05, SE 0.87, p = 0.024. The present study provides further evidence regarding the safety of the COPE treatment and factors associated with improvement in PTSD symptom severity. The identification of only a small number of predictors of the outcome points to the broad applicability of the COPE treatment to PTSD and substance use disorder (SUD patients.

  17. Catamenial pneumothorax caused by thoracic endometriosis

    Directory of Open Access Journals (Sweden)

    Paolo Maniglio, MD

    2018-02-01

    Conclusion: The diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.

  18. Thoracic disc herniation: Surgical treatment.

    Science.gov (United States)

    Court, C; Mansour, E; Bouthors, C

    2018-02-01

    Thoracic disc herniation is rare and mainly occurs between T8 and L1. The herniation is calcified in 40% of cases and is labeled as giant when it occupies more than 40% of the spinal canal. A surgical procedure is indicated when the patient has severe back pain, stubborn intercostal neuralgia or neurological deficits. Selection of the surgical approach is essential. Mid-line calcified hernias are approached from a transthoracic incision, while lateralized soft hernias can be approached from a posterolateral incision. The complication rate for transthoracic approaches is higher than that of posterolateral approaches; however, the former are performed in more complex herniation cases. The thoracoscopic approach is less invasive but has a lengthy learning curve. Retropleural mini-thoracotomy is a potential compromise solution. Fusion is recommended in cases of multilevel herniation, herniation in the context of Scheuermann's disease, when more than 50% bone is resected from the vertebral body, in patients with preoperative back pain or herniation at the thoracolumbar junction. Along with complications specific to the surgical approach, the surgical risks are neurological worsening, dural breach and subarachnoid-pleural fistulas. Giant calcified herniated discs are the largest contributor to myelopathy, intradural extension and postoperative complications. Some of the technical means that can be used to prevent complications are explored, along with how to address these complications. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Thoracic splenosis mimicking a pleuropneumonia

    Science.gov (United States)

    Baldolli, Aurélie; Coeuret, Solène; Le Pennec, Vincent; Agostini, Denis; Verdon, Renaud

    2017-01-01

    Abstract Rationale: Splenosis is the development of one or more heterotopic splenic tissue autoimplants following rupture of the spleen and remains mostly asymptomatic. Patient concerns: We report a case of a 50-year old post-traumatic splenectomized man admitted for a left side community acquired pneumonia resistant to antibiotics. Diagnoses: The diagnosis of intrathoracic ectopic spleen was suspected because of the history of spleen trauma with diaphragm rupture and the absence of Howell-Jolly bodies. Interventions: Technetium (Tc)-99m colloid scintigraphy SPECT, fused with CT scan showed an intense radionuclide uptake on hyper vascularized masses without any additional pathologic uptake and confirmed the diagnosis of thoracic splenosis. Outcomes: Despite any lifelong penicillin prophylaxis, he had no history of infections eight years after the diagnosis. Lessons: Physician must be aware of this differential diagnosis and of its consequences. Depending on its size and location, it may lead to incorrect diagnosis (tumor, empyema, abscess ...), treatment and invasive procedures while the diagnosis of splenosis only relies upon imaging studies associated with functionnal study of the uptake of particles or cells. PMID:28723778

  20. Brief Therapy at a University Counseling Center: Working Alliance, Readiness to Change, and Symptom Severity

    Science.gov (United States)

    Mahon, Megan; Laux, John M.; Ritchie, Martin H.; Piazza, Nick J.; Tiamiyu, Mojisola F.

    2015-01-01

    The authors investigated whether students receiving short-term individual counseling at a university counseling center showed progress as evidenced by perceived client and counselor outcomes and the roles that client readiness to change and working alliance played in this setting. The results indicated that the counselor reports, not the client…

  1. Changes in Depressive Symptoms in First Time Mothers in Home Visitation

    Science.gov (United States)

    Ammerman, Robert T.; Putnam, Frank W.; Altaye, Mekibib; Chen, Liang; Holleb, Lauren J.; Stevens, Jack; Short, Jodie A.; Van Ginkel, Judith B.

    2009-01-01

    Objective: The expansion of Home Visitation Programs for at-risk, first-time mothers and their young children has drawn attention to the potential impact of depression on program outcomes, yet little research has examined depression in the context of home visitation. The purpose of this study was to determine the prevalence of and changes in…

  2. THORACIC KYPHOSIS TREATED WITH GLOBAL POSTURAL REEDUCATION

    OpenAIRE

    Pita, Marisa de Castro

    2008-01-01

    This article describes the case of a patient subjected to physical therapy who had thoracic kyphosis of 55 degrees, chronic lumbar pain, and other postural deviations. The physical therapeutic treatment used was the technique of Global Posture Reeducation (RPG), aiming at morphological corrections and pain relief. The results obtained demonstrated improvement concerning the postural aspect, decrease of 16 degrees in the thoracic kyphosis and remission of the pain.

  3. A History of Thoracic Aortic Surgery.

    Science.gov (United States)

    McFadden, Paul Michael; Wiggins, Luke M; Boys, Joshua A

    2017-08-01

    Ancient historical texts describe the presence of aortic pathology conditions, although the surgical treatment of thoracic aortic disease remained insurmountable until the 19th century. Surgical treatment of thoracic aortic disease then progressed along with advances in surgical technique, conduit production, cardiopulmonary bypass, and endovascular technology. Despite radical advances in aortic surgery, principles established by surgical pioneers of the 19th century hold firm to this day. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Thoracic ultrasound: the pneumologist's new stethoscope

    OpenAIRE

    HEINEN, Vincent; DUYSINX, Bernard; CORHAY, Jean-Louis; LOUIS, Renaud

    2012-01-01

    We now have access to a large library of publications validating transparietal thoracic echography in various clinical situations. Parietal lesions, including osteolysis, can be detected and biopsied during the thoracic ultrasound (TUS) examination. To evaluate the parietal extension of lung cancers, TUS has proved superior to tomodensitometry. Pleural effusions can be easily diagnosed and aspirated. Pneumothoraces can be detected using well defined lung artifacts with a high frequency probe....

  5. Rare location of spondylitis tuberculosis;atlanto-axial, sacral and cervico-thoracic junction

    Science.gov (United States)

    Victorio; Nasution, M. D.; Ibrahim, S.; Dharmajaya, R.

    2018-03-01

    Three cases of rare location spondylitis tuberculosis are reported, each in atlantoaxial, cervico-thoracic junction,and sacral. The complaints were aweakness of motoric strength and local back pain. Patients’thoracal x-ray was normal, there was no complaint of acough, PCR forTB was early diagnostic and positive in all three cases, HIV negative, intraoperative tissue samplings were sent for histopathology examination and the results showed thespecific inflammatory process. Lesions were evaluated with computer tomography and/or MRI imaging.Preoperative TB regimens therapy were given for 2 weeks and continued for nine months. The surgical procedurewas done in all cases with excellent improvement of symptoms and motoric strength. In our institution,25 cases of total TB spondylitis were performed in 2 years, only 1 case eachwas found in atlanto-axial, cervico-thoracic and sacral.

  6. The subclavius posticus muscle: an unusual cause of thoracic outlet syndrome.

    Science.gov (United States)

    Smayra, T; Nabhane, L; Tabet, G; Menassa-Moussa, L; Hachem, K; Haddad-Zebouni, S

    2014-09-01

    We present the case of a 30-year-old female, complaining of thoracic outlet compression symptoms caused by a supernumerary muscle, the subclavius posticus, accompanied by a caudally inserted middle scalenus muscle on the second rib. This rare anatomic variant was clearly shown on CT angiography and MRI images and surgical treatment was successful. As first described by Rosenmuller in 1800, subclavius posticus is a supernumerary muscle originating from the cranial surface of the sternal end of the first rib, running laterodorsally beneath the clavicle, and inserting into the superior border of the scapula. Its role in thoracic outlet syndrome has been seldom demonstrated in living patients nor described in imaging, although it is theoretically easily recognizable on modern imaging modalities. It should be taken into account during workout of patients with thoracic outlet syndrome, since it can be potentially treated.

  7. Gastrointestinal symptoms of infantile colic and their change after light needling of acupuncture: a case series study of 913 infants

    Directory of Open Access Journals (Sweden)

    Ullman Dacil

    2011-08-01

    Full Text Available Abstract Background Infantile colic is a common painful clinical condition associated with signs of distended intestines and an increase in colon peristalsis. However, clinical documentation of observed gastrointestinal functions in the condition is still lacking. Even though the ailment is common, no clear treatment guidelines exist. While acupuncture with minimal stimulation has been shown to be effective in reducing crying behaviour of infants suffering from colic, the documented effect of acupuncture on gastrointestinal function in children with infantile colic is scarce. This case series study aims to document the symptoms of routinely rated gastrointestinal function and the changes in these symptoms after minimal acupuncture in a larger group of children with infantile colic. Methods This study included 913 infants with normal weights, and lengths at birth. The infants' mean age was 5.4 weeks when the observations started, and had colic symptoms since two weeks after birth. Light needling stimulation of the acupuncture point LI4 was performed for 10-20 seconds bilaterally on a daily basis for a mean of 6.2 consecutive days. A questionnaire with verbal rating scales for the parents' evaluation was used before and after the treatment period. Results Before treatment the infants were assessed by the parents in terms of 'often have inflated stomachs' (99% and 'seldom drool' (76%, 'regurgitate' (53% and 'belch' (62%. Moreover, the reported frequency of defecation was 5-8 times per day (64%, with a yellowish-green colour (61% and with a water-thin consistency (74%. After treatment, the variables of inflated stomachs, drooling and regurgitating were systematically changed, and rated by the parents as occurring 'sometimes' while belching was rated as occurring 'often' and the frequency of defecation was reduced to 1-4 times/day with a mustard yellow colour and a gruel-like consistency. The parents also rated their impression of the infants

  8. Thoracic outlet syndrome: a neurological and vascular disorder.

    Science.gov (United States)

    Klaassen, Zachary; Sorenson, Edward; Tubbs, R Shane; Arya, Rahul; Meloy, Patrick; Shah, Rajnil; Shirk, Samuel; Loukas, Marios

    2014-07-01

    Thoracic outlet syndrome (TOS) is a condition arising from compression of the subclavian vessels and/or brachial plexus as the structures travel from the thoracic outlet to the axilla. Despite the significant pathology associated with TOS, there remains some general disagreement among experts on the specific anatomy, etiology, and pathophysiology of the condition, presumably because of the wide variation in symptoms that manifest in presenting patients, and because of lack of a definitive gold standard for diagnosis. Symptoms associated with TOS have traditionally been divided into vascular and neurogenic categories, a distinction based on the underlying structure(s) implicated. Of the two, neurogenic TOS (nTOS) is more common, and typically presents as compression of the brachial plexus; primarily, but not exclusively, involving its lower trunk. Vascular TOS (vTOS) usually involves compression of the vessel, most commonly the subclavian artery or vein, or is secondary to thrombus formation in the venous vasculature. Any anatomical anomaly in the thoracic outlet has the potential to predispose a patient to TOS. Common anomalies include variations in the insertion of the anterior scalene muscle (ASM) or scalenus minimus muscle, the presence of a cervical rib or of fibrous and muscular bands, variations in insertion of pectoralis minor, and the presence of neurovascular structures, which follow an atypical course. A common diagnostic technique for vTOS is duplex imaging, which has generally replaced more invasive angiographic techniques. In cases of suspected nTOS, electrophysiological nerve studies and ASM blocks provide guidance when screening for patients likely to benefit from surgical decompression of TOS. Surgeons generally agree that the transaxillary approach allows the greatest field of view for first rib excision to relieve compressed vessels. Alternatively, a supraclavicular approach is favored for scalenotomies when the ASM impinges on surrounding

  9. MRI of thoracic outlet syndrome in children

    Energy Technology Data Exchange (ETDEWEB)

    Chavhan, Govind B.; Batmanabane, Vaishnavi [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); Muthusami, Prakash [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); The Hospital for Sick Children, Division of Image Guided Therapy, Department of Diagnostic Imaging, Toronto, ON (Canada); Towbin, Alexander J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology and Medical Imaging, Cincinnati, OH (United States); Borschel, Gregory H. [The Hospital for Sick Children and University of Toronto, Division of Plastic Surgery, Department of Pediatric Surgery, Toronto, ON (Canada)

    2017-09-15

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  10. MRI of thoracic outlet syndrome in children

    International Nuclear Information System (INIS)

    Chavhan, Govind B.; Batmanabane, Vaishnavi; Muthusami, Prakash; Towbin, Alexander J.; Borschel, Gregory H.

    2017-01-01

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  11. Clinical innovations in Philippine thoracic surgery.

    Science.gov (United States)

    Danguilan, Jose Luis J

    2016-08-01

    Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open chest and refinements in thoracic anesthetic and surgical approaches, Filipino surgeons began performing thoracoplasties, then lung resections for pulmonary tuberculosis and later for lung cancer in specialty hospitals dealing with pulmonary diseases-first at the Quezon Institute (QI) and presently at the Lung Center of the Philippines although some university and private hospitals made occasional forays into the chest. Esophageal surgery began its early attempts during the post-World War II era at the Philippine General Hospital (PGH), a university hospital affiliated with the University of the Philippines. With the introduction of minimally invasive thoracic surgical approaches, Filipino thoracic surgeons have managed to keep up with their Asian counterparts although the problems of financial reimbursement typical of a developing country remain. The need for creative innovative approaches of a focused multidisciplinary team will advance the boundaries of thoracic surgery in the Philippines.

  12. Thoracic trauma: analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Maíra Benito Scapolan

    2010-09-01

    Full Text Available Objective: To analyze thoracic trauma assisted by the EmergencyService of Hospital da Irmandade da Santa Casa de Misericórdia deSão Paulo. Methods: One hundred patients with thoracic trauma wereassisted throughout six months in 2006. Data from their records werecollected and a protocol of thoracic trauma was fulfilled. The RevisedTrauma Score was used to evaluate gravity of injury and to calculatethe survival index. Results: Prevalence of trauma injury in male from20 to 29 years old was observed. Out of all patients, 44 had blunttrauma and 56 penetrating trauma (78.6% presented stab woundsand 21.4% gun shots. Up to the settings of injuries, 23% were in thethoracoabdominal transition, 7% in the precordium and 70% in theremainder thoracic area. In those with the thoracoabdominal transitioninjury, 22.7% were hemodynamically unstable and 77.3% stable.Thoracoabdominal injury patients presented 40.9% of diaphragmwound and all were stable. Of those with precordium wound, 37.5%presented cardiac injury. In cardiac onset, 66.7% presented stableand 33.3% unstable. Thoracic drainage was the most accomplishedsurgical procedure (71%. Conclusions: The thoracic trauma patientis most prevalently young male with stab wound penetrating injury,without associated injuries, hemodynamically stable, presentinghemothorax, with high probability of survival.

  13. Initial thoracic involvement in lymphoma. CT assessment

    International Nuclear Information System (INIS)

    Bustos, A.; Corredoira, J.; Ferreiros, J.; Cabeza, B.; Jorquera, M.; Pedrosa, I.; Martinez, R.; Fernandez, C.

    2002-01-01

    To analyze the initial thoracic involvement by CT in a consecutive series of patients with lymphoma. A retrospective analysis was made of thoracic CT studies made at the time of diagnosis of 259 patients with lymphoma. Mediastinal pulmonary, pleural, pericardial and chest wall involvement was assessed by CT. Of 259 patients (129 men y 130 women), 56 had Hodgkin's disease (HD) and 203 had non-Hodgkin lymphoma (NHL). Forty-two percent (42.5%, 110/259) of the patients had chest involvement on CT: 33 of 56 patients with HD (58.9%) and 77 of 203 patients with NHL (37.9%). All the patients with thoracic HD) and 71.4% of patients with thoracic NHL, had mediastinal lymph node involvement. of the patients with thoracic involvement 12.1% (4/33) of the patient with HD and 23.3% (18/77) of the patients with NHL had pulmonary involvement. Thoracic involvement on CT was more frequent in HD. Mediastinal lymph node involvement was the most common finding fundamentally in HD. Pulmonary disease always occurred in the presence of mediastinal lymph node involvement in HD but could occur as an isolated finding in NHL. (Author) 24 refs

  14. MRI of thoracic outlet syndrome in children.

    Science.gov (United States)

    Chavhan, Govind B; Batmanabane, Vaishnavi; Muthusami, Prakash; Towbin, Alexander J; Borschel, Gregory H

    2017-09-01

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation.

  15. Expanded Level of Sympathetic Chain Removal Does Not Increase Incidence or Severity of Compensatory Hyperhidrosis Following Endoscopic Thoracic Sympathectomy

    Science.gov (United States)

    Gunn, Tyler M.; Davis, Diane M.; Speicher, James E.; Rossi, Nicholas P.; Parekh, Kalpaj R.; Lynch, William R.; Iannettoni, Mark D.

    2015-01-01

    Objective Compensatory hyperhidrosis is a common devastating adverse effect following endoscopic thoracic sympathectomy for patients undergoing surgical treatment of primary hyperhidrosis. We sought to determine if there was a correlation in our patient population between the level and extent of sympathetic chain resection and the subsequent development of compensatory hyperhidrosis. Methods All patients undergoing endoscopic thoracic sympathectomy in the T2-3, T2-4, T2-5, or T2-6 levels for palmar or axillary hyperhidrosis at the University of Iowa Hospital and Clinics (n=97) between January 2004 and January 2013 were retrospectively reviewed. Results Differences in preoperative patient characteristics were not statistically significant between patients receiving either T2-3, T2-4, T2-5, or T2-6 level resections. Of the ninety-seven patients included in this study, twenty-eight patients (29%) experienced transient compensatory hyperhidrosis and four patients (4%) complained of severe compensatory hyperhidrosis and required further treatment. There were no operative mortalities and morbidity was similar amongst the groups. Conclusions Most patients had successful outcomes after undergoing extensive resection without change in incidence of compensatory hyperhidrosis. Therefore, we recommend performing a complete and adequate resection for relief of symptoms in patients with primary hyperhidrosis. PMID:25131173

  16. Respiratory and Nasal Symptoms, Immunological Changes, and Lung Function in Industrial Bakers

    OpenAIRE

    Mijakoski, Dragan; Minov, Jordan; Stoleski, Saso

    2012-01-01

    Background: Several studies reported that occupational exposure in bakery may cause respiratory impairment in exposed workers.Aim: To assess the respiratory effects and immunological changes of occupational exposure in industrial bakers.Material and Methods: We performed a cross-sectional study including 43 industrial bakers (20 males and 23 females, aged 34-55 years) and an equal number of office workers, matched by sex, age and smoking status. Evaluation of examined subjects included comple...

  17. Upper thoracic-spine disc degeneration in patients with cervical pain.

    Science.gov (United States)

    Arana, Estanislao; Martí-Bonmatí, Luis; Mollá, Enrique; Costa, Salvador

    2004-01-01

    To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6 +/- 14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P < 0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated ( P = 0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together ( P < 0.001), but not with any thoracic disc. A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms.

  18. Upper thoracic-spine disc degeneration in patients with cervical pain

    Energy Technology Data Exchange (ETDEWEB)

    Arana, Estanislao; Marti-Bonmati, Luis; Costa, Salvador [Department of Radiology, Clinica Quiron, Avda Blasco Ibanez 14, 46010, Valencia (Spain); Molla, Enrique [Department of Radiology, Clinica Quiron, Avda Blasco Ibanez 14, 46010, Valencia (Spain); Department of Morphological Sciences, University of Valencia, Valencia (Spain)

    2004-01-01

    To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6{+-}14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P<0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated (P=0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together (P<0.001), but not with any thoracic disc. A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms. (orig.)

  19. Upper thoracic-spine disc degeneration in patients with cervical pain

    International Nuclear Information System (INIS)

    Arana, Estanislao; Marti-Bonmati, Luis; Costa, Salvador; Molla, Enrique

    2004-01-01

    To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6±14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P<0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated (P=0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together (P<0.001), but not with any thoracic disc. A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms. (orig.)

  20. Changes in marijuana use symptoms and emotional functioning over 28-days of monitored abstinence in adolescent marijuana users.

    Science.gov (United States)

    Jacobus, Joanna; Squeglia, Lindsay M; Escobar, Silvia; McKenna, Benjamin M; Hernandez, Margie Mejia; Bagot, Kara S; Taylor, Charles T; Huestis, Marilyn A

    2017-12-01

    Advancing marijuana prevention and intervention efforts are important given the decreasing perception of harm among adolescents and increasing marijuana legalization. This study evaluates how a monitored abstinence protocol may contribute to emotional functioning and changes in marijuana problems that can enhance successful outcomes for non-treatment-seeking adolescent marijuana users. Adolescent marijuana users (n = 26) and demographically matched controls (n = 30) completed 28 days of monitored abstinence confirmed by biweekly urine toxicology. Participants were given measures of emotional functioning, marijuana use symptoms, and reward sensitivity during monitored abstinence. All participants (n = 56) completed the protocol, and 69% of marijuana users (n = 18 of 26) were confirmed abstinent for 28 days, with all users showing decreasing marijuana use. Reductions in subsyndromal depression, positive marijuana use expectancies, and poor sleep quality were observed by the end of the monitored abstinence period (n = 26, p values < .05). Marijuana users also reported more attentional impulsivity and less responsiveness to reward stimuli during the second week of abstinence compared to controls. Later age of onset of regular marijuana use and more cumulative lifetime use were associated with a greater degree of emotional change and increased recognition of the negative effects of marijuana use. Monitored abstinence programs may be beneficial in reducing marijuana use, subsyndromal emotional distress symptoms, and changing beliefs about marijuana use. Future prevention and intervention efforts may consider targeting reward sensitivity and impulsivity, in addition to marijuana use, expectancies, and emotional functioning.

  1. Internal thoracic artery collateral to the external iliac artery in chronic aortoiliac occlusive disease

    International Nuclear Information System (INIS)

    Kim, Jinna; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

    2003-01-01

    To evaluate the incidence and angiographic findings of the collateral pathway involving the internal thoracic artery in patients with chronic aortoiliac occlusive disease. Between March 2000 and Februrary 2001, 124 patients at our hospital underwent angiographic evaluation of chronic aortoiliac occlusive disease, and in 15 of these complete obstruction or severe stenosis of the aortoiliac artery was identified. The aortograms and collateral arteriograms obtained, including internal thoracic arteriograms, as well as the medical records of the patients involved, were evaluated. In nine patients there was complete occlusion of the infrarenal aorta, or diffuse stenosis of 75% or more in the descending thoracic aorta, and in the other six, a patent aorta but complete occlusion or stenosis of 75% or more of the common iliac artery was demonstrated. Collateral perfusion via hypertrophied internal thoracic arteries and rich anastomoses between the superior and inferior epigastric arteries, reconstituting the external iliac artery, were noted in all fifteen patients, regardless of symptom duration, which ranged from six months to twelve years. In patients with chronic aortoiliac occlusive disease, the internal thoracic artery, along with visceral collaterals and those from the contralateral side, is one of the major parietal collateral pathways

  2. The relative importance of body change strategies, weight perception, perceived social support, and self-esteem on adolescent depressive symptoms: longitudinal findings from a national sample.

    Science.gov (United States)

    Rawana, Jennine S

    2013-07-01

    This study aimed to evaluate the relative importance of body change strategies and weight perception in adolescent depression after accounting for established risk factors for depression, namely low social support across key adolescent contexts. The moderating effect of self-esteem was also examined. Participants (N=4587, 49% female) were selected from the National Longitudinal Study of Adolescent Health. Regression analyses were conducted on the association between well-known depression risk factors (lack of perceived support from parents, peers, and schools), body change strategies, weight perception, and adolescent depressive symptoms one year later. Each well-known risk factor significantly predicted depressive symptoms. Body change strategies related to losing weight and overweight perceptions predicted depressive symptoms above and beyond established risk factors. Self-esteem moderated the relationship between trying to lose weight and depressive symptoms. Maladaptive weight loss strategies and overweight perceptions should be addressed in early identification depression programs. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Imaging after radiation therapy of thoracic tumors

    International Nuclear Information System (INIS)

    Ghaye, B.; Wanet, M.; El Hajjam, M.

    2016-01-01

    Radiation-induced lung disease (RILD) is frequent after therapeutic irradiation of thoracic malignancies. Many technique-, treatment-, tumor- and patient-related factors influence the degree of injury sustained by the lung after irradiation. Based on the time interval after the completion of the treatment RILD presents as early and late features characterized by inflammatory and fibrotic changes, respectively. They are usually confined to the radiation port. Though the typical pattern of RILD is easily recognized after conventional two-dimensional radiation therapy (RT), RILD may present with atypical patterns after more recent types of three or four-dimensional RT treatment. Three atypical patterns are reported: the modified conventional, the mass-like and the scar-like patterns. Knowledge of the various features and patterns of RILD is important for correct diagnosis and appropriate treatment. RILD should be differentiated from recurrent tumoral disease, infection and radiation-induced tumors. Due to RILD, the follow-up after RT may be difficult as response evaluation criteria in solid tumours (RECIST) criteria may be unreliable to assess tumor control particularly after stereotactic ablation RT (SABR). Long-term follow-up should be based on clinical examination and morphological and/or functional investigations including CT, PET-CT, pulmonary functional tests, MRI and PET-MRI. (authors)

  4. Symptoms of change in multi-scale observations of arctic ecosystem carbon cycling

    Science.gov (United States)

    Stoy, P. C.; Williams, M. D.; Hartley, I. P.; Street, L.; Hill, T. C.; Prieto-Blanco, A.; Wayolle, A.; Disney, M.; Evans, J.; Fletcher, B.; Poyatos, R.; Wookey, P.; Merbold, L.; Wade, T. J.; Moncrieff, J.

    2009-12-01

    Arctic ecosystems are responding rapidly to observed climate change. Quantifying the magnitude of these changes, and their implications for the climate system, requires observations of their current structure and function, as well as extrapolation and modelling (i.e. ‘upscaling’) across time and space. Here, we describe the major results of the International Polar Year (IPY) ABACUS project, a multi-scale investigation across arctic Fennoscandia that couples plant and soil process studies, isotope analyses, flux and micrometeorological measurements, process modelling, and aircraft and satellite observations to improve predictions of the response of the arctic terrestrial biosphere to global change. We begin with a synthesis of eddy covariance observations from the global FLUXNET database. We demonstrate that a simple model parameterized using pan-arctic chamber measurements explains over 80% of the variance of half-hourly CO2 fluxes during the growing season across most arctic and montane tundra ecosystems given accurate measurements of leaf area index (LAI), which agrees with the recently proposed ‘functional convergence’ paradigm for tundra vegetation. The ability of MODIS to deliver accurate LAI estimates is briefly discussed and an adjusted algorithm is presented and validated using direct observations. We argue for an Information Theory-based framework for upscaling in Earth science by conceptualizing multi-scale research as a transfer of information across scales. We then demonstrate how error in upscaled arctic C flux estimates can be reduced to less than 4% from their high-resolution counterpart by formally preserving the information content of high spatial and spectral resolution aircraft and satellite imagery. Jaynes’ classic Maximum Entropy (MaxEnt) principle is employed to incorporate logical, biological and physical constraints to reduce error in downscaled flux estimates. Errors are further reduced by assimilating flux, biological and remote

  5. Patients' in-session experiences and symptom change: Session-to-session effects on a within- and between-patient level.

    Science.gov (United States)

    Rubel, Julian A; Rosenbaum, David; Lutz, Wolfgang

    2017-03-01

    Knowledge of patients' in-session experiences that lead to symptom change in psychotherapy is limited. This study aims to investigate the within- and between-patient relationships between three in-session processes in psychotherapy (coping skills, therapeutic relationship quality, and emotional involvement) and symptom change on a session-by-session level. Participants (n = 1550) with various disorders, including primarily depression and anxiety, were treated with CBT in a German outpatient clinic. Symptom distress was assessed before each session and patients' in-session experiences were assessed at the end of each session using session reports. Person-mean centering was applied to disaggregate within- and between-patients. Within- and between-patient process scores were tested in multilevel models as predictors of next session symptom change. On a within-patient level, better session-specific coping skills, better therapeutic alliance, and deeper emotional involvement were followed by next session symptom improvements. In a combined model, only coping skills specifically predicted next session symptom change. Additionally, these coping skills were especially helpful when combined with a better therapeutic relationship quality. On a between-patient level, better therapeutic alliance and more coping skills were associated with lower symptom scores during treatment, while deeper emotional involvement was associated with higher symptom scores. Testing these between-patient effects in a combined model left only coping skills (the more, the greater symptom improvement) and emotional involvement (the deeper, the less symptom improvement) as significant predictors. These two also exhibited a combined effect on symptom change on the between-patient level. The results highlight the importance of a thorough disaggregation of within- and between-patient variability in psychotherapy process-outcome research as well as the consideration of several potentially important time

  6. Thoracic wall reconstruction after tumor resection

    Directory of Open Access Journals (Sweden)

    Kamran eHarati

    2015-10-01

    Full Text Available Introduction: Surgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft tissue reconstruction of the thoracic wall improves life quality and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors.Material und methods: This article is based on a review of the current literature and the evaluation of a patient database.Results: Several plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft tissue defects after tumor resection can be covered by local, pedicled or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the life quality of these patients. Discussion: In curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, stadium plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve

  7. Differences in urinary incontinence symptoms and pelvic floor structure changes during pregnancy between nulliparous and multiparous women

    Directory of Open Access Journals (Sweden)

    Dan Luo

    2017-07-01

    Full Text Available Background This study was performed to compare changes in urinary incontinence (UI symptoms and pelvic floor structure during pregnancy between nulliparous and multiparous women. Methods A cross-sectional survey was performed among pregnant women from July 2016 to January 2017. In total, 358 pregnant women from two hospitals underwent an interview and pelvic floor transperineal ultrasound assessment. A questionnaire regarding sociodemographic, gynecological, obstetric features and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF were used for the interview. Imaging data sets were analyzed offline to assess the bladder neck vertical position (BNVP, urethral angles (α, β, and γ angles, and hiatal area (HA at rest and at maximal Valsalva maneuver (VM. Results After excluding 16 women with invalid data, 342 women were included. The prevalence (χ2 = 9.15, P = 0.002, frequency (t = 2.52, P = 0.014, usual amount of UI (t = 2.23, P = 0.029 and scores of interference with daily life (t = 2.03, P = 0.045 during pregnancy were higher in multiparous than nulliparous women. A larger bladder neck descent (BND (F = 4.398, P < 0.001, HA (F = 6.977, P < 0.001, α angle (F = 2.178, P = 0.030, β angle (F = 4.404, P < 0.001, and γ angle (F = 2.54, P = 0.011 at VM were discovered in pregnant women with UI than without UI. Multiparous women had a significantly higher BND (t = 2.269, P = 0.024 and a larger α angle (F = 2.894, P = 0.004, β angle (F = 2.473, P = 0.014, and γ angle (F = 3.255, P = 0.001 at VM than did nulliparous women. Conclusion Multiparous women experienced more obvious UI symptoms and pelvic floor structure changes during pregnancy than did nulliparous women.

  8. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2017 Update on Research.

    Science.gov (United States)

    Gaissert, Henning A; Fernandez, Felix G; Crabtree, Traves; Burfeind, William R; Allen, Mark S; Block, Mark I; Schipper, Paul H; Jacobs, Jeffrey P; Habib, Robert H; Shahian, David M

    2017-11-01

    The outcomes research efforts based on The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database include two established research programs with dedicated task forces and with data analyses conducted at the STS data analytic center: (1) The STS-sponsored research by the Access and Publications program, and (2) grant and institutionally funded research by the Longitudinal Follow-Up and Linked Registries Task Force. Also, the STS recently introduced the research program enabling investigative teams to apply for access to deidentified patient-level General Thoracic Surgery Database data sets and conduct related analyses at their own institution. Last year's General Thoracic Surgery Database-based research publications and the new Participant User File research program are reviewed. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Thoracic CT in the ED: a study of thoracic computed tomography utilisation.

    LENUS (Irish Health Repository)

    Williams, E

    2010-02-01

    The aim of this retrospective study was to investigate the use of thoracic Computed Tomography (CT) in the Emergency Department of a Dublin Academic Teaching Hospital over a six month period. Data was retrieved using the hospital\\'s computerised information system. There were 202 referrals in total for thoracic CT from the Emergency Department during this time period. The most common indication for thoracic CT referral was for the investigation of pulmonary embolism with 127 (63%) referrals. There were 40 (25%) referrals for suspected malignancy and lung disease, whilst 8 (4%) of the referrals were for investigation of thoracic aortic dissection, 8 (4%) for infection, and 6 (3%) were for investigation of thoracic injury. Only 8 (4%) of all referrals were for investigation of injury as a result of chest trauma.

  10. Pre-treatment attachment anxiety predicts change in depressive symptoms in women who complete day hospital treatment for anorexia and bulimia nervosa.

    Science.gov (United States)

    Keating, Leah; Tasca, Giorgio A; Bissada, Hany

    2015-03-01

    Individuals with eating disorders are prone to depressive symptoms. This study examines whether depressive symptoms can change in women who complete intensive day treatment for anorexia and bulimia nervosa (BN), and whether these changes are associated with pre-treatment attachment insecurity. Participants were 141 women with anorexia nervosa restricting type (n = 24), anorexia nervosa binge purge type (n = 30), and BN (n = 87) who completed a day hospital treatment programme for eating disorders. They completed a pre-treatment self-report measure of attachment, and a pre-treatment and post-treatment self-report measure of depressive symptoms. Participants experienced significant reductions in depressive symptoms at post-treatment. Eating disorder diagnosis was not related to these improvements. However, participants lower in attachment anxiety experienced significantly greater improvement in depressive symptoms than those who were higher in attachment anxiety. These results suggest that clinicians may tailor eating disorders treatments to patients' attachment patterns and focus on their pre-occupation with relationships and affect regulation to improve depressive symptoms. That depressive symptoms can decrease in women who complete day hospital treatment for anorexia and BN. That improvements in depressive symptoms do not vary according to eating disorder diagnosis in these women. That patients who complete treatment and who have higher attachment anxiety experience less improvements in depressive symptoms compared to those lower in attachment anxiety. That clinicians may attend to aspects of attachment anxiety, such as need for approval and up-regulation of emotions, to improve depressive symptoms in female patients with eating disorders. © 2014 The British Psychological Society.

  11. Single amino acid change in the helicase domain of the putative RNA replicase of turnip crinkle virus alters symptom intensification by virulent satellites.

    Science.gov (United States)

    Collmer, C W; Stenzler, L; Chen, X; Fay, N; Hacker, D; Howell, S H

    1992-01-01

    The virulent satellite [satellite C (sat C)] of turnip crinkle virus (TCV) is a small pathogenic RNA that intensifies symptoms in TCV-infected turnip plants (Brassica campestris). The virulence of sat C is determined by properties of the satellite itself and is influenced by the helper virus. Symptoms produced in infections with sat C differ in severity depending on the helper virus. The TCV-JI helper virus produces more severe symptoms than the TCV-B helper virus when inoculated with sat C. To find determinants in the TCV helper virus genome that affect satellite virulence, the TCV-JI genome was cloned and the sequence compared to the TCV-B genome. The genomes were found to differ by only five base changes, and only one of the base changes, at nucleotide position 1025, produced an amino acid change, an aspartic acid----glycine in the putative viral replicase. A chimeric TCV genome (TCV-B/JI) containing four of the five base changes (including the base change at position 1025) and a mutant TCV-B genome (TCV-B1025G) containing a single base substitution at position 1025 converted the TCV-B genome into a form that produces severe symptoms with sat C. The base change a position 1025 is located in the helicase of the putative viral replicase, and symptom intensification appears to result from differences in the rate of replication of the satellite supported by the two helper viruses. Images PMID:1370351

  12. Thoracic surgical resident education: a costly endeavor.

    Science.gov (United States)

    Calhoon, John H; Baisden, Clint; Holler, Ben; Hicks, George L; Bove, Ed L; Wright, Cameron D; Merrill, Walter H; Fullerton, Dave A

    2014-12-01

    We sought to define an accurate measure of thoracic surgical education costs. Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Thoracic fractures and dislocations in motorcyclists

    International Nuclear Information System (INIS)

    Daffner, R.H.; Deeb, Z.L.; Rothfus, W.E.

    1987-01-01

    Motorcyclists who are involved in accidents generally suffer severe multiple injuries, some of which are not readily apparent on initial examination. One such subtle injury is fracture, with or without dislocation, in the upper thoracic spine. The severe spinal cord damage produced by the injury is often overshadowed by cerebral or cervical injury. Proper diagnosis is further hampered by the fact that the upper thoracic region is difficult to examine radiographically on plain films, particularly when using portable equipment. Of a group of 14 motorcyclists having 26 fractures and/or dislocations in the thoracic region, 12 had 24 injuries between T3 and T8. These 24 injuries represented 56% of the fractures and/or dislocations encountered in a larger study of trauma to the thoracic vertebral column. All of these were flexion injuries, suffered when the individual was thrown from the motorcycle and struck a large, solid object. In three cases, the diagnosis was delayed as much as 48 h because proper films were not obtained initially. Because of the serious consequences of delayed treatment, we recommended that all motorcyclists who have sustained severe trauma be examined by overpenetrated film of the upper thoracic region. (orig.)

  14. Thoracic CT findings at hypovolemic shock

    International Nuclear Information System (INIS)

    Rotondo, A.; Angelelli, G.; Catalano, O.; Grassi, R.; Scialpi, M.

    1998-01-01

    Purpose: To describe and discuss the thoracic CT features of hypovolemic shock. Material and Methods: From a group of 18 patients with signs of hypovolemia on contrast-enhanced abdominal CT, 11 were selected for our study as having also undergone a complete chest examination. Pulse rate, blood pressure, trauma score value, Glasgow coma scale value, surgical result, and final outcome were retrospectively evaluated. The CT features analyzed were: decreased cardiac volume, reduced caliber of the thoracic aorta, aortic branches and caval venous system, increased enhancement of the aorta, and increased enhancement of the pulmonary collapses/contusions. Results: All 11 subjects presented severe injuries and hemodynamic instability; 7 were stable enough to undergo surgery; only 1 of the 11 survived. Two patients showed none of the features of thoracic hypovolemia. All the other patients presented at least two signs: reduced caliber of the thoracic aorta in 7 cases; decreased volume of the cardiac chambers and increased aortic enhancement in 6; decreased caliber of the aortic vessels in 4; decreased caliber of the caval veins in 3; and increased enhancement of the pulmonary collapses/contusions in 3. Conclusions: In patients with hypovolemia, CT may show several thoracic findings in addition to abdominal ones. Knowledge of these features is important for distinguishing them from traumatic injuries. (orig.)

  15. Symptomatic thoracic spinal cord herniation: case series and technical report.

    Science.gov (United States)

    Hawasli, Ammar H; Ray, Wilson Z; Wright, Neill M

    2014-09-01

    Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

  16. Ewing sarcoma of the thoracic wall

    International Nuclear Information System (INIS)

    Weigel, W.

    1978-01-01

    Ewing's sarcomas in the chest wall have in common the facts that the ribs are mainly changed asteolytically; sclerosing is initially seen very seldom, it usually occurs after the therapy; and periosteal detachment with stratification or spicula formation was not observed. All our children had considerably larger intrathoracic tumors than tumors palpable at the chest wall and a notably low number of symptoms in regard of the partially gigantic tumors. (orig.) [de

  17. Physical environment may modify the association between depressive symptoms and change in waist circumference: the multi-ethnic study of atherosclerosis.

    Science.gov (United States)

    Remigio-Baker, Rosemay A; Diez Roux, Ana V; Szklo, Moyses; Crum, Rosa M; Leoutsakos, Jeannie-Marie; Franco, Manuel; Schreiner, Pamela J; Carnethon, Mercedes R; Nettleton, Jennifer A; Mujahid, Mahasin S; Michos, Erin D; Gary-Webb, Tiffany L; Golden, Sherita H

    2014-01-01

    Although the bidirectional association between depressive symptoms and adiposity has been recognized, the contribution of neighborhood factors to this relationship has not been assessed. This study evaluates whether physical and social neighborhood environments modify the bidirectional relationship between depressive symptoms and adiposity (measured by waist circumference and body mass index). Using data on 5,122 men and women (ages 45 to 84 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) we investigated whether neighborhood physical (i.e., walking environment and availability of healthy food) and social (i.e., safety, aesthetics, and social coherence) environments modified the association between the following: (1) baseline elevated depressive symptoms (Center for Epidemiologic Study Depression Scale score ≥ 16) and change in adiposity (as measured by waist circumference and body mass index) and (2) baseline overweight/obesity (waist circumference > 102 cm for men and >88 cm for women, or body mass index ≥ 25 kg/m(2)) and change in depressive symptoms using multilevel models. Neighborhood-level factors were obtained from the MESA Neighborhood Study. A greater increase in waist circumference in participants with vs without elevated depressive symptoms was observed in those living in poorly-rated physical environments but not in those living in better-rated environments (interaction p = 0.045). No associations were observed with body mass index. Baseline overweight/obesity was not associated with change in depressive symptoms and there was no modification by neighborhood-level factors. Elevated depressive symptoms were associated with greater increase in waist circumference among individuals living in poorly-rated physical environments than in those in better-rated physical environments. No association was found between overweight/obesity and change in depressive symptoms. © 2014 Published by Academy of Psychosomatic Medicine on behalf of Academy

  18. Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention.

    Science.gov (United States)

    Chilcot, Joseph; Moss-Morris, Rona

    2013-10-01

    A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later. IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects. Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment. Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Changes in Parenting Behaviors, Attachment, Depressive Symptoms, and Suicidal Ideation in Attachment-Based Family Therapy for Depressive and Suicidal Adolescents

    Science.gov (United States)

    Shpigel, Maya S.; Diamond, Gary M.; Diamond, Guy S.

    2012-01-01

    This study examined whether Attachment-Based Family Therapy (ABFT) was associated with decreases in maternal psychological control and increases in maternal psychological autonomy granting, and whether such changes were associated with changes in adolescents' attachment schema and psychological symptoms. Eighteen suicidal adolescents and their…

  20. Change in depressive symptoms and mental health-related quality of life in northeast Germany between 1997-2001 and 2008-2012.

    Science.gov (United States)

    Baumeister, Sebastian E; Schomerus, Georg; Schmidt, Carsten-Oliver; Möckel, Franz; van den Berg, Neeltje; Hoffmann, Wolfgang; Völzke, Henry; Grabe, Hans J

    2015-01-01

    Little is known about changes in depression and quality of life in East Germany. We examined changes in the prevalence of lifetime and current depressive symptoms and mental health-related quality of life among adults in northeast Germany between 1997-2001 and 2008-2012. Population-based data were drawn from two repeated cross-sectional surveys conducted 11 years apart within the Study of Health of Pomerania project (Ns of 4,228 and 4,251). Assessments included screening items for lifetime depressive symptoms from the Munich Composite International Diagnostic Interview (M-CIDI), the Depression and Exhaustion Scale (DEEX), and the Short Form Health Survey (SF-12). Lifetime depressive symptoms rose from 13.2 to 27.8%. The increase was stronger in men than in women and in individuals aged 35-64 years. No substantial changes occurred in the overall prevalence of current depressive symptoms (DEEX) and mental health-related quality of life (SF-12). A small decrease in current depressive symptoms was observed in middle-aged men and older women and small improvements in mental health-related quality of life in young adults. Higher reporting of lifetime depressive symptoms might reflect methodological influences as well as lower stigmatization and higher awareness, while the current burden seems similar.

  1. Impact and change of attitudes toward Internet interventions within a randomized controlled trial on individuals with depression symptoms.

    Science.gov (United States)

    Schröder, Johanna; Berger, Thomas; Meyer, Björn; Lutz, Wolfgang; Späth, Christina; Michel, Pia; Rose, Matthias; Hautzinger, Martin; Hohagen, Fritz; Klein, Jan Philipp; Moritz, Steffen

    2018-02-28

    Most individuals with depression do not receive adequate treatment. Internet interventions may help to bridge this gap. Research on attitudes toward Internet interventions might facilitate the dissemination of such interventions by identifying factors that help or hinder uptake and implementation, and by clarifying who is likely to benefit. This study examined whether attitudes toward Internet interventions moderate the effects of a depression-focused Internet intervention, and how attitudes change over the course of treatment among those who do or do not benefit. We recruited 1,004 adults with mild-to-moderate depression symptoms and investigated how attitudes toward Internet interventions are associated with the efficacy of the program deprexis, and how attitudes in the intervention group change from pre to post over a 3 months intervention period, compared to a control group (care as usual). This study consists of a subgroup analysis of the randomized controlled EVIDENT trial. Positive initial attitudes toward Internet interventions were associated with greater efficacy (η 2 p  = .014) independent of usage time, whereas a negative attitude (perceived lack of personal contact) was associated with reduced efficacy (η 2 p  = .012). Users' attitudes changed during the trial, and both the magnitude and direction of attitude change were associated with the efficacy of the program over time (η 2 p  = .030). Internet interventions may be the most beneficial for individuals with positive attitudes toward them. Informing potential users about evidence-based Internet interventions might instill positive attitudes and thereby optimize the benefits such interventions can provide. Assessing attitudes prior to treatment might help identify suitable users. © 2018 Wiley Periodicals, Inc.

  2. Brain Tumor Symptoms

    Science.gov (United States)

    ... Brain Anatomy Brain Tumor Symptoms Headaches Seizures Memory Depression Mood Swings & Cognitive Changes Fatigue Other Symptoms Diagnosis Types of Tumors Risk Factors Brain Tumor Statistics Brain Tumor Dictionary Webinars Anytime Learning About Us ...

  3. National Quality Forum Metrics for Thoracic Surgery.

    Science.gov (United States)

    Cipriano, Anthony; Burfeind, William R

    2017-08-01

    The National Quality Forum (NQF) is a multistakeholder, nonprofit, membership-based organization improving health care through preferential use of valid performance measures. NQF-endorsed measures are considered the gold standard for health care measurement in the United States. The Society of Thoracic Surgeons is the steward of the only six NQF-endorsed general thoracic surgery measures. These measures include one structure measure (participation in a national general thoracic surgery database), two process measures (recording of clinical stage and recording performance status before lung and esophageal resections), and three outcome measures (risk-adjusted morbidity and mortality after lung and esophageal resections and risk-adjusted length of stay greater than 14 days after lobectomy). Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Palpation of the upper thoracic spine

    DEFF Research Database (Denmark)

    Christensen, Henrik Wulff; Vach, Werner; Vach, Kirstin

    2002-01-01

    OBJECTIVE: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. DESIGN: A repeated-measures des......OBJECTIVE: To assess the intraobserver reliability (in terms of hour-to-hour and day-to-day reliability) and the interobserver reliability with 3 palpation procedures for the detection of spinal biomechanic dysfunction in the upper 8 segments of the thoracic spine. DESIGN: A repeated...... procedure. RESULTS: Using an "expanded" definition of agreement that accepts small inaccuracies (+/-1 segment) in the numbering of spinal segments, we found--based on the pooled data from the thoracic spine--kappa values of 0.59 to 0.77 for the hour-to-hour and the day-to-day intraobserver reliability...

  5. Thoracal paravertebral block for breast surgery

    Directory of Open Access Journals (Sweden)

    Serbülent Gökhan Beyaz

    2012-12-01

    Full Text Available Thoracic paravertebral block (TPVB is an alternativemethod to general anesthesia because of provides a safeanesthesia with balanced hemodynamic response, allowspostoperative pain control by means of catheter and haslow side effect profile. TPVB performed safely for the patientsundergoing breast cancer surgery with the samereason, has used in too few center instead of general anesthesia.This technique provides an adequate anesthesiafor the patients undergoing breast surgery and in additionprovides stable hemodynamic status with unilateralsomatic and sympathetic blockade, near-perfect controlof postoperative pain, minimal nausea and vomiting rate,early discharge and low cost. For this reason, thoracicparavertebral block which is a standard method in breastsurgeries for some centers should be known by all anesthesiologists.We believe that, thoracic paravertebralblock is a method can be applied instead of general anesthesia.Key words: Paravertebral block, thoracic, breast surgery,regional anesthesia

  6. Strengthening exercises improve symptoms and quality of life but do not change autonomic modulation in fibromyalgia: a randomized clinical trial.

    Science.gov (United States)

    Gavi, Maria Bernadete Renoldi Oliveira; Vassalo, Dalton Valentin; Amaral, Fabian Tadeu; Macedo, Danielle Constância Felício; Gava, Pablo Lúcio; Dantas, Eduardo Miranda; Valim, Valéria

    2014-01-01

    Autonomic dysfunction is an important mechanism that could explain many symptoms observed in fibromyalgia (FM). Exercise is an effective treatment, with benefits potentially mediated through changes in autonomic modulation. Strengthening is one of the less studied exercises in FM, and the acute and chronic effects of strengthening on the autonomic system remain unknown. The objective of this study was to assess the chronic effects of strengthening exercises (STRE) on autonomic modulation, pain perception and the quality of life (QOL) of FM patients. Eighty sedentary women with FM (ACR 1990) were randomly selected to participate in STRE or flexibility (FLEX) exercises in a blinded controlled trial. The intensity of STRE was set at 45% of the estimated load of 1 Repetition Maximum (RM) in 12 different exercises. Outcomes were Visual Analog Scale (VAS) for pain, Heart Rate Variability (HRV) analysis, treadmill test, the sit and reach test (Wells and Dillon's Bench), maximal repetitions test and handgrip dynamometry; and quality of life by the Fibromyalgia Impact Questionnaire (FIQ), the Beck and Idate Trait-State Inventory (IDATE), a short-form health survey (SF-36). The STRE group was more effective to strength gain for all muscles and pain control after 4 and 16 weeks (panxiety (panxiety and quality of life, no effect was observed on the autonomic modulation in both groups. This observation suggests that changes in autonomic modulation are not a target tobe clinically achieved in fibromyalgia. ClinicalTrials.gov NCT02004405.

  7. Blunt thoracic aortic injuries: an autopsy study.

    Science.gov (United States)

    Teixeira, Pedro G R; Inaba, Kenji; Barmparas, Galinos; Georgiou, Chrysanthos; Toms, Carla; Noguchi, Thomas T; Rogers, Christopher; Sathyavagiswaran, Lakshmanan; Demetriades, Demetrios

    2011-01-01

    The objective of this study was to identify the incidence and patterns of thoracic aortic injuries in a series of blunt traumatic deaths and describe their associated injuries. All autopsies performed by the Los Angeles County Department of Coroner for blunt traumatic deaths in 2005 were retrospectively reviewed. Patients who had a traumatic thoracic aortic (TTA) injury were compared with the victims who did not have this injury for differences in baseline characteristics and patterns of associated injuries. During the study period, 304 (35%) of 881 fatal victims of blunt trauma received by the Los Angeles County Department of Coroner underwent a full autopsy and were included in the analysis. The patients were on average aged 43 years±21 years, 71% were men, and 39% had a positive blood alcohol screen. Motor vehicle collision was the most common mechanism of injury (50%), followed by pedestrian struck by auto (37%). A TTA injury was identified in 102 (34%) of the victims. The most common site of TTA injury was the isthmus and descending thoracic aorta, occurring in 67 fatalities (66% of the patients with TTA injuries). Patients with TTA injuries were significantly more likely to have other associated injuries: cardiac injury (44% vs. 25%, p=0.001), hemothorax (86% vs. 56%, pinjury (74% vs. 49%, pinjury. Patients with a TTA injury were significantly more likely to die at the scene (80% vs. 63%, p=0.002). Thoracic aortic injuries occurred in fully one third of blunt traumatic fatalities, with the majority of deaths occurring at the scene. The risk for associated thoracic and intra-abdominal injuries is significantly increased in patients with thoracic aortic injuries.

  8. Pulmonary function tests correlated with thoracic volumes in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Ledonio, Charles Gerald T; Rosenstein, Benjamin E; Johnston, Charles E; Regelmann, Warren E; Nuckley, David J; Polly, David W

    2017-01-01

    Scoliosis deformity has been linked with deleterious changes in the thoracic cavity that affect pulmonary function. The causal relationship between spinal deformity and pulmonary function has yet to be fully defined. It has been hypothesized that deformity correction improves pulmonary function by restoring both respiratory muscle efficiency and increasing the space available to the lungs. This research aims to correlate pulmonary function and thoracic volume before and after scoliosis correction. Retrospective correlational analysis between thoracic volume modeling from plain x-rays and pulmonary function tests was conducted. Adolescent idiopathic scoliosis patients enrolled in a multicenter database were sorted by pre-operative Total Lung Capacities (TLC) % predicted values from their Pulmonary Function Tests (PFT). Ten patients with the best and ten patients with the worst TLC values were included. Modeled thoracic volume and TLC values were compared before and 2 years after surgery. Scoliosis correction resulted in an increase in the thoracic volume for patients with the worst initial TLCs (11.7%) and those with the best initial TLCs (12.5%). The adolescents with the most severe pulmonary restriction prior to surgery strongly correlated with post-operative change in total lung capacity and thoracic volume (r 2  = 0.839; p Scoliosis correction in adolescents was found to increase thoracic volume and is strongly correlated with improved TLC in cases with severe restrictive pulmonary function, but no correlation was found in cases with normal pulmonary function. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:175-182, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Thoracic pain in a collegiate runner.

    Science.gov (United States)

    Austin, G P; Benesky, W T

    2002-08-01

    This case study describes the process of examination, re-examination, and intervention for a collegiate runner with mechanical thoracic pain preventing athletic participation and limiting daily function. Unimpaired function fully returned in less than 3 weeks with biweekly sessions to re-establish normal and painfree thoracic mechanics via postural hygiene, exercise, mobilization, and manipulation. The outcome of this case study supports the original hypothesis that the pattern of impairments was in fact responsible for the functional limitations and disability in this athlete. At the time of publication the athlete was without functional limitations and had fully returned to competitive sprinting for the university track team.

  10. Failures and complications of thoracic drainage

    Directory of Open Access Journals (Sweden)

    Đorđević Ivana

    2006-01-01

    Full Text Available Background/Aim. Thoracic drainage is a surgical procedure for introducing a drain into the pleural space to drain its contents. Using this method, the pleura is discharged and set to the physiological state which enables the reexpansion of the lungs. The aim of the study was to prove that the use of modern principles and protocols of thoracic drainage significantly reduces the occurrence of failures and complications, rendering the treatment more efficient. Methods. The study included 967 patients treated by thoracic drainage within the period from January 1, 1989 to June 1, 2000. The studied patients were divided into 2 groups: group A of 463 patients treated in the period from January 1, 1989 to December 31, 1994 in whom 386 pleural drainage (83.36% were performed, and group B of 602 patients treated form January 1, 1995 to June 1, 2000 in whom 581 pleural drainage (96.51% were performed. The patients of the group A were drained using the classical standards of thoracic drainage by the general surgeons. The patients of the group B, however, were drained using the modern standards of thoracic drainage by the thoracic surgeons, and the general surgeons trained for this kind of the surgery. Results. The study showed that better results were achieved in the treatment of the patients from the group B. The total incidence of the failures and complications of thoracic drainage decreased from 36.52% (group A to 12.73% (group B. The mean length of hospitalization of the patients without complications in the group A was 19.5 days versus 10 days in the group B. The mean length of the treatment of the patients with failures and complications of the drainage in the group A was 33.5 days versus 17.5 days in the group B. Conclusion. The shorter length of hospitalization and the lower morbidity of the studied patients were considered to be the result of the correct treatment using modern principles of thoracic drainage, a suitable surgical technique, and a

  11. A RARE CASE OF THORACIC ACTINOMYCOSIS

    Directory of Open Access Journals (Sweden)

    Priyanka Das

    2017-10-01

    Full Text Available PRESENTATION OF CASE Actinomycetes are branching gram-positive anaerobic bacteria belonging to Actinomycetaceae family and are commensals in human oropharynx, gastrointestinal tract and female genitalia. Thoracic or pulmonary actinomycosis is an uncommon bacterial infection. The diagnosis of pulmonary or thoracic actinomycosis is often confounding because of its shared clinical features with malignant lung diseases and chronic suppurative lung diseases. However, chest physicians should be aware of actinomycosis being a differential diagnosis in persistent shadows in lung as early diagnosis leads to good prognosis. 1

  12. [Algorithms for procedures in thoracic trauma].

    Science.gov (United States)

    Obretenov, E; Vidolov, P; Dimov, G; Vŭlcheva, S

    2003-01-01

    The study includes 1127 injured with thoracic trauma, 23 percent of them with polytrauma. The worse thoracic trauma were these with formed flail chest with pleural and lung complications, accompanied by severe disfunction in circulation and biomechanics of breathing. The application of minimal surgical procedures like pleural punctures and drainage of pleural cavities with aspiration achieved good results. Thoracotomy was performed on clear indications (unstoppable bleeding, large ruptures of lung parenchyma, suppurative lung haematoma, cardiac tamponade, rupture of major airways, rupture of diaphragm, rupture of oesophagus and coagulated haemothorax). The achieved mortality of 5.9 percent is an excellent index suggesting a choice of treatment.

  13. Pleural puncture with thoracic epidural: A rare complication?

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2011-01-01

    Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

  14. Three year stability of Five-Factor Model personality traits in relation to changes in symptom levels in patients with schizophrenia or related disorders.

    Science.gov (United States)

    Boyette, Lindy-Lou; Nederlof, Jan; Meijer, Carin; de Boer, Froukje; de Haan, Lieuwe

    2015-09-30

    Five-Factor Model (FFM) personality traits are related to a wide range of clinical outcome in patients with psychotic disorders. However, it is not sufficiently clear whether psychotic illness, particularly fluctuation in negative symptoms and psychotic relapse, affects personality. The current study examined the 3-year temporal stability of FFM traits in 91 patients with non-affective psychotic disorders with a maximum duration of illness of 10 years and 32 control subjects without a (family member with) a diagnosis of psychotic illness. In patients, change in negative symptoms predicted changes in Neuroticism and (inversely) in Extraversion and Openness. However, when correcting for depressive symptoms, negative symptoms no longer predicted change in any FFM trait. Clinical characteristics, such as psychotic relapse, were also not found to be related to change in FFM traits. Patients showed a slight increase in Conscientiousness levels, the other FFM traits showed mean-level stability. Rank-order stability of the FFM traits was moderate to strong, although weaker for Neuroticism in patients. Our findings indicate that psychotic symptoms exert limited effect on the stability of FFM traits in patients with psychotic disorders. Consistent with general population findings, one should guard against state-trait confusion between Neuroticism/Extraversion and depression. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Utilization of Cupping Therapy in the Treatment of Vascular Thoracic Outlet Syndrome in a Collegiate Pitcher: A Case Study

    Directory of Open Access Journals (Sweden)

    Stephen A. Cage

    2017-12-01

    Full Text Available Objective: Present a clinical case detailing the effectiveness of dry cupping therapy in treating thoracic outlet syndrome. The utilization of dry cupping therapy on a 20-year-old collegiate baseball pitcher with diagnosed thoracic outlet syndrome is presented. Background: Thoracic outlet syndrome is a relatively rare musculoskeletal condition affecting 1/100,000 patients annually. Dry cupping therapy is an ancient therapeutic modality that utilizes various means of suction with the goal of decompressing myofascial layers. Treatment: Following diagnosis, patient was successfully treated in two weeks using dry cupping therapy. The patient experienced no further incidence of thoracic outlet syndrome symptoms and was able to complete the remainder of his competitive season. Uniqueness: The patient’s thoracic outlet syndrome was diagnosed at an early stage, leading to the need of clearance from a vascular specialist before returning to competition. To the author’s knowledge, there are currently no published case reports detailing the use of cupping therapy to treat thoracic outlet syndrome. Conclusion: Cupping therapy may be a viable treatment option when seeking to address tight musculature. Further research needs to be conducted to determine optimal parameters for cupping therapy as a therapeutic modality.

  16. Symptomatic Thoracic Nerve Root Herniation into an Extradural Arachnoid Cyst : Case Report and Review of the Literature

    NARCIS (Netherlands)

    Shanbhag, Nagesh C.; Duyff, Ruurd F.; Groen, Rob J. M.

    2017-01-01

    BACKGROUND: Spinal extradural arachnoid cysts (SEACs) are relatively rare and usually asymptomatic. They preferentially are situated in the thoracic extradural space and almost always dorsal. SEACs may present with back pain and/or cord compression symptoms. Needle aspiration, needle fenestration,

  17. Who benefits most from therapist-assisted internet-delivered cognitive behaviour therapy in clinical practice? Predictors of symptom change and dropout.

    Science.gov (United States)

    Edmonds, M; Hadjistavropoulos, H D; Schneider, L H; Dear, B F; Titov, N

    2018-03-01

    Internet-delivered cognitive behavioral therapy (ICBT) is effective for treating anxiety and depression, but not for all patients. Predictors of dropout and outcomes from ICBT remain unclear and the literature could benefit from study of response to ICBT among larger community samples using advanced statistical techniques. In this study, we sought to identify predictors of dropout and symptom change in a large community sample (n = 1201) who received therapist-assisted transdiagnostic ICBT targeting anxiety and/or depression. Logistic regression was used to assess dropout, and showed that those who fully completed ICBT lessons (n = 880) were older and endorsed lower psychological distress at intake than those who only partially completed ICBT lessons (n = 321). During the course of therapy, patients responded to the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 at six time points. Autoregressive latent trajectory models were fitted to this data to assess the ability of demographic variables, program engagement, psychological and medical service usage, and psychological distress to explain individual variance in initial symptom levels and symptom change over time. Higher symptom scores at pre-treatment were predictive of greater symptom improvement. Symptom improvement was greater in those who were off work on disability and those without higher post-secondary education. Clinical implications are discussed. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Breast size, bra fit and thoracic pain in young women: a correlational study.

    Science.gov (United States)

    Wood, Katherine; Cameron, Melainie; Fitzgerald, Kylie

    2008-03-13

    A single sample study was undertaken to determine the strength and direction of correlations between: a) breast size and thoracic spine or posterior chest wall pain; b) bra fit and thoracic spine or posterior chest wall pain and; c) breast size and bra fit, in thirty nulliparous women (18-26 years), with thoracic spine or posterior chest wall pain, who wore bras during daytime. Pain (Short Form McGill Pain Questionnaire), bra size (Triumph International), bra fit (Triumph International). Most (80%) women wore incorrectly sized bras: 70% wore bras that were too small, 10% wore bras that were too large. Breast size was negatively correlated with both bra size (r = -0.78) and bra fit (r = -0.50). These results together indicate that large breasted women were particularly likely to be wearing incorrectly sized and fitted bras. Negligible relationships were found between pain and bra fit, and breast size and pain. Menstrual cycle stage was moderately positively correlated with bra fit (r = 0.32). In young, nulliparous women, thoracic pain appears unrelated to breast size. Bra fit is moderately related to stage of menstrual cycle suggesting that this research may be somewhat confounded by hormonal changes or reproductive stage. Further research is needed to clarify whether there is a relationship between breast size or bra fit and thoracic pain in women during times of hormonal change.

  19. Adolescent Idiopathic Scoliosis Thoracic Volume Modeling: The Effect of Surgical Correction.

    Science.gov (United States)

    Wozniczka, Jennifer K; Ledonio, Charles G T; Polly, David W; Rosenstein, Benjamin E; Nuckley, David J

    2017-12-01

    Scoliosis has been shown to have detrimental effects on pulmonary function, traditionally measured by pulmonary function tests, which is theorized to be correlated to the distortion of the spine and thorax. The changes in thoracic volume with surgical correction have not been well quantified. This study seeks to define the effect of surgical correction on thoracic volume in patients with adolescent idiopathic scoliosis. Images were obtained from adolescents with idiopathic scoliosis enrolled in a multicenter database (Prospective Pediatric Scoliosis Study). A convenience sample of patients with Lenke type 1 curves with a complete data set meeting specific parameters was used. Blender v2.63a software was used to construct a 3-dimensional (3D) computational model of the spine from 2-dimensional calibrated radiographs. To accomplish this, the 3D thorax model was deformed to match the calibrated radiographs. The thorax volume was then calculated in cubic centimeters using Mimics v15 software. The results using this computational modeling technique demonstrated that surgical correction resulted in decreased curve measurement as determined by Cobb method, and increased postoperative thoracic volume as expected. Thoracic volume significantly increased by a mean of 567 mm (P3D changes in thoracic volumes using 2-dimensional imaging. This is an assessment of the novel modeling technique, to be used in larger future studies to assess clinical significance. Level 3-retrospective comparison of prospectively collected data.

  20. Postoperative spinal alignment remodeling in Lenke 1C scoliosis treated with selective thoracic fusion

    DEFF Research Database (Denmark)

    Wang, Yu; Bünger, Cody E; Zhang, Yanqun

    2012-01-01

    BACKGROUND CONTEXT: Selective thoracic fusion may cause spinal imbalance in certain patients; how the spinal alignment changes over time after surgery is highly correlated with the final spinal balance. PURPOSE: To investigate how spinal alignment changes over time after selective thoracic fusion...... after surgery. Although some patients regained spinal balance through postoperative spinal alignment remodeling, 11 patients remained imbalanced at 2-year follow-up. CONCLUSIONS: Selective thoracic fusion is prone to cause leftward spinal imbalance in Lenke 1C scoliosis patients. Postoperative spinal...... alignment remodeling can facilitate recovery of spinal balance in some patients. Postoperative spinal imbalance in Lenke 1C scoliosis patients could be prevented by selecting stable vertebra or the vertebrae above as LIV, checking the balance condition during surgery, or considering ratio criteria when...

  1. Effects of Endoscopic Thoracic Sympathectomy on Raynaud's Disease.

    Science.gov (United States)

    Karapolat, Sami; Turkyilmaz, Atila; Tekinbas, Celal

    2018-01-12

    Raynaud's disease is a disorder that is characterized by attacks of pain, cyanosis, redness, and numbness in the upper extremities caused by vasospasm of digital arteries due to cold or emotional stress. We aimed at demonstrating our experiences with endoscopic thoracic sympathectomy (ETS) in the treatment of Raynaud's disease. From 48 patients who underwent ETS for various reasons at our department between January 2014 and January 2015, we reviewed 9 patients with Raynaud's disease (18.7%) with respect to their demographic characteristics such as gender and age, postoperative complications, short-term results, side effects, recurrence of symptoms, and long-terms results. The symptoms and findings reappeared and the number and dosage of the drugs used returned to their preoperative levels in 66.6% of the patients at month 6, and in all patients except 1 at the end of the 1st year. ETS should be considered an ultimate choice for patients with Raynaud's disease who have treatment-resistant severe symptoms and serious complications, disturbed social and daily lives, and impaired quality of life, and all patients should be properly informed before the surgery about the possibility of a high rate of recurrence.

  2. Recognizing Symptoms

    Science.gov (United States)

    ... for IBS Signs and Symptoms Overview Recognizing Symptoms Diagnosis of IBS Pain in IBS IBS with Constipation Constipated Diarrhea IBS ... for IBS Signs and Symptoms Overview Recognizing Symptoms Diagnosis of IBS Pain in IBS IBS with Constipation Constipated Diarrhea IBS ...

  3. Accreditation Council for Graduate Medical Education Case Log: General Surgery Resident Thoracic Surgery Experience

    Science.gov (United States)

    Kansier, Nicole; Varghese, Thomas K.; Verrier, Edward D.; Drake, F. Thurston; Gow, Kenneth W.

    2014-01-01

    Background General surgery resident training has changed dramatically over the past 2 decades, with likely impact on specialty exposure. We sought to assess trends in general surgery resident exposure to thoracic surgery using the Accreditation Council for Graduate Medical Education (ACGME) case logs over time. Methods The ACGME case logs for graduating general surgery residents were reviewed from academic year (AY) 1989–1990 to 2011–2012 for defined thoracic surgery cases. Data were divided into 5 eras of training for comparison: I, AY89 to 93; II, AY93 to 98; III, AY98 to 03; IV, AY03 to 08; V, AY08 to 12. We analyzed quantity and types of cases per time period. Student t tests compared averages among the time periods with significance at a p values less than 0.05. Results A total of 21,803,843 general surgery cases were reviewed over the 23-year period. Residents averaged 33.6 thoracic cases each in period I and 39.7 in period V. Thoracic cases accounted for nearly 4% of total cases performed annually (period I 3.7% [134,550 of 3,598,574]; period V 4.1% [167,957 of 4,077,939]). For the 3 most frequently performed procedures there was a statistically significant increase in thoracoscopic approach from period II to period V. Conclusions General surgery trainees today have the same volume of thoracic surgery exposure as their counterparts over the last 2 decades. This maintenance in caseload has occurred in spite of work-hour restrictions. However, general surgery graduates have a different thoracic surgery skill set at the end of their training, due to the predominance of minimally invasive techniques. Thoracic surgery educators should take into account these differences when training future cardiothoracic surgeons. PMID:24968766

  4. Thoracic epidural anaesthesia for major abdominal surgeries ...

    African Journals Online (AJOL)

    The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Data were obtained from the ... In a previous study, Consani et al.3 documented the feasibility of thoracic epidural ... thoracostomy and mastectomy in high-risk patients.2,6 Since TEA places less demand on drugs, ...

  5. Thoracic endometriosis syndrome: Current concept in ...

    African Journals Online (AJOL)

    Background: Thoracic endometriosis is a rare pathology. The diagnosis is often delayed or missed, however recently, there has been significant advances in the knowledge of this condition and hence, an improvement in the diagnosis and treatment. Objective: To review the current concepts in the pathophysiology and ...

  6. November 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2017 Arizona Thoracic Society meeting was held on Wednesday, November 15, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with a lecture followed by case presentations. There were 15 in attendance representing the pulmonary, critical care, sleep, allergy, infectious disease and radiology communities. At the beginning of the meeting several issues were discussed: 1. CME offered by the Southwest Journal of Pulmonary and Critical Care Medicine (SWJPCC is currently offered to only the Southwest state thoracic societies and the Mayo Clinic. After discussion it was felt that this restriction of access was no longer appropriate and CME credits should be available to all. 2. Efforts continue to obtain CME for the Arizona Thoracic Society meetings. Our Chapter Representative, Dr. Gerry Schwartzberg, is approaching this with the American Thoracic Society. Locally, HonorHealth sent out a survey on CME needs. Members were encouraged …

  7. Thoracic myelocystomeningocele in a neurologically intact infant ...

    African Journals Online (AJOL)

    This case is an example of a high congenital spinal lesion with very minimal or negligible neurological deficits, with no other congenital malformations. Key Words: Thoracic spine, Myelocystomeningocele, Intact nervous system. Résumé Rapporter un cas peu commun et un cas rare d'une anomalie congenitale vertébrale ...

  8. Evolution of Thoracic Surgery in Canada

    Directory of Open Access Journals (Sweden)

    Jean Deslauriers

    2015-01-01

    Full Text Available BACKGROUND: Canada’s contributions toward the 21st century’s practice of thoracic surgery have been both unique and multilayered. Scattered throughout are tales of pioneers where none had gone before, where opportunities were greeted by creativity and where iconic figures followed one another.

  9. March 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-03-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2017 Arizona Thoracic Society meeting was held on Wednesday, March 22, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There 11 attendance representing the pulmonary, critical care, sleep, thoracic surgery and radiology communities. There was a discussion of supporting the Tobacco 21 bill which had been introduced into the Arizona State Legislature. The bill was assigned to the House Commerce Committee but was not scheduled for a hearing by the Chair-Representative, Jeff Wininger from Chandler. It seems likely that the bill will be reintroduced in the future and the Arizona Thoracic Society will support the bill in the future. Three cases were presented: 1. Dr. Bridgett Ronan presented a 57-year-old man with cough and shortness of breath. His physical examination and spirometry were unremarkable. A thoracic CT scan showed large calcified and noncalcified pleural plaques and mediastinal lymphadenopathy. …

  10. REVIEW ARTICLE Thoracic endometriosis syndrome: current ...

    African Journals Online (AJOL)

    KESIEME

    b. Pathogenesis. Many theories have been postulated to explain thoracic endometriosis; however, none of them can wholly explain the phenomenon. One of the most popular is the Sampson. Theory of Retrograde Menstruation.16,17 The theory states that eutopic endometrium is sloughed into the peritoneal cavity via the.

  11. Specific elements of thoracic wound management.

    Science.gov (United States)

    Avaro, J-P; De Lesquen, H; Beranger, F; Cotte, J; Natale, C

    2017-12-01

    Damage control for thoracic trauma combines definitive and temporary surgical gestures specifically adapted to the lesions present. A systematic assessment of all injuries to prioritize the specific lesions and their treatments constitutes the first operative stage. Packing and temporary closure have a place in the care of chest injuries. Copyright © 2017. Published by Elsevier Masson SAS.

  12. Survey of thoracic anesthetic practice in Italy.

    Science.gov (United States)

    Della Rocca, Giorgio; Langiano, Nicola; Baroselli, Antonio; Granzotti, Saskia; Pravisani, Chiara

    2013-12-01

    The object of this study was to conduct and analyze the output of a survey involving a cohort of all Italian hospitals performing thoracic surgery to gather data on anesthetic management, one-lung ventilation (OLV) management, and post-thoracotomy pain relief in thoracic anesthesia. Survey. Italy. An invitation to participate in the survey was e-mailed to all the members of the Italian Society of Anesthesia and Intensive Care Medicine. None. A total of 62 responses were received from 47 centers. The key findings were: Double-lumen tube is still the first choice lung separation technique in current use; pressure-controlled ventilation and volume-controlled ventilation modes are homogenously distributed across the sample and, a tidal volumes (VT) of 4-6 mL/kg during OLV was preferred to all others; moderate or restrictive fluid management were the most used strategies of fluid administration in thoracic anesthesia; thoracic epidural analgesia represented the "gold standard" for post-thoracotomy pain relief in combination with intravenous analgesia. The results of this survey showed that Italian anesthesiologist follow the recommended standard of care for anesthetic management during OLV. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. [Cervical thoracic duct cyst: An uncommon entity].

    Science.gov (United States)

    Carreira-Delgado, Manuel; Fernández-Rodríguez, Elvira; Martínez-Míguez, Marta; Álvarez-Martín, María Jesús; Nuño Vázquez-Garza, José Manuel

    2017-12-01

    Cervical thoracic duct cysts are a rare anomaly. To report a case of cervical thoracic duct cyst, and perform a literature review. A 78-year-old female, with a one-year history of a left-sided asymptomatic supraclavicular cystic mass. Computerized tomography revealed a cystic mass 42mm in diameter. We performed a fine needle aspiration puncture, obtaining a thick, milky, whitish liquid. The patient underwent surgery; finding a left-sided supraclavicular cystic mass, with some lymph vessels heading towards the jugulo subclavian venous junction. We performed a ligation of these lymph vessels and resection of the mass. The histopathologic study confirmed the diagnosis of thoracic duct cyst. Diagnosis of cervical thoracic duct cyst should be suspected with a cystic lesion in the left supraclavicular region, which when perforated exudes a very distinctive thick milky, whitish liquid with a high content of lymphocytes and triglycerides. Treatment should be complete removal with ligation of the lymphatic afferent vessels. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  14. Thoracic trauma: presentation and management outcome

    International Nuclear Information System (INIS)

    Saaiq, M.; Shah, S. A.

    2008-01-01

    To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages. out of 143 patients, 119 (83)% were males and 24 (17)% were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66)% patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45%) patients. Seventeen (11.88%) patients were managed with mechanical ventilation. there were 17 deaths with a mortality rate of 11.88%. Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions. (author)

  15. April 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated at 150 words. The April 2014 Arizona Thoracic Society meeting was held on Wednesday, 4/23/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 15 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. It was announced that there will be a wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting. The tasting will be led by Peter Wagner and is scheduled for the Cobalt Room in the Hilton San Diego Bayfront on Tuesday, May 20, from 4-8 PM. Guideline development was again discussed. The consensus was to await publication of the IDSA Cocci Guidelines and respond appropriately. George Parides, Arizona Chapter Representative, gave a presentation on Hill Day. Representatives of the Arizona, New Mexico and Washington Thoracic Societies met with their Congressional delegations, including Rep. David Schweikert, to discuss the Cigar Bill, NIH funding, and the Medicare Sustainable Growth ...

  16. Experience Of Thoracic Surgery Performed Under Difficult ...

    African Journals Online (AJOL)

    rely on a standard thoracic set with Finocchietto retractor, lung retractor, rib cutter and Lubsche sternotome. After completing the operation, proper haemostasis was obtained and the pleural cavity was irrigated with warm physiologic solution. Two chest tubes (size 36F and 28F) were applied and connected with "under.

  17. Thoracic radiographic anatomy in goats | Makungu | Tanzania ...

    African Journals Online (AJOL)

    . The aorta was not clearly visible on lateral views. The mean ratio of the CVC diameter to the height of the fourth thoracic vertebral body (T4) was 1.08 ± 0.07. Speciesspecific differences exist in the normal radiographic anatomy of the thorax.

  18. Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes: the LADIS study.

    Science.gov (United States)

    Verdelho, Ana; Madureira, Sofia; Moleiro, Carla; Ferro, José M; O'Brien, John T; Poggesi, Anna; Pantoni, Leonardo; Fazekas, Franz; Scheltens, Philip; Waldemar, Gunhild; Wallin, Anders; Erkinjuntti, Timo; Inzitari, Domenico

    2013-11-01

    Depressive symptoms (DS) have been associated with increased risk of cognitive decline. Our aim was to evaluate the longitudinal influence of DS on cognition in independent older people, accounting for the severity of white matter changes (WMC). The LADIS (Leukoaraiosis And DISability in the elderly) prospective study evaluated the impact of WMC on the transition of independent older subjects into disability. Subjects were evaluated annually over a 3 year period with a comprehensive clinical and neuropsychological evaluation. Previous episodes of depression and current DS were assessed during each interview. Severity of DS was assessed using the self-rated 15 item Geriatric Depression Scale. A neuropsychological battery and clinical criteria for cognitive impairments were applied in all clinical visits, and cognitive compound measures were made based on neuropsychological results. MRI was performed at baseline and at year 3. 639 subjects were included (74.1 ± 5 years old, 55% women, 9.6 ± 3.8 years of schooling). Dementia was diagnosed in 90 patients and cognitive impairment not dementia in 147 patients at the last clinical evaluation. DS were an independent predictor of cognitive impairment (dementia and not dementia) during follow-up, independent of the effect of the severity of WMC, medial temporal lobe atrophy, age, education or global cognitive function at baseline. DS are associated with an increase risk of cognitive decline, independent of the effect of WMC, probably due to an additive or synergistic effect. In this context, DS probably represent a subtle ongoing organic dysfunction.

  19. Change in health-related quality of life over 1 month in cancer patients with high initial levels of symptoms and problems

    DEFF Research Database (Denmark)

    Lund Rasmussen, Charlotte; Johnsen, Anna Thit; Petersen, Morten Aagaard

    2016-01-01

    PURPOSE: To investigate the mean changes over time in health-related quality of life among advanced cancer patients who did not receive any intervention, comparing changes among all patients versus changes in subgroups of patients with high initial symptom scores. METHODS: Patients with advanced...... = -0.9 (95 % CI -1.5;-0.6)]. In the subgroups of patients initially scoring at least 33, 50, or 66 % of maximum, the score improved with mean changes of -9.2 (95 % CI -10.1;-8.4), -13.1 (95 % CI -14.4;-11.8), and -15.6 (95 % CI -17.2;-13.9), respectively. CONCLUSIONS: We quantified the magnitude...... of change over a 1-month period in health-related quality of life in advanced cancer patients, and in subgroups selected according to certain initial symptom levels. This information may help the interpretation of longitudinal studies of patients selected via screening....

  20. Percutaneous approach to the upper thoracic spine: optimal patient positioning

    Science.gov (United States)

    Bayley, Edward; Clamp, Jonathan

    2009-01-01

    Percutaneous access to the upper thoracic vertebrae under fluoroscopic guidance is challenging. We describe our positioning technique facilitating optimal visualisation of the high thoracic vertebrae in the prone position. This allows safe practice of kyphoplasty, vertebroplasty and biopsy throughout the upper thoracic spine. PMID:19575242

  1. The association between parenting stress, parenting self-efficacy, and the clinical significance of child ADHD symptom change following behavior therapy.

    Science.gov (United States)

    Heath, Corey L; Curtis, David F; Fan, Weihua; McPherson, Robert

    2015-02-01

    We examined parenting stress (PST) and self-efficacy (PSE) following participation in behavioral parent training (BPT) with regard to child treatment response. Forty-three families of children diagnosed with ADHD participated in a modified BPT program. Change in PST and PSE was evaluated using a single group, within-subjects design. Parenting outcomes based on child treatment response were evaluated based upon (1) magnitude and (2) clinical significance of change in child symptom impairment. Parents reported significant improvements in stress and self-efficacy. Parents of children who demonstrated clinically significant reduction in ADHD symptoms reported lower stress and higher self-efficacy than those of children with continued impairments. Magnitude of child impairment was not associated with parent outcomes. Clinical implications for these results include extending treatment duration to provide more time for symptom amelioration and parent-focused objectives to improve coping and stress management.

  2. Effects of thoracic epidural analgesia on lower urinary tract function in women.

    Science.gov (United States)

    Wuethrich, Patrick Y; Burkhard, Fiona C; Panicker, Jalesh N; Kessler, Thomas M

    2011-01-01

    The need for an indwelling transurethral catheter in patients with postoperative thoracic epidural analgesia (TEA) is a matter of controversy. Subjective observations are ambivalent and the literature addressing this issue is scarce. As segmental blockade can be achieved with epidural analgesia, we hypothesized that analgesia within segments T4-T11 has no or minimal influence on lower urinary tract function. Thus, we evaluated the effect of TEA on lower urinary tract function by urodynamic studies. In 13 women with no preoperative lower urinary tract symptoms undergoing open kidney surgery by lumbotomy under TEA, we prospectively assessed changes in urodynamic parameters the day before and 2-3 days after surgery with the patients under TEA. Before versus during TEA, there was a significant increase in postvoid residual (median, 5 ml vs. 220 ml, PcmH(2) O vs. 5 cmH(2) O, P=0.001), detrusor pressure at maximum flow rate (median, 18 cmH(2) O vs. 5 cmH(2) O, P=0.001), maximum flow rate (median, 12 ml/sec vs. 3 ml/sec, PcmH(2) O to 56 cmH(2) O (P=0.002). Bladder sensation, maximum cystometric capacity, compliance, and functional profile length at rest were not influenced by TEA. TEA has a significant effect on bladder emptying with clinically relevant postvoid residual (PVR) necessitating (indwelling or intermittent) catheterization or monitoring of PVR. Copyright © 2010 Wiley-Liss, Inc.

  3. Therapeutic Lifestyle Changes: Impact on Weight, Quality of Life, and Psychiatric Symptoms in Veterans With Mental Illness.

    Science.gov (United States)

    Tessier, Jillian M; Erickson, Zachary D; Meyer, Hilary B; Baker, Matthew R; Gelberg, Hollie A; Arnold, Irina Y; Kwan, Crystal; Chamberlin, Valery; Rosen, Jennifer A; Shah, Chandresh; Hellemann, Gerhard; Lewis, Melissa M; Nguyen, Charles; Sachinvala, Neena; Amrami, Binyamin; Pierre, Joseph M; Ames, Donna

    2017-09-01

    Veterans with mental illness tend to have shorter life spans and suboptimal physical health because of a variety of factors. These factors include poor nutrition, being overweight, and smoking cigarettes. Nonphysical contributors that may affect quality of life are the stigma associated with mental illness, social difficulties, and spiritual crises. Current mental health treatment focuses primarily on the delivery of medication and evidence-based psychotherapies, which may not affect all the above areas of a Veteran's life as they focus primarily on improving psychological symptoms. Clinicians may find greater success using integrative, comprehensive, multifaceted programs to treat these problems spanning the biological, psychological, social, and spiritual domains. These pilot studies test an adjunctive, holistic, behavioral approach to treat mental illness. This pilot work explores the hypotheses that engagement in a greater number of therapeutic lifestyle changes (TLCs) leads to improvement in quality of life, reduction of psychiatric symptoms, and weight loss. Institutional Review Boards for human subjects at the Veterans Affairs (VA) Greater Los Angeles and Long Beach Healthcare Systems approved pilot study activities at their sites. Pilot Study 1 was a prospective survey study of Veterans with mental illness, who gained weight on an atypical antipsychotic medication regimen, participating in a weight management study. At each session of the 1-year study, researchers asked a convenience sample of 55 Veterans in the treatment arm whether they engaged in each of the eight TLCs: exercise, nutrition/diet, stress management and relaxation, time in nature, relationships, service to others, religious or spiritual involvement, and recreation. Pilot Study 2 applied the TLC behavioral intervention and examined 19 Veterans with mental illness, who attended four classes about TLCs, received individual counseling over 9 weeks, and maintained journals to track TLC practice

  4. Change in depressive symptoms over higher education and professional establishment - a longitudinal investigation in a national cohort of Swedish nursing students.

    Science.gov (United States)

    Christensson, Anna; Runeson, Bo; Dickman, Paul W; Vaez, Marjan

    2010-06-15

    There are indications of a high prevalence of psychological distress among students in higher education and also that distress increases over the course of study. However, not all studies on student distress controlled for sociodemographic differences and few followed development of distress over an extended period through professional establishment. We investigated if there is an independent effect of time in education and the first two years in the profession on depressive symptoms and mapped change over the period in a national cohort of students. Data came from LANE, a nation-wide longitudinal panel survey of Swedish nursing students (N = 1700) who responded to annual questionnaires over five years from 2002 to 2007. Depressive symptoms were measured by the Major Depression Inventory and change over time analysed in a linear mixed effects model for repeated measures. There was a significant change in level of depressive symptoms over time: an increase from the first to later years in education and a decrease to levels similar to baseline after graduation and a year in the profession. The change in symptoms remained significant after adjustment for sociodemographic factors (p education and professional establishment on depressive symptoms. We think heightened distress over education abates as the graduate accommodates to the profession. Nevertheless, within education, the differences in depressive symptoms associated to demographic factors can help identify student groups more vulnerable to distress. Also, as individual differences in distress seem to persist over time, perhaps students highly distressed in the beginning of education can be helped by awareness among educators of the elevated levels of distress in late education.

  5. Percutaneous phenol block of the upper thoracic sympathetic chain with computed tomography guidance. A new technique

    Energy Technology Data Exchange (ETDEWEB)

    Dondelinger, R.F.; Kurdziel, J.C.

    Twenty-one percutaneous neurolyses of the upper thoracic sympathetic chain were performed in 12 patients with CT guidance by a single injection of 1 to 3 ml of phenol at the level of Th3. Results were assessed after a follow-up period varying from 4 to 33 months. Three patients with hyperhidrosis had immediate and complete disappearance of symptoms, but only one patient remained dry. In 7/14 procedures done for Raynaud's disease symptoms disappeared or diminished. These long term results are competitive with surgery. Three transitory Horner syndromes and one pneumothorax occurred.

  6. Autonomic nervous activity changes in relation to the reporting of subjective symptoms among male workers in an information service company.

    Science.gov (United States)

    Karita, Kanae; Nakao, Mutsuhiro; Nishikitani, Mariko; Nomura, Kyoko; Yano, Eiji

    2006-05-01

    The objective of the study was to clarify the relationship between major subjective symptoms and autonomic nervous system function by power spectral analysis of heart rate variability (HRV). Short-term HRV was examined for 413 male workers in a Japanese information service company aged 19-45 years, and questionnaire survey on subjective symptoms and biochemical measurements were conducted at annual health checkup. The most prevalent subjective symptom (> or =10%) was dullness, followed by fatigue, backache, diarrhea, sleep disorder, and irritation. HRV in high frequency (HF 0.15-0.40 Hz) bands and the coefficient of variance in the electrocardiographic R-R interval (CVrr) were lower in the subjects with any of these six symptoms than in those without the symptoms. Both parameters were negatively associated with the reporting of any of the six symptoms by multiple regression analyses, controlling for the significant effects of age (HF and CVrr) and plasma cortisol levels (HF). It was suggested that the reporting of the subjective symptoms is one of good predictors for reduced parasympathetic tones.

  7. Stress sensitivity interacts with depression history to predict depressive symptoms among youth: prospective changes following first depression onset.

    Science.gov (United States)

    Technow, Jessica R; Hazel, Nicholas A; Abela, John R Z; Hankin, Benjamin L

    2015-04-01

    Predictors of depressive symptoms may differ before and after the first onset of major depression due to stress sensitization. Dependent stressors, or those to which characteristics of individuals contribute, have been shown to predict depressive symptoms in youth. The current study sought to clarify how stressors' roles may differ before and after the first depressive episode. Adolescents (N = 382, aged 11 to 15 at baseline) were assessed at baseline and every 3 months over the course of 2 years with measures of stressors and depressive symptoms. Semi-structured interviews were conducted every 6 months to assess for clinically significant depressive episodes. Hierarchical linear modeling showed a significant interaction between history of depression and idiographic fluctuations in dependent stressors to predict prospective elevations of symptoms, such that dependent stressors were more predictive of depressive symptoms after onset of disorder. Independent stressors predicted symptoms, but the strength of the association did not vary by depression history. These results suggest a synthesis of dependent stress and stress sensitization processes that might maintain inter-episode depressive symptoms among youth with a history of clinical depression.

  8. The psychometric properties of the Readiness and Motivation Questionnaire: a symptom-specific measure of readiness for change in the eating disorders.

    Science.gov (United States)

    Geller, Josie; Brown, Krista E; Srikameswaran, Suja; Piper, William; Dunn, Erin C

    2013-09-01

    Readiness for change, as assessed by the readiness and motivation interview (RMI), predicts a number of clinical outcome variables in eating disorders including enrollment in intensive treatment, symptom change, dropout, and relapse. Although clinically useful, the training and administration of the RMI is time consuming. The purpose of this research was to (a) develop a self-report, symptom-specific version of the RMI, the readiness and motivation questionnaire (RMQ), that can be used to assess readiness for change across all eating disorder diagnoses and (b) establish its psychometric properties. The RMQ provides stage of change, internality, and confidence scores for each of 4 eating disorder symptom domains (restriction, bingeing, and cognitive and compensatory behaviors). Individuals (N = 244) with current eating disorder diagnoses completed the RMQ and measures of convergent, discriminant, and criterion validity. Similar to the RMI scores, readiness scores on the RMQ differed according to symptom domain. Regarding criterion validity, RMQ scores were significantly associated with ratings of anticipated difficulty of recovery activities and completion of recovery activities. The RMQ contributed significant unique variance to anticipated difficulty of recovery activities, beyond those accounted for by the RMI and a questionnaire measure of global readiness. The RMQ is thus an acceptable alternative to the RMI, providing global and domain-specific readiness information when time or cost prohibits use of an interview.

  9. Development of depressive symptoms and depression during organizational change--a two-year follow-up study of civil servants

    DEFF Research Database (Denmark)

    Netterstrøm, Bo; Blønd, Morten; Nielsen, Martin

    2010-01-01

    On 1 January 2007, Denmark went through a major reorganization, where most of its 275 municipalities and 14 counties merged into larger units. Our study aimed to examine the development of depressive symptoms and incident depression among employees affected by this organizational change....

  10. Predictors of Patient Cognitive Therapy Skills and Symptom Change in Two Randomized Clinical Trials: The Role of Therapist Adherence and the Therapeutic Alliance

    Science.gov (United States)

    Webb, Christian A.; DeRubeis, Robert J.; Dimidjian, Sona; Hollon, Steven D.; Amsterdam, Jay D.; Shelton, Richard C.

    2012-01-01

    Objective: Previous research has found that therapist adherence to concrete, problem-focused cognitive therapy (CT) techniques predicts depressive symptom change (e.g., Feeley, DeRubeis, & Gelfand, 1999). More recently, Strunk, DeRubeis, Chui, and Alvarez (2007) demonstrated that in-session evidence of patients' use of CT skills was related to…

  11. Relationships among Client and Counselor Agreement about the Working Alliance, Session Evaluations, and Change in Client Symptoms Using Response Surface Analysis

    Science.gov (United States)

    Marmarosh, Cheri L.; Kivlighan, Dennis M., Jr.

    2012-01-01

    Two studies explored how counselor and client agreement on the therapy alliance, at the beginning of treatment, influenced early session evaluations and symptom change. Unlike prior studies that operationalized alliance convergence as either a profile similarity correlation or a difference score, the present study used polynomial regression and…

  12. Pretrauma Problems, Prior Stressor Exposure, and Gender as Predictors of Change in Posttraumatic Stress Symptoms among Physically Injured Children and Adolescents

    Science.gov (United States)

    Doron-LaMarca, Susan; Vogt, Dawne S.; King, Daniel W.; King, Lynda A.; Saxe, Glenn N.

    2010-01-01

    Objective: This study addressed predictors of change in posttraumatic stress symptoms (PTSS) among youths who had experienced physical injuries. The influences of pretrauma internalizing and externalizing problems, prior stressor exposure, and gender were investigated. Additionally, gender was examined as a moderator of the associations between…

  13. Dry needling for the management of thoracic spine pain

    Science.gov (United States)

    Fernández-de-las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-01-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

  14. The effect of lifetime cumulative adversity on change and chronicity in depressive symptoms and quality of life in older adults.

    Science.gov (United States)

    Shrira, Amit

    2012-12-01

    Lifetime cumulative adversity (LCA) has a detrimental effect on mental health. However, it is less clear whether it also increases the risk for mental health deterioration across time, and whether it is related to a continuous impairment in mental health among older adults. The current study aimed to examine whether LCA is related to deterioration and to continuous vulnerability in depressive symptoms and quality of life. Nine thousand one hundred fifty four older adults (mean age = 63 at Wave 1) who participated in the first three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) reported exposure to negative life events, depressive symptoms, and quality of life. Respondents with more LCA were at greater risk of high level of depressive symptoms and low level of quality of life. Those with more adversity were at greater risk of reporting an increase in depressive symptoms and a decrease in quality of life between waves. LCA was also related to continuous high level of depressive symptoms and low level of quality of life. The effect of LCA was stronger for depressive symptoms than for quality of life. LCA is associated with decline, as well as with continuous impairment, in major markers of mental health at the second half of life. The overall modest effects imply that resilience to LCA is widespread among older adults. Still, prevention and intervention programs should target old people with cumulative adversity, as they are in risk for deterioration and chronic vulnerability in important components of mental health.

  15. Thoracic gas volume in early childhood.

    Science.gov (United States)

    Hatch, D J; Taylor, B W

    1976-01-01

    A total body plethysmograph is descirbed which was used to study thoracic gas volume (TGV) in infants and young children from birth to 2 1/2 years, and was suitable for use even in very sick babies. Normal TGV values were obtained in 42 studies of 35 healthy infants and young children, and 16 children with abnormal lung volume are described. TGV correlated well with length, weight, chest circumference, and age in the healthy infants. A low TGV was found in children with respiratory difficulties after cardiac and thoracic surgery, in respiratory distress syndrome of the newborn, and in association with pulmonary infection and chest cage abnormalities. Abnormally high TGV was most frequently seen in infants with small airways disease. PMID:1008592

  16. Incidental Cardiac Findings on Thoracic Imaging.

    LENUS (Irish Health Repository)

    Kok, Hong Kuan

    2013-02-07

    The cardiac structures are well seen on nongated thoracic computed tomography studies in the investigation and follow-up of cardiopulmonary disease. A wide variety of findings can be incidentally picked up on careful evaluation of the pericardium, cardiac chambers, valves, and great vessels. Some of these findings may represent benign variants, whereas others may have more profound clinical importance. Furthermore, the expansion of interventional and surgical practice has led to the development and placement of new cardiac stents, implantable pacemaker devices, and prosthetic valves with which the practicing radiologist should be familiar. We present a collection of common incidental cardiac findings that can be readily identified on thoracic computed tomography studies and briefly discuss their clinical relevance.

  17. [Digital thoracic radiology: devices, image processing, limits].

    Science.gov (United States)

    Frija, J; de Géry, S; Lallouet, F; Guermazi, A; Zagdanski, A M; De Kerviler, E

    2001-09-01

    In a first part, the different techniques of digital thoracic radiography are described. Since computed radiography with phosphore plates are the most commercialized it is more emphasized. But the other detectors are also described, as the drum coated with selenium and the direct digital radiography with selenium detectors. The other detectors are also studied in particular indirect flat panels detectors and the system with four high resolution CCD cameras. In a second step the most important image processing are discussed: the gradation curves, the unsharp mask processing, the system MUSICA, the dynamic range compression or reduction, the soustraction with dual energy. In the last part the advantages and the drawbacks of computed thoracic radiography are emphasized. The most important are the almost constant good quality of the pictures and the possibilities of image processing.

  18. Comminuted fracture of the thoracic spine.

    LENUS (Irish Health Repository)

    Cashman, J P

    2012-02-03

    BACKGROUND: Road deaths fell initially after the introduction of the penalty points but despite this, the rate of spinal injuries remained unchanged. AIMS: We report a patient with a dramatic spinal injury, though without neurological deficit. We discuss the classification, management and economic impact of these injuries. METHODS: We describe the management of a patient with a comminuted thoracic spinal fracture without neurological injury. We conducted a literature review with regard to the availability of literature of the management of these injuries. RESULTS: This 17-year-old female was managed surgically and had a good functional outcome. There is no clear consensus in the published literature on the management of these injuries. CONCLUSIONS: Comminuted thoracic spinal factures are potentially devastating. Such a patient presents challenges in determining the appropriate treatment.

  19. Awareness of heart attack symptoms among US adults in 2007, and changes in awareness from 2001 to 2007.

    Science.gov (United States)

    Fang, Jing; Gillespie, Cathleen; Keenan, Nora L; Greenlund, Kurt J

    2011-05-01

    Timely access to emergency care, prompt receipt of advanced treatment and survival from heart attack is dependent on both the early recognition of heart attack symptoms, by both victims and bystanders, and by immediately calling the emergency services. The objective of this study is to measure the awareness of heart attack symptoms and the emergency response among US adults. We analyzed data from the Behavioral Risk Factor Surveillance System's module on heart attack and stroke, which was conducted in 17 states/territories in 2001 and 12 states/territories in 2007. The module included five questions related to heart attack symptoms, one decoy question and one question regarding the first action to take if someone is having a heart attack. Age-adjusted prevalence of awareness was estimated, and odds ratios were calculated. Differences between 2001 and 2007 were assessed for five states that used the module in both years. In 2007, among 76,864 adults, awareness of individual heart attack symptoms ranged from 49% (pain in jaw, neck or back) to 92% (chest pain). Although 97% of adults recognized at least one symptom, only 10.7% recognized all five symptoms, knew that 'sudden trouble seeing in one or both eyes' was not a symptom of heart attack and recognized the need to call the emergency services. This estimate varied significantly by age, sex, race/ethnicity and level of education. The estimate was significantly higher for women (12.2%) than men (7.7%), White (11.6%) than Black (5.7%) or Hispanic people (4.5%), those with a higher level of education (13.5%) than lower educational level (4.5%) and for those with coronary heart disease (16.2%) than without the disease (9.5%). Comparison of awareness between 2001 (the referent) and 2007, in five states, revealed that awareness of all symptoms and calling the emergency services, were 9.7 and 10.3% for 2001 and 2007, respectively (p heart attack symptoms among adults in 12 states was low and little improvement was

  20. Evaluation of registration methods on thoracic CT

    DEFF Research Database (Denmark)

    Murphy, K.; van Ginneken, B.; Reinhardt, J.

    2011-01-01

    comprised the comprehensive evaluation and comparison of 20 individual algorithms from leading academic and industrial research groups. All algorithms are applied to the same set of 30 thoracic CT pairs. Algorithm settings and parameters are chosen by researchers expert in the configuration of their own....... This article details the organisation of the challenge, the data and evaluation methods and the outcome of the initial launch with 20 algorithms. The gain in knowledge and future work are discussed....

  1. One-stage sequential bilateral thoracic expansion for asphyxiating thoracic dystrophy (Jeune syndrome).

    Science.gov (United States)

    Muthialu, Nagarajan; Mussa, Shafi; Owens, Catherine M; Bulstrode, Neil; Elliott, Martin J

    2014-10-01

    Jeune syndrome (asphyxiating thoracic dystrophy) is a rare disorder characterized by skeletal dysplasia, reduced diameter of the thoracic cage and extrathoracic organ involvement. Fatal, early respiratory insufficiency may occur. Two-stage lateral thoracic expansion has been reported, addressing each side sequentially over 3-12 months. While staged repair theoretically provides less invasive surgery in a small child with respiratory distress, we utilized a single stage, bilateral procedure aiming to rapidly maximize lung development. Combined bilateral surgery also offered the chance of rapid recovery, and reduced hospital stay. We present our early experience of this modification of existing surgical treatment for an extremely rare condition, thought to be generally fatal in early childhood. Nine children (6 males, 3 females; median age 30 months [3.5-75]) underwent thoracic expansion for Jeune syndrome in our centre. All patients required preoperative respiratory support (5 with tracheostomy, 8 requiring positive pressure ventilation regularly within each day/night cycle). Two children underwent sequential unilateral (2-month interval between stages) and 7 children bilateral thoracic expansion by means of staggered osteotomies of third to eighth ribs and plate fixation of fourth to fifth rib and sixth to seventh rib, leaving the remaining ribs floating. There was no operative mortality. There were 2 deaths within 3 months of surgery, due to pulmonary hypertension (1 following two-stage and 1 following single-stage thoracic expansion). At the median follow-up of 11 months (1-15), 3 children have been discharged home from their referring unit and 2 have significantly reduced respiratory support. One child remains on non-invasive ventilation and another is still ventilated with a high oxygen requirement. Jeune syndrome is a difficult condition to manage, but bilateral thoracic expansion offers an effective reduction in ventilator requirements in these children

  2. October 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-10-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on 10/24/2012 at Scottsdale Shea beginning at 6:30 PM. There were 23 in attendance representing the pulmonary, critical care, sleep, infectious disease, pathology, and radiology communities. An announcement was made that the Colorado Thoracic Society has accepted an invitation to partner with the Arizona and New Mexico Thoracic Societies in the Southwest Journal of Pulmonary and Critical Care Medicine. Discussions continue to be held regarding a combined Arizona Thoracic Society meeting with Tucson either in Casa Grande or electronically. Six cases were presented: Dr. Tim Kuberski, chief of Infectious Disease at Maricopa Medical Center, presented a 48 year old female who had been ill for 2 weeks. A CT of the chest revealed a left lower lobe nodule and a CT of the abdomen showed hydronephrosis and a pelvic mass. Carcinoembryonic antigen (CEA was elevated. All turned out to be coccidioidomycosis on biopsy. CEA decreased …

  3. MRI in Thoracic Tuberculosis of Children.

    Science.gov (United States)

    Sodhi, Kushaljit Singh; Sharma, Madhurima; Saxena, Akshay Kumar; Mathew, Joseph L; Singh, Meenu; Khandelwal, Niranjan

    2017-09-01

    To explore the utility of lung magnetic resonance imaging (MRI) in children with thoracic tuberculosis (TB). This prospective study of forty children (age range of 5 to 15 y) with thoracic TB was approved by the institutional ethics committee. Chest radiograph, lung MRI and computed tomography (CT) scan were performed in all children. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of MRI were calculated and kappa test of agreement was used to determine the strength of agreement between the MRI and CT findings. MRI performed equivalent to CT scan in detection of mediastinal and hilar lymphadenopathy, pleural effusion and lung cavitation (considered typical for TB) with sensitivity and specificity of 100%. MRI also yielded a sensitivity of 88.2% and specificity of 95.7% for nodules, with sensitivity of 100% and specificity of 92.9% for consolidation. Kappa agreement between CT and MRI in detection of each finding was almost perfect (k: 0.8-1). Although CT scan is still superior to MRI in detection of smaller nodules, MRI demonstrates a very high degree of correlation and agreement with CT scan for detecting lung and mediastinal pathology related to TB, in children with thoracic TB and can be particularly useful in select population and follow-up of these children to avoid repeated radiation exposures.

  4. Surgical outcome of video-assisted thoracic surgery for acute thoracic empyema using pulsed lavage irrigation.

    Science.gov (United States)

    Nakamura, Hiroshige; Taniguchi, Yuji; Miwa, Ken; Adachi, Yoshin; Fujioka, Shinji; Haruki, Tomohiro

    2010-03-01

    The essential points of video-assisted thoracic surgery (VATS) for acute thoracic empyema are the decortication of thickened pleura, resection of necrotic tissues and fibrin blocks, and drainage. Pulsed lavage irrigation, which is commonly used in orthopedic surgery as a method of sufficiently performing the technique, was used under a thoracoscope to study the efficacy of the treatment for acute thoracic empyema. The subjects comprised 31 patients who had undergone VATS for acute thoracic empyema. There were 26 men and 5 women with an average age of 60.5 years. For the surgical technique, the thickened pus-producing pleura were decorticated under a thoracoscope. The pulsed lavage irrigation system was used after the intrathoracic space had become a single cavity. Using the tip for an intraspinal space, lavage and suctioning were repeated with 5-10 l of a pressurized warm saline solution. Fibrin blocks and necrotic tissues were easily removed by spray washing with pressurized fluid. The operating time was 150.8 min; the amount of bleeding, including suctioned pleural effusion, was 478.5 g; and the postoperative duration of drainage was 10.7 days. During the postoperative course, the addition of open window thoracotomy due to the relapse of empyema due to methicillin-resistant Staphylococcus aureus was observed in only one patient (3.2%). All of the other patients improved despite their concomitant diseases. The use of pulsed lavage irrigation under a thoracoscope for acute thoracic empyema provides simple, efficient débridement or drainage.

  5. Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

    Science.gov (United States)

    Nie, Hong-Fei; Liu, Kai-Xuan

    2013-01-01

    Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery. PMID:24455232

  6. Plague Symptoms

    Science.gov (United States)

    ... Healthcare Professionals Clinicians Public Health Officials Veterinarians Prevention History of Plague Resources FAQ Symptoms Recommend on Facebook Tweet Share Compartir Plague symptoms depend on how ...

  7. Thoracic epidural analgesia reduces gastric microcirculation in the pig

    DEFF Research Database (Denmark)

    Ambrus, Rikard; Strandby, Rune B; Secher, Niels H.

    2016-01-01

    BACKGROUND: Thoracic epidural analgesia (TEA) is used for pain relief during and after abdominal surgery, but the effect of TEA on the splanchnic microcirculation remains debated. We evaluated whether TEA affects splanchnic microcirculation in the pig. METHODS: Splanchnic microcirculation...... was assessed in nine pigs prior to and 15 and 30 min after induction of TEA. Regional blood flow was assessed by neutron activated microspheres and changes in microcirculation by laser speckle contrast imaging (LSCI). RESULTS: As assessed by LSCI 15 min following TEA, gastric arteriolar flow decreased by 22...... regional blood flow 30 min following induction of TEA (p = 0.048). These manifestations took place along with a drop in systolic blood pressure (p = 0.030), but with no significant change in mean arterial pressure, cardiac output, or heart rate. CONCLUSION: The results indicate that TEA may have an adverse...

  8. The use of nonthrust manipulation in an adolescent for the treatment of thoracic pain and rib dysfunction: a case report.

    Science.gov (United States)

    Kelley, Jason L; Whitney, Susan L

    2006-11-01

    Case report. Back pain is a common presentation of patients in the orthopedic physical therapy setting. In an athletic environment, back pain can limit an athlete's ability to perform running, cutting, and throwing. This case report describes the use of a spinal nonthrust manipulation in conjunction with therapeutic exercise for the management of thoracic and rib pain in an adolescent athlete. A 16-year-old male presented to the outpatient clinic without physician referral. His chief complaint was right-sided thoracic and rib pain during running, jumping, cutting, and kicking that began 1 month before the initial physical therapy visit. He had no previous episodes of pain or associated injuries. A screening examination for serious underlying pathology was negative. After physical examination, it was determined that manual therapy was indicated. A thoracic nonthrust manipulation was applied to the painful area (the right-side thoracic facet joints of segments 5-7). Immediately after the thoracic nonthrust manipulation, the patient experienced a decrease in tenderness to palpation of the thoracic erector spinae musculature and the associated intercostal spaces of ribs 6 through 8 (a decrease of 1-2 points on the pain scale), an increase in thoracic side-bending active range of motion recorded at T3 and T9, and improved chest expansion, which had been limited by pain before treatment. This case report demonstrates the use of a spinal nonthrust manipulation that seems to have helped an adolescent return to pain-free sports activity, with an immediate decrease in pain after 1 visit. Follow-up telephone calls were made 1 month and 9 months after treatment, in which no return of symptoms was reported.

  9. Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component

    Directory of Open Access Journals (Sweden)

    Hidayet Sari

    2016-12-01

    Full Text Available There were only a few cases describing spontaneous regression of calcified thoracic disc herniation in the literature. We present a 38-year-old male office worker who had left paramedian-foraminal extruded disc at T7–T8 with calcifications of the T7–T8 and T8–T9 intervertebral discs. This case was unique in that the non-calcified extruded disc material regressed almost completely in 5 months while the calcified intervertebral discs remained the same during the process of regression. This report stresses that regression of the herniated material of the thoracic discs with subsidence of the symptoms is still possible even if the disc material is calcified.

  10. Research Review: Changes in the prevalence and symptom severity of child post-traumatic stress disorder in the year following trauma - a meta-analytic study.

    Science.gov (United States)

    Hiller, Rachel M; Meiser-Stedman, Richard; Fearon, Pasco; Lobo, Sarah; McKinnon, Anna; Fraser, Abigail; Halligan, Sarah L

    2016-08-01

    Understanding the natural course of child and adolescent posttraumatic stress disorder (PTSD) has significant implications for the identification of, and intervention for, at-risk youth. We used a meta-analytic approach to examine longitudinal changes in youth PTSD prevalence and symptoms over the first 12 months posttrauma. We conducted a systematic review to identify longitudinal studies of PTSD in young people (5-18 years old), excluding treatment trials. The search yielded 27 peer-reviewed studies and one unpublished dataset for analysis of pooled prevalence estimates, relative prevalence reduction and standardised mean symptom change. Key moderators were also explored, including age, proportion of boys in the sample, initial prevalence of PTSD and PTSD measurement type. Analyses demonstrated moderate declines in PTSD prevalence and symptom severity over the first 3-6 months posttrauma. From 1 to 6 months posttrauma, the prevalence of PTSD reduced by approximately 50%. Symptoms also showed moderate decline, particularly across the first 3 months posttrauma. There was little evidence of further change in prevalence or symptom severity after 6 months, suggesting that it is unlikely a child would lose a PTSD diagnosis without intervention beyond this point. The current findings provide key information about the likelihood of posttrauma recovery in the absence of intervention and have important implications for our understanding of child and adolescent PTSD. Results are discussed with reference to the timing of PTSD screening and the potential role of early interventions. Findings particularly highlight the importance of future research to develop our understanding of what factors prevent the action of normal recovery from the 'acute' posttrauma period. © 2016 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

  11. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    Energy Technology Data Exchange (ETDEWEB)

    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  12. Thoracic endovascular aortic repair and off-pump coronary artery bypass grafting after renal transplantation: a case report.

    Science.gov (United States)

    Yanase, Yohsuke; Muraki, Satoshi; Koyanagi, Tetsuya; Watanabe, Noriyasu; Kurimoto, Yoshihiko

    2011-01-01

    Twelve years after receiving a renal transplant, a 50-year-old woman developed asthmatic symptoms. Chest CT revealed a descending thoracic aortic aneurysm. She had undergone percutaneous coronary intervention to treat the left anterior descending artery 10 years earlier. Coronary artery angiography revealed restenosis of the left anterior descending artery (99%, #6 in-stent). Because cardiopulmonary bypass may cause problems for transplanted kidney, we performed off-pump coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery) and thoracic endovascular graft placement to treat the aortic aneurysm. Considering that the artery of the transplanted kidney was attached to the right iliac artery, and then the left common femoral artery was selected as the access root for GORE TAG(®) endografts (34 × 200 and 34 × 150 mm) (stentgrafts were deployed for the descending aortic artery). Postoperative angiography showed a patent bypass graft. Postoperative CT confirmed the absence of endoleaks. The postoperative course was uneventful, and she was discharged without complications. Ischemic heart disease and descending thoracic aortic aneurysm in recipients of kidney transplants can be treated using off-pump coronary bypass grafting and thoracic endovascular graft placement. The transplanted kidney was protected without using cardiopulmonary bypass (CPB).

  13. Change in blood levels of eicosapentaenoic acid and posttraumatic stress symptom: A secondary analysis of data from a placebo-controlled trial of omega3 supplements.

    Science.gov (United States)

    Matsuoka, Yutaka J; Hamazaki, Kei; Nishi, Daisuke; Hamazaki, Tomohito

    2016-11-15

    Eicosapentaenoic acid (EPA) is suggested to be protective against posttraumatic stress disorder (PTSD) from two observational studies. We previously conducted a randomized controlled trial and found no effect of docosahexaenoic acid (DHA) for prevention of PTSD. This secondary analysis aimed to determine whether change in blood levels of EPA is associated with PTSD symptoms. The percentages of EPA, DHA, and arachidonic acid (AA) were measured in erythrocyte membranes at baseline and posttreatment in 110 participants with severe physical injury who were randomly assigned to receive either a daily dose of 1,470mg DHA and 147mg EPA or of placebo for 12 weeks. Associations between change in erythrocyte fatty acid levels during the trial controlling for each baseline level and PTSD severity at 12 weeks were analyzed by treatment arm. In the omega3 supplements arm, changes in EPA+DHA (p=.023) and EPA (p=.001) as well as the EPA:AA ratio (p=.000) and EPA: DHA ratio (p=.013) were inversely correlated with PTSD severity. Change in AA was positively correlated with PTSD severity (p=.001). This trial was conducted at a single-center in Japan and PTSD symptoms in most participants were not serious. Increased erythrocyte level of EPA during the trial was associated with low severity of PTSD symptoms in patients receiving omega3 supplements. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Changes in psychological resources moderate the effect of socioeconomic status on distress symptoms: a 10-year follow-up among young adults.

    Science.gov (United States)

    Kiviruusu, Olli; Huurre, Taina; Haukkala, Ari; Aro, Hillevi

    2013-06-01

    This study examined the impact of socioeconomic status (SES) on changes in psychological resources and whether these changes in turn moderate the effect of SES on distress symptoms in a prospective 10-year follow-up among young adults. Subjects (N = 1239) were participants in two phases (1989, 22 years; 1999, 32 years) of a Finnish cohort study. The measurements were SES (basic education at 22 years, occupation at 32 years), distress symptoms (index of 17 somatic and mental complaints), and psychological resources (self-esteem, meaningfulness, locus of control). The results showed that lower SES is associated with poorer psychological resources both concurrently and prospectively. Lower SES at age 22 also predicted slower resource development, but only among females. In prospective analyses among both genders, changes in psychological resources moderated the effect of SES on distress symptoms: for those with losses in psychological resources, lower SES was associated with greater increases in distress between 22 and 32 years of age, whereas for those with stable or increasing resources, no effects of SES on distress were found. The results indicate that higher SES is associated with more favorable changes in psychological resources. In a longitudinal setting, SES differences in health seem to increase only when psychological resources decrease during the same period. The results emphasize the importance of dynamic conceptualizations of psychological resources in SES-health research. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  15. Change in health-related quality of life over 1 month in cancer patients with high initial levels of symptoms and problems.

    Science.gov (United States)

    Lund Rasmussen, Charlotte; Johnsen, Anna Thit; Petersen, Morten Aagaard; Groenvold, Mogens

    2016-10-01

    To investigate the mean changes over time in health-related quality of life among advanced cancer patients who did not receive any intervention, comparing changes among all patients versus changes in subgroups of patients with high initial symptom scores. Patients with advanced cancer answered two questionnaires, containing the EORTC QLQ-C30 (15 multi- or single-item scales), with approximately 1 month in between and received no known intervention in between. For each QLQ-C30 scale, we estimated the mean change among all patients and in subgroups of patients scoring at least 33, 50, and 66 %, respectively, of maximum (maximal symptom score or maximally reduced function score) in the first questionnaire. In total, 1014 patients completed both questionnaires. As hypothesized, we found no change over time in mean scores when including all patients [average mean change = -0.9 (95 % CI -1.5;-0.6)]. In the subgroups of patients initially scoring at least 33, 50, or 66 % of maximum, the score improved with mean changes of -9.2 (95 % CI -10.1;-8.4), -13.1 (95 % CI -14.4;-11.8), and -15.6 (95 % CI -17.2;-13.9), respectively. We quantified the magnitude of change over a 1-month period in health-related quality of life in advanced cancer patients, and in subgroups selected according to certain initial symptom levels. This information may help the interpretation of longitudinal studies of patients selected via screening.

  16. Developmental Associations between Adolescent Change in Depressive Symptoms and Menstrual-Cycle-Phase-Specific Negative Affect during Early Adulthood

    Science.gov (United States)

    Kiesner, Jeff; Poulin, Francois

    2012-01-01

    The causal factors associated with increases in depressive symptoms among adolescent girls remain an area of theoretical debate, and the limited research considering a hormonal influence has provided mixed results. The goal of the present study was to test a set of longitudinal associations, that, if found, would provide support for a hormonal…

  17. DSM-5 Changes and the Prevalence of Parent-Reported Autism Spectrum Symptoms in Fragile X Syndrome

    Science.gov (United States)

    Wheeler, Anne C.; Mussey, Joanna; Villagomez, Adrienne; Bishop, Ellen; Raspa, Melissa; Edwards, Anne; Bodfish, James; Bann, Carla; Bailey, Donald B.

    2015-01-01

    We used survey methodology to assess parent-reported autism symptomology in 758 individuals (639 males; 119 females) with fragile X syndrome (FXS). Caregivers reported whether their child with FXS had been diagnosed with an autism spectrum disorder (ASD) and endorsed symptoms based on a list of observable behaviors related to ASD diagnoses.…

  18. Time-Series Analysis of Daily Changes in Mindfulness, Repetitive Thinking, and Depressive Symptoms During Mindfulness-Based Treatment

    NARCIS (Netherlands)

    Snippe, Evelien; Bos, Elisabeth H.; van der Ploeg, Karen M.; Sanderman, Robbert; Fleer, Joke; Schroevers, Maya J.

    2015-01-01

    Mindfulness and ruminative thinking have been shown to mediate the effects of mindfulness-based treatments on depressive symptoms. Yet, the dynamic interplay between these variables in daily life during mindfulness-based treatment has received little attention. The present study focuses on the

  19. Change in Autism Symptoms and Maladaptive Behaviors in Adolescence and Adulthood: The Role of Positive Family Processes

    Science.gov (United States)

    Woodman, Ashley C.; Smith, Leann E.; Greenberg, Jan S.; Mailick, Marsha R.

    2015-01-01

    Little is known about outcomes for individuals with autism spectrum disorders (ASD) into adulthood. Several characteristics of individuals with ASD predict long-term outcomes, and the family environment may also play a role. The present study uses a prospective, longitudinal design to describe and predict trajectories of autism symptoms and…

  20. A Case of The Reduction of Symptoms, But No Change on The CT Scanning in HNP by Oriental Medical Treatment Added Mori cortex-Bee Venom Acupuncture

    Directory of Open Access Journals (Sweden)

    Lee, Byung-Hoon

    2001-06-01

    Full Text Available By process of treatment for a case which diagnosed as HNP of left posterolateral aspect of L4/5 disc and treated from the 10th, May 2001 to the 23rd, Jun 2001, the results are as follows. Method & Results : This patient was medicated Hwallaktang-gami, taken acupuncture, phototherapy, TENS, electric acupuncture, exercises, Mori Cortex-bee venom acupuncture. As a result, the patient's clinical symptom were improved but a computed tomagraphy confirmed L4/5 and L5/S1 HNP was not changed as seen on repeated CT scanning. Conclusion : These results suggest that among conservative therapies the oriental medical treatments including Mori Cortex-bee venom acupuncture improve clinical symptom effectively. But in this case, the structure of herniated disc was not changed.

  1. An evaluation of two types of exercise classes, containing shoulder exercises or a combination of shoulder and thoracic exercises, for the treatment of nonspecific shoulder pain: A case series.

    Science.gov (United States)

    Barrett, Eva; Conroy, Carmela; Corcoran, Marie; Sullivan, Kieran O'; Purtill, Helen; Lewis, Jeremy; McCreesh, Karen

    2017-12-04

    A case series was carried out. There is a lack of evidence exploring the effectiveness of group exercise classes for people with nonspecific shoulder pain (NSSP). Also, there is a lack of research that measures potential reductions in thoracic kyphosis after exercise interventions in people with NSSP. To observe changes in shoulder pain, disability, and thoracic kyphosis in 2 groups of people with NSSP, after 2 different types of group exercise classes. People with NSSP received a 6-week block of exercises classes containing either shoulder exercises alone (shoulder group, n = 20) or a mixture of shoulder and thoracic extension exercises (thoracic group, n = 19). The Disabilities of the Arm, Shoulder and Hand questionnaire for disability and the Numeric Rating Scale for pain were measured at baseline, 6 weeks, and 6 months. Thoracic kyphosis was measured at baseline and 6 weeks using the manual inclinometer. Significant and clinically meaningful improvements in Numeric Rating Scale and Disabilities of the Arm, Shoulder and Hand were demonstrated in both groups at 6-week and 6-month follow-up (P shoulder group and 0.85-1.88 in the thoracic group. Thoracic kyphosis did not change beyond measurement error in either group. Group exercise classes can improve shoulder pain and disability in people with NSSP. Resting thoracic kyphosis did not change after either exercise intervention, which suggests that the treatment effect was not due to a change in static thoracic spine posture. Copyright © 2017 Hanley & Belfus. All rights reserved.

  2. Clinical presentation and management of arterial thoracic outlet syndrome.

    Science.gov (United States)

    Vemuri, Chandu; McLaughlin, Lauren N; Abuirqeba, Ahmmad A; Thompson, Robert W

    2017-05-01

    Arterial thoracic outlet syndrome (TOS) is a rare condition characterized by subclavian artery pathology associated with a bony abnormality. This study assessed contemporary clinical management of arterial TOS at a high-volume referral center. A prospectively maintained database was used to conduct a retrospective review of patients undergoing primary or reoperative treatment for arterial TOS during an 8-year period (2008 to 2016). Presenting characteristics, operative findings, and clinical and functional outcomes were evaluated. Forty patients underwent surgical treatment for arterial TOS, representing 3% of 1401 patients undergoing operations for all forms of TOS during the same interval. Patients were a mean age of 40.3 ± 2.2 years (range, 13-68 years), and 72% were women. More than half presented with upper extremity ischemia/emboli (n = 21) or posterior stroke (n = 2), including eight that had required urgent brachial artery thromboembolectomy. The presentation in 17 (42%) was nonvascular, with 11 having symptoms of neurogenic TOS and six having an asymptomatic neck mass or incidentally discovered subclavian artery dilatation. All patients underwent thoracic outlet decompression (25 supraclavicular, 15 paraclavicular), of which there were 30 (75%) with a cervical rib (24 complete, 6 partial), 5 with a first rib abnormality, 4 with a clavicle fracture, and 1 (reoperation) with no remaining bone abnormality. Subclavian artery reconstruction was performed in 70% (26 bypass grafts, 1 patch, 1 suture repair), and 30% had mild subclavian artery dilatation (<100%) requiring no arterial reconstruction. Mean postoperative length of stay was 5.4 ± 0.6 days. During a mean follow-up of 4.5 ± 0.4 years (range, 0.9-8.1 years), subclavian artery patency was 92%, none had further dilatation or embolism, and chronic symptoms were present in six (4 postischemic/vasospasm, 2 neurogenic). Functional outcomes measured by scores on the 11-item version of the

  3. Self-compassion influences PTSD symptoms in the process of change in trauma-focused cognitive-behavioral therapies: A study of within-person processes

    Directory of Open Access Journals (Sweden)

    Asle eHoffart

    2015-08-01

    Full Text Available AbstractAlthough self-compassion is considered a promising change agent in the treatment of PTSD, no studies of this hypothesis exist. This study examined the within-person relationship of self-compassion components (self-kindness, common humanity, mindfulness, self-judgment, isolation, over-identification and subsequent PTSD symptoms over the course of therapy. Method: PTSD patients (n = 65 were randomized to either standard prolonged exposure, which includes imaginal exposure (IE to the traumatic memory, or modified prolonged exposure, where imagery re-scripting (IR of the memory replaced IE as the imagery component of prolonged exposure in a 10 week residential program. They were assessed weekly on self-compassion and PTSD symptom measures. The centering method of detrending was used to separate the variance related to the within-person process of change over the course of treatment from between-person variance. Results: The self-compassion components self-kindness, self-judgment, isolation, and over-identification had a within-person effect on subsequent PTSD symptoms. These relationships were independent of therapy form. The within-person relationship between self-judgment and subsequent PTSD symptoms was stronger in patients with higher initial self-judgment. By contrast, there were few indications that within-person variations in PTSD symptoms predict subsequent self-compassion components. Conclusion: The results support the role of self-compassion components in maintaining PTSD and imply the recommendation to facilitate decrease of self-judgment, isolation, and over-identification and increase of self-kindness in the treatment of PTSD patients. The reduction of self-judgment appears to be most important, especially for patients with a high initial level of self-judgment.

  4. Change in self-stigma among persons with schizophrenia enrolled in rehabilitation: associations with self-esteem and positive and emotional discomfort symptoms.

    Science.gov (United States)

    Lysaker, Paul H; Roe, David; Ringer, Jamie; Gilmore, Emily M; Yanos, Philip T

    2012-08-01

    Self-stigma is a barrier to the recovery of persons with schizophrenia. Little is known about whether participation in rehabilitation is naturalistically linked to declines in self-stigma, and if so, what is correlated with changes in self-stigma. The current study examined in a quasi-experimental design the rate of change of self-stigma and whether changes were correlated with self-esteem, positive symptoms, and emotional distress for persons enrolled in rehabilitation. Symptoms were measured using the Positive and Negative Syndrome Scale (Kay, Fizsbein, & Opler, 1987), self-esteem was measured with the Multidimensional Self-Esteem Inventory (Lysaker, Ringer, & Davis, 2008), and self-stigma was assessed using the Internalized Stigma of Mental Illness Scale (Ritsher, Otilingam, & Grajales, 2003). Seventy persons with schizophrenia who worked at least one month in a vocational rehabilitation program were assessed on all measures at baseline and five months later. Results indicated a 25% decrease in self-stigma for 38% of the sample; these individuals tended to have less emotional distress both at baseline and follow-up, and had higher levels of self-esteem at follow-up. No differences in positive symptoms were found for groups whose stigma did or did not decrease. Results suggest that decreases in self-stigma may be correlated with increased self-esteem, while higher levels of emotional distress may be a barrier to stigma reduction. (c) 2012 APA, all rights reserved.

  5. Official American Thoracic Society technical standards: spirometry in the occupational setting.

    Science.gov (United States)

    Redlich, Carrie A; Tarlo, Susan M; Hankinson, John L; Townsend, Mary C; Eschenbacher, William L; Von Essen, Susanna G; Sigsgaard, Torben; Weissman, David N

    2014-04-15

    This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.

  6. Symptom distress in older adults following cancer surgery.

    Science.gov (United States)

    Van Cleave, Janet H; Egleston, Brian L; Ercolano, Elizabeth; McCorkle, Ruth

    2013-01-01

    Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05). Age, type of cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.

  7. Outcome of Trans-Axillary Approach for Surgical Decompression of Thoracic Outlet: A Retrospective Study in a Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Mohd Riyaz Lattoo

    2014-05-01

    Full Text Available Objective: The aim of this study was to evaluate the trans-axillary surgical approach in patients with thoracic outlet syndrome. Methods: This retrospective study is comprised of data acquired from January 1998 until Oct 2008. Case histories of all the patients were reviewed from the Medical Records Department of Sher-i-Kashmir Institute. Relevant information and follow-up of the patients was carried out by examining the relevant clinical notes available by telephone interviews and personal contact whenever possible. All data was compiled and analyzed statistically. Results: There were a total of 139 patients. The female: male ratio was about 6:1. Pain was the most common presenting symptom followed by weakness and parasthesia. Nerve conduction velocity was abnormal in 111 patients. Twenty-eight patients had abnormal Doppler study of subclavian vessels. Preoperative symptoms persisted in 13 patients. Overall, 126 patients showed improvement in symptoms and no recurrence or persistence of symptoms on follow-up examination. Conclusion: Trans-axillary approach provides a good exposure and cosmesis in patients with thoracic outlet syndrome. It should be considered as the gold standard in the management of thoracic outlet syndrome.

  8. The Effect of Changes in Cannabis Exposure on Psychotic Symptoms in Patients With Comorbid Cannabis Use Disorder

    DEFF Research Database (Denmark)

    Toftdahl, Nanna Gilliam; Nordentoft, Merete; Hjorthøj, Carsten

    2016-01-01

    abstract: Objective: It remains unclear whether there is an association between severity of cannabis use and psychotic symptom severity over time. Shedding light on this under-researched matter could have clinical implications for this patient group. Methods: This was a secondary analysis...... of a randomized, parallel-group, superiority, assessor-blinded trial. We followed 60 patients with dually diagnosed psychosis and cannabis use disorders from the Danish CapOpus trial, which included assessments at baseline, post-treatment (6 months) and 10 months. Cannabis use was registered by self...... with severe and persistent cannabis use (severe use group) had significantly higher scores, as compared to those with minor use, on the positive symptom (17.0, 95% CI [4.7–19.2] vs. 12.7, 95% CI [10.4–15.0], respectively, adjusted p

  9. Surgery for paediatric thoracic outlet syndrome.

    Science.gov (United States)

    Teddy, P J; Johnson, R D; Cai, R R; Wallace, D

    2012-02-01

    The effectiveness of operative treatment of paediatric thoracic outlet syndrome (TOS) has been analysed, and an attempt made to improve the definition of the condition in terms of presentation, aetiology and diagnosis. A retrospective review of postoperative pain, functional capability and overall outcome was carried out on 13 patients (poor. Mean functional improvement was good, and overall operative outcomes excellent. Therefore, surgery was successful for paediatric TOS in this series. Anatomical anomalies and sport participation may be related to early onset of TOS in many paediatric patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Digital subtraction angiography of the thoracic aorta

    International Nuclear Information System (INIS)

    Grossman, L.B.; Buonocore, E.; Modic, M.T.; Meaney, T.F.

    1984-01-01

    Forty-three patients with acquired and congenital abnormalities of the thoracic aorta were studied using digital subtraction angiography (DSA) after an intravenous bolus injection of 40 ml of contrast material. Abnormalities studied included coarctation, pseudocoarctation, Marfan syndrome, cervical aorta, double aortic arch, aneurysm, dissection, and tumor. Twenty-four patients also had conventional angiography. DSA was accurate in 95% of cases; in the other 5%, involving patients with acute type I dissection, the coronary arteries could not be seen. The authors concluded that in 92% of their patients, DSA could have replaced the standard aortogram

  11. Digital subtraction angiography of the thoracic aorta

    Energy Technology Data Exchange (ETDEWEB)

    Grossman, L.B.; Buonocore, E.; Modic, M.T.; Meaney, T.F.

    1984-02-01

    Forty-three patients with acquired and congenital abnormalities of the thoracic aorta were studied using digital subtraction angiography (DSA) after an intravenous bolus injection of 40 ml of contrast material. Abnormalities studied included coarctation, pseudocoarctation, Marfan syndrome, cervical aorta, double aortic arch, aneurysm, dissection, and tumor. Twenty-four patients also had conventional angiography. DSA was accurate in 95% of cases; in the other 5%, involving patients with acute type I dissection, the coronary arteries could not be seen. The authors concluded that in 92% of their patients, DSA could have replaced the standard aortogram.

  12. Video-Assisted Thoracic Sympathectomy for Hyperhidrosis.

    Science.gov (United States)

    Milanez de Campos, Jose Ribas; Kauffman, Paulo; Gomes, Oswaldo; Wolosker, Nelson

    2016-08-01

    By the 1980s, endoscopy was in use by some groups in sympathetic denervation of the upper limbs with vascular indications. Low morbidity, cosmetic results, reduction in the incidence of Horner syndrome, and the shortened time in hospital made video-assisted thoracic sympathectomy (VATS) better accepted by those undergoing treatment for hyperhidrosis. Over the last 25 years, this surgical procedure has become routine in the treatment of hyperhidrosis, leading to a significant increase in the number of papers on the subject in the literature. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Integrated diagnostic imaging of primary thoracic rhabdomyosarcoma

    International Nuclear Information System (INIS)

    Almberger, M.; Iannicelli, E.; Matrunola, M.; Schiavetti, A.; Capocaccia, P.

    2001-01-01

    We report a rare case of primary thoracic rhabdomyosarcoma in a girl who was referred with acute chest pain, hacking cough, and wheezing. A chest X-ray revealed a complete opacity of the right hemithorax. Ultrasound revealed a right-sided pleural effusion and a solid mass above the liver dome, suggesting a neoplastic disease, which quickly led to further specific examination. Use of CT and MRI together with bone scintigraphy completed the investigation. The biopsy specimen showed a pattern of alveolar rhabdomyosarcoma. This case was reported to emphasize the role of US in the evaluation of a child with hemithorax opacity. (orig.)

  14. Multiple giant mid-thoracic esophageal diverticula in a teenager

    Directory of Open Access Journals (Sweden)

    Moo Cho

    2017-12-01

    Full Text Available Esophageal diverticula in the pediatric population are rare. The etiologies and presentations can vary widely which can make it difficult to diagnose without imaging or direct visualization. We are reporting a case of a 14-year-old male with history of asthma, anorexia, weight loss, and chest discomfort. CXR findings of mediastinal widening prompted a more extensive evaluation. He was found to have two esophageal diverticula, phlegmonous changes, and osteomyelitis of the T5 and T6 vertebra. He was initially treated with IV antibiotic therapy, bypassing the affected area with nasogastric enteric tube feedings, and a cervical thoracic orthosis brace for spine stability. He regained his lost weight and became asymptomatic, returning to a regular diet. The family has declined to pursue surgical intervention at present.

  15. Examining mechanisms of change in a yoga intervention for women: the influence of mindfulness, psychological flexibility, and emotion regulation on PTSD symptoms.

    Science.gov (United States)

    Dick, Alexandra M; Niles, Barbara L; Street, Amy E; DiMartino, Dawn M; Mitchell, Karen S

    2014-12-01

    This study explored possible mechanisms through which symptoms of posttraumatic stress disorder (PTSD) were reduced in a randomized controlled trial comparing the effect of a yoga intervention with an assessment control. We examined whether changes in psychological flexibility, mindfulness, and emotion regulation strategies (expressive suppression and reappraisal) were associated with posttreatment PTSD symptoms for 38 women with Diagnostic and Statistical Manual of Mental Disorders Fourth Edition full or subthreshold PTSD. Hierarchical linear regression models revealed that expressive suppression significantly decreased for the yoga group relative to the assessment control. Psychological flexibility increased significantly for the control but not yoga group. However, increases in psychological flexibility were associated with decreases in PTSD symptoms for the yoga but not control group. Preliminary findings suggest that yoga may reduce expressive suppression and may improve PTSD symptoms by increasing psychological flexibility. More research is needed to replicate and extend these findings. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  16. Asthma Exacerbations and Symptom Variability in Children Due to Short-term Ambient Air Pollution Changes in Ostrava, Czech Republic

    Czech Academy of Sciences Publication Activity Database

    Velická, H.; Puklová, V.; Keder, J.; Brabec, Marek; Malý, Marek; Bobák, M.; Kotlík, B.; Jiřík, V.; Janout, V.; Kazmarová, H.

    2015-01-01

    Roč. 23, č. 4 (2015), s. 292-298 ISSN 1210-7778 Grant - others:GA MZd(CZ) NT14608 Institutional support: RVO:67985807 Keywords : asthma * air pollution * short-term exposure * respiratory symptoms * children Subject RIV: DN - Health Impact of the Environment Quality Impact factor: 0.525, year: 2015 http://apps.szu.cz/svi/cejph/show.php?kat=archiv/2015-4-03

  17. The Effect of Changes in Cannabis Exposure on Psychotic Symptoms in Patients With Comorbid Cannabis Use Disorder.

    Science.gov (United States)

    Toftdahl, Nanna Gilliam; Nordentoft, Merete; Hjorthøj, Carsten

    2016-01-01

    It remains unclear whether there is an association between severity of cannabis use and psychotic symptom severity over time. Shedding light on this under-researched matter could have clinical implications for this patient group. This was a secondary analysis of a randomized, parallel-group, superiority, assessor-blinded trial. We followed 60 patients with dually diagnosed psychosis and cannabis use disorders from the Danish CapOpus trial, which included assessments at baseline, post-treatment (6 months) and 10 months. Cannabis use was registered by self-report assisted by timeline follow-back. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) positive, negative, and general symptoms scores. Analyses were adjusted for potential confounders. Patients were classified into four categories: minor use (0-30 joints at baseline and 0-9 joints at follow-up; n = 19), moderate use (0-30 joints at baseline and 10-196 joints at follow-up; n = 11), high (reducing) use (31-240 joints at baseline and 0-9 joints at follow-up; n = 9), and severe use (31-240 joints at baseline and 10-196 joints at follow-up; n = 21). Those with severe and persistent cannabis use (severe use group) had significantly higher scores, as compared to those with minor use, on the positive symptom (17.0, 95% CI [4.7-19.2] vs. 12.7, 95% CI [10.4-15.0], respectively, adjusted p cannabis use and psychosis. Treatment of psychosis and comorbid cannabis use disorder could in the future incorporate treatment strategies emphasising encouragement to reduce cannabis use. CapOpus is registered at clinicaltrials.gov (NCT00484302).

  18. Changes in Allergy Symptoms and Depression Scores Are Positively Correlated In Patients With Recurrent Mood Disorders Exposed to Seasonal Peaks in Aeroallergens

    Directory of Open Access Journals (Sweden)

    Teodor T. Postolache

    2007-01-01

    Full Text Available Although growing evidence supports an association between allergy, allergens and depression, it remains unknown if this relationship is between “states” (possible triggers or “traits” (possible vulnerabilities. We hypothesized that patients with recurrent mood disorders who are sensitized to tree pollen (as determined by allergen specific IgE antibodies, in comparison to those who are not sensitized, would report larger negative changes in mood during exposure to tree pollen in spring. We also hypothesized that differences between high and low tree pollen periods in self reported allergy symptoms would correlate positively with differences in self reported depression scores. We present 1-year preliminary data on the first 51 patients with unipolar or bipolar disorder (age: 19-63 years, 65% female, twelve patients were tree-pollen IgE positive. Ratings of mood and allergic disease status were performed once during the peak airborne pollen counts and once during the period of low airborne pollen counts, as reported by two local pollen counting stations. Linear regression models were developed to examine associations of changes in depression scores (dependent variable with tree pollen sensitization, changes in the allergy symptom severity score, adjusted for gender and order of testing. We did not confirm the hypothesized relationship between a specific tree pollen sensitization and changes in mood during tree pollen exposure. We did confirm the hypothesized positive relationship between the changes in allergy symptoms and changes in subjects' depression scores (adjusted p<0.05. This result is consistent with previous epidemiological evidence connecting allergy with depression, as well as our recent reports of increased expression of cytokines in the prefrontal cortex in victims of suicide and in experimental animals sensitized and exposed to tree pollen. A relationship between changes in allergy symptom scores and changes in depression

  19. Delayed chronic intracranial subdural hematoma complicating resection of a tanycytic thoracic ependymoma.

    Science.gov (United States)

    Maugeri, Rosario; Giugno, Antonella; Graziano, Francesca; Visocchi, Massimiliano; Giller, Cole; Iacopino, Domenico Gerardo

    2016-01-01

    To demonstrate that the diagnosis of an intracranial subdural hematoma should be considered for patients presenting with acute or delayed symptoms of intracranial pathology following resection of a spinal tumor. We present a case of a 57-year-old woman found to have a chronic subdural hematoma 1 month following resection of a thoracic extramedullary ependymoma. Evacuation of the hematoma through a burr hole relieved the presenting symptoms and signs. Resolution of the hematoma was confirmed with a computed tomography (CT) scan. Headache and other symptoms not referable to spinal pathology should be regarded as a warning sign of an intracranial subdural hematoma, and a CT scan of the head should be obtained. The mechanism of the development of the hematoma may be related to the leakage of cerebrospinal fluid with subsequent intracranial hypotension leading to an expanding subdural space and hemorrhage.

  20. The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients.

    Science.gov (United States)

    Yang, Seong-Rae; Kim, Kyung; Park, Sun-Ja; Kim, Kyung

    2015-12-01

    [Purpose] To investigate whether thoracic spine mobilization added to stabilization exercises increases the muscular strength and range of motion of the thoracic vertebrae of chronic low-back pain patients. [Subjects] This study enrolled 20 patients with chronic low back pain, who were divided into two groups. Ten subjects were randomly selected for the stabilization exercise group and the remaining 10 subjects received thoracic spine mobilization in addition to performing the stabilization exercises. [Methods] The patients performed stabilization exercises and received thoracic spine mobilization for 12 weeks. The range of motion and isometric muscular strength of the vertebrae of all subjects were measured before and after the intervention. [Results] In the comparison of muscular strength before and after the intervention, the change in muscular strength of the trunk flexors in the stabilization exercise group was 16.0±7.4 Nm, and that of the thoracic spine mobilization group was 34.2±7.6 Nm, a significant difference in each group. In the post-intervention intergroup comparison, the muscular strength of trunk flexors in the stabilization exercise group was 111.1±16.9 Nm, while that of the thoracic spine mobilization group was 125.9±11.3 Nm, a significant difference. Also, the muscular strength of the trunk extensors in the stabilization exercise group was 148.9±31.8 Nm, while that of the thoracic spine mobilization group was 182.9±37.2 Nm, a significant difference. The thoracic spine flexion in the stabilization exercise group was 29.8±9 degrees, while that of the thoracic spine mobilization group was 38.7±6.9 degrees, a significant difference. However, there was no significant difference in lumbar flexion values between the two groups. [Conclusion] Thoracic spine mobilization added to a stabilization exercise increased the muscular strength of patients with chronic low back pain.

  1. The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis.

    Science.gov (United States)

    Azadinia, Fatemeh; Kamyab, Mojtaba; Behtash, Hamid; Maroufi, Nader; Larijani, Bagher

    2013-10-01

    Hyperkyphosis increases the risk of falls for elderly people by reducing postural balance. Spinomed orthosis and the posture-training support are two available options for improving postural balance but have never been compared. To compare the effect of the Spinomed orthosis and the posture-training support on balance in elderly people with thoracic hyperkyphosis. This study is a clinical trial on an accessible sample of elderly people with thoracic kyphosis. Eighteen participants (16 women and 2 men), aged 60-80 years, with thoracic kyphosis greater than 50°, completed the study procedure. Subjects were randomly allocated to two groups, namely, Spinomed orthosis and the posture-training support groups. Sensory organization test and limits of stability were assessed using the EquiTest system and the Balance Master system, respectively. Balance score, directional control, and reaction time were measured to evaluate balance with and without orthosis in a random order. In the posture-training support group, significant changes were observed in the studied balance parameters: balance score (p elderly with thoracic hyperkyphosis in a similar manner.

  2. Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series

    Directory of Open Access Journals (Sweden)

    Barad Meredith

    2009-09-01

    Full Text Available Abstract Currently, notalgia paresthetica (NP is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle stimulation (EMS of the serratus anterior can successfully and conservatively treat NP. In four cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible treatment, and we discuss the implications of these findings on better diagnosing and treating notalgia paresthetica.

  3. Clinical observation on thoracic paravertebral nerve block with ozone treatment in patients with postherpetic neuralgia

    Directory of Open Access Journals (Sweden)

    GUO Xiang-fei

    2013-10-01

    Full Text Available Objective To analyze the clinical efficacy of thoracic paravertebral nerve block with ozone in the treatment of postherpetic neuralgia. Methods Eighty-five patients suffered postherpetic neuralgia were divided into 4 groups: Group A (oral drugs + intramuscular injection of vitamin B12 + local nerve block of lesion area, Group B (oral drugs + intramuscular injection of compound trivitamin B + local nerve block of lesion area, Group C (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block + local nerve block of lesion area, Group D (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block with ozone + local nerve block of lesion area. Treatment outcomes were evaluated by Visual Analogue Scale (VAS, Quality of Sleep (QS, Self-Rating Depression Scale (SDS and C-reactive protein (CRP before treatment and 4 weeks after treatment. Results After treatment, VAS, QS and SDS scores of 4 groups were lower than that before treatment, and the differences were statistically significant (P 0.05, for all, while a significant change in CRP was observed in patients of group D between before and after treatment (P < 0.05. The improvement of VAS, QS and SDS scores of group D was significantly better than other 3 groups (P < 0.05, for all. Conclusion Thoracic paravertebral nerve block combined with ozone is a quick and effective method for postherpetic neuralgia patients.

  4. Functional reorganization of the forepaw cortical representation immediately after thoracic spinal cord hemisection in rats.

    Science.gov (United States)

    Yagüe, J G; Humanes-Valera, D; Aguilar, J; Foffani, G

    2014-07-01

    Spinal cord injury may produce long-term reorganization of cortical circuits. Little is known, however, about the early neurophysiological changes occurring immediately after injury. On the one hand, complete thoracic spinal cord transection of the spinal cord immediately decreases the level of cortical spontaneous activity and increases the cortical responses to stimuli delivered to the forepaw, above the level of the lesion. On the other hand, a thoracic spinal cord hemisection produces an immediate cortical hyperexcitability in response to preserved spinothalamic inputs from stimuli delivered to the hindpaw, below the level of the lesion. Here we show that a thoracic spinal cord hemisection also produces a bilateral increase of the responses evoked in the forepaw cortex by forepaw stimuli, associated with a bilateral decrease of cortical spontaneous activity. Importantly, the increased cortical forepaw responses are immediate in the cortex contralateral to the hemisection (significant within 30min after injury), but they are progressive in the cortex ipsilateral to the hemisection (reaching significance only 2.5h after injury). Conversely, the decreased cortical spontaneous activity is progressive both ipsilaterally and contralaterally to the hemisection (again reaching significance only 2.5h after injury). In synthesis, the present work reports a functional reorganization of the forepaw cortical representation immediately after thoracic spinal cord hemisection, which is likely important to fully understand the mechanisms underlying long-term cortical reorganization after incomplete spinal cord injuries. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Do changes in subjective sleep and biological rhythms predict worsening in postpartum depressive symptoms? A prospective study across the perinatal period.

    Science.gov (United States)

    Krawczak, Elizabeth M; Minuzzi, Luciano; Hidalgo, Maria Paz; Frey, Benicio N

    2016-08-01

    Abnormalities of sleep and biological rhythms have been widely implicated in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD). However, less is known about the influence of biological rhythm disruptions across the perinatal period on postpartum depression (PPD). The objective of this study was to prospectively evaluate the relationship between subjective changes in both sleep and biological rhythms and worsening of depressive symptoms from pregnancy to the postpartum period in women with and without mood disorders. Eighty-three participants (38 euthymic women with a history of a mood disorder and 45 healthy controls) were studied. Participants completed subjective assessments of sleep (Pittsburgh Sleep Quality Index), biological rhythm disturbances (Biological Rhythms Interview of Assessment in Neuropsychiatry), and depressive symptoms (Edinburgh Postnatal Depression Scale) prospectively at two time points: third trimester of pregnancy and at 6-12 weeks postpartum. Multivariate regression analyses showed that changes in biological rhythms across the perinatal period predicted worsening of depressive symptoms in both groups. Moreover, women with a history of a mood disorder showed higher levels of sleep and biological rhythm disruption during both pregnancy and the postpartum period. These findings suggest that disruptions in biological rhythms during the perinatal period increase the risk for postpartum mood worsening in healthy pregnant as well as in pregnant women with a history of mood disorders.

  6. Change in Motor and Nonmotor Symptoms Severity in a “Real-Life” Cohort of Subjects with Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Adib Jorge de Saráchaga

    2015-01-01

    Full Text Available Background. Parkinson’s disease (PD is a chronic and progressive disorder. Rates of change in motor symptoms have been more studied compared to nonmotor symptoms. The objective was to describe these changes in a real-life cohort of subjects with PD. Methods. A cohort study was carried out from 2011 to 2013. Consecutive patients with PD were recruited from a movement disorders clinic. MDS-UPDRS, PDQ-8, and NMSS were applied to all subjects at an initial evaluation and a subsequent visit (21±3 months. Disease severity was categorized using a recent classification of MDS-UPDRS severity. Results. The MDS-UPDRS Part III showed a significant decrease of 7.2±2.31 points (p=0.001 between evaluations. A mean increase of 0.9±0.6 points (p=0.015 in the MDS-UPDRS Part IV was observed. An increase of 14.3±11.4 points (p=0.043 in the NMSS total score was found; when assessed individually, the difference was statistically significant only for the perceptual problems/hallucinations item. Quality of life remained unchanged. Conclusion. Motor improvement was observed accompanied by an increase in motor complications possibly as a result of treatment optimization. Nonmotor symptoms worsened as a whole. The overall effect in the quality of life was negligible.

  7. January 2013 Arizona Thoracic Society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-01-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on Wednesday, 1/23/2013 at Scottsdale Shea beginning at 6:30 PM. There were 25 in attendance representing the pulmonary, critical care, sleep, infectious disease, thoracic surgery and radiology communities.Dr. George Parides presented a plaque to Al Thomas for being voted Arizona’s Clinician of the Year (Figure 1. Rick Robbins, editor of the Southwest Journal of Pulmonary and Critical Care, gave a PowerPoint slide presentation updating the membership on the Arizona Thoracic Society’s official journal. Five cases were presented:1. Tim Kuberski, chief of infectious disease at Maricopa Medical Center, presented a 29 year old diabetic who underwent a sinus operation for a sinus mass which proved to be a fungus ball. A biopsy was also done of the bone which showed osteomyelitis with cultures showing methicillin-sensitive Staphylococcus aureus. The patient received a 6 week course of daptomycin. Near the end of his daptomycin he began …

  8. CT findings of thoracic involvement of lymphoma

    International Nuclear Information System (INIS)

    Kim, Hee Jin; Choe, Kyu Ok; Cho, Hee Kyung

    1993-01-01

    Chest CT scans of 70 patients with malignant lymphoma were reviewed to evaluate the thoracic manifestation of malignant lymphoma. Sixteen patients had Hodgkin's disease and 54 patients had non-Hodgkin's lymphoma. The thoracic involvement of malignant lymphoma was observed i 47 patients (67.1%) and 11 of these patients had Hodgkin's disease, and 36 had non-Hodgkin's lymphoma. The most common finding was mediastinal lymphadenopathy and the most frequently involved sites were anterior mediastinal and paratracheal lymph nodes. Pulmonary parenchymal involvement was seen in 11 patients (15.7%), and CT scan showed thickening of bronchovascular bundle, parenchymal consolidation and nodules. Pleural effusion was seen in 18 patients (25.7%), however, without any evidence of parietal pleural thickening in all cases. Involvement of chest wall and breast was seen in two patient (2.9%). The data obtained through the current study showed no differences from those of previous reports, except the fact that there was no CT evidence of pleural thickening in patients who had pleural effusion

  9. Selective nonoperative management of penetrating thoracic injury.

    Science.gov (United States)

    Van Waes, Oscar J F; Halm, Jens A; Van Imhoff, Diederik I; Navsaria, Pradeep H; Nicol, Andrew J; Verhofstad, Michael H J; Vermeulen, Jefrey

    2018-02-01

    Thoracic penetrating injury is a cause for up to one-fifth of all non-natural deaths. The aim of this study was to determine the success of selective nonoperative management (SNOM) of patients presenting with a penetrating thoracic injury (PTI). This was a prospective study of patients with PTI who presented to a level 1 Trauma Center between April 2012 and August 2012. A total of 248 patients were included in the study, with 5.7% (n=14) requiring immediate emergency surgery. Overall, five of these 248 patients died, resulting in a mortality rate of 2.0%. Primarily 221 patients (89.1%) were managed with SNOM, of whom 15 (6.8%) failed conservative management. Failure of SNOM was primarily caused by complications of chest tube drainage (n=12) (e.g. retained clot, empyema) and delayed development of cardiac tamponade (n=3). The survival rate in the SNOM group was 100%. PTI has a low in-hospital mortality rate. Only 16.5% (41/248) of the patients presenting with PTI will need surgical treatment. The other patients are safe to be treated conservatively according to a protocolized SNOM approach for PTI without any additional mortality. Conservative treatment of patients who were selected for this nonoperative treatment strategy with repeated clinical reassessment was successful in 93.2%.

  10. September 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The September 2017 Arizona Thoracic Society meeting was held on Wednesday, September 27, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 16 in attendance representing the pulmonary, critical care, sleep, and radiology communities. There was a discussion of the Tobacco 21 bill which had been introduced the last session in the Arizona State Legislature. Since it seems likely that the bill will be reintroduced, the Arizona Thoracic Society will support the bill in the future. Dr. Rick Robbins announced that the SWJPCC has applied to be included in PubMed. In addition, Dr. Robbins was assigned the task of tracking down the campaign contributions to congressional members from the tobacco PAC before the next election. There were 7 case presentations: 1.\tAshley L. Garrett, MD, pulmonary fellow at Mayo, presented an elderly man with insulin-dependent diabetes who felt he …

  11. Changes over time in the relationship between symptoms of asthma, rhinoconjunctivitis and eczema: a global perspective from the International Study of Asthma and Allergies in Childhood (ISAAC).

    Science.gov (United States)

    Asher, M I; Stewart, A W; Wong, G; Strachan, D P; García-Marcos, L; Anderson, H R

    2012-01-01

    The International Study of Asthma and Allergies in Childhood (ISAAC) identified trends in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema over a seven-year period. We hypothesised that environmental influences on the three diseases are different and therefore investigated the correlation over time between trends in the prevalence of these diseases and their combinations at centre and individual level. Centre level analyses were correlations between time trends in the prevalence of symptoms. At an individual level, odds ratios were calculated for associations between symptoms between Phases One and Three. We also investigated potential effect modification in the younger versus older age group; male versus female; and by average Gross National Income per capita (GNI). Both phases were completed in 66 centres in 37 countries for the 6-7 year age group and in 106 centres in 56 countries for the 13-14 year age group. We found that the correlations in time trends were stronger for the older age group than the younger one. Between symptoms of diseases, correlations of time trends were the strongest for rhinoconjunctivitis with eczema and weakest for eczema with asthma. The relationship between the three diseases was generally consistent over the seven-year period, and there was little association found with average GNI. Despite some increase in the proportion of children with symptoms of asthma, rhinoconjunctivitis and eczema, the pattern between the three diseases has not changed much, suggesting that similar factors may be affecting them at a global level. Copyright © 2011 SEICAP. Published by Elsevier Espana. All rights reserved.

  12. Intrinsic response of thoracic propriospinal neurons to axotomy

    Directory of Open Access Journals (Sweden)

    Stelzner Dennis J

    2010-06-01

    Full Text Available Abstract Background Central nervous system axons lack a robust regenerative response following spinal cord injury (SCI and regeneration is usually abortive. Supraspinal pathways, which are the most commonly studied for their regenerative potential, demonstrate a limited regenerative ability. On the other hand, propriospinal (PS neurons, with axons intrinsic to the spinal cord, have shown a greater regenerative response than their supraspinal counterparts, but remain relatively understudied in regards to spinal cord injury. Results Utilizing laser microdissection, gene-microarray, qRT-PCR, and immunohistochemistry, we focused on the intrinsic post-axotomy response of specifically labelled thoracic propriospinal neurons at periods from 3-days to 1-month following T9 spinal cord injury. We found a strong and early (3-days post injury, p.i upregulation in the expression of genes involved in the immune/inflammatory response that returned towards normal by 1-week p.i. In addition, several regeneration associated and cell survival/neuroprotective genes were significantly up-regulated at the earliest p.i. period studied. Significant upregulation of several growth factor receptor genes (GFRa1, Ret, Lifr also occurred only during the initial period examined. The expression of a number of pro-apoptotic genes up-regulated at 3-days p.i. suggest that changes in gene expression after this period may have resulted from analyzing surviving TPS neurons after the cell death of the remainder of the axotomized TPS neuronal population. Conclusions Taken collectively these data demonstrate that thoracic propriospinal (TPS neurons mount a very dynamic response following low thoracic axotomy that includes a strong regenerative response, but also results in the cell death of many axotomized TPS neurons in the first week after spinal cord injury. These data also suggest that the immune/inflammatory response may have an important role in mediating the early strong

  13. Magnetic resonance imaging of the cervical and thoracic spine and the spinal cord

    International Nuclear Information System (INIS)

    Larsson, E.M.

    1989-01-01

    Magnetic resonance imaging (MR), using a 0.3 T resistive scanner with an iron core and a vertical magnetic field, was evaluated in patients with different diseases affecting the cervical and thoracic spine and the spinal cord. The results indicate that MR is well suited as the procedure of choice for emergency examination of patients with spinal cord symptoms, for examination of patients with suspected spinal multiple sclerosis and for pre-operative evaluation of patients with rheumatoid arthritis with neurological symptoms emanating from the cranio-cervical junction. In patients with cervical radiculapathy and/or myelopathy, caused by spondylosis or disk herniation, MR was found to be equivalent with myelography and CT myelography but MR has several practical advantages. MR at 0.3 T using a vertical magnetic field provided information comparable to that reported from examinations performed with superconducting MR scanners. In order to optimize the MR examinations of the spine, the signal characteristics of different coils available when using a vertical magnetic field were determined by phantom studies. Recommendations for optimal coil selection for different levels of the cervical and thoracic spine are given. In addition, the paramagnetic contrast medium gadolinium-DTPA was administered intravenously to patients with suspected spinal multiple sclerosis. Enhancement of clinically active lesions in the cervical spinal cord was observed. Serial MR examinations with gadolinium-DTPA showed that a decrease in enhancement could be correlated with decrease in clinical symptoms and signs. (author)

  14. Changes in ocular and nasal signs and symptoms among air crew in relation to air humidification on intercontinental flights.

    Science.gov (United States)

    Norbäck, Dan; Lindgren, Torsten; Wieslander, Gunilla

    2006-04-01

    This study evaluates the influence of air humidification in aircraft on symptoms, tear-film stability, nasal patency, and peak expiratory flow. Commercial air crew (N=71) were given a medical examination during eight flights from Stockholm to Chicago and eight flights in the opposite direction. Examinations were done onboard one Boeing 767 aircraft equipped with an evaporation humidifier in the forward part of the cabin. The investigators followed the air crew, staying one night in Chicago and returning with the same crew. Four of the flights had the air humidification device active in-flight to Chicago and deactivated when returning to Stockholm. The other four flights had the inverse humidification sequence. The humidification sequence was randomized and double blind. Hygienic measurements were performed. The humidification increased the relative air humidity by 10% in the 1st row in business class, by 3% in the last row (39th row) in tourist class, and by 3% in the cockpit. Air humidification increased tear-film stability and nasal patency and decreased ocular, nasal, and dermal symptoms and headache. The mean concentration of viable bacteria [77-108 colony-forming units (cfu)/m(3)], viable molds (74-84 cfu/m(3)), and particulate matter (1-8 microg/m(3)) was low, both during the humidified and non-humidified flights. Relative air humidity is low (10-12%) during intercontinental flights and can be increased by the use of a ceramic evaporation humidifier, without any measurable increase of microorganisms in cabin air. Air humidification could increase passenger and crew comfort by increasing tear-film stability and nasal patency and reducing various symptoms.

  15. Eye Symptoms

    Science.gov (United States)

    ... Prevention News Ask an Ophthalmologist Patient Stories Español Eye Symptoms This symptoms list is for general reference ... Y Z A-Z A B Blood in Eye Bloodshot Eye Blurriness Burning Eyes C Crusty Eyelid ...

  16. Early Alliance, Alliance Ruptures, and Symptom Change in a Nonrandomized Trial of Cognitive Therapy for Avoidant and Obsessive–Compulsive Personality Disorders

    Science.gov (United States)

    Strauss, Jennifer L.; Hayes, Adele M.; Johnson, Sheri L.; Newman, Cory F.; Brown, Gregory K.; Barber, Jacques P.; Laurenceau, Jean-Philippe; Beck, Aaron T.

    2011-01-01

    Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive–compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last session. Alliance variables were patients’ first alliance rating and “rupture-repair” episodes, which are disruptions in the therapeutic relationship that can provide corrective experiences and facilitate change. Stronger early alliances and rupture-repair episodes predicted more improvement in symptoms of personality disorder and depression. This work points to potentially important areas to target in treatment development for these personality disorders. PMID:16649878

  17. Thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis: a case report.

    Science.gov (United States)

    Takagi, Yasutaka; Yamada, Hiroshi; Ebara, Hidehumi; Hayashi, Hiroyuki; Iwanaga, Takeshi; Shimozaki, Kengo; Kitano, Yoshiyuki; Kagechika, Kenji; Tsuchiya, Hiroyuki

    2017-04-01

    Diffuse idiopathic skeletal hyperostosis has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Neurological complications are rare in diffuse idiopathic skeletal hyperostosis. However, if they do occur, the consequences are often significant enough to warrant major neurosurgical intervention. Neurological complications occur when the pathological process of ossification in diffuse idiopathic skeletal hyperostosis extends to other vertebral ligaments, causing ossification of the posterior longitudinal ligaments and/or ossification of the ligamentum flavum. Thoracic spondylolisthesis with spinal cord compression in diffuse idiopathic skeletal hyperostosis has not previously been reported in the literature. A 78-year-old Japanese man presented with a 6-month history of gait disturbance. A magnetic resonance imaging scan of his cervical and thoracic spine revealed anterior spondylolisthesis and severe cord compression at T3 to T4 and T10 to T11, as well as high signal intensity in a T2-weighted image at T10/11. Computed tomography revealed diffuse idiopathic skeletal hyperostosis at T4 to T10. He underwent partial laminectomy of T10 and posterior fusion of T9 to T12. The postoperative magnetic resonance imaging revealed resolution of the spinal cord compression and an improvement in the high signal intensity on the T2-weighted image. We report the first case of thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis. Neurosurgical intervention resulted in a significant improvement of our patient's neurological symptoms.

  18. Guan-Din method: a novel surgical technique for selective thoracic fusion to maximize the rate of selective thoracic fusion and compensatory correction.

    Science.gov (United States)

    Chang, Kao-Wha; Chen, Yin-Yu; Leng, Xiangyang; Wu, Chi-Ming; Chen, Tsung-Chein; Wang, Yu-Fei; Zhang, Guo-Zhi

    2014-02-15

    Retrospective radiographical review. To evaluate the outcome of selective thoracic fusion (STF) by using the Guan-Din method for the treatment of major thoracic compensatory lumbar (MTCL) curves. Performing STF for MTCL curves is to minimize the loss of lumbar motion and the risk of lumbar degeneration or pain. Surgical treatment of MTCL curves aims to maximize the rate of STF for MTCL curves while optimizing instrumental thoracic and compensatory lumbar correction. The Guan-Din method has been demonstrated to be able to enhance the lumbar curve's capacity for spontaneous correction and broaden the current curve criteria of MTCL curves for STF. Between 2004 and 2010, 510 consecutive surgically treated MTCL curves were reviewed. Of these MTCL curves, who met the criteria of lumbar side bending Cobb 35° or less and without global thoracic hyperkyphosis and/or thoracolumbar kyphosis (T10-L2 ≤20°), were treated with STF using the Guan-Din method. Radiographs were analyzed before surgery, immediately after surgery, and at the most recent follow-up (range, 2-8 yr). Curve types of 510 MTCL curves according to Lenke system were as follows: 1A (n = 91), 2A (n = 74), 3A (n = 6), 4A (n = 2), 1B (n = 93), 2B (n = 34), 3B (n = 8), 4B (n = 5), 1C (n = 84), 2C (n = 26), 3C (n = 72), and 4C (n = 15). Of the 510 MTCL curves, 458 (90%) curves were treated with STF. A mean 73% thoracic correction and 63% lumbar correction was obtained at the most recent follow-up. Of the 197 surgically treated MTCL curves with a lumbar C modifier, 148 (75%) curves that contained 57 Lenke 1C and 2C curves and 40 Lenke 3C and 4C curves that did not meet Lenke curve criteria for STF, were successfully treated with STF. A mean 67% thoracic correction and 57% lumbar correction was obtained at the most recent follow-up. The rate of STF and the magnitude of correction of MTCL curves in this study were significantly greater than those in all other reports. No significant change in global coronal and

  19. Successful treatment of familial congenital chylothorax by ligation of the thoracic duct: A case report

    Directory of Open Access Journals (Sweden)

    Leopoldini Dori

    2017-01-01

    Full Text Available A full term boy was admitted with respiratory distress in the fourth week of his life due to spontaneous chylothorax in his right hemithorax. Spontaneous chylothorax occurred previously in a first cousin of the neonate establishing that way the final diagnosis of familial idiopathic congenital pneumothorax. Failure of the conservative treatment consisting of chest tube drainage, discontinuation of oral diet and administration of total parenteral nutrition in combination with octreotide for one month was followed by the successful ligation of the thoracic duct through a right thoracotomy. The boy still remains free of symptoms and without recurrence of the chylothorax two years later.

  20. The American Thoracic Society’s Spirometric Criteria Alone is Inadequate in Asthma Diagnosis

    Directory of Open Access Journals (Sweden)

    John A Gjevre

    2006-01-01

    Full Text Available BACKGROUND: The diagnosis of asthma is based on clinical symptoms, physical examination and pulmonary function tests, and can be very challenging. Most patients with asthma have a significant postbronchodilator response on spirometry indicating airway hyperresponsiveness. However, having a significant bronchodilator response by itself is not diagnostic of asthma. The definition of a ‘significant’ response has also been controversial. Many respirologists use the American Thoracic Society (ATS postbronchodilator response criteria of 12% (provided it is 200 mL or greater improvement in forced expiratory volume in 1 s (or forced vital capacity from the baseline spirometry.

  1. MR demonstration of spontaneous acute epidural hematoma of the thoracic spine

    International Nuclear Information System (INIS)

    Avrahami, E.; Tadmor, R.; Feibel, M.; Itzhak, Y.; Tel Aviv Univ.; Ram, Z.; Tel Aviv Univ.

    1989-01-01

    Two patients with spontaneous epidural hematoma of the thoracic spine are presented. The magnetic resonance (MR) examination performed within the first hours following the onset of symptoms demonstrated an epidural elongated lesion impinging on the spinal cord, compatible with hematoma. In one of the patients this finding was surgically confirmed. The second patient improved under steroid treatment. The MR findings were highly suggestive of the pathological nature of the lesion. The MR examination should replace other diagnostic procedures, such as computerised tomography (CT) and myelography. (orig.)

  2. Thoracic Outlet Syndrome in a Volleyball Player Due to Nonunion of the First Rib Fracture.

    Science.gov (United States)

    Puttmann, Kathleen T; Satiani, Bhagwan; Vaccaro, Patrick

    2016-11-01

    Fracture of the first rib with ensuing callus formation is a rare cause of thoracic outlet syndrome. We report a case of a 17-year-old female volleyball player who presented with months of chronic arm pain. Radiographic imaging demonstrated nonunion fracture of the first rib. Physical therapy had been unsuccessful in relieving the pain, and surgical management was performed with resection of the first rib through a transaxillary approach with complete resolution of symptoms. Inflammation surrounding such fractures may destroy tissue planes, making dissection more technically difficult.

  3. Biomechanical study of the funnel technique applied in thoracic ...

    African Journals Online (AJOL)

    Background: Funnel technique is a method used for the insertion of screw into thoracic pedicle. Aim: To evaluate the biomechanical characteristics of thoracic pedicle screw placement using the Funnel technique, trying to provide biomechanical basis for clinical application of this technology. Methods: 14 functional spinal ...

  4. Video-assisted thoracic surgery: a renaissance in surgical therapy.

    Science.gov (United States)

    Yim, A P; Izzat, M B; Lee, T W; Wan, S

    1999-03-01

    Within a few years, video-assisted thoracic surgery (VATS) has become the accepted or preferred approach over a wide range of thoracic procedures. The authors review the development of this technique, the basic operative strategies and the current surgical indications. Technical pitfalls and future developments are also discussed.

  5. Reconstruction of a Rollover Crash for Thoracic Injury Etiology Investigation

    Directory of Open Access Journals (Sweden)

    Tana Tan

    2017-11-01

    Full Text Available The cause of serious and fatal thoracic injuries in passenger vehicle rollover crashes is currently not well understood. Previous research on thoracic injuries resulting from rollover crashes have focused primarily on statistical analysis of crash data. This study seeks to develop a better understanding of where in the rollover sequence thoracic injuries may occur. To do this, a real-world passenger vehicle rollover crash where the driver sustained serious bilateral thoracic injuries was reconstructed. Multi-body analysis was used to determine the vehicle’s pre-trip trajectory and to obtain the vehicle’s position and kinematics at the point of trip. This information was then used to prescribe the motion of the vehicle in a finite element analysis. A finite element model of the EuroSID-2re anthropomorphic test device was placed in the driver’s seat. Four simulations, each with the anthropomorphic test device positioned in different postures, were performed. Rib deflection, spinal acceleration, and thoracic impact velocity were obtained from the anthropomorphic test device and compared to existing thoracic injury assessment reference values. From the analysis, lateral thoracic impact velocity indicates that a serious thoracic injury is likely to have occurred when the driver impacted the centre console during the vehicle’s fourth quarter-turn.

  6. Menstruation in an unusual place: A case of thoracic endometriosis ...

    African Journals Online (AJOL)

    While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in Uganda is given. A 34 year old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered ...

  7. Emergency endovascular stent grafting for thoracic aortic pathology

    NARCIS (Netherlands)

    Bos, Wendy T. G. J.; Verhoeven, Eric L. G.; Zeebregts, Clark J. A. M.; Tielliu, Ignace F. J.; Prins, Ted R.; Oranen, Bjorn L.; van den Dungen, Jan J. A. M.

    2007-01-01

    Our aim was to report single-center results of emergency endovascular treatment for thoracic aortic disease. From March 1998 to January 2006, 30 acute thoracic EVAR procedures were carried out in 29 patients. One patient received two procedures in different settings. Four patients died before

  8. The major thoracic vascular invasion of lung cancer

    Directory of Open Access Journals (Sweden)

    Soichi Oka

    2017-08-01

    Conclusion: The positive predictive value of the preoperative CT findings for tumor invasion of the thoracic vessels was low. Therefore, surgical opportunities that offer the chance of a cure shouldn't be missed in advanced lung cancer patients because the tumor is located near the major thoracic vessels on preoperative CT.

  9. MDCT angiography after open thoracic aortic surgery: pearls and pitfalls.

    Science.gov (United States)

    Hoang, Jenny K; Martinez, Santiago; Hurwitz, Lynne M

    2009-01-01

    The purpose of this article is to review open thoracic aortic surgical techniques and to describe the range of postoperative findings on CT angiography (CTA). An understanding of surgical thoracic aortic procedures will allow appropriate differentiation of normal from abnormal CTA findings on postoperative imaging.

  10. State of the art thoracic ultrasound: intervention and therapeutics

    NARCIS (Netherlands)

    Corcoran, John P.; Tazi-Mezalek, Rachid; Maldonado, Fabien; Yarmus, Lonny B.; Annema, Jouke T.; Koegelenberg, Coenraad F. N.; St Noble, Victoria; Rahman, Najib M.

    2017-01-01

    The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will

  11. Thoracic cage injury imaging in rugby players | de Villiers | SA ...

    African Journals Online (AJOL)

    Rugby players often sustain high-impact collisions and are therefore at risk of significant traumatic thoracic injuries. Injury to the thoracic cage may be associated with potentially life-threatening sequelae. Player management is often based on the accuracy of the imaging report. The author suggests a combination of ...

  12. Thoracic sympathectomy for digital ischemia : A summary of evidence

    NARCIS (Netherlands)

    Coveliers, Hans M. E.; Hoexum, Frank; Nederhoed, Johanna H.; Wisselink, Willem; Rauwerda, Jan A.

    Background: Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia. Methods: We reviewed the English literature between 1980 and 2010. Our analysis included reports with the

  13. Chronic posttraumatic pseudoaneurysm of the thoracic aorta 55 ...

    African Journals Online (AJOL)

    Chronic posttraumatic pseudoaneurysm of the thoracic aorta 55 Years after a blunt trauma - A case report with review of literature. M H Milad, A M Gamal, M M Rab. Abstract. Injuries of thoracic aorta due to blunt trauma carry very high mortality rates and studies estimated that less than 2% of people who sustain it remain ...

  14. Severe blunt thoracic trauma: Differences between adults and ...

    African Journals Online (AJOL)

    both adults and children requires advanced imaging and critical care support that places strain on a resource-limited healthcare system. Paediatric trauma from MVCs is often multisystem, with a high incidence of thoracic involvement.[5] Paediatric blunt thoracic trauma presents difficulties in both diagnosis and management.

  15. Lung cancer screening and video-assisted thoracic surgery

    DEFF Research Database (Denmark)

    Petersen, René Horsleben; Hansen, Henrik Jessen; Dirksen, Asger

    2012-01-01

    The objective of this study is to report the impact of computed tomography (CT) screening on the use of Video-Assisted Thoracic Surgery (VATS) in a randomized screening trial.......The objective of this study is to report the impact of computed tomography (CT) screening on the use of Video-Assisted Thoracic Surgery (VATS) in a randomized screening trial....

  16. Is the thoracic aorta a safe site for the proximal anastomosis for bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia?

    Science.gov (United States)

    Barr, James; Kokotsakis, John; Velissarios, Konstantinos; Athanasiou, Thanos

    2017-05-01

    A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether the thoracic aorta is a safe site for the proximal anastomosis when bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia. Five articles reported the use of the thoracic aorta as the site of proximal anastomosis in 35 patients with chronic mesenteric ischaemia. All of these studies were retrospective case reports or case series. The ascending aorta was the site for the proximal anastomosis in 7 patients with the descending thoracic aorta being used in the other 28 patients. The ascending aorta was used when there was disease of the descending thoracic aorta. Out of the 35 patients there was only 1 perioperative death (3%). Rates of graft patency and freedom from recurrent symptoms were excellent. The published literature supports the use of the thoracic aorta as an option for the site of the proximal anastomosis when bypass from elsewhere is not possible. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  17. Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findings

    International Nuclear Information System (INIS)

    Payabvash, S.; Oswood, M.C.; Truwit, C.L.; McKinney, A.M.

    2015-01-01

    Aim: To determine acute computed tomography perfusion (CTP) changes in seizure patients presenting with stroke-like symptoms and to correlate those changes with clinical presentation and electroencephalography (EEG). Materials and methods: The medical records of all patients who presented to the emergency department with acute stroke-like symptoms and underwent CTP (n=1085) over a 5.5-year period were reviewed. Patients were included who had primary seizure as the final diagnosis, and underwent CTP within 3 hours of symptom onset. A subset of patients had a follow-up EEG within 7 days. The perfusion changes and EEG findings were compared between different clinical presentations. Results: Eighteen of 1085 patients (1.7%) who underwent CTP following an acute stroke-like presentation were included. The abnormality on CTP was usually focal, unilateral hyperperfusion — increased relative cerebral blood flow (rCBF) and volume (rCBV) (n=14/18), which most often affected the temporal lobe. Those patients who presented with a motor or speech deficit (n=12) had a higher temporal lobe rCBV, and rCBF, and lower relative mean transit time (rMTT) compared to those with non-focal neurological deficit at presentation. Early EEG was available in 13 patients; a sharp-spike epileptiform EEG discharge pattern (n=5) was associated with higher temporal lobe ipsilateral rCBF and rCBV, and lower rMTT on admission CTP examination. Conclusion: Seizure patients who present with a unilateral motor or speech deficit most commonly have contralateral hyperperfusion in the corresponding eloquent brain regions on the acute-stage CTP examination. In such patients, epileptiform discharges on the early follow-up EEG are associated with ipsilateral hyperperfusion on the admission CTP. -- Highlights: •Seizure patients with stroke-mimic symptoms show contralateral hyperperfusion on acute phase CTP (<3 hours of onset). •Seizure patients with unilateral paralysis/aphasia showed asymmetric perfusion

  18. Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

    Energy Technology Data Exchange (ETDEWEB)

    Kirova, Youlia M., E-mail: youlia.kirova@curie.net [Department of Radiation Oncology, Institut Curie, Paris (France); Menard, Jean; Chargari, Cyrus; Mazal, Alejandro [Department of Radiation Oncology, Institut Curie, Paris (France); Kirov, Krassen [Department of Anesthesiology and Reanimation, Institut Curie, Paris (France)

    2012-07-01

    To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

  19. Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

    International Nuclear Information System (INIS)

    Kirova, Youlia M.; Menard, Jean; Chargari, Cyrus; Mazal, Alejandro; Kirov, Krassen

    2012-01-01

    To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

  20. Spontaneous and complete regression of a thoracic disc herniation; Regression spontanee et complete en IRM d`une hernie discale dorsale

    Energy Technology Data Exchange (ETDEWEB)

    Coevoet, V.; Benoudiba, F.; Doyon, D.; Lignieres, C.; Said, G. [Centre Hospitalier Universitaire de Bicetre, 94 - Le Kremlin-Bicetre (France)

    1997-09-01

    Spontaneous regression of disc herniation is well known but the mechanism is not clear. Some hypotheses have been made. We present here a large thoracic disc herniation diagnosed by MRI which completely regressed one year after a medical treatment with complete amendment of symptoms. (authors). 11 refs.

  1. Thoracic epidural anesthesia attenuates hemorrhagic-induced splanchnic hypo-perfusion in post-resuscitation experimental hemorrhagic shock

    Directory of Open Access Journals (Sweden)

    Amir S Madjid

    2008-06-01

    Full Text Available The purpose of present study was to assess the effects of thoracic epidural anesthesia on splanchnic perfusion, bacterial translocation and histopathologic changes in experimental hemorrhagic shock in short-tailed macaques (Macaca nemestrina. Sixteen Macaca nemestrinas were randomly assigned to one of two groups i.e. the lidocaine group (n = 8, receiving general anesthesia plus lidocaine thoracic epidural anesthesia; and the saline group (n = 8, receiving general anesthesia alone as control. Hemorrhagic shock was induced by withdrawing blood gradually to a mean arterial pressure (MAP of 40 mm Hg, and maintained for 60 minutes. Animals were then resuscitated with their own blood and ringer lactate solution (RL. After resuscitation, epidural lidocaine 2% was given in the lidocaine group and saline in the control group. Resuscitation that was performed after one hour hemorrhagic shock, with hemodynamic variables and urine output returned to normal, revealed there was no improvement of splanchnic perfusion. PgCO2, P(g-aCO2, and pHi remained in critical value and tended to deteriorate in the saline group. Contrast to saline group, splanchnic perfusion in lidocaine group tended to improve. This condition was supported by the finding of less bacterial translocation and better histopathologic changes in lidocaine thoracic epidural anesthesia group than in saline group. This study concludes that lidocaine thoracic epidural anesthesia attenuates splachnic hypoperfusion in post-resuscitation hemorrhagic shock in Macaca nemestrina. (Med J Indones 2008; 17: 73-81Keywords: thoracic epidural anesthesia, lidocaine, hemorrhagic shock, splanchnic hypoperfusion, bacterial translocation

  2. CONSERVATIVE TREATMENT OF POST-PNEUMONIC THORACIC EMPYEMA IN CHILDREN

    Directory of Open Access Journals (Sweden)

    N. G. Nilesh Nagdeve

    2016-11-01

    Full Text Available BACKGROUND The aim of the study is to retrospectively review data of the outcome of post-pneumonic empyema in children managed in our institute over last seven years. MATERIALS AND METHODS The medical records of children below 12 years of age admitted over last seven years in Government Medical College, Nagpur, with the diagnosis of post-pneumonic thoracic were reviewed. Patients with empyema due to tuberculosis, patients with chest tube drainage or any surgical intervention done before admission were excluded from analysis. The data regarding age, duration of pre-hospital illness, complaints, blood and pleural fluid analyses, radiological evaluations, microbiological studies, modes of treatment, duration of chest tube drainage and length of hospital stay was noted and analysed. RESULTS A total of 105 patients (65 males, 45 females diagnosed as post-pneumonic empyema were evaluated. The peak incidence was in the 3-6-year-old group with male preponderance. A mean duration between onset of symptoms and hospitalisation was 9.32±1.68 days. The WBC counts were >15,000 in 71.12% of the patients. Examination of pleural fluid revealed frank pus in 84.38%. Bacterial growth was observed in only 27.6% patients. Radiologically, 60% patients presented in fibropurulent stage without loculations while 40% patients had loculations. 64% showed clinical improvement after the start of antibiotics and insertion of chest tube while 36% patients required the second line antibiotics after five days of admission. Chest tubes were left in place for a mean period of 8.9±5.8 days. The length of hospitalisation was 12.3±6.0 days. Twelve patients with bronchopleural fistula had hospital stay of 26±7.36 days. Three patients needed thoracotomy and decortication for continued pleural pathology even after 5 days of second line antibiotics. The relationship between presence of loculations and need for surgical intervention was not statistically significant (p<0.05. All

  3. Developmental Change and Time-Specific Variation in Global and Specific Aspects of Self-Concept in Adolescence and Association with Depressive Symptoms

    Science.gov (United States)

    Kuzucu, Yasar; Bontempo, Daniel E.; Hofer, Scott M.; Stallings, Michael C.; Piccinin, Andrea M.

    2014-01-01

    Previous research has demonstrated that adolescents make differential self-evaluations in multiple domains that include physical appearance, academic competence, and peer acceptance. We report growth curve analyses over a seven year period from age 9 to age 16 on the six domains of the Harter Self-Perception Profile for Children. In general, we find little change in self-concept, on average, but do find substantial individual differences in level, rate of change, and time-specific variation in these self- evaluations. The results suggest that sex differences and adoptive status were related to only certain aspects of the participants’ self-concept. Depressive symptoms were found to have significant effects on individual differences in rate of change and on time-specific variation in general self-concept, as well as on some of the specific domains of self-concept. PMID:25143664

  4. Developmental Change and Time-Specific Variation in Global and Specific Aspects of Self-Concept in Adolescence and Association with Depressive Symptoms.

    Science.gov (United States)

    Kuzucu, Yasar; Bontempo, Daniel E; Hofer, Scott M; Stallings, Michael C; Piccinin, Andrea M

    2014-06-01

    Previous research has demonstrated that adolescents make differential self-evaluations in multiple domains that include physical appearance, academic competence, and peer acceptance. We report growth curve analyses over a seven year period from age 9 to age 16 on the six domains of the Harter Self-Perception Profile for Children. In general, we find little change in self-concept, on average, but do find substantial individual differences in level, rate of change, and time-specific variation in these self- evaluations. The results suggest that sex differences and adoptive status were related to only certain aspects of the participants' self-concept. Depressive symptoms were found to have significant effects on individual differences in rate of change and on time-specific variation in general self-concept, as well as on some of the specific domains of self-concept.

  5. Changing Treatment Paradigms for Brain Metastases From Melanoma-Part 1: Diagnosis, Prognosis, Symptom Control, and Local Treatment.

    Science.gov (United States)

    Venur, Vyshak Alva; Funchain, Pauline; Kotecha, Rupesh; Chao, Samuel T; Ahluwalia, Manmeet S

    2017-08-15

    Melanoma is the third most common cause of brain metastases, after lung and breast cancer. The management of melanoma brain metastases can be broadly divided into symptom control and therapeutic strategies. Supportive treatments include corticosteroids to reduce peritumoral edema, antiepileptics for seizure control, and medications to preserve cognitive function. Until recently, therapeutic strategies consisted primarily of local treatments, including surgery, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Surgery, WBRT, and SRS-alone and in various combinations-still play an important role in treatment, especially in patients with few and/or smaller brain lesions. Much work has been done recently to try to determine the optimal settings for these therapies, the most effective ways to combine them, and ideal radiation dose and fractions.

  6. Development of depressive symptoms and depression during organizational change--a two-year follow-up study of civil servants.

    Science.gov (United States)

    Netterstrøm, Bo; Blønd, Morten; Nielsen, Martin; Rugulies, Reiner; Eskelinen, Leena

    2010-11-01

    On 1 January 2007, Denmark went through a major reorganization, where most of its 275 municipalities and 14 counties merged into larger units. Our study aimed to examine the development of depressive symptoms and incident depression among employees affected by this organizational change. A total of 685 civil servants employed in the administration of 5 municipalities and 2 counties participated in the study. They answered a postal questionnaire, 8 months prior to and 16 months after the reorganization, regarding working conditions, psychosocial work environment factors, and depressive symptoms, based on the Major Depression Inventory (MDI). During the follow-up period of 2006-2008, 295 employees had experienced a merger with other workplaces (hereafter the merger group), 259 had got a new job (the new job group), and 131 who experienced no change in workplace served as the control group. The three groups were compared to each other for (i) mean score of MDI and (ii) incident cases of depression using general linear models and logistic regression analyses, separately by gender. After adjustment of the MDI for age, occupation, supervisor function, and department at baseline in 2006, no significant differences in increase in MDI were found between the groups. The incidence of depression in the merger group was not significantly higher than the control group [women: odds ratio (OR) 1.5 (95% confidence interval [95% CI] 0.6-3.9), men: OR 1.7 (95% CI 0.2-18.7)], after adjustment for confounders. This study showed no significantly increased risk of depression or increase in depressive symptoms among employees exposed to organizational change as a part of a major local government reform.

  7. AN INTERVENTION-BASED CLINICAL REASONING FRAMEWORK TO GUIDE THE MANAGEMENT OF THORACIC PAIN IN A DANCER: A CASE REPORT.

    Science.gov (United States)

    Masaracchio, Michael; Kirker, Kaitlin; Collins, Cristiana Kahl; Hanney, William; Liu, Xinliang

    2016-12-01

    As a result of the anatomical proximity of the thoracic spine to the cervical, lumbar, and shoulder regions, dysfunction in the thoracic spine can influence pain, mobility, and stability across these areas. Currently, a paucity of evidence exists addressing treatment of individuals with primary thoracic pain, especially in young, athletic patients. Furthermore, current research discussing clinical reasoning frameworks focus on the differential diagnostic process. The purpose of this case report was to present a framework that describes the clinical reasoning process for the implementation and sequencing of procedural interventions for the management of a dancer with thoracic pain. A 21-year-old female dancer presented to physical therapy with a medical diagnosis of thoracic pain. The patient reported exacerbation of left thoracic pain with prolonged sitting, twisting/arching her back during dance, and lifting >15 lbs overhead. Examination revealed hypomobility with positive pain provocation during mobility testing of T1-T3 and the sternocostal junction of ribs 2-4, with associated muscle guarding palpated in the left iliocostalis thoracis and levator scapulae. Following 10 visits, the patient had no pain, no functional deficits, and a Global Rating of Change (GROC) of + 6. She returned to full competition, and a 3-month follow-up revealed continued success with dancing and a GROC of +7. This case report described the successful management of a dancer with primary thoracic pain using a clinical reasoning framework for the sequencing of procedural interventions, while incorporating Olson's impairment-based classification system. A combination of manual therapy techniques and neuromuscular control exercises were incorporated to address mobility, stability, mobility on stability, and skill level impairments, which allowed the patient to return to dance activities safely. Future studies should consider the development of further treatment-based clinical reasoning

  8. Motion correction in thoracic positron emission tomography

    CERN Document Server

    Gigengack, Fabian; Dawood, Mohammad; Schäfers, Klaus P

    2015-01-01

    Respiratory and cardiac motion leads to image degradation in Positron Emission Tomography (PET), which impairs quantification. In this book, the authors present approaches to motion estimation and motion correction in thoracic PET. The approaches for motion estimation are based on dual gating and mass-preserving image registration (VAMPIRE) and mass-preserving optical flow (MPOF). With mass-preservation, image intensity modulations caused by highly non-rigid cardiac motion are accounted for. Within the image registration framework different data terms, different variants of regularization and parametric and non-parametric motion models are examined. Within the optical flow framework, different data terms and further non-quadratic penalization are also discussed. The approaches for motion correction particularly focus on pipelines in dual gated PET. A quantitative evaluation of the proposed approaches is performed on software phantom data with accompanied ground-truth motion information. Further, clinical appl...

  9. Telomere Biology and Thoracic Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Thomas Aschacher

    2017-12-01

    Full Text Available Ascending aortic aneurysms are mostly asymptomatic and present a great risk of aortic dissection or perforation. Consequently, ascending aortic aneurysms are a source of lethality with increased age. Biological aging results in progressive attrition of telomeres, which are the repetitive DNA sequences at the end of chromosomes. These telomeres play an important role in protection of genomic DNA from end-to-end fusions. Telomere maintenance and telomere attrition-associated senescence of endothelial and smooth muscle cells have been indicated to be part of the pathogenesis of degenerative vascular diseases. This systematic review provides an overview of telomeres, telomere-associated proteins and telomerase to the formation and progression of aneurysms of the thoracic ascending aorta. A better understanding of telomere regulation in the vascular pathology might provide new therapeutic approaches. Measurements of telomere length and telomerase activity could be potential prognostic biomarkers for increased risk of death in elderly patients suffering from an aortic aneurysm.

  10. Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma

    Directory of Open Access Journals (Sweden)

    Abdurrahman Aycan

    2016-01-01

    Full Text Available A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS. The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI showed an image of a mass compressing the medulla.

  11. Thoracic spinal cord compression by a tophus.

    Science.gov (United States)

    Ntsiba, Honoré; Makosso, Edouard; Moyikoua, Armand

    2010-03-01

    We report a case of thoracic (T10) spinal cord compression by a tophus in a patient with known chronic gout. Spastic paraplegia developed gradually over 6 months in this 43-year-old man with hypertension, alcohol abuse, and chronic gouty arthritis with tophi. Magnetic resonance imaging and computed tomography visualized an intradural nodule measuring 1.5cm in diameter at the level of T10, as well as geodes in the left T10 lamina and left T9-T10 articular processes. The nodule was removed surgically and shown by histological examination to be a tophus. The neurological impairments resolved rapidly and completely. We found about 60 similar cases in the literature. Spinal cord compression in a patient with chronic gout can be caused by a tophus. Copyright 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  12. Signs of Imminent Dying and Change in Symptom Intensity During Pharmacological Treatment in Dying Nursing Home Patients: A Prospective Trajectory Study.

    Science.gov (United States)

    Sandvik, Reidun K; Selbaek, Geir; Bergh, Sverre; Aarsland, Dag; Husebo, Bettina S

    2016-09-01

    To investigate whether it is possible to determine signs of imminent dying and change in pain and symptom intensity during pharmacological treatment in nursing home patients, from day perceived as dying and to day of death. Prospective, longitudinal trajectory trial. Forty-seven nursing homes within 35 municipalities of Norway. A total of 691 nursing home patients were followed during the first year after admission and 152 were assessed carefully in their last days of life. Time between admission and day of death, and symptom severity by Edmonton symptom assessment system (ESAS), pain (mobilization-observation-behavior-intensity-dementia-2), level of dementia (clinical dementia rating scale), physical function (Karnofsky performance scale), and activities of daily living (physical self-maintenance scale). Twenty-five percent died during the first year after admission. Increased fatigue (logistic regression, odds ratio [OR] 1.8, P = .009) and poor appetite (OR 1.2, P = .005) were significantly associated with being able to identify the day a person was imminently dying, which was possible in 61% of the dying (n = 82). On that day, the administration of opioids, midazolam, and anticholinergics increased significantly (P dying nursing home patients; however, most symptoms, including pain and dyspnea, were still common at day of death. Results emphasize critical needs for better implementation of guidelines and staff education. ClinicalTrials.govNCT01920100. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. Quality of life in patients with lower urinary tract symptoms associated with BPH: change over time in real-life practice according to treatment--the QUALIPROST study.

    Science.gov (United States)

    Alcaraz, Antonio; Carballido-Rodríguez, Joaquín; Unda-Urzaiz, Miguel; Medina-López, Rafael; Ruiz-Cerdá, José L; Rodríguez-Rubio, Federico; García-Rojo, Darío; Brenes-Bermúdez, Francisco J; Cózar-Olmo, José M; Baena-González, Víctor; Manasanch, José

    2016-05-01

    To evaluate change in quality of life (QoL) and symptoms in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) in conditions of current clinical practice. Prospective, longitudinal, multicenter open-label study was carried out in urology outpatient clinics. Patients were ≥40 years of age with an International Prostate Symptom Score (IPSS) score ≥ 8. QoL and symptoms were measured at baseline and 6 months using the Benign Prostatic Hyperplasia Impact Index (BII) and the IPSS. 1713 patients were included for analysis. Mean (SD) IPSS and BII scores at baseline were 16.8 (5.4) and 6.8 (2.6), respectively. 8.9 % (n = 153) of study participants did not receive treatment (watchful waiting, WW), 70.3 % (n = 1204) were prescribed monotherapy (alpha-adrenergic blockers [AB]; phytotherapy [PT, of which 95.2 % was the hexanic extract of Serenoa repens, HESr]; or 5-alpha-reductase inhibitors [5ARI]), and 20.8 % (n = 356) received combined treatment (AB + 5ARI; AB + HESr; others). At 6 months, improvements in QoL were similar across the different medical treatment (MT) groups, both for monotherapy (AB: mean improvement [SD] of 2.4 points [2.4]; PT: 1.9 [2.4]; 5ARI: 2.5 [2.3]) and combined therapy (AB + 5ARI: 3.1 [2.9]; AB + PT: 3.1 [2.5]). There were no clinically significant differences between MT groups and all showed significant improvement over WW (p life practice to manage patients with moderate or severe LUTS. HESr showed an equivalent efficacy to AB and 5ARI with fewer side effects.

  14. Is compensatory hyperhidrosis after thoracic sympathicotomy in palmar hyperhidrosis patients related to the excitability of thoracic sympathetic ganglions?

    Science.gov (United States)

    Chen, Jun-Peng; Peng, A-Jing; Xu, Chen-Hui; Li, Guo-Ying

    2017-01-01

    Background The mechanism of compensatory hyperhidrosis remains unclear. The aim of this study was to explore the relationship between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability to assess the effectiveness of thoracoscopic T4 sympathicotomy for treating palmar hyperhidrosis. Methods Sixty-six cases of T4 sympathetic ganglions were prospectively collected from patients with palmar hyperhidrosis who underwent thoracoscopic T4 sympathicotomy from 2013 to 2016 in our department. The expression levels of choline acetyltransferase (ChAT), vasoactive intestinal peptide (VIP), and synaptophysin were detected using immunohistochemistry. Patients with palmar hyperhidrosis were followed-up for examination of postoperative sweating status. Results Thirty-eight cases (57.6%) of compensatory hyperhidrosis were identified. Mild compensatory hyperhidrosis occurred in 26 patients (39.4%), moderate in 11 (16.7%), and severe in 1 (1.5%). The rate of compensatory hyperhidrosis was higher in patients with axilla hyperhidrosis than those without (76.0% vs. 46.3%, P=0.018). However, the clinical data were similar between the compensatory hyperhidrosis group and the no compensatory hyperhidrosis group. In addition, the ChAT, VIP, and synaptophysin expression levels were not significantly different between the two groups (P values of 0.356, 0.071, and 0.141, respectively). Furthermore, the ChAT, VIP, and synaptophysin expression levels in the mild group were similar to those observed in the moderate/intense group (P values of 0.089, 0.124, and 0.149, respectively). The remission rate was 100% in palmar hyperhidrosis, 48.2% (27/56) in pedal hyperhidrosis, 56.0% (14/25) in axilla hyperhidrosis and 88.9% (16/18) in skin symptoms. No signs of chapped skin on the palms were found. Conclusions There was no significant correlation between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability; however, compensatory hyperhidrosis is more likely to

  15. The temporal relationship between change in symptoms of prolonged grief and posttraumatic stress following old age spousal bereavement

    DEFF Research Database (Denmark)

    O Connor, Maja; Nickerson, Angela; Aderka, Idan M.

    2015-01-01

    following the death of a loved one. The purpose of this study was to examine the temporal relationship between change in high levels of PGS and PTSS during the first four years following old age spousal loss. Methods: Participants were 237 Danes (40% male; mean age = 73 years, SD = 4.4; range 65-81) who...... bereavement to a greater extent than vice versa. Conclusions: The findings in the present study indicate that changes in PGS may precede and potentially directly impact changes in PTSS following bereavement. This tentative conclusion points to the potential value of targeting PGS in psychological...

  16. Threat Reappraisal as a Mediator of Symptom Change in Cognitive-Behavioral Treatment of Anxiety Disorders: A Systematic Review

    NARCIS (Netherlands)

    Smits, J.A.J.; Julian, K.; Rosenfield, D.; Powers, M.B.

    2012-01-01

    Objective: Identifying mediators of therapeutic change is important to the development of interventions and augmentation strategies. Threat reappraisal is considered a key mediator underlying the effects of cognitive-behavioral therapy (CBT) for anxiety disorders. The present study systematically

  17. Radiation recall pneumonitis induced by erlotinib after palliative thoracic radiotherapy for lung cancer: Case report and literature review.

    Science.gov (United States)

    Awad, Raef; Nott, Louise

    2016-03-01

    Radiation lung injury usually develops 1-6 months after cessation of radiation therapy to the lung. Acute change in the previously irradiated lung after administration of antineoplastic agent is known as radiation recall pneumonitis. Erlotinib is a reversible epidemal growth factor receptor tyrosine kinase inhibitor, which is effective for patients with advanced lung cancer with epidermal growth factor receptor mutations. Here we report a rare case of radiation recall pneumonitis following treatment with erlotinib 4 months after palliative radiotherapy to the lung. A 76-year-old man with non-small cell lung cancer was treated with polychemotherapy, palliative thoracic irradiation (30 Gy in 12 fractions) and erlotinib thereafter. Two months after administration of erlotinib he developed of severe dyspnea, cough, anorexia and lack of energy. CT chest revealed extensive radiation pneumonitis. Erlotinib was ceased and high-dose steroids were started. The symptoms ultimately resolved and erlotinib was resumed cautiously after 11 weeks. On dosimetric analysis, lung V20 and the mean lung dose were 20.33% and 10.7 Gy, respectively, and hence, the risk of radiation pneumonitis is very low. These data indicate that systemic administration of erlotinib after low-dose palliative radiation therapy can be associated with unexpected toxicity when visceral organs are within the radiation field. © 2016 John Wiley & Sons Australia, Ltd.

  18. [Changes in comorbid symptoms and subjective interference in a habit reversal therapy in children with chronic tic disorder - a pilot study].

    Science.gov (United States)

    Woitecki, Katrin; Döpfner, Manfred

    2012-05-01

    This pilot study investigates the effects of habit reversal training in a German-speaking population of children and young adults with chronic tic disorders on comorbid symptoms and subjective interference. 16 children were treated using a manualized program. Comorbid-symptoms (ADHD, anxiety and OCD, depression) were assessed using parent and self-ratings. Additionally, the correlation of tic symptoms with comorbid symptoms at the beginning of the therapy was analyzed. We obtained positive results in reducing comorbid symptoms during a primary treatment of tic symptoms. We further found a correlation of tic symptoms and comorbid symptoms especially in parent ratings. These first findings show that a primary treatment of tics may be indicated in patients with comorbid symptoms, because a therapy of tic symptoms has also positive effects on comorbid symptoms.

  19. Focal Anterior Displacement of the Thoracic Spinal Cord without Evidence of Spinal Cord Herniation or an Intradural Mass

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Yoon; Lee, Joon Woo; Lee, Guen Young; Kang, Heung Sik [Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of)

    2014-07-01

    We report magnetic resonance imaging (MRI) findings on focal anterior displacement of the thoracic spinal cord in asymptomatic patients without a spinal cord herniation or intradural mass. We identified 12 patients (male:female = 6:6; mean age, 51.7; range, 15-83 years) between 2007 and 2011, with focal anterior displacement of the spinal cord and without evidence of an intradural mass or spinal cord herniation. Two radiologists retrospectively reviewed the MRI findings in consensus. An asymmetric spinal cord deformity with a focal dented appearance was seen on the posterior surface of the spinal cord in all patients, and it involved a length of 1 or 2 vertebral segments in the upper thoracic spine (thoracic vertebrae 1-6). Moreover, a focal widening of the posterior subarachnoid space was also observed in all cases. None of the patients had myelopathy symptoms, and they showed no focal T2-hyperintensity in the spinal cord with the exception of one patient. In addition, cerebrospinal fluid (CSF) flow artifacts were seen in the posterior subarachnoid space of the affected spinal cord level. Computed tomography myelography revealed preserved CSF flow in the two available patients. Focal anterior spinal cord indentation can be found in the upper thoracic level of asymptomatic patients without a spinal cord herniation or intradural mass.

  20. Focal Anterior Displacement of the Thoracic Spinal Cord without Evidence of Spinal Cord Herniation or an Intradural Mass

    International Nuclear Information System (INIS)

    Lee, Jong Yoon; Lee, Joon Woo; Lee, Guen Young; Kang, Heung Sik

    2014-01-01

    We report magnetic resonance imaging (MRI) findings on focal anterior displacement of the thoracic spinal cord in asymptomatic patients without a spinal cord herniation or intradural mass. We identified 12 patients (male:female = 6:6; mean age, 51.7; range, 15-83 years) between 2007 and 2011, with focal anterior displacement of the spinal cord and without evidence of an intradural mass or spinal cord herniation. Two radiologists retrospectively reviewed the MRI findings in consensus. An asymmetric spinal cord deformity with a focal dented appearance was seen on the posterior surface of the spinal cord in all patients, and it involved a length of 1 or 2 vertebral segments in the upper thoracic spine (thoracic vertebrae 1-6). Moreover, a focal widening of the posterior subarachnoid space was also observed in all cases. None of the patients had myelopathy symptoms, and they showed no focal T2-hyperintensity in the spinal cord with the exception of one patient. In addition, cerebrospinal fluid (CSF) flow artifacts were seen in the posterior subarachnoid space of the affected spinal cord level. Computed tomography myelography revealed preserved CSF flow in the two available patients. Focal anterior spinal cord indentation can be found in the upper thoracic level of asymptomatic patients without a spinal cord herniation or intradural mass

  1. It is possible to classify non-erosive reflux disease (NERD) patients into endoscopically normal groups and minimal change groups by subjective symptoms and responsiveness to rabeprazole -- a report from a study with Japanese patients.

    Science.gov (United States)

    Kusano, Motoyasu; Shirai, Naohito; Yamaguchi, Kanako; Hongo, Michio; Chiba, Tsutomu; Kinoshita, Yoshikazu

    2008-12-01

    The hypothesis that non-erosive reflux disease (NERD) patients comprise various subgroups is gaining popularity. This study was conducted to investigate the possibility of categorizing NERD patients according to symptom types and response to acid-suppressive drug rabeprazole (RPZ) 10 mg/day. NERD patients were classified as grade N (endoscopically normal), M (minimal change), or erosive GERD, and answered a 51-item, yes-or-no questionnaire pre and post-treatment. Compared to erosive GERD, clear differences existed in pretreatment prevalence of symptoms and responsiveness to RPZ in grades N and M; the results suggested stomachaches (especially at night) were significant symptoms in grade N and dysmotility-like symptoms like bloated stomach were significant in grade M while gastroesophageal reflux symptoms were significant in erosive GERD. Clinical significance of classifying NERD was indicated from different symptoms and responsiveness to PPI.

  2. Robotic thoracic surgery: The state of the art

    Science.gov (United States)

    Kumar, Arvind; Asaf, Belal Bin

    2015-01-01

    Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures. PMID:25598601

  3. Complications associated with thoracic pedicle screws in spinal deformity

    Science.gov (United States)

    Li, Gang; Lv, Guohua; Passias, Peter; Kozanek, Michal; Metkar, Umesh S.; Liu, Zhongjun; Wood, Kirkham B.; Rehak, Lubos

    2010-01-01

    Thoracic pedicle screws have superior anchoring strength compared with other available fixation techniques. However, these are not universally accepted in many developing countries because of the concerns regarding safety and complications. In addition, there is evidence that pedicle morphology is unique in Chinese patients. The goal of this study was to analyze the complications seen at our institution, while using thoracic pedicle screws for the treatment of thoracic deformity, and to determine the safety of our techniques for the treatment of thoracic deformity in a Chinese population. From 1998 to 2005, there were 208 thoracic deformity patients treated at our institution, 70 of whom were male and 138 were female. Their age ranged from 11 to 55 years (mean of 14.9 years). All of them underwent corrective deformity surgery using posterior pedicle screw systems and follow-up was available for at least 3 years. Etiologic diagnoses included adolescent idiopathic scoliosis in 119 patients, congenital kyphoscoliosis in 38, adult scoliosis in 37 and undetermined in 14. Screw positions were evaluated using intraoperative and postoperative radiographs and a CT scan was performed when a concern for screw malposition was present. All radiographic evaluations were carried out in a double-blinded fashion. A total of 1,123 thoracic pedicle screws were inserted (5.4 thoracic screws/patient). The deformity correction rate was 81, 65 and 62% for idiopathic, congenital and adult scoliosis patients, respectively. The overall complication rate was 16.5% at the final follow-up. Complication rates directly and indirectly related to pedicle screws were 7.2 and 9.3%, respectively. There were no significant screw-related neurologic or visceral complications that adversely affected long-term results. The complications seen with thoracic pedicle screws in a Chinese population were similar to other populations and could be utilized safely for the treatment of thoracic deformity in this

  4. Breakthrough in the Transplantation of Thoracic Organs in Hungary.

    Science.gov (United States)

    Rényi-Vámos, F; Hartyánszky, I; Szabolcs, Z; Lang, G

    2017-09-01

    In 2016 the focus was, by all means, on the transplantation on thoracic organs. More than 50 heart transplantations were performed in this year. With this achievement, the Hungarian Heart Transplantation Program became one of the leading programs in the world. In the Thoracic Surgery Unit of the National Institute of Oncology and the Thoracic Surgery Department of Semmelweis University the first successful lung transplantation was carried out on December 12, 2015 when the Hungarian Lung Transplantation Program was launched. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Reconstruction of Thoracic Wall Defect with Polytetrafluoroethylene Graft

    Directory of Open Access Journals (Sweden)

    Erkan Akar

    2014-03-01

    The most common causes of major thoracic traumas are stabwounds, traffic accidents and gunshot wounds. Thoracic wall defects developing due to these injuries should be repaired if they lead to paradoxal respiration. We repaired the thoracic wall defect of the 25-year-old male patient who was admitted to our clinic with gunshot wound with Polytetrafluoroethylene graft as expansion dysfunction and paradoxal respiration developed. No complications developed and he was discharged with recovery.  In conclusion, Polytetrafluoroethylene graft is a good reconstruction tool at present because it prevents paradoxal respiration successfully, applied easily and cosmetic. 

  6. Magnetic resonance in prenatal diagnosis of thoracic anomalies

    International Nuclear Information System (INIS)

    Pietrani, M.; Elias, D.; Wojakowski, A.; Fataljaef, V.; Carcano, M.; Otano, L.

    2007-01-01

    The objective of this article is to communicate the experience in the evaluation of fetal anomalies thoracic by means of magnetic resonance. Between January, 2001 - March, 2007 16 fetus were evaluated by means of magnetic resonance with echographic diagnosis of thoracic anomalies. An equipment of 1.5 TESLA was used. The thoracic anatomy was valued in general. At the presence of discovering pulmonary mass, their size, volume and intensity of sign were determined. The echographic and magnetic resonance findings were checked against the perinatal results [es

  7. Ultrasonographic Diagnosis of Thoracic Outlet Syndrome Secondary to Brachial Plexus Piercing Variation

    Science.gov (United States)

    Leonhard, Vanessa; Caldwell, Gregory; Goh, Mei; Reeder, Sean

    2017-01-01

    Structural variations of the thoracic outlet create a unique risk for neurogenic thoracic outlet syndrome (nTOS) that is difficult to diagnose clinically. Common anatomical variations in brachial plexus (BP) branching were recently discovered in which portions of the proximal plexus pierce the anterior scalene. This results in possible impingement of BP nerves within the muscle belly and, therefore, predisposition for nTOS. We hypothesized that some cases of disputed nTOS result from these BP branching variants. We tested the association between BP piercing and nTOS symptoms, and evaluated the capability of ultrasonographic identification of patients with clinically relevant variations. Eighty-two cadaveric necks were first dissected to assess BP variation frequency. In 62.1%, C5, superior trunk, or superior + middle trunks pierced the anterior scalene. Subsequently, 22 student subjects underwent screening with detailed questionnaires, provocative tests, and BP ultrasonography. Twenty-one percent demonstrated atypical BP branching anatomy on ultrasound; of these, 50% reported symptoms consistent with nTOS, significantly higher than subjects with classic BP anatomy (14%). This group, categorized as a typical TOS, would be missed by provocative testing alone. The addition of ultrasonography to nTOS diagnosis, especially for patients with BP branching variation, would allow clinicians to visualize and identify atypical patient anatomy. PMID:28677632

  8. Differential change on depressive symptom factors with antidepressant medication and cognitive behavior therapy for major depressive disorder.

    Science.gov (United States)

    Dunlop, Boadie W; Cole, Steven P; Nemeroff, Charles B; Mayberg, Helen S; Craighead, W Edward

    2018-03-15

    Major depressive disorder (MDD) is a heterogeneous condition and individual patients are likely to be differentially responsive to specific treatments. In an exploratory factor analysis of three rating scales, the Genome-based Therapeutic Drugs for Depression (GENDEP) trial identified three factors that were differentially associated with outcome to nortriptyline and escitalopram. However, this factor analysis has neither been replicated or applied to a psychotherapy treatment. We replicated the GENDEP analytic method in the Emory Predictors of Remission to Individual and Combined Treatments (PReDICT) study. The 17-item Hamilton Depression Rating Scale, Montgomery Asberg Depression Rating Scale, and Beck Depression Inventory were administered to 306 MDD patients in the PReDICT study, which randomized previously untreated adults to 12 weeks of treatment with cognitive behavior therapy (CBT), escitalopram, or duloxetine. Utilizing Item Response Theory methodologies, factor scores were derived from the three scales and the efficacy of the three treatments was compared for the identified factor scores. Four factors were identified: "Despair," "Mood and Interest," "Sleep," and "Appetite." These factors closely aligned with the factors identified in GENDEP. Compared to CBT, escitalopram and duloxetine produced more rapid but ultimately similar improvement on the Despair and Mood and Interest factors; no significant differences between treatments emerged on the other factors. The scales contained differing numbers of items pertaining to specific depressive symptoms. The heterogeneity of MDD can be parsed into a consistent factor structure, with the factors showing differential rapidity, but ultimately similar, improvement across treatments. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Depressive Symptoms, Depletion, or Developmental Change? Withdrawal, Apathy, and Lack of Vigor in the Geriatric Depressive Scale.

    Science.gov (United States)

    Adams, Kathryn Betts

    2001-01-01

    This study has dual goals of confirming the existence of a "Withdrawal/Apathy/[Lack of] Vigor" (WAV) dimension of the Geriatric Depression Scale (GDS) and determining if it is descriptive of either depletion or disengagement-related change in older adults. High endorsement rates suggest WAV may be congruent with disengagement or depletion and may…

  10. Early psychosis symptoms

    International Nuclear Information System (INIS)

    Naqvi, H.A.; Hussain, S.; Islam, M.

    2014-01-01

    Objective: To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking. Study Design: A cross-sectional study. Place and Duration of Study: The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009. Methodology: A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis (IROAS). Results: Fifty five (59%) participants were male while 41% (n=38%) were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 (55%) concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced (p < 0.001) for depressed mood (66%), worries (65%), tension (63%), withdrawal/mistrust (54%) and loss of self-confidence (53%). Thought withdrawal (22%) and passivity (15%) were elicited only through structured interview (IROAS). When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness. Conclusion: Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of long term psychosis. (author)

  11. Adults miscoded and misdiagnosed as having pneumonia: results from the British Thoracic Society pneumonia audit.

    Science.gov (United States)

    Daniel, Priya; Bewick, Thomas; Welham, Sally; Mckeever, Tricia M; Lim, Wei Shen

    2017-04-01

    A key objective of the British Thoracic Society national community-acquired pneumonia (CAP) audit was to determine the clinical characteristics and outcomes of hospitalised adults given a primary discharge code of pneumonia but who did not fulfil accepted diagnostic criteria for pneumonia. Adults miscoded as having pneumonia (n=1251) were older compared with adults with CAP (n=6660) (median 80 vs 78 years, p<0.001) and had more comorbid disease, significantly fewer respiratory symptoms (fever, cough, dyspnoea, pleuritic pain), more constitutional symptoms (general deterioration, falls) and significantly lower 30-day inpatient mortality (14.3% vs 17.0%, adjusted OR 0.75, p=0.003). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. Extended replacement of the thoracic aorta.

    Science.gov (United States)

    Hino, Yutaka; Okada, Kenji; Oka, Takanori; Inoue, Takeshi; Tanaka, Akiko; Omura, Atsushi; Kano, Hiroya; Okita, Yutaka

    2013-01-01

    We present our experience of total aortic arch replacement. Twenty-nine patients (21 males and 8 females; mean age 63.3 ± 13.3 years) with extended thoracic aortic aneurysms underwent graft replacement. The pathology of the diseased aorta was non-dissecting aneurysm in 11 patients, including one aortitis and aortic dissection in 18 patients (acute type A: one, chronic type A: 11, chronic type B: six). Five patients had Marfan syndrome. In their previous operation, two patients had undergone the Bentall procedure, three had endovascular stenting, one had aortic root replacement with valve sparing and 12 had hemi-arch replacement for acute type A dissection. Approaches to the aneurysm were as follows: posterolateral thoracotomy with rib-cross incision in 16, posterolateral thoracotomy extended to the retroperitoneal abdominal aorta in seven, mid-sternotomy and left pleurotomy in three, anterolateral thoracotomy with partial lower sternotomy in two and clam-shell incision in one patient. Extension of aortic replacement was performed from the aortic root to the descending aorta in 4, from the ascending aorta to the descending aorta in 17 and from the ascending to the abdominal aorta in eight patients. Arterial inflow for cardiopulmonary bypass consisted of the femoral artery in 15 patients, ascending aorta and femoral artery in seven, descending or abdominal aorta in five and ascending aorta in two. Venous drainage site was the femoral vein in 10, pulmonary artery in eight, right atrium in five, femoral artery with right atrium/pulmonary artery in four and pulmonary artery with right atrium in two patients. The operative mortality, 30-day mortality and hospital mortality was one (cardiac arrest due to aneurysm rupture), one (rupture of infected aneurysm) and one (brain contusion), respectively. Late mortality occurred in three patients due to pneumonia, ruptured residual aneurysm and intracranial bleeding. Actuarial survival at 5 years after the operations was 80.6

  13. Transcriptome changes in apple peel tissues during CO2 injury?symptom development under controlled atmosphere storage regimens

    OpenAIRE

    Johnson, Franklin T; Zhu, Yanmin

    2015-01-01

    Apple (Malus ? domestica Borkh.) is one of the most widely cultivated tree crops, and fruit storability is vital to the profitability of the apple fruit industry. Fruit of many apple cultivars can be stored for an extended period due to the introduction of advanced storage technologies, such as controlled atmosphere (CA) and 1-methylcyclopropane (1-MCP). However, CA storage can cause external CO2 injury for some apple cultivars. The molecular changes associated with the development of CO2 inj...

  14. Uniportal video-assisted thoracic surgery lobectomy using a novel perfused ex vivo simulation model.

    Science.gov (United States)

    Avila, Ruben; Achurra, Pablo; Tejos, Rodrigo; Varas, Julian; Solovera, María; Salas, Patricio

    2016-01-01

    Simulation may provide a solution to acquire advanced skills in thoracic surgery, however to date there are no reports in the English literature about a perfused ex vivo model. We developed a low cost and hi fidelity model using an ex vivo in bloc heart and lung specimen from a swine. The swine was previously used in a non-thoracic experiment, so we extracted the lung and heart for this ex vivo based model to reduce animal use. The cost of the whole model is 70 USD and it can be reused many times changing the ex vivo tissue, so this model may help reduce the costs and animal use associated to this high complexity surgery.

  15. [Post-operative analgesia in thoracic surgery: physiopathological features, therapeutic framework and methodologies].

    Science.gov (United States)

    Pavia, R; Barresi, P; Puliafito, M; Canciglia, A; Mondello, B

    2006-01-01

    Pain after surgery is a major handicap for patients as it bounds and decreases ability for spontaneous movement, cough and deep breathing, aiding the onset of complications and invalidating the recovery capabilities of operated patients. In thoracic surgery, the need to compile and employ guidelines for post-surgical pain management has become a pressing requirement in recent years. Currently available protocols include several options of treatment that are frequently a subject in the most recent scientific papers and play a key role, as they constitute the framework upon