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Slipped capital femoral epiphysis is the most common hip disorder in adolescents, and it has a prevalence of 10.8 cases per 100,000 children. It usually occurs in children eight to 15 years of age, and it is one of the most commonly missed diagnoses in children. Slipped capital femoral epiphysis is classified as stable or unstable based on the stability of the physis. The condition is associated with obesity and growth surges, and it is occasionally associated with endocrine disorders such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. Patients usually present with limping and poorly localized pain in the hip, groin, thigh, or knee. Diagnosis is confirmed by bilateral hip radiography, which needs to include anteroposterior and frog-leg lateral views in patients with stable slipped capital femoral epiphysis, and anteroposterior and cross-table lateral views in patients with the unstable form. The goals of treatment are to prevent slip progression and avoid complications such as avascular necrosis and chondrolysis. Stable slipped capital femoral epiphysis is usually treated using in situ screw fixation. Treatment of unstable slipped capital femoral epiphysis usually involves in situ fixation, but there is controversy about the timing of surgery, value of reduction, and whether traction should be used. [ABSTRACT FROM AUTHOR]

The 'understandability phenomenon' (Blanchard, 1992) asserts that older people believe depression to be a normal consequence of old age. However, there is limited empirical evidence to support this concept. A measure was developed with community dwelling depressed and nondepressed older people that examined their belief in this concept. The 'understandability phenomenon' was not related to depression but was related to older peoples' beliefs about their own aging. Depressed and nondepressed older people shared the belief that depression is an inevitable consequence of old age. The understandabilty phenomenon was endorsed by the oldest-old and particularly those living alone. [ABSTRACT FROM AUTHOR]

Reliable assessment of tumor growth in malignant glioma poses a common problem both clinically and when studying novel therapeutic agents. We aimed to evaluate two software-systems in their ability to estimate volume change of tumor and/or edema on magnetic resonance (MR) images of malignant gliomas. Twenty patients with malignant glioma were included from different sites. Serial post-operative MR images were assessed with two software systems representative of the two fundamental segmentation methods, single-image fuzzy analysis (3DVIEWNIX-TV) and multi-spectral-image analysis (Eigentool), and with a manual method by 16 independent readers (eight MR-certified technologists, four neuroradiology fellows, four neuroradiologists). Enhancing tumor volume and tumor volume plus edema were assessed independently by each reader. Intraclass correlation coefficients (ICCs), variance components, and prediction intervals were estimated. There were no significant differences in the average tumor volume change over time between the software systems (p > 0.05). Both software systems were much more reliable and yielded smaller prediction intervals than manual measurements. No significant differences were observed between the volume changes determined by fellows/neuroradiologists or technologists.Semi-automated software systems are reliable tools to serve as outcome parameters in clinical studies and the basis for therapeutic decision-making for malignant gliomas, whereas manual measurements are less reliable and should not be the basis for clinical or research outcome studies. [ABSTRACT FROM AUTHOR]

Objective: The use of laparoscopic techniques in resection of malignant tumours has been proposed to offer potential benefit to the patient in the form of earlier recovery and less immune paresis; however, reported tumour seeding, both peritoneal and at port site, has put this approach into question. The biological effects of the introduction of carbon dioxide or helium to form a pneumoperitoneum on tumour invasion and dissemination are unknown. Methods: A human colonic adenocarcinoma cell line (SW1222) was exposed to in vitro laparoscopic environment of either carbon dioxide or helium for 4 h, mimicking the duration of a laparoscopic colorectal resection. Alteration in production of matrix metalloproteinase (MMP)-2, MMP-9 and urokinase-type plasminogen activator (uPA) due to exposure to a laparoscopic environment was determined by zymogra phy and correlated to invasive capacity by a standard Matrigel-based invasion assay. Incorporation of specific gelatinase inhibitors or antibodies directed at the uPA receptor was utilized to determine the relative importance of proteases. Results: Exposure to the laparoscopic environment significantly enhanced production of the proteases MMP-2, MMP-9 and uPA. A concomitant enhancement of invasive capacity was also observed, being blocked by specific protease inhibitors. Changes in both protease production and aggression were observable for at least 24 h following the removal of the operative environment, indicating the possible long-term effects of the initial insult. Conclusion: Exposure to the laparoscopic environment enhances the invasive capacity of colonic adenocarcinomas via a well-defined protease-determined pathway. It therefore appears likely that tumour cells released into the operative field can be made increasingly aggressive by a laparoscopic operative environment and can thus contribute to disease dissemination. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Although many outcome measures are available, there is little empirical evidence to help clinicians to decide which to adopt in clinical, as opposed to research settings.Aims: To assess the content validity and levels of agreement between professionals and service users of three approaches to outcome measurement--a standard measure devised by mental health professionals (Health of the Nation Outcome Scale, HoNOS), a standard measure devised by service users and health professionals in partnership (the Avon Mental Health Measure, AVON), and an idiographic scale the Outcome of Problems of Users of Services (OPUS).Method: The three measures were completed by nearly 700 predominantly long-term users of mental health services, and by their key worker clinicians. All major psychiatric diagnoses were represented in the cohort. A small sub-sample had repeat testing after 3 months to assess sensitivity to change of the three measures.Results: Agreement between the three measures was low. Avon was more likely to detect problems, and to produce agreement between service users and key-workers, than HoNOS. Both omit key problem areas elicited using OPUS. All measures were sensitive to change.Conclusion: The Avon detects problems that service users judge to be important.Declaration of interest: The current study was funded wholly by the Chief Scientist Office of the Scottish Executive; RH has in the past been in receipt of educational support from a number of pharmaceutical companies. [ABSTRACT FROM AUTHOR]

Previous studies have suggested that cognitive assessments of adult psychiatric patients can be carried out as reliably via teleconsultation as they can face to face. However, the designs of these studies have often been less than satisfactory. The present study used videoconferencing at 128 kbit/s for the cognitive assessment of individuals with a history of alcohol abuse. Twenty-seven participants were given a range of assessments with two equivalent forms. One of the forms was given via videoconferencing and the other face to face. All participants were assessed using both media and the order of presentation was balanced across participants. Aspects of participant satisfaction with teleconsultations were also assessed, on 10-point scales. The teleconsultations were significantly longer (mean 40.7 min, SD 6.4) than the face-to-face sessions (mean 33.0 min, SD 5.3). For most of the outcome measures, cognitive assessment via teleconsultation produced similar results to face-to-face assessment. Most participants expressed high overall satisfaction with the teleconsultation (mean rating 8.2). The average ratings for the sound quality (mean 7.6) and visual quality of the equipment (mean 7.9) were also high. The findings imply that it is not necessary for patients and neuropsychologists to be present at the same location for cognitive assessments to be carried out. [ABSTRACT FROM AUTHOR]

Reports that mouse myoblasts transfected to constitutively express the human muscle-specific 125K glycosylphosphatidylinositol-linked neural cell adhesion molecule (NCAM) isoform more readily fuse to form myotubes. Methods; Results; Discussion.

The article discusses about reversal of a severe case of self-mutilation. When the commoner drug regimes and behavioral procedures have failed to eliminate severe self-injurious behavior (SIB), continuing deterioration in the patient's mental and physical condition may, not only logically but also necessarily, lead to the reluctant consideration of punishment as an ingredient in treatment. The decision to employ a punishment procedure in the case to be described was only reached after consideration and trial of other behavioral treatment procedures, including establishment of (incompatible) alternative behavior and extinction. The adequate use of extinction procedures has been found to be impractical in most hospital settings due to shift changes, individual nursing techniques and turnover.