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Crime prevention and its discourse in the USA has been a series of fits and starts since at least the late 1990s. There continues to exist an absence of any driving force giving direction to a true prevention movement. Most major initiatives that could be considered “prevention” tend to be gut level responses by criminal justice system actors to address existing offending (tertiary prevention) rather than identifying emerging opportunities or prospective problems and developing/initiating true primary or secondary preventive actions. When attempts are made to eliminate initial acts or opportunities to act, there is a marked lack of follow through, leaving only halfhearted attempts. This article attempts to illustrate this failure and the reasons for the failure, and makes suggestions for improving primary and secondary prevention in the future.

Background: A graded series of ocular surface changes has been described throughout the bulbar conjunctiva. The most advanced changes occurring directly over the pterygium surface, confirming that pterygium is indeed an ocular surface disorder.Purpose: Pterygium is characterized as invasive, proliferative fibro-vascular altered conjunctival tissue. The extensive vascular network is likely to significantly contribute to the progression of the disease. The present study aims to correlate the findings obtained from studying the epithelium of true primary pterygium by impression cytology technique and microscopic picture.Design: Prospective clinical study.Methods: This study is a prospective study designed to analyze data of 20 eyes of 20 patients presenting to the Department of Ophthalmology at “Ain Shams University” and at the “Research institute of ophthalmology” with clinically diagnosed pterygium.Results: Histopathological study identified pathological change in epithelium and subepithelial fibrovascular tissue of the pterygium.Conclusion: Histopathological examination of the epithelium of pterygia revealed epithelial changes most prominent directly above the head of pterygium.

Sympatric speciation has been of key interest to biologists investigating how natural and sexual selection drive speciation without the confounding variable of geographic isolation. The advent of the genomic era has provided a more nuanced and quantitative understanding of the different and often complex modes of speciation by which sympatric sister taxa arose, and a reassessment of some of the most compelling empirical case studies of sympatric speciation. However, I argue that genomic studies based on contemporary populations may never be able to provide unequivocal evidence of true primary sympatric speciation, and there is a need to incorporate palaeogenomic studies into this field. This inability to robustly distinguish cases of primary and secondary 'divergence with gene flow' may be inconsequential, as both are useful for understanding the role of large effect barrier loci in the progression from localised genic isolation to genome-wide reproductive isolation. I argue that they can be of equivalent interest due to shared underlying mechanisms driving divergence and potentially leaving similar patterns of coalescence.

Primary insulin-like growth factor-I (IGF-I) deficiency is a synonym of growth hormone (GH) insensitivity (GHI), however the necessity of direct confirmation of GH resistance by IGF-I generation test (IGF-GT) is discussed. GHI may disturb intrauterine growth, nevertheless short children born small for gestational age (SGA) are treated with GH. We tested the hypothesis that children with appropriate birth size (AGA), height standard deviation score (SDS) &lt, &minus, 3.0, GH peak in stimulation tests (stimGH) &ge, 10.0 &micro, g/L, IGF-I &lt, 2.5 centile, and excluded GHI may benefit during GH therapy. The analysis comprised 21 AGA children compared with 6 SGA and 20 GH-deficient ones, with height SDS and IGF-I as in the studied group. All patients were treated with GH up to final height (FH). Height velocity, IGF-I, and IGF binding protein-3 (IGFBP-3) concentrations before and during first year of treatment were assessed. Effectiveness of therapy was better in GHD than in IGF-I deficiency (IGFD), with no significant difference between SGA and AGA groups. All but two AGA children responded well to GH. Pretreatment IGF-I and increase of height velocity (HV) during therapy but not the result of IGFGT correlated with FH. As most AGA children with apparent severe IGFD benefit during GH therapy, direct confirmation of GHI seems necessary to diagnose true primary IGFD in them.

Purpose of review The purpose of this article will be to review neuroendocrine tumours (NETs) of the gynaecological tract. NETs are generally considered to be uncommon and primary tumours in the gynaecological tract on arrival rare or very rare. It is important to distinguish true primary tumours from metastatic as the management is very different. These tumours ranged from highly aggressive small cell carcinomas (SCCs) sometimes associated with secretion of neuropeptides that may be functional and cause distinctive syndromes. On the other hand, the well differentiated low-grade NETs generally behave in a very indolent manner with an excellent prognosis. Very recent new data have identified a molecular marker for small cell carcinomas of the ovary although as yet there is no associated candidate drug. Recent findings Recent developments include the identification of a molecular marker for small cell carcinomas of the ovary of hypercalcaemic type; this will help to identify these tumours more confidently. New therapeutic developments for well differentiated NETs include mammalian target of rapamycin pathway inhibitors and peptide receptor radionuclide therapy. Summary In summary, these are rare tumours with a low incidence although higher prevalence. They require a multidisciplinary approach to management and should be supervised by specialist teams familiar with NETs.

Key points Retrieval medicine is the process by which suitably qualified and trained personnel utilize appropriate equipment and transport platforms to clinically manage and safely transport a patient from one location to another.1 Retrievals can be subclassified into primary, secondary, and tertiary. Primary retrieval is the transport of patients to their initial hospital reception. This may be their nearest hospital, or directly to a larger and more distant centre such as a designated trauma centre.2,3 Secondary retrievals move patients from a non-specialized hospital to a higher level of clinical care such as for neurosurgery, interventional cardiology, complex obstetrics, or paediatrics. Tertiary retrievals transport patients between two similarly specialized hospitals. In ‘modified primary retrievals’, an injured or unwell patient has already been taken to an initial health facility that has minimal capacity to increase the level of care to that provided in the prehospital environment. In these circumstances, the retrieval team apply similar practices to a true primary retrieval, albeit in a more controlled clinical environment.3 In Australia, owing to the large land mass and relatively low population density, specialized medical services are clustered mostly in coastal urban centres. Therefore, many referrals are from rural and remote areas where access to specialist medical services is limited.2 Journeys range from a few kilometres and a few minutes in major capital cities to several thousand kilometres over many hours from isolated rural communities. While distance might not be limiting, other access issues such as …

Background The objectives of this study were to identify a subgroup of patients with putative primary dermal melanoma after thorough multidisciplinary clinical and histological evaluation, and to describe the clinical, histological and selected molecular features of these lesions. Methods The records of the Western Australian Melanoma Advisory Service were searched for potential cases of primary dermal melanoma. The clinical and histological features were reviewed, immunohistochemical assessment was performed and clinical outcomes recorded. Results Eighteen cases of putative primary dermal melanoma with available clinical data were identified. Two of 12 cases in which further histological sections could be obtained were excluded because of the presence of findings suggesting an epidermal origin on these further sections. In one additional case, such origin could not be histologically excluded. Median follow-up period for the remaining cases was 68 months. Confirmed primary dermal melanoma accounts for 0.87% of cases of melanoma referred to a subspecialist melanoma advisory service. These cases show significant histological overlap with dermal/subcutaneous metastases of melanoma, but display a relatively good prognosis, with a 5-year survival of 87.5%. Conclusion Our results support the recognition of a distinct group of melanoma that mimics metastatic melanoma, but is associated with a relatively favourable outcome. The group of putative primary dermal melanoma is likely to be heterogenous, including cases of primary nodular melanoma in which epidermal connection has not been identified, metastatic melanoma with an occult primary lesion and true primary dermal melanoma.

Aim Ovarian cancer is a common cause of death in women worldwide. The purpose of this article was to report a case series and draw physicians’ attention to the benefits of histpathologic techniques in determining uncommon metastatic diseases. Methods In this study, we report a case series of axillary involvement of ovarian cancer in 6 patients. The data were collected between 2006 and 2015 by analyzing patient's characteristics, and biochemical and immunohistochemical features. No pathologic lesions were detected in breasts. Specific immunohistochemical methods such as GCDFP-15, CA12-5, WT-1, and PAX-8 supported evidence of metastasis from ovarian cancer to axillary lymph nodes. Results Biochemical tests showed increased levels of CA12-5 in all patients. In 5 patients, GCDFP-15 was negative and WT-1 was positive with specific immunohistochemical staining. PAX-8 was positive in 3 of 5 patients. Conclusions Physicians need to be aware that histopathologic and immunohistochemical results can make a significant contribution in determining the true primary tissue of metastatic adenocarcinoma, even in the absence of typical clinical findings.

Unlike primary dysmenorrhea, the managements of primary and secondary menorrhagia are often intertwined and complicated by the prevalence of difficult-to-identify secondary causes. When true primary menorrhagia is encountered, the same prostaglandin reduction strategies that work so well in primary dysmenorrhea work well for heavy menstrual bleeding. They also work well for many forms of secondary menorrhagia, raising the possibility that underlying pathologies may be missed if a careful assessment is not carried out before treatment, with equally careful monitoring after initiation. Treatment without such evaluation and care may miss symptoms of an easily corrected condition or neoplastic disease.

The origins of this book began with the success in growing the smallest esophageal segments to normal size in patients with esophageal atresia (EA). It had become clear that the growth procedure effectively tapped into the considerable developmental potential of even the most rudimentary blind ends of the esophagus allowing the benefits of a true primary repair to be realized across the full EA spectrum [1]. Although congenital defects are often loosely considered to be primarily genetic mistakes, the evidence suggests that many of these problems arise from faulty development and, therefore, are potentially reversible. A tiny esophageal primordium poses an obvious obstacle to a primary esophageal repair; however, only the signal is required to effectively restart the well-orchestrated and complex three-dimensional organ development. The signal for the growth and development of organs and tissue is often a biomechanical stimulus, and in the case of long gap EA, axial tension provides it [1, 2].

Long-gap esophageal atresia (LG-EA) has posed repair difficulties for surgeons in rough proportion to the gap length. The possibility of repair will also be affected by the size and condition of the patient and the experience of the surgeon, effectively making the gap longer or shorter. As discussed under The Long-Gap Esophageal Atresia Problem (in this chapter), a good working definition of a long gap is whatever distance makes it difficult and risky for the surgeon to try a true primary repair. It is also clear that a gap length declared by some writers to be favorable for a primary repair will not necessarily be satisfactory in other operating rooms. Consequently, a long gap will not be defined here by a given length but will be left as a conclusion to be made by the surgeon. Certainly, the decision to attempt a primary repair in a patient with LG-EA should be carefully made with a good understanding of the operative techniques which will make it possible.

O A. sintetiza a Exortação Apostólica Pós-Sinodal Verbum Domini, realçando sua estrutura dialógica e chamando a atenção para o que considera os pontos fortes do documento: a continuidade entre a Verbum Domini e a Dei Verbum (do Vat. II) no que concerne à centralidade da Palavra de Deus (Cristo); esta, como sendo o miolo do documento, não a Bíblia, embora esta seja seu receptáculo; uma renovada comunhão entre exegese, teologia e pastoral; Maria, ponto de referência para se compreender a relação entre Palavra de Deus e Igreja; leitura orante e lectio divina como abordagens que favorecem o encontro pessoal e comunitário com a Palavra; a dimensão inerentemente missionária da Palavra de Deus, que se dá, sobretudo, pelo testemunho de vida; o impulso ao diálogo ecumênico e inter-religioso decorrente do encontro com a Palavra; a comunhão e a alegria, resultantes desse encontro; o estilo sapiencial do texto e sua linguagem viva, calorosa e comunicativa, fruto da experiência de encontro com o Verbo encarnado, Palavra de Deus. Neste quadro, a Bíblia é vista como verdadeiro código primordial da humanidade, capaz de falar a uma sociedade plural, desejosa, em tempos de árido relativismo, do Evangelho da Vida.Abstract: The Author summarizes the Post-Synod Verbum Domini Apostolic Exhortation, emphasizing its dialogical structure and calling attention to what he considers to be the strong points of the document: the continuity between the Verbum Domini and the Dei Verbum (of the Vatican II) with regard to the centrality of God’s Word (Christ’s); considering the latter – rather than the Bible that would be just its receptacle – as the kernel of the document; a renewed communion between exegesis, theology and pastoral; Maria as a point of reference in order to understand the relationship between God’s Word and the Church; praying-reading and lectio divina as the types of approaches that encourage the individual and the community encounter with the Word; the inherently missionary dimension of God’s Word, that happens, above all, by the testimony of life; the impulse towards the ecumenical and inter-religious dialogue resulting from the meeting with the Word; the communion and the joy resulting from this meeting; the sapiential style of the text and its lively, warm and communicative language, fruit of the experience of the meetingwith the incarnated Word, God’s Word. In this picture, the Bible is seen as mankind’s true primary code able to speak to a plural and yearning society, at a time of arid relativism of the Gospel of Life.

Luning., K. G., Lake, S. and Linde, M. 1984. Genetics of inbred Drosophila melanogaster XII. Effects of an X-chromosome inversion on primary and secondary non-disjunction.—-Hereditas 100: 247–257. Lund, Sweden. ISSN 0018–0661. Received August 1, 1983 In an inbred line of Drosophila melanogaster. Oregon (code 2), an inversion covering the proximal half of the X-chromosome was induced (symbol: In(l) Lu-l y wd cxvf-2). It has been shown that inversion homozygotes have low frequencies of primary nun-disjunction. in the same manner as equilinear females with regular gene order of the 2–line. Intra-strain structural heterozygotes gave an excess of XO exceptionals but also a 5–fold increase of true primary non-disjunction (XXY) as compared to structural hornozygotes. Inter-strain crosses with mothers from line “K” revealed an influence both by the maternal genome and by the origin of the cytoplasm. Tests of secondary non-disjunction in structural heterozygous XXY females from both intra- and inter-strain crosses indicated highly complicated relations. When the mothers were of “2” origin the first brood showed lower frequencies of XXY exceptionals than in successive broods. whereas when the mother was of “K” origin there was a decrease after the 3rd brood (7th day). The “K”-line showed a dominance effect which was manifested by higher frequencies of XXY exceptionals. In regular daughters the Y-chromosome followed preferentially the proximal part of the X-chromosome of “K”. origin. There was no preference in the Y-chromosome distribution in intra-strain hybrids. There was a pronounced low frequency of recombinants among exceptionals. This indicates that the high frequencies of exceptionals from inversion heterozygous XXY females occur by another mechanism than in equilinear XXY females with the same genetic background.

Interest in primary prevention in mental health has varied depending on the socio-economic, cultural and political climate. True primary prevention looks at the institutional and social structure that fosters growth, promotes adequate development, and optimises mastery as well as identifying and assisting those at high risk. Current ideological forces either ignore or add confusion to that highly complex area. The history of the changes in the paediatric hospitalisation of young children over the last three decades, which originated in the United Kingdom and has covered the globe, serves as a model for looking at what primary prevention can do and its significance for the field of mental health.

The concept and pathologic basis of erythromelalgia outlined by Mitchell in 1878 remained elusive for one century until Michiels discovered aspirin responsive erythromelalgiain thrombocythemia in 1978. On the basis of the description of Mitchell [1] and clinical observations in 81 cases in which burning pain in the hands or feet was a prominent or disabling symptom, Brown postulated in 1932 five basic criteria for the diagnosis of true primary variant of burning red congested extremities [2].

OBJECTIVE: To determine whether or not a true primary repair, without myotomies and with the gastroesophageal junction below the diaphragm, can be accomplished across the esophageal atresia (EA) spectrum. Our hypothesis is that the esophageal anastomosis can withstand significant tension. The consequences, particularly for those patients with a very long gap atresia, were assessed. SUMMARY OF BACKGROUND DATA: Difficulties arise roughly in proportion to the size of the gap between esophageal segments. Reported surgical complications remain frequent, and particularly at the far end of the EA spectrum, not all children are left with a satisfactorily functioning esophagus or esophageal substitute. METHODS: The outcomes of all infants who had a true primary repair of EA from 1976-1997 were determined. Surgically, the methods used to achieve a reliable true primary repair were expanded to accomplish this, even for a very long gap EA. RESULTS: From 1976-97, 70 infants with or without associated tracheoesophageal fistula (TEF) had primary repairs performed with no surgery-related deaths and 11% later deaths. No interpositions were performed since 1983. There were no discernible anastomotic leaks and one late recurrent TEF related to the early use of balloon dilation. Ten infants had gaps of 5.0-6.8 cm and, among these, four had gaps of 5.5-6.8 cm that could not be pulled together initially. Traction sutures in the esophageal ends, however, produced sufficient lengthening within 6-10 days for a true primary repair. Very long gap repairs produced more reflux (10 of 10 required a fundoplication versus 24 of 70 overall) and more dilations to relieve strictures. Two infants underwent stricture resection with no recurrence. On follow-up, all patients over 2 years of age were eating well or satisfactorily, and none had a gastrostomy tube. CONCLUSIONS: (1) The esophageal anastomosis can withstand considerable tension and allows a reliable true primary repair for the full EA spectrum. (2) Growth is rapid and traction sutures will produce significant esophageal lengthening within days. (3) With increasing tension, gastroesophageal reflux (GER) and strictures are more common; however, both are treatable. Follow-up reveals the benefits of true primary repair over other solutions.

It is difficult for many persons with physical disabilities to find and access primary health care. This article discusses this problem from the perspective of a physiatrist. It discusses the components of primary health care and then compares and contrasts the current status of the training, skills, and interest levels of generalist physicians and physiatrists in providing primary medical care for disabled persons. It includes a discussion of the artificiality of the specialist/generalist dichotomy and the concept of specialists providing true primary care to certain patient populations. General and personal strategies are suggested to influence and to change the health care system so disabled persons can find and have improved access to good primary health care.

We report a case of nontraumatic, spontaneous venous aneurysm of the left axillary vein. This case may represent only the second such case ever reported in the English-language medical literature. Venous aneurysms are often associated with trauma, arteriovenous fistula, or other venous abnormal hemodynamic conditions, but true primary venous aneurysms are very rare. Surgical excision was uncomplicated and performed easily.

Malignant melanoma involving the respiratory tract is nearly always metastatic. True primary tumors are very rare, and only approximately 28 cases have been reported in the literature. Extensive clinical and histopathological examinations are needed to ascertain that the lung is the primary site. We present the case of a 67-year-old man with an apparent primary malignant melanoma of the lung in the right lower lobe. We also review the literature.

Issue tracking systems play a critical role in software maintenance by allowing users and developers to submit problem reports for observed failures. A major problem in these systems is that two or more users can, and do, submit reports describing the same issue. Automated classification of such duplicate problem reports is an area of active research. The corpus of existing research shows a slow improvement in classification accuracy using relatively small subsets of problem report data. When applied to an entire project's problem repository, they exhibit a reduction in performance. In this paper we propose a novel duplicate report detection approach using multi-label classification. We use a suite of 24 duplicate classification techniques and MULAN software package to train a multi-label classifier. This multi-label classifier selects a set of similarity measures (from a pool of measures) that are most likely to find the true primary report. To demonstrate its effectiveness the method was tested on the entire Firefox repository. This data set encompasses 12+ years of problem reports and contains over 30, 000 duplicate reports. Our results indicate that multi-label classification boosts the performance of the individual measures by up to 40% while returning overall results that match or outperform existing methods. The proposed method uses less than 1% of the dataset for training.

Leibniz looked upon space as an order of co-existing, independent things which differ from each other. Starting from this approach, we may ask whether two specific differences among given things - e.g. one between A and B , the other between C and D - in their turn differ from one another. Steiner, inspired by Leibniz’s approach, showed that on this second level of abstraction they indeed do. However, if we proceed to a third level of abstraction, comparing differences observed on the second stage of abstraction, we shall no longer detect any material, “palpable” difference. In short: Setting off from the co-existence of different things and analysing whether qualitative, material differences are still evident on a second and a third level of abstraction, we are led to conceive space as a system comprising three qualitatively discernible dimensions. - Concerning time , Leibniz and Steiner looked upon it as an arrangement of items succeeding one another. To understand this requires - if we follow Leibniz − to be able to perceive motion . Now, most moving items are passively driven into motion, depending on an external source which imparts the movement. In contrast to that, an actively moving thing generates within itself the impulse to modify its location in relation to other items. Within the world of sensory perceptions, “organic bodies” ( i.e. organisms) are capable of self-motion to a certain extent. Nonetheless, a true primary self-motion can only be postulated of a completely independent being. Herewith, Leibniz’s approach to the origin of motion and the therein implied up-welling of time reveals itself to be intimately related to lines of thought developed by Plato, Aristotle, and Plotinus - albeit employing completely different terms.

Numerous cases of associations of encyrtid wasps with ants have already been reported. In the majority of these cases, however, wasps are associated only indirectly with ants (interference associations) through primary parasitism of the trophobionts (Coccoidea), which are exploited and protected by ants. Suspected direct parasitism cases are unusual and no direct attack of encyrtids on ants has ever been demonstrated. Here we provide both a revised list of all known cases of associations between encyrtid wasps and ants, and a report of the first record of a true primary encyrtid parasitoid of ants. Of two colonies of the arboreal ponerine ant, Pachycondyla goeldii (Forel), examined from French Guiana, one had 3 pupae parasitized by males and females of a gregarious, minute encyrtid wasp species, identified as Blanchardiscus pollux Noyes, and 2 other cocoons presented evidence of pararasitism. This first host record for the genus Blanchardiscus, which has always been placed near other genera that ...

Community-wide or population approaches are essential in most health promotion and prevention strategies. However, much less is known about these methods compared with traditional clinical approaches. Why is the community approach essential? Most common health problems amenable to prevention have strong environmental, cultural, lifestyle, and behavioral components. People, communities, whole countries make choices about whether or not to consume alcohol, and drive, smoke cigarettes, exercise, or have their children immunized. All of these involve individual choices but also involve societal or cultural barriers and enticements, access, and availability, monetary and opportunity costs, laws, and other community-wide factors. While some prevention issues respond to traditional clinical or health care approaches, most do not. They require a coordinated community approach to support the preventive efforts of the health care sector and develop an environment and an educated population which makes prevention possible. If we are to approach true primary prevention or elimination of major health impairing conditions, the population approach is a necessary element.

Sarcoidosis is a systemic disease of unknown cause resulting in the development of non-caseating granulomas that can affect all organs of the body, but with predominant pulmonary involvement. Pulmonary sarcoidosis has a wide variety of radiographic features. The most common computed tomography (CT) feature of pulmonary sarcoidosis is irregularly-thickened bronchovascular bundles that pathologically present as the presence of peribronchial granulomas.1 However, cavitary pulmonary lesions are uncommon, and in particular, true primary cavitary sarcoidosis extremely rare.2e4 In this report, we present a case of a primary cavitary sarcoidosis with “lotus seed-like” manifestations.

A report of 22 cases of true primary transitional carcinoma of the ureter is presented. Evaluation of these cases shows that grades III and IV lesions have a poorer prognosis than grades I and II and that staging in ureteral tumors is a difficult task and unreliable for predicting survival. A conservative approach at management of low-grade lesions is suggested.

True primary cervical pregnancies are rare. Although these can cause massive hemorrhage, most of these abort during the first trimester without having been diagnosed. However, cervico-isthmic and cervico-isthmic corporeal pregnancies are more likely to persist to an advanced gestation in the second and third trimester and cause profuse bleeding with attempted removal of the placenta.A case of cervico-isthmic corporeal pregnancy at term with near exsanguinating hemorrhage is reported. A 35-year-old Sri Lankan woman presented for prenatal care with the complaint of daily, painless vaginal bleeding. An ultrasound showed a cervical pregnancy. Despite counseling regarding the poor outcome of cervical pregnancies, the patient wished to continue the pregnancy. At repeat cesarean section, bleeding was profuse requiring pressure, electrocautery, and oversewing the uterus. The patient developed massive bleeding in the recovery room, requiring laparotomy, and total abdominal hysterectomy to control bleeding. She received multiple blood transfusions and required re-exploration for recurrent hemorrhage. The pathology report revealed a placenta accreta and chorionic villi at the junction of the isthmus and cervix. After a long hospital course, the patient was discharged.Cervical pregnancies involving the isthmus and isthmus and corpus are more common than true cervical pregnancies. They are significant because placental involvement of the cervix can cause erosion of the uterine arteries and massive bleeding when placental removal is attempted. Anticipatory planning, including permission for hysterectomy if necessary, may lead to improved maternal and fetal morbidity.ObstetriciansGynecologists, Family Physicians.After completion of this article, the reader should be able to distinguish the different types of cervical pregnancies, describe management strategies for cervical pregnancies, and summarize the diagnostic criteria for cervical pregnancies.

A study was undertaken to analyze seton fistulotomy with counter drainage as a treatment modality for horseshoe abscess fistula. In a previous report of 27 patients with partial or complete horseshoe abscess fistula, 24 patients underwent primary fistulotomy and counter drainage with a recurrence rate of 28.6 percent. Two patients were treated by seton fistulotomy and counter drainage with no recurrence. Therefore, nine additional patients underwent this procedure. Recurrent horseshoe abscess fistula occurred in 2 of 11 patients (18.1 percent). Seton fistulotomy with counter drainage has become the authors' operative procedure of choice for horseshoe abscess fistula. This method may prove more effective if the true primary abscess cavity is identified, the seton is removed appropriately, and postoperative care of the cavity is adequate. Method of management is discussed.

Individuals with primary aldosteronism make up a substantial proportion of those with hypertension. Less well appreciated is what appears to be inappropriately elevated aldosterone secretion in hypertensive patients who do not meet the criteria for true primary aldosteronism. This finding is particularly true of African-Americans. An additional, recently described, aspect of aldosterone excess is its apparent contribution to insulin resistance as evidenced by the frequent association of primary aldosteronism with the metabolic syndrome. Thus in the management of, not only hypertension, but also certain metabolic conditions, greater consideration should be given to the participation of aldosterone.

Objectives Eye injuries are relatively common following detonations. The majority of these are caused by secondary fragments. Primary blast injury to the eye (from the air-blast alone) has been described historically, but the differentiation of air-blast and fragment aetiologies in the reports is not clear. The aim of this review is to consider the evidence in the literature for true primary blast injury to the eye. Methods A literature review using Medline, Pub-med and Web of Knowledge databases. Conclusions Overall, there is little conclusive evidence that primary ocular blast injury occurs in survivors of explosions. However, some case reports do surmise its occurrence and it cannot be unequivocally ruled out. If it does occur, it is more likely to be at high overpressures that will produce life-threatening injuries. The development of enhanced blast weapons may result in an increased incidence. At present however, the most severe and damaging threat to the eyes from blast remains the impact of fragments and debris.

Context.—Primary bladder angiosarcomas are extremely rare, and their clinical and pathologic features are not well described. Objective.—To further refine the clinical features of primary bladder angiosarcomas and define their pathologic spectra. Data Sources.—Relevant sources were identified using MEDLINE and a subsequent bibliographic search of all pertinent reports and reviews. We also searched the M. D. Anderson pathology archives. Study Selection.—After excluding 4 cases that likely secondarily involved the bladder, we identified 9 true primary bladder angiosarcomas. Data Extraction.—Data were extracted on the following: demographics, clinical presentation, predisposing factors, gross pathology, microscopic pathology, immunophenotype, therapy, and outcomes. Data Synthesis.—Primary bladder angiosarcomas were found at a mean age of 64.2 years, with a male-female ratio of 8:1. Two cases arose in a postirradiation setting. Primary bladder angiosarcomas typically presented with hematuria and were grossly hemorrhagic, raised masses (mean size, 6.7 cm) of the trigone and/or dome. Histologically, most showed classic anastomosing channels lined by plump hyperchromatic cells, though many showed variant histology such as solid growth and epithelioid cytology. Three (43%) of 7 patients died within a year, but only 1 patient died with evidence of disease. The remaining patients were alive at the time of publication of their respective cases (mean, 22 months). Conclusions.—Primary angiosarcomas of the bladder are typically rare tumors of middle-aged and elderly men that present with locally advanced disease and show a wide histologic spectrum. However, their prognosis may be better than previously thought.

Our purpose is to present our results using a flexible surgical approach to achieve a true primary repair for all infants with esophageal atresia (EA). The proposed methods are designed to reach this goal, even when most of the intrathoracic esophagus is missing. What has made this goal attainable is the ability to rapidly induce esophageal growth. We reviewed the results of 63 consecutive patients who presented between 1984 and 2004 with an esophageal gap of greater than 2.5 cm, a distance where increasingly difficult repairs begin. Gaps of 4 cm or longer (46), 6.0 cm or longer (14), and over 10 cm (3) were included. Repairs begun elsewhere (20) included 17 spit fistulas. We present 3 surgical stages, designed to overcome tension and, for longer gaps, induce esophageal growth. For 25 infants, traction in the operating room was sufficient to dissipate tension and allow a primary repair. For the longest gaps, successful esophageal growth was induced over days in 38 patients by internal (5), external (23), and mixed internal/external traction (10). Growth quickly produced adequate esophagus for a primary repair. We conclude that adequate esophageal growth can be induced within days, even early in infancy, and this flexible approach allows the entire EA spectrum to be repaired primarily.

Ink jet printing is the only true primary non-impact printing process whereby a liquid ink is squirted through very fine nozzles and the resultant ink droplets form an image directly on the substrate (Gregory, 1991). In the main competing technologies of electrophotography (photocopying and laser printing) and thermal transfer printing, further components and steps are required to form the image, namely a photoconductor drum or belt and a transfer ribbon, respectively.

Urethral calculi could be either classified as either primary or secondary calculi based on their origin. Primary calculi form in the urethra, whereas secondary calculi have their origin elsewhere in the urinary tract.1 True primary calculi are rare and they mostly form in prostatic and membranous …

True primary venous aneurysms are rare. This is the first report of such an aneurysm involving the lesser saphenous vein. Though most often a medical curiosity, such lesions can result in serious morbidity and even mortality. Because of their rarity they are often misdiagnosed. Salient features pertaining to classification, diagnosis, and treatment are reviewed.

Dear Editor, Antiphospholipid syndrome (APS) has become a popular diagnosis among practicing clinicians owing to rapid developments over the last two decades. Uppal and Bammigatti need to be commended for their extensive review of the recent advances in the classification, pathogenesis and management of the syndrome. 1 In addition to describing the basic pathophysiology well, they have succeeded in keeping a strong clinical focus. Originally described in patients with SLE, and later identified in patients sans SLE; two major classes of APS, were recognized. Recent revisions in diagnostic criteria have highlighted five categories of APS, as described in this current update. Predominantly seen in younger female patients with functional ovaries, extensive infarcts leading to cortical blindness and neurological sequelae have been reported even in an octogenarian with APS in a single case report. 2 As the first event of thrombosis usually occurs before the age of 60 years, it is necessary to exert caution before interpreting this as a case of true primary APS developing denovo after the age of 60 years. It is also noteworthy that as many as 7–50% elderly patients have been found positive for aPL or aCL antibodies in different series, especially associated with multiinfarct dementia. 3,4 Clinicians should rule out malignancy before diagnosing primary APS in elderly patients and a higher risk of bleeding merits a careful risk benefit analysis before setting target INR for anticoagulation. 4 The current article is especially useful for postgraduates and practicing clinicians alike and aptly highlights the recent guidelines on the diagnosis and treatment as well as the various controversies surrounding anticoagulation. We request the editors to include more such clinically relevant and practically oriented reviews in future issues of the journal.

Ore lead isotope ratios from 37 deposits in the Svecokarelian of Fennoscandia are linearly related. Although the anomalous Svecokarelian ore lead line is generally compatible with the Stacey—Kramer two-stage model for the growth of primary lead, closer inspection reveals that the ore lead isotope variations are more consistent with a continuous mixing process. The anomalous lead line is consistent with Hietanen's plate tectonic model for the Fennoscandian Svecokarelinides. The ore lead isotope ratios are spatially related to a trench related to a sub-duction zone in the south-west of the region. This relationship is comparable to that observed in the 1.8-Ga younger Japanese island arc. The Svecokarelian leads are not true primary leads, and the mineralization age given by the Stacey—Kramer model is a minimum age. The apparent source age probably has no simple geological meaning.

A pair of monozygotic female twins with true primary microcephaly is described. The autosomal-recessive nature of the disease is supported by the following: the twins are concordant for the disease; the parents, themselves normal, are related; the reduced skull dimensions were noted at birth; neurologic problems are absent; the karyotype is normal; the gestation and delivery were normal, without any history of influences capable of inducing microcephaly. A detailed dermatoglyphic study is given.

The availability of natural matrix reference materials evaluated for trace element content has resulted in their widespread use as standards (i.e., calibration materials; comparators) for instrumental neutron activation analysis (INAA). Due to the uncertainties associated with their certified values, the limited number available, and the relative matrix independence of INAA, these reference materials are more properly utilized as quality assessment materials, after calibration of the INAA analytical system with true primary standards. Terminology is defined, the use of matrix reference materials to evaluate the analytical system is discussed, techniques for the accurate preparation of primary standards for trace element analyses are reviewed, and necessary precautions in the accurate comparison of samples to standards are presented.

Summary To clarify the old morphological problem of homologies of the grass seedling, 267 species of Monocotyledoneae, representing 136 genera of 36 families (including 48 genera of Gramineae) were investigated at seedling stage. The so-called “primary root” of grasses is an ordinary shoot-borne root as well as all the following ones. Every shoot-borne root, developing in early seedling stages, possesses a coleorhiza, which develops from outer cortical tissue by strong cell elongation. Such coleorhizas are widespread among monocotylous seedlings. The coleorhiza of the first endogenous root of the grasses develops from root pole tissue of the embryo owing to the growth direction of this root. The embryonic root pole or a vestigial primary root, respectively, is situated on the top of this first coleorhiza. No true primary root among flowering plants possesses a coleorhiza.

SummaryThe petrological interpretation of the variation of K2O content with depth to the Benioff zone in orogenic magmas is complicated by several factors: (1) Magmas may not be true primary liquids but have under-gone differentiation. K2O contents, at a specific SiO2level, will depend upon the SiO2content of the parental magma and the natureof the crystallizing phases more than on original K2O content. (2) The depth to the Benioff zone may not give a true reflection of the depth of melting. Magmas may not be derived from the uppermost layer of subducted oceanic crust but rather the overlying upper mantle. Earthquakes may not occur in the uppermost layer of the subducted plate, but in its colder, central parts. Hence, earthquake depth may not be related to the source of the magma. (3) It is difficult to envisage how the temporal increase in K2O may occur in certain areas (e.g.Aleutian I., Fiji) if it is primarily controlled by the depth to the Benioff zone.There may be some correlation between K2O content of magmas and earthquake depth, but its cause is difficult to determine. None of the existing explanations is entirely satisfactory, and it is suggested that varying degrees of fractional crystallization may play an important role in controlling K2O contents.

It has been generally accepted in many surgeons that the anal crypt, duct and glands are recognized en bloc as the source of origin of fistula-in-ano. Being derived from clinical experinces and concepts, I attach importance to the anal gland and its surrounding tissue as a true primary focus of the fistula-in-ano. The excision of the primary focus has shown very effective to my expectation. In my consideration it is suggested that the excision of primary focus can bring an extinction, of inflammation of unexcised tracks and abscess due to the favoralbe role of preserved mucosa, preventing from contamination. This method could be suitalble to the hope that the ultimate aim of operation lies in obtaining best results diminshing unfortunate distress and disturbances after the operation. Though several pro-blems are still left to be answered in the future, I have recognized the significant role of presserved mucosa and obtained very interesting results.The foundamental method of operation was described with showing two simple cases.

Twenty-five patients with primary genital herpes were treated in a double-blind placebo-controlled randomized trial of intravenous acyclovir. Thirteen patients received the drug and 12 a placebo. Three in each group were male. In the acyclovir group 10 patients had true primary herpes compared with six in the control group. The median time to healing of all lesions was significantly decreased from 11 to seven days (p less than 0.05), and the median duration of viral shedding from all lesions was decreased from eight to two days (p less than 0.001). The time to cessation of new lesions was decreased from a median of two days to zero days (p less than 0.001). Intravenous acyclovir is an effective treatment in decreasing the length and severity of primary genital herpes.

Radiometric dating of the serorogenic Svecokarelian Enkullen and Fjallberg granites, south central Sweden, yield two parallel Rb-Sr whole-rock isochron ages of 1755 ± 17 Ma and 1758 ± 14 Ma, respectively. The initial 87Sr/86Sr ratios arc also similar; 0.7063 + 0.0056 and 0.7065 ± 0.0034, respectively. A U-Pb dating of zircons from the Fjallberg granite also gives a corrsponding age, i.e., an upper intercept with concordia of 1748+74 -45 Ma. A recalculation of the zircons with the U-Pb model of Wickman (1983) yields an age of 1765 Ma. The agreement between the Rb-Sr and U-Pb datings strongly indicates that they represent true primary crystallizing ages.

The photolysis of pure N2O, N2O and N2, and N2O and C3H6 mixtures at 1470 A and room temperature has been studied to determine the relative importance of the primary processes. The results are where ϕ{O(1D)} = 0.515 represents both the O(1D) produced in the primary act and that produced by collisional quenching of O(1S); ϕ{N2(3Σ)} = 0.084 represents only that portion of N2(3ϕ) which dissociates N2O on deactivation; and ϕ{O(1S)} = 0.38 – ±{N(2D)} represents only that portion of O(1S) which enters into chemical reaction with N2O. If the reaction of O(1S) with N2O yields only N2 and O2 as products, which seems likely from potential-energy curve considerations then ±{O(1S)} = 0.135 ± 0.06 and ϕ{N(2D)} = 0.245 ± 0.06. Young and coworkers [4] have found from spectroscopic observations that the total quantum yield of O(1S) is about 0.5. Thus it can be concluded that collisional removal of O(1S) by N2O yields mainly O(1D) with chemical reaction being less important. Furthermore, most of the O(1D) is produced this way, and the true primary yield of O(1D) is about 0.15. The metastable N(2D) is not deactivated by N2O, but is removed by chemical reaction to produce N2 and NO. The results further indicate that N2(3Σ) dissociates N2O at least 80% of the time during quenching. The relative efficiency of N2O compared to N2 is about 2 for the removal of O(1D). O(1S) is removed about 90 times as efficiently by C3H6 as by N2O.

The efficacy of a delayed release preparation of metformin (‘Obin’)† has been evaluated in 60 diabetic patients either obese and uncontrolled by diet alone or true primary or secondary failures to sulphonylurea treatment. The results show no difference in the therapeutic response between single and twice daily administration of ‘Obin’; likewise there was no difference in frequency of side-effects.

In cases of true primary carcinoma of the lung surgery as yet offers little hope of relief. No completed group of cases of this disease treated by irradiation has been reported, and among the cases reported singly there are no authentic cures. A group of nineteen patients treated by high-voltage roentgen rays is reported. All died within ten months, all but three within four months. This brief period of survival is the same as that in a group of cases in which there was no treatment. In spite of the fact that life is not prolonged, roentgen-ray treatment in all but advanced cases gives marked temporary palliation.