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Michelle T Nguyen, Laurence B McCullough, Frank A Chervenak
In obstetric practice, each pregnant woman presents with a composite of maternal and fetal characteristics that can alter the risk of significant harm without cesarean intervention. The hospital's availability of resources and the obstetrician's training, experience, and skill level can also alter the risk of significant harm without cesarean intervention. This paper proposes a clinical ethical framework that takes these clinical and organizational factors into account, to promote a deliberative rather than simplistic approach to decision-making and counseling about cesarean delivery...
October 25, 2016: Journal of Perinatal Medicine
Peter Angelos
When an esteemed elderly colleague needs assistance completing procedures safely, fellow health professionals have the responsibility to respond in order to mitigate risk to patients. There is a strong ethical basis for bringing the surgeon's declining capacity to his or her attention as well as to the attention of others. Ongoing capacity assessments could be one method for tracking diminished capacities among surgeons so that they can stop practicing surgery before putting patients at risk.
October 1, 2016: AMA Journal of Ethics
Monica Chahal-Kummen, Trond-Eirik Strand, Jan Ove Owe, Eigil Gulliksen, Anthony S Wagstaff
BACKGROUND: A candidate with paraplegia contacted the Institute of Aviation Medicine, Oslo, requesting a medical examination and medical certification for flying back seat on an F-16 Fighting Falcon. Thorough aeromedical examinations, including specialist evaluations, were initiated for the final decision to be made. CASE REPORT: Almost 13 yr earlier the candidate had acquired spinal cord damage at neurological level L1 after falling 4 m (13 ft) from out of a window...
2016: Aerospace Medicine and Human Performance
Johan De Meester
From late nineteen nineties, the higher number of suitable renal transplant candidates has forced the transplant community to re-explore the whole spectrum of deceased donors after brain death (DBD) as well as after cardiac death (DCD); in practice, donors of older age and donors with more chronic diseases or "medical complexities". This new kidney donor population - finally defined as extended criteria donors (ECD) - currently comprises on average 20 to 25%. In his seminal paper in 2003 on the introduction of ECD in the US, Metzger et al...
October 25, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Inger Hagqvist, Stig Rödjer, Anna Aggeryd, Ebba Holmberg, Göran Bondjers
Experiences from PLUS - program for learning and development in Swedish health care In Sweden, more than half of newly registered physicians have been trained outside of the country. Thus, they are not familiar with Swedish culture and the Swedish healthcare system. To support their introduction to a professional carrier in Sweden, in line with the WHO ethical code for recruitment of health personnel, the health care region of Western Sweden established PLUS - program for learning and development in Swedish Health care...
October 24, 2016: Läkartidningen
Gen Kano, Hisashi Tsujii, Kazuhiko Takeuchi, Kaname Nakatani, Makoto Ikejiri, Satoru Ogawa, Hisami Kubo, Mizuho Nagao, Takao Fujisawa
Primary ciliary dyskinesia (PCD) is a rare genetic disorder caused by structural and/or functional impairment of cilia throughout the whole body. Early diagnosis of PCD is important for the prevention of long‑term sequelae, however early diagnosis is a challenge due to the phenotypic heterogeneity of PCD. In the current study, the patient with PCD was diagnosed at nine years old following several efforts to control intractable airway symptoms. The patient experienced a chronic productive cough beginning in early childhood and had multiple episodes of pneumonia and otitis media with effusion and sinusitis...
October 21, 2016: Molecular Medicine Reports
Hashim Ali Khan, Muhammad Aamir Shahzad
PURPOSE: To report a case of atypical serpiginous choroiditis with previously unreported findings on optical coherence tomographic angiography. CASE REPORT: A 35-year-old otherwise healthy man had a 1-week history of vision loss in his right eye. The visual acuity in right eye was counting fingers at 1 meter. Fundoscopy showed a classic peripapillary serpiginous lesion and a solitary macular lesion. Fundus fluorescein angiography revealed early hypofluorescence of active lesions with gradual increase in fluorescence across the phase of angiogram...
October 25, 2016: Optometry and Vision Science: Official Publication of the American Academy of Optometry
L Balazova, K Krskova, M Suski, V Sisovsky, N Hlavacova, R Olszanecki, D Jezova, S Zorad
Increasing evidence indicates a role of oxytocin in controlling energy metabolism. The aim of his study was to investigate oxytocin effects on obese phenotype in leptin-resistant Zucker fatty rats, focusing on glucose and lipid metabolism. Zucker fatty rats and their lean controls were treated with oxytocin (3.6 μg/100g body weight/day) by osmotic minipumps implanted subcutaneously for 2 weeks. Two-hours intraperitoneal glucose tolerance test was performed in fasting rats. Oxytocin decreased food intake in both phenotypes while body weight gain reduced only in obese animals...
August 2016: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
S Sindhu
Stripped of any sense of comfort or dignity on that hospital bed, my 84-year-old father, my best friend, was enduring raw, intrusive medical procedures against his own wish; defenseless, vulnerable, agonized. A feeding tube went in through his nose; catheter tubes drained urine out of his bladder; a suction pump drew out fluid from his airway. A needle jammed into the central line, making it impossible for him to turn his head. Dialysis took over the job of his kidneys. But no painkillers were given for fear his weak heart could not take more chemicals...
October 25, 2016: Journal of Pain & Palliative Care Pharmacotherapy
N Vos de Wael
There is a growing interest in the cost-effectiveness of psychiatry in general. How do client organisations regard this growing interest?<br/> AIM: To discuss the cost-effectiveness of psychiatry in general seen from the perspective of the patient/civilian and his or her environment.<br/> METHOD: A critical appraisal of cost-effectiveness in psychiatry on the basis of a case-study and relevant developments in society.<br/> RESULTS: The increasing interest in the cost-effectiveness of psychiatry should be seen as a positive development, but we must be aware of the complexity of the factors involved and of the complications that are linked to this increased interest...
2016: Tijdschrift Voor Psychiatrie
Lessandro Curcio, Bruno Salama, Daniel Luis Pinto, Antonio Claudio Ahouagi
BACKGROUND: Nephron sparing surgery (NSS) is well established as the standard of care for most surgical small renal tumors when technically feasible. While the majority of sporadic renal tumors are solitary, multifocal tumors have been reported in 5.4% to 25% of patients with tumors smaller than 5cm. We present a video where we approach, through laparoscopy, four tumors on the same kidney. CASE STUDY: Male, 58y, went through a routine abdominal ultrasound which showed a 5cm left kidney nodule...
October 20, 2016: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Jose Luis Ramírez-Bellver, Joaquín López, Elena Macías, Victoria Alegría, Ignacio Gimeno, Alejandra Pérez-Plaza, Heinz Kutzner, Luis Requena
Liposarcoma usually arises in deep soft tissues and pleomorphic liposarcoma is the rarest histopathologic variant. However, 15 cases of entirely dermal pleomorphic liposarcoma have been reported. We describe a case of a 79 year-old male who developed a rapidly growing nodule on his thorax. Excisional biopsy was performed and immunohistochemical studies were carried. The lesion was a well-circumscribed dermal nodule composed of multivacuolated pleomorphic lipoblasts and atypical mitotic figures. Neoplastic cells expressed CD10 and resulted negative S100 protein, Melan A, MITF-1, AE1/AE3, CD4, CD68 (PGM1), Retinoblastoma gene family protein, pericentrine and lysozyme...
October 24, 2016: Journal of Cutaneous Pathology
John D Fisher
In the words of the legendary late John Messenger, pacemakers have evolved from the equivalent of a pirate's peg leg that simply prevents you from falling down, to a fully articulated prosthesis. Each "ultimate" step has been succeeded by ever more sophisticated devices. Very early attempts at providing atrioventricular synchrony included metal wire connections between atrium and ventricle, and His bundle pacing with large screw-in electrodes. These efforts failed, largely because of poor conductivity, excessive fibrosis and loss of capture...
October 24, 2016: Pacing and Clinical Electrophysiology: PACE
James P Daubert
Stimulation of the His bundle was reported first in canines and then in humans nearly half-century ago and was characterized by a QRS morphology identical to both the native QRS and to that produced by atrial pacing. (1 2 3,4) The isoelectric interval between the His bundle pacing stimulus and the QRS equaled the native HV interval. This article is protected by copyright. All rights reserved.
October 24, 2016: Pacing and Clinical Electrophysiology: PACE
Simone Fattorini
Hewett Cottrell Watson and Edward Forbes were two naturalists of the Victorian age. They were protagonists on a dispute that generated comment and serves as an illuminating case study of misunderstanding in priority issues. Watson accused Forbes of having plagiarized his original classification of the British plants into groups on the basis of their geographical distribution. This controversy originated mostly from a so-far-ignored basic difference in Watson's and Forbes' ideas about biogeographical regionalization...
October 24, 2016: Journal of the History of Biology
Malgorzata Banys-Paluchowski, Eike Burandt, Joanna Banys, Stefan Geist, Guido Sauter, Natalia Krawczyk, Peter Paluchowski
Breast cancer (BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation...
October 10, 2016: World Journal of Clinical Oncology
Yasutaka Tajima, Mariko Matsumura, Hiroaki Yaguchi, Yasunori Mito
In rare instances, recipients of organ transplants from human T-lymphotropic virus type I- (HTLV-I-) positive donors reportedly developed neurologic symptoms due to HTLV-I-associated myelopathy (HAM). We present herein two cases of HAM associated with renal transplantation from HTLV-I seropositive living-donors. The first patient was a 42-year-old woman with chronic renal failure for twelve years and seronegative for HTLV-I. She underwent renal transplantation with her HTLV-I seropositive mother as the donor, and she developed HAM three years after the transplantation...
2016: Case Reports in Neurological Medicine
Melissa A Wilson, Kelly Guld, Steven Galetta, Ryan D Walsh, Julia Kharlip, Madhura Tamhankar, Suzanne McGettigan, Lynn M Schuchter, Leslie A Fecher
BACKGROUND: Ipilimumab, a humanized CLTA-4 antibody is a standard therapy in the treatment of advanced melanoma. While ipilimumab provides an overall survival benefit to patients, it can be associated with immune related adverse events (IrAEs). CASE PRESENTATION: Here we describe a patient treated with ipilimumab who experienced known IrAEs, including hypophysitis, as well as a profound vision loss due to optic neuritis. There are rare reports of optic neuritis occurring as an adverse event associated with ipilimumab treatment...
2016: Journal for Immunotherapy of Cancer
Rosa M Michel Ortega, Daynna J Wolff, Cynthia A Schandl, Harry A Drabkin
BACKGROUND: Malignancy after transplantation is an uncommon multifactorial occurrence. Immunosuppression to prevent graft rejection is described as a major risk factor in malignancy development in the post-transplant state. Donor-derived malignancy is a rare reported complication. Herein, we review our patient history and discuss diagnostic strategies and the implications of immunosuppression for donor-derived malignancy. CASE PRESENTATION: This is a 69-year-old man with post-renal-transplant urothelial carcinoma determined to be of donor origin...
2016: Journal for Immunotherapy of Cancer
Kenneth G Liu, Amit Verma, Olga Derman, Noah Kornblum, Murali Janakiram, Ira Braunschweig, Ramakrishna Battini
BACKGROUND: Population studies showed that patients with JAK2 V617F mutation had increased mortality, and increased risk of any cancer, hematologic cancer, and myeloproliferative disease. CASE PRESENTATION: A 68-year-old Asian male with JAK2 V617F mutation developed four different hematologic and non-hematologic neoplastic processes. In 2009, he was diagnosed with stage IA lung adenocarcinoma and also noted to have worsening leukocytosis and thrombocytosis with peak platelet count of 1,054,000/mL)...
2016: Biomarker Research
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