摘要:

The provision of health care is increasingly being led by the primary sector and the necessity to eliminate ineffective procedures has been recognised. Eventually, scarcity will have to be dealt with by ethical resource allocation. Advances in radiology and, in particular, medical ultrasound, result mainly from technological push and not from clinical pull. Emerging ultrasonic technologies include image guidance of interventional procedures, elastography and three-dimensional microscopy. In some situations, it will become possible for images to be replaced by visual pictures of reality, which will be comprehensible to people not specialised in imaging. Since the effect of advanced imaging techniques ultimately is merely to increase disease prevalence and improve prognosis, health technology assessment has to focus on the impact of imaging on patient management. The shift to primary care provision will lead to the development of departments of diagnosis, prognosis and resource allocation which will control entry to the hospital sector. The future of radiology lies here and in the exploitation of new techniques such as image-guided procedures, contrast agents and new microscopies.

ISSN:1011-7571    

DOI:10.1159/000157549

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

It has been claimed that lack of knowledge of diabetes mellitus has been a cause of excess admissions and morbidity. There is also some evidence that diabetic education programs can improve self-regulatory behaviour and reduce hospital admissions. In this report we test the hypothesis that greater knowledge of diabetes should be associated with better glycaemic control and lower fasting blood glucose levels. Responses to diabetes knowledge questions were provided by 420 patients attending diabetic clinics in Kuwait. In an earlier and complementary report a principal components analysis revealed that knowledge of diabetes cannot be understood in terms of a single general factor. With a subsequent Varimax rotation we obtained 12 uncorrelated knowledge factors with eigenvalues greater than unity and these would all be confounded in the simple aggregation of correct answers to diabetes knowledge questions employed in earlier studies. Results are now described which show that the 12-factor model of diabetes knowledge is better able to predict blood glucose levels than the scores obtained on a single scale by just summing the correct answers to all diabetes knowledge questions. A standard multiple linear regression with the diabetes knowledge factors age, sex and ‘years since diagnosis’ as independent variables, and fasting blood glucose levels as the dependent variable, shows that 4 of the 12 factors yield statistically significant semi-partial correlation coefficients that account for unique fractions of the total variance of blood glucose levels. The meaning of these 4 factors is discussed with special reference to glycaemic control and blood glucose lev

ISSN:1011-7571    

DOI:10.1159/000157550

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The prevalence of dyslipidaemia in Arab children with insulin-dependent diabetes mellitus (IDDM) and its relation to glycaemic control was studied in a group of 55 diabetic children and 55 controls. Serum cholesterol, HDL, LDL and triglycerides were measured in both groups. The degree of glycaemic control was assessed by measuring glycosylated haemoglobin. Results showed that children with IDDM had higher mean cholesterol levels (4.53 ± 0.64 vs. 3.97 ± 0.86 mmol/lp < O.001), LDL levels (3.15 ± 0.79 vs. 2.75 ± 0.74 mmol/l, p < 0.01) and HDL levels (1.21 ± 0.42 vs. 1.06 ± 0.35 mmol/ 1, p < 0.05) than non-diabetic controls. Serum cholesterol levels were raised in 63.6% of children with diabetes and 29.1% of controls (p < 0.001), while serum cholesterol and triglycerides were raised in 9.1% compared with 3.6% in the control group. Two of the diabetic children had isolated hypertriglyceridaemia compared to none in the controls. There was no significant association between serum lipids and glycaemic control as measured by glycosylated haemog

ISSN:1011-7571    

DOI:10.1159/000157551

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Myocardial perfusion imaging is used in the assessment of coronary artery disease by stressing patients either physically or pharmacologically. Adenosine was used as a pharmacologic stressor when administered at a dose of 0.14 mg/kg/min for 6 min to determine its safety at this dose level. Twenty patients referred for myocardial perfusion imaging were stressed with adenosine. The protocol was completed in 18 patients; 1 patient needed early termination of the infusion while another patient needed dose reduction. Three patients did not experience any side effects and 17 patients experienced side effects that were short-lived. All the patients showed good tolerance to the test. Hence adenosine is a safe pharmacologic stressor at this dose level for myocardial perfusion imaging.

ISSN:1011-7571    

DOI:10.1159/000157552

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

It is expected that the circulation of wild-type poliovirus strains will stop world-wide due to the WHO-recommended expanded programme of immunization. In Kuwait the situation is rather unique because thousands of the workforce come from countries where a number of polio cases are reported every year. The question is whether imported wild polio strains can survive in a well-vaccinated population. To answer this question we investigated the vaccine-relatedness of 60 poliovirus strains isolated in Kuwait. Reverse-transcription polymerase chain reaction (RT-PCR) coupled with restriction fragment length polymorphism assay were used for the identification of poliovirus isolates. Fragments obtained after digesting the RT-PCR-amplified product with three restriction enzymes (Haelll, Ddel, HpaII) were compared with that of standard wild and vaccine type poliovirus strains. Isolates from healthy, vaccinated infants (n = 15), children (n = 15) and from patients with the diagnosis of aseptic meningitis (n = 30) were analysed. Molecular characterization revealed a strict vaccine-relatedness of all the 60 poliovirus isolates. The results suggest that the rigorous vaccination policy implemented in Kuwait provides a high level of immunity which prevents the circulation of wild poliovirus strains in Kuwait.

ISSN:1011-7571    

DOI:10.1159/000157553

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The emergence of Streptococcus pneumoniae resistant to penicillin (PRP) in different parts of the world has complicated the epidemiology, antimicrobial susceptibility testing and management of serious infections caused by this organism. Experience in the past decade indicates that S. pneumoniae 0.5–1.0 µg/ml). Recently, however, 2 cases of clinical infections with high-level PRP were encountered at the Cancer Center in Kuwait. The patients involved were a 7-year-old female neutropenic patient who had an overwhelming PRP septicemia and a 70-year-old male patient with chronic lymphocytic leukemia and lower respiratory tract infection. The S. pneumoniae isolates were identified by standard bacteriology methods, and the antimicrobial susceptibility and subsequent interpretation of results were according to the recommended criteria of the National Committee for Clinical Laboratory Standards. With both strains the minimal inhibitory concentration (MIC) of penicillin was 2 µg/ml each. The MIC of cefotaxime for the isolate from the 7-year-old child was also high (MIC 2 µg/ml). This is the first report of PRP with high-level β-lactam resistance in K

ISSN:1011-7571    

DOI:10.1159/000157554

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

A phenotypic female patient 18 years old with primary amenorrhea, absent uterus, male serum testosterone level, and 47, XYY karyotype is discussed. An ultrasound scanning of the pelvic organs revealed the absence of uterus, and a laparoscopy confirmed the ultrasound findings. Laparotomy and bilateral gonadectomy were also performed. Histopathological study of both gonads showed that each was formed of small testicular tubules lined by Sertoli cells without spermatogenic elements. Neither vas nor epididymis were identified macroscopically or microscopically. These findings are consistent with the complete form of testicular feminization syndrome in association with 47, XYY karyotype.

ISSN:1011-7571    

DOI:10.1159/000157555

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Myelodysplastic syndromes are a group of bone marrow disorders that rarely occur in children. We report on a child who presented with recurrent soft tissue abscesses and was found to have myelodysplasia.

ISSN:1011-7571    

DOI:10.1159/000157556

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

This study reports bilateral, symmetric peripheral schwannomas (neurilemmomas), presents their sonographic appearance, and compares them with other soft tissue tumors.

ISSN:1011-7571    

DOI:10.1159/000157557

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Much has been learned in microbiologic sophistication that has been helpful in medical infections often relying upon precise therapy. For most surgical infections, mixed flora of community origin resident surface flora are presumed, whether or not identified, and treated, even if not isolated. The treatment of choice for a mixed surgical infection is an operation with an adjunctive presumptive monotherapy. Culture practices have improved management of superinfection and precise treatment of emerging pathogens. Culture protocols have not helped or have actually interfered with management of surgical risks which must be treated presumptively. Funds expended in culture identification of contamination microbes would better be spent precisely.

ISSN:1011-7571    

DOI:10.1159/000157558

出版商:S. Karger AG    

年代:1997

数据来源: Karger