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Review of Systems

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125341. Collecting system invasion in renal cell carcinoma: impact on prognosis and future staging strategies. (Abstract)

Collecting system invasion in renal cell carcinoma: impact on prognosis and future staging strategies. To define further the prognostic impact of urothelial invasion in renal cell carcinoma (RCC) we examined the outcome in patients presenting to our institution with kidney cancer treated with nephrectomy.We reviewed the medical records of 895 patients with RCC who were treated with nephrectomy between 1989 and 1999. Median followup was 31 months. Kaplan-Meier survival curves were constructed (...) with respect to 1997 TNM stage, Fuhrman grade and University of California-Los Angeles Integrated Staging System stage, comparing patients with and without collecting system invasion. Univariate and multivariate analyses were performed. Overall survival was defined as time from nephrectomy to time of death or last followup.Of the 895 patients 124 (14%) demonstrated collecting system invasion. Patients with collecting system invasion were more likely to be symptomatic and have associated metastases

2003 Journal of Urology

125342. Is common sheath extravesical reimplantation an effective technique to correct reflux in duplicated collecting systems? (Abstract)

Is common sheath extravesical reimplantation an effective technique to correct reflux in duplicated collecting systems? We evaluate the outcome vesicoureteral reflux (VUR) in duplicated collecting systems compared to single collecting systems corrected using an extravesical detrusorrhaphy approach.We reviewed the records of 266 patients (422 ureters) treated for VUR using an extravesical approach between 1991 and 2001. Inclusion criteria were primary reflux in single (201 patients, 125 (...) bilateral) or duplicated collecting systems (65, 31 bilateral) in patients not undergoing other concomitant surgery with at least 1 year of postoperative followup. The indication for surgical intervention was unresolved reflux (greater than 4 years) in more than 70% of patients. Postoperative evaluation included a voiding cystourethrogram at 3 months and 12 months if reflux was unresolved at 3 months. Also ultrasound was performed at 6 weeks or earlier if clinically indicated and 12 months.Group 1

2003 Journal of Urology

125343. Diagnostic and prognostic significance of anti-C1q antibodies in systemic lupus erythematosus. (Abstract)

, markers for the diagnosis and follow-up of nephritis are very important. Anti-C1q autoantibodies are strongly associated with renal involvement in systemic lupus erythematosus. This study will review recent findings on the pathogenic role and clinical importance of anti-C1q antibodies in lupus nephritis.Recent clinical studies have clearly emphasized the diagnostic relevance of anti-C1q autoantibody levels in patients with lupus nephritis. With a possible negative predictive value of 100%, anti-C1q (...) Diagnostic and prognostic significance of anti-C1q antibodies in systemic lupus erythematosus. The presence of a wide variety of autoantibodies is a characteristic finding in systemic lupus erythematosus. Autoantibodies against nuclear proteins, such as anti-nuclear and anti-double-stranded DNA antibodies, are used as diagnostic markers in systemic lupus erythematosus. Renal involvement is frequently found in systemic lupus erythematosus and is an important risk factor for death. Therefore

2003 Current Opinion in Nephrology and Hypertension

125344. Emerging evidence for a central epinephrine-innervated alpha 1-adrenergic system that regulates behavioral activation and is impaired in depression. Full Text available with Trip Pro

by brain epinephrine (EPI) that potentially modulates the above three monoamine systems in parallel and plays a critical role in depression. The present review covers the evidence for this system and includes findings that brain alpha(1)-adrenoceptors are instrumental in behavioral activation, are located near the major monoamine cell groups or target areas, receive EPI as their neurotransmitter, are impaired or inhibited in depressed patients or after stress in animal models, and are restored (...) Emerging evidence for a central epinephrine-innervated alpha 1-adrenergic system that regulates behavioral activation and is impaired in depression. Currently, most basic and clinical research on depression is focused on either central serotonergic, noradrenergic, or dopaminergic neurotransmission as affected by various etiological and predisposing factors. Recent evidence suggests that there is another system that consists of a subset of brain alpha(1B)-adrenoceptors innervated primarily

2003 Neuropsychopharmacology

125345. The Mexican HIV/AIDS surveillance system: 1986-2001. (Abstract)

before and during the literature search.Two hundred and twenty articles and conference abstracts were reviewed and showed that the Mexican surveillance system has undergone many adaptations. The HIV/AIDS surveillance system began in 1986, when the focus was on identifying AIDS cases. This period was followed by special studies among risk groups, and served as the basis for the sentinel surveillance system that was adopted in 1990. The system now requires HIV and AIDS case reporting as well (...) as sentinel surveillance. Mexico has also carried out the piloting of the behavioural surveillance component of Second Generation Surveillance.The Mexican experience illustrates how surveillance systems need to be dynamic in order to monitor trends in HIV over time. This review also demonstrates that middle-income countries can successfully implement surveillance systems. However, although Mexico has had many successes, a need exists to address issues that limit its ability to implement AIDS case

2002 AIDS

125346. Dead bird clusters as an early warning system for West Nile virus activity. Full Text available with Trip Pro

Dead bird clusters as an early warning system for West Nile virus activity. An early warning system for West Nile virus (WNV) outbreaks could provide a basis for targeted public education and surveillance activities as well as more timely larval and adult mosquito control. We adapted the spatial scan statistic for prospective detection of infectious disease outbreaks, applied the results to data on dead birds reported from New York City in 2000, and reviewed its utility in providing an early (...) warning of WNV activity in 2001. Prospective geographic cluster analysis of dead bird reports may provide early warning of increasing viral activity in birds and mosquitoes, allowing jurisdictions to triage limited mosquito-collection and laboratory resources and more effectively prevent human disease caused by the virus. This adaptation of the scan statistic could also be useful in other infectious disease surveillance systems, including those for bioterrorism.

2003 Emerging Infectious Diseases

125347. Pathological findings in the central nervous system of AIDS patients on assumed antiretroviral therapeutic regimens: retrospective study of 1597 autopsies. (Abstract)

Pathological findings in the central nervous system of AIDS patients on assumed antiretroviral therapeutic regimens: retrospective study of 1597 autopsies. To evaluate the prevalence of HIV-related central nervous system (CNS) lesions (HIV-encephalitis and/or HIV-leukoencephalopathy: HIV-E/L) with and without concomitant opportunistic diseases in a large autopsy series, and to correlate it with the changes in antiretroviral treatment that have occurred since the beginning of the epidemic.We (...) reviewed 1597 consecutive autopsies of HIV-positive patients performed between 1984 and 2000, and divided into four time periods on the basis of the therapeutic regimens available: 1984-1987, no therapy; 1988-1994, monotherapy (zidovudine); 1995-1996, dual combination therapy with nucleoside reverse transcriptase inhibitors (NRTI); and 1997-2000, triple combination therapy including two NRTI and at least one protease inhibitor or non-NRTI. The data concerning the treatment actually received were

2002 AIDS

125348. A user evaluation of the Nosocomial Infection National Surveillance System: surgical site infection module. (Abstract)

A user evaluation of the Nosocomial Infection National Surveillance System: surgical site infection module. The Nosocomial Infection National Surveillance Scheme (NINSS) enables hospitals in England to undertake surveillance of healthcare associated infection, compare their results with national aggregated data, and use the information to improve patient care. A surgical site infection (SSI) module was introduced in 1997, and participation has increased steadily since its inception. This survey (...) . The majority of ICTs (89%) gave the results directly to the surgeons. For some users (29%) it was too early to assess the value of the surveillance. Of the remainder, although results provided evidence of good performance for some, 46% identified high rates of SSI in one or more groups of surgical patients. In about two-thirds of these hospitals, a review or change in clinical practice was initiated as a result. Three main areas for development were identified: an extended range of surgical procedures

2002 Journal of Hospital Infection

125349. The new liver allocation system: moving toward evidence-based transplantation policy. (Abstract)

etiologies and across a broad spectrum of liver disease severity. Except for the most urgent patients, all patients will be ranked continuously under the new policy by their MELD/PELD score. Waiting time is used only to prioritize patients with identical MELD/PELD scores. Patients who are not well served by the MELD/PELD scores can be prioritized through a regionalized peer review system. This new liver allocation plan is based on more objective, verifiable measures of disease severity with minimal (...) The new liver allocation system: moving toward evidence-based transplantation policy. In 1999, the Institute of Medicine suggested that instituting a continuous disease severity score that de-emphasizes waiting time could improve the allocation of cadaveric livers for transplantation. This report describes the development and initial implementation of this new plan. The goal was to develop a continuous disease severity scale that uses objective, readily available variables to predict mortality

2002 Liver Transplantation

125350. Beta-lactam activity against resistant pneumococcal strains is enhanced by the immune system. (Abstract)

and the immune system. We review here the in vitro increase in the bactericidal activity of aminopenicillins by non-specific immunity (complement and polymorphonuclear leucocytes). Few data are available on the collaboration of specific immunity and beta-lactams. We also review the effect of the presence of specific antibodies on the in vivo T > MIC needed for the therapeutic efficacy of amoxicillin, and on blood bacterial clearance in animal models. The effect that immunity has on pharmacodynamic parameters (...) Beta-lactam activity against resistant pneumococcal strains is enhanced by the immune system. Pandemic resistance in Streptococcus pneumoniae is compromising antibiotic activity. Antibiotics that act on the cell wall, such as beta-lactams, may have a combined effect with the immune system against S. pneumoniae, since both act on the bacterial envelope. This combined effect can be studied in vitro or in vivo with respect to bacterial killing, since lysis is the end-point of both beta-lactams

2002 Journal of Antimicrobial Chemotherapy

125351. T cells in the central nervous system: the delicate balance between viral clearance and disease. Full Text available with Trip Pro

T cells in the central nervous system: the delicate balance between viral clearance and disease. The central nervous system (CNS) is considered an "immunoprivileged" site with restricted access and a unique microenvironment that profoundly affects the capacity of T cells to exert their functions. The lymphocytic choriomeningitis virus model offers a unique system in which to evaluate the contrasting roles of specific T cells in causing lethal CNS disease or curing pervasive and life-long CNS (...) infection. Specific T cell kinetics in the periphery is briefly discussed. The T cell-mediated mechanisms leading to fatal choriomeningitis are reviewed as are recent methodologic advances that will facilitate the study of antigen-specific T cells in disease pathogenesis. Understanding the specific constraints imposed by the CNS on local T cell activity has important consequences for the design of therapeutic strategies aimed at preventing or curing CNS infection.

2002 Journal of Infectious Diseases

125352. The chemokine system in neuroinflammation: an update. Full Text available with Trip Pro

The chemokine system in neuroinflammation: an update. Chemokines and their receptors govern physiologic and pathologic leukocyte trafficking. The function of the chemokine system may be of particular interest for hematogenous leukocyte infiltration of the central nervous system (CNS) because of the distinct character of CNS inflammation and the exquisite specificity with which the chemokine system regulates cellular migration events. This review summarizes recent information about (...) the expression and function of elements of the chemokine system in CNS inflammatory processes. Animal models of CNS demyelinating disease and the corresponding human disorder, multiple sclerosis are both considered.

2002 Journal of Infectious Diseases

125353. Abdominal and digestive system associations of familial Mediterranean fever. (Abstract)

Abdominal and digestive system associations of familial Mediterranean fever. Familial Mediterranean fever (FMF) is a hereditary episodic febrile syndrome that is expressed by acute spells of fever, painful manifestations in the abdomen, chest and joints, and slow development of nephropathic amyloidosis. Despite the recent cloning of the FMF gene (MEFV) and the identification of about 40 disease-related mutations, the diagnosis is still clinically dependent, and the pathogenesis and most (...) of the clinical heterogeneity remain to be explained. Because episodic abdominal pain affects 95% of FMF patients, most of them are seen by gastroenterologists and undergo complete or partial abdominal imaging before the diagnosis is made. Focusing on recent advances in FMF, this article reviews both common and infrequent manifestations that a gastroenterologist may encounter during workups of FMF patients. These include episodic abdominal pain, paralytic or mechanical ileus, constipation, diarrhea, ascites

2003 American Journal of Gastroenterology

125354. Cholesterol crystal embolization to the digestive system: characterization of a common, yet overlooked presentation of atheroembolism. (Abstract)

the digestive system, based on our institutional experience and a review of the literature. Cases with CCE in a 7-yr period (1995-2001) were sought in the computerized records of our medical center. Of the CCE patients, those with digestive system involvement that could be related to CCE were included in this study. The clinical features of CCE were determined and compared with those found in published series. Fourteen cases with CCE were identified, giving an annual incidence of 0.8 per 10(5). Digestive (...) Cholesterol crystal embolization to the digestive system: characterization of a common, yet overlooked presentation of atheroembolism. In the 1359 published patients with multiorgan cholesterol crystal embolism (CCE), the digestive system seems to be the third most frequently affected system. Yet, this system received hitherto only little attention in the medical literature. Therefore, the aim of the present study was to clinically characterize the subset of patients with CCE involving

2003 American Journal of Gastroenterology

125355. Standardized quality-assessment system to evaluate pressure ulcer care in the nursing home. (Abstract)

requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation.The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of NH (...) Standardized quality-assessment system to evaluate pressure ulcer care in the nursing home. To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs).Descriptive.Eight NHs.One hundred ninety-one NH residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated.Nine quality indicators (two related to screening and prevention of PU, two focused

2003 Journal of the American Geriatrics Society

125356. Integrating 'omic' information: a bridge between genomics and systems biology. Full Text available with Trip Pro

. Here, we review the recent development of strategies for such integration and we argue that these will be important for a systems approach to modular biology. (...) Integrating 'omic' information: a bridge between genomics and systems biology. The availability of genome sequences for several organisms, including humans, and the resulting first-approximation lists of genes, have allowed a transition from molecular biology to 'modular biology'. In modular biology, biological processes of interest, or modules, are studied as complex systems of functionally interacting macromolecules. Functional genomic and proteomic ('omic') approaches can be helpful

2003 Trends in Genetics

125357. Reliability of a staging assessment system for recurrent respiratory papillomatosis. (Abstract)

course and response to the therapy over time. In using this system, it would be of benefit to know what level of variability can be expected from one surgeon to another in the assessment of an RRP patient and the assignment of a score.Ten videotaped recordings of endoscopic assessments of patients with RRP were reviewed by 15 pediatric otolaryngologists and scored based on the criteria of the staging assessment system.Analysis was conducted for 15 raters of scoring severity over 25 sites of 10 (...) Reliability of a staging assessment system for recurrent respiratory papillomatosis. A staging system for the assessment of severity of disease and response to the therapy in recurrent respiratory papillomatosis (RRP) was proposed several years ago. It includes both a subjective functional assessment of clinical parameters and an anatomic assessment of disease distribution. The anatomic score can then be used in combination with the functional score to measure an individual patient's clinical

2003 International Journal of Pediatric Otorhinolaryngology

125358. Bilateral vocal fold paresis and multiple system atrophy. (Abstract)

Bilateral vocal fold paresis and multiple system atrophy. To review a case series of patients with systemic neurodegenerative disease presenting to a laryngologist for workup of dysphonia and found to have bilateral vocal fold paresis.Case series.Tertiary care voice center.Series of patients with neurodegenerative disorders examined for dysphonia.History and physical examination including fiberoptic laryngoscopy were performed on all patients. Some patients underwent polysomnography.Seven (...) patients during a 2-year period were noted to have bilateral abductor vocal fold paresis. Five of 7 (71%) had the diagnosis of multiple system atrophy proposed by the laryngologist. All 7 patients described sleep-disordered breathing with stridor.Patients with systemic neurodegenerative disorders such as Parkinson disease should be examined for multiple system atrophy and for evidence of bilateral vocal fold paresis. Workup for stridor should include polysomnography. Treatment of glottic obstruction

2002 Archives of Otolaryngology Head and Neck Surgery

125359. The renin-angiotensin system as a risk factor and therapeutic target for cardiovascular and renal disease. (Abstract)

The renin-angiotensin system as a risk factor and therapeutic target for cardiovascular and renal disease. The renin-angiotensin system (RAS) plays an important homeostatic role in BP regulation, water and salt balance, and tissue growth control under physiologic conditions. On the other hand, a pivotal involvement of the RAS in the pathophysiology of cardiovascular and renal disease is extensively supported by both basic and clinical evidence. In particular, it is today recognized (...) or antagonizing its binding to cell membrane receptors by selective antagonists, is associated with highly beneficial outcomes in major disease conditions (hypertension, diabetes, renal failure, heart failure, myocardial infarction, stroke, and others). This article briefly reviews the current views on the biologic organization of RAS evidence supporting a pathogenic role of the RAS activity in promoting cardiac, vascular, and renal disease, and finally provides the basis for considering inhibition of RAS

2002 Journal of the American Society of Nephrology

125360. An Internet-based evaluation system for a surgical residency program. (Abstract)

An Internet-based evaluation system for a surgical residency program. Efficient and meaningful evaluation of performance is critical to the professional development of trainees in surgical residency programs. Current paper-based evaluation instruments have numerous limitations. We developed an Internet-based evaluation system to more rapidly and efficiently assess the experience of residents, faculty, and rotations.An on-line evaluation system was designed and implemented in October 1999 (...) . Custom evaluations were created for residents, faculty, and rotations. Evaluations were completed via the Internet site from remote locations with standard computers and standard Web browser software. Completed evaluations were automatically available on-line for review and data analysis. Data were analyzed by chi-square analysis with a probability value of less than 0.05 considered statistically significant.Compliance in completion of evaluations improved from 50% to 80% in the initial 6 months

2003 Journal of the American College of Surgeons

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