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Oral Paper Presentation Session III Parallel ; Infection & Neurology ; pelvic muscles as well. 13. Comparative Study of 99mTc EC and 99mTc DTPA in Routine Nephro-Urological Practice Kashyap P. Lanka, Vibhor Mahendru, Abhishek Gupta, Satyawati Deswal, P. K. Pradhan Dept. of Nuclear Medicine, SGPGIMS, Lucknow Aim: The aim of the study is to compare the result of 99m Tc EC and 99mTc DTPA in routine nephro-urological practice. Introduction: 99mTc EC is a tubular agent that has found its use in routine clinical practice. 99mTc DTPA is a glomerular agent and DTPA renography is one of the preferred methods of measuring the GFR. However under certain clinical circumstances, mostly in renal failure, the renal handling of the tracer becomes poor and unreliable. 99mTc EC, being a tubular agent, reflects the ERPF and the renal function better. In case of hydroneprosis being followed up conservatively, though it is ideal to use the same radiopharmaceutical, we have found that both these radiopharmaceuticals can be used interchangeably. Materials and Methods: A total of 21 patients were taken for the study 12 males, 9 females ; . The age range varied from 2 months to 60years. Both 99mTc DTPA and EC renography was done in all the patients time interval ranging from 2 days to 6 months ; , They were divided into 3 groups. Group A consisted of voluntary kidney donors with no known existing renal pathology. Group B consisted of patients with known renal failure. Serum creatinine was also measured at the time of both the scans. Group C consisted of patients with known renal pathology but not in overt failure. 99mTc DTPA and EC Renography was performed in all the patients. Standard acquisition procedures were used. The observations were analyzed by two nuclear medicine physicians, independently. Observations and results: In Group A, both agents showed similar results with no significant difference. Due to the inherent pharmacokinetic differences between the two radiopharmaceuticals, 99mTc EC showed sharper peak and faster clearance. The image quality was also superior due to rapid background clearance. Group B patients were further divided into those with mild renal failure creatinine 1.6-2.0 mg% ; and moderate renal failure creatinine 2.0-3.0mg% ; . We were not able to analyze any case with serum creatinine 3.0 mg% with both agents. The tests were repeated within 2 days wit stable creatinine values. None of the patients had undergone dialysis or any other intervention during this time. With 99m Tc DTPA, all patients showed reduced GFR values with increased background and renogram curves typical of failure pattern. When the scan was repeated with 99mTc EC, all patients showed similar reductions in ERPF with no significant difference in reduced percentages as compared to those according to age and sex. Also the relative functions of both the kidneys were similar. However, the image quality and visualization of kidney was superior with appreciation of broad peaks and impaired clearance in few of the patients. Group C was a miscellaneous group. Those patients with hydronephrosis who were being followed up conservatively, and being advised follow up scans with DTPA or EC, the scan was done by interchanging the radiotracer. No significant difference was noted in any of the patients. Although the peaks, depicted by Tmax, were sharper and clearance faster, the overall function was reproducible in all cases. Conclusion: When used in routine clinical practice, 99m Tc EC gives comparable results to 99m Tc DTPA. However, in a subset of patients with renal failure, 99m Tc EC is shown to be superior to 99m Tc DTPA. In those patients on routine follow up with conservative treatment, both agents can be used interchangeably, although caution should be exercised while interpreting the clearance patterns. However, due to the small number of patients, statistical figures could not be generated and more patients need to be included to support the conclusion.
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Said later. "To exclude me from the equation isn't right either." Dr. Mecklenburg also had Dr. Storey present Aetna's results directly to the medical center's 26 department heads. Like many doctors, Virginia Mason's physicians "didn't pay attention to the cost of care" until then, says Dr. Mecklenburg. Most were trained to see cost concerns as antithetical to focusing on patients' needs. "Guys, I know Virginia Mason and I respect you, but here's how you look to the market, " Aetna's Dr. Storey remembers telling the silent roomful of doctors.
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Corey, G., Corey, M. S., & Callanan, P. 2000 ; . Issues and ethics in the helping professions 6th Edition ; . Pacific Grove, CA: Brooks Cole Publishing Co. Crawford, N. 2002 ; . Help for those who work with adolescents. Monitor on Psychology, 33 11 ; , 5455. Culbert, T., & Reaney, J. B. 1998 ; . Biofeedback and self-regulation skills training for children. Biofeedback, 26 3 ; , 10-12. Davies, T. C. 2003 ; . A comprehensive approach to primary care medicine: Mind and body in the clinic. In D. Moss, A. McGrady, T. C. Davies, & I. Wickramasekera Eds. ; , Handbook of mind-body medicine for primary care. Thousand Oaks, CA: Sage Publications. DeAngelis, T. 2001 ; . New strategies in children's mental health. Monitor on Psychology, 32 11 ; , 52-53. DeAngelis, T. 2002 ; . New lessons on children and stress. Monitor on Psychology, 33 4 ; , 30-32. Feldman-Winters, L., & McAbee, G. N. 2002 ; . Legal issues in caring for adolescent patients. Postgraduate Medicine, 111 5 ; , 1-6. Kitchener, K. S. 2000 ; . Foundations of ethical practice, research, and teaching in psychology. Mahwah, NJ: Lawrence Erlbaum Associates. O'Conner, E. M. 2001 ; . Medicating ADHD: Too much? Too Soon? Monitor on Psychology, 32 11 ; , 50-51. Sales, B. D., & Shuman, D. W. 1996 ; . Law, mental health, and mental disorder. Pacific Grove, CA: Brooks Cole Publishing Co. Striefel, S. 1998a ; . Legal and ethical concerns when working with children and adolescents: Part I: Rights and informed consent. Biofeedback, 26 3 ; , 7-8. Striefel, S. 1998b ; . Legal and ethical concerns when working with children and adolescents: Part II: Right to treatment and confidentiality. Biofeedback, 26 3 ; , 8-9. Striefel, S. 2000 ; . Some core ethical principles and their application. Biofeedback, 28 4 ; , 4-5, & 11. Striefel, S. 2003 ; . Professional ethics and practice standards in mind-body medicine. In D. Moss, A. McGrady, T. C. Davies, & I. Wickramasekera Eds. ; , Handbook of mind-body medicine for primary care. Thousand Oaks, CA: Sage Publications. Striefel, S. in press ; . The application of ethics in daily practice. In M. S. Schwartz & F. Andrasik Eds. ; , Biofeedback: A practitioner's guide 3rd Edition ; . New York, NY: Guilford Press. Wrightsman, L. S., Nietzel, M. T., & Fortune, W. H. 1998 ; . Psychology & the legal system 4th Edition ; . Pacific Grove, CA: Brooks Cole Publishing Co, for instance, .
Down but not out Increased scrutiny and regulatory pressures may impact values in pharmaceutical industry Sarbanes-Oxley: Will your company make the grade? Fairness is in the eye of the beholder Spotlight On. Christine A. Wilkins Representative Engagements and nimotop.
There is little information concerning the level of knowledge about stroke within the Australian Lars Kammersgaard, Berit Rasmussen, Henrik Jrgensen, Jakob Reith, Uno Weber, Jacob community. In addition, there is a belief in the community that little can be done about stroke Houth, Tom Olsen with few people recognising that stroke is a medical emergency. The "Brain Attack" campaigns launched both internationally and within Australia have attempted to increase public awareness Purpose: We investigated cardiovascular risk factor profile that may predict five year survival about the emergent nature of stroke. in acute stroke patients. The purpose of this study was to examine delay in seeking treatment among people with an Methods: 1191 patients were included in the Copenhagen Stroke Study. The following possible evolving stroke or TIA admitted to a tertiary hospital and identify clinical, behavioural and predictors of stroke outcome were considered: age, gender, marital status, time from stroke demographic factors that contributed to the delay. onset to admission, initial stroke severity, stroke subtype, body temperature, atrial fibrillation, Methods hypertension, ischemic heart disease, intermittent claudication, diabetes, alcohol intake, daily All patients admitted to the study hospital with a diagnosis of stroke or TIA were asked to smoking, previous TIA, and previous stroke. Long-term follow-up was performed mean 84 participate in the study. Eligibility criteria included admission from home not a nursing home ; , months after stroke and entry in the Copenhagen Stroke Study. Information on date of death less than 72 hours since admission to hospital and diagnosis of TIA determined by a presenting were obtained from the Central Patient Registry for patients who had died. symptoms ; or a stroke confirmed by CT scan ; . Results: The overall 5-year survival rate was 37%. Univariately, survivors were younger 70 vs. Once consent was obtained medical records were reviewed to determine demographic and 77 years, p 0.0001 ; , had milder strokes ISS 44.8 vs. 30.8, p 0.0001 ; , less frequently atrial clinical data. All participants were given the Response to Stroke Symptoms Questionnaire. The fibrillation 9% vs. 24%, p 0.0001 ; , less frequently ischemic heart disease 16% vs. 28%, six domains included in the questionnaire were: 1 ; context in which the stroke occurred; 2 ; p 0.0001 ; , but no differences were found for hypertension, intermittent claudication and daily antecedents to symptoms; 3 ; affective response to symptoms; 4 ; behavioural response to smoking. Independent predictors of 5-year survival were younger age OR 2.2; 95%CI 1.8 symptoms; 5 ; cognitive response to symptoms; 6 ; the response of others to patient symptoms. per 10 years ; , initial stroke severity OR 1.5; 95%CI 1.31.7, per 10 points increase of SSS Statistical analyses score ; , atrial fibrillation OR 0.6; 95%CI 0.4 ; , daily smoking OR 0.6; 95%CI 0.4 ; , but Analysis of data included chi square to test differences between patient characteristics and not hypertension, ischemic heart 2007 past clinical histories. Independent t-tests or analysis of variance were used to analyse the Downloaded from stroke.ahajournals by on September 21, disease or intermittent claudication, for instance, vitiligo.
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Figure 2 ; , recent imaging studies have shown that cerebral blood flow in motor cortex and cerebellum is altered by Vim-DBS Ceballos-Baumann et al., 2001; Fukuda et al., 2004 ; . Besides Vim surgery, DBS of the caudal zona incerta region discussed above, e.g., Kitagawa et al., 2000; Murata et al., 2003 ; has recently been shown to be highly efficacious in ET and other forms of tremor, especially those with a prominent proximal limb involvement. Recent case reports have suggested that DBS of the STN may also be effective in some cases of ET, specifically in cases in whom ET coexists with other movement disorders, such as PD Stover et al., 2005 ; . Tremor Associated with Multiple Sclerosis. Multiple sclerosis is frequently associated with severe intention tremor, most likely because of the predilection of demyelinating lesions for the cerebellar outflow tracts. Thalamic DBS has proven to be at least partially effective, especially in young patients with little comorbidity Berk et al., 2002; Moringlane et al., 2004 ; . A recent analysis of 75 published cases of DBS in multiple sclerosis came to the conclusion that the majority of patients benefited from the procedures, although complete cessation of tremor was rare Wishart et al., 2003 ; . As discussed above for ET, the caudal zona incerta target appears to be beneficial for the treatment of tremor associated with multiple sclerosis Nandi et al., 2002a ; . Holmes Tremor and Other Tremor Forms. Holmes tremor, resulting from brainstem lesions that affect cerebellar outflow, is a combined rest, postural, and intention tremor. Only a small number of cases of this tremor type have been treated with Vim-DBS e.g., Romanelli et al., 2003 ; , and these cases have had excellent results. Vim stimulation has also been used for other tremor forms, often due to rare diseases, such as phenylketonuria Payne et al., 2005 ; or inherited cerebellar ataxia Schramm et al., 2005 ; . DBS Use in Neuropsychiatric Disorders The previous era of psychosurgery ended in the 1970s because of severe condemnation of the excessive and indiscriminate use of these procedures, their disappointing outcomes, and the lack of patient protection. It may seem surprising, then, that neurologists, neurosurgeons, and psychiatrists are again exploring surgical procedures for severe psychiatric disorders, such as OCD, TS, and depression. The acceptance of DBS is due to several facts, including 1 ; the failure of existing drugs to deal effectively with the psychiatric condition in a subset of patients, 2 ; the remarkable success of DBS procedures in treating movement disorders, 3 ; the relatively less invasive and reversible nature of DBS, 4 ; the greater public awareness of the enormous lifelong burden of these disorders on patients and their caregivers, and 5 ; the greater scrutiny and protection of patient rights. DBS procedures for neuropsychiatric conditions remain strictly experimental at this point. Use of DBS in neuropsychiatric diseases is based on findings suggesting that these conditions are, at least partly, due to abnormalities within the nonmotor basal ganglia circuits, most prominently the limbic circuitry. As shown in Figure 1, the limbic circuit originates from the anterior cingulate and medial orbitofrontal cortices; engages the ventral striatum, the ventral and rostrome.
Tumor necrosis factor- in postinfarction dysfunctional myocardium. Circulation. 1999; 99: 14921498. Kukielka GL, Smith CW, Manning AM, Youker KA, Michael LH, Entman ML. Induction of interleukin-6 synthesis in the myocardium. Potential role in post-reperfusion inflammatory injury. Circulation. 1995; 92: 1866 Lee SH, Wolf PL, Escudero R, Deutsch R, Jamieson SW, Thistlethwaite PA. Early expression of angiogenesis factors in acute myocardial ischemia and infarction. N Engl J Med. 2000; 342: 626 Li J, Brown LF, Hibberd MG, Grossman JD, Morgan JP, Simons M. VEGF, flk-1, and flt-1 expression in a rat myocardial infarction model of angiogenesis. J Physiol. 1996; 270: H1803H1811. Sata M, Saiura A, Kunisato A, Tojo A, Okada S, Tokuhisa T, Hirai H, Makuuchi M, Hirata Y, Nagai R. Hematopoietic stem cells differentiate into vascular cells that participate in the pathogenesis of atherosclerosis. Nat Med. 2002; 8: 403 Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med. 1999; 340: 115126. Shintani S, Murohara T, Ikeda H, Ueno T, Honma T, Katoh A, Sasaki K, Shimada T, Oike Y, and Imaizumi T. Mobilization of endothelial progenitor cells in patients with acute myocardial infarction. Circulation. 2001; 103: 2776 Massa M, Rosti V, Ferrario M, Campanelli R, Ramajoli I, Rosso R, De Ferrari GM, Ferlini M, Goffredo L, Bertoletti A, Klersy C, Pecci A, Moratti R, Tavazzi L. Increased circulating hematopoietic and endothelial progenitor cells in the early phase of acute myocardial infarction. Blood. 2005; 105: 199 Francis J, Chu Y, Johnson AK, Weiss RM, Felder RB. Acute myocardial infarction induces hypothalamic cytokine synthesis. J Physiol Heart Circ Physiol. 2004; 286: H2264 H2271. Waage A, Sorensen M, Stordal B. Differential effect of oxpentifylline on tumour necrosis factor and interleukin-6 production. Lancet. 1990; 335: 543. Zabel P, Wolter DT, Schonharting MM, Schade UF. Oxpentifylline in endotoxaemia. Lancet. 1989; 334: 1474 Okabe M, Ikawa M, Kominami K, Nakanishi T, Nishimune Y. Green mice as a source of ubiquitous green cells. FEBS Lett. 1997; 407: 313319. Adachi Y, Saito Y, Kishimoto I, Harada M, Kuwahara K, Takahashi N, Kawakami R, Nakanishi M, Nakagawa Y, Tanimoto K, Saitoh Y, M, Yasuno S, Usami S, Iwai M, Horiuchi M, Nakao K. Angiotensin II type 2 receptor deficiency exacerbates heart failure and reduces survival after acute myocardial infarction in mice. Circulation. 2003; 107: 2406 Izumi T, Saito Y, Kishimoto I, Harada M, Kuwahara K, Hamanaka I, Takahashi N, Kawakami R, Li Y, Takemura G, Fujiwara H, Garbers DL, Mochizuki S, Nakao K. Blockade of the natriuretic peptide receptor guanylyl cyclase-A inhibits NF- B activation and alleviates myocardial ischemia reperfusion injury. J Clin Invest. 2001; 108: 203213. Sata M, Maejima Y, Adachi F, Fukino K, Saiura A, Sugiura S, Aoyagi T, Imai Y, Kurihara H, Kimura K, Omata M, Makuuchi M, Hirata Y, Nagai R. A mouse model of vascular injury that induces rapid onset of medial cell apoptosis followed by reproducible neointimal hyperplasia. J Mol Cell Cardiol. 2000; 32: 20972104. Vanden Berghe W, Vermeulen L, De Wilde G, De Bosscher K, Boone E, Haegeman G. Signal transduction by tumor necrosis factor and gene regulation of the inflammatory cytokine interleukin-6. Biochem Pharmacol. 2000; 60: 11851195. Iwama H, Uemura S, Naya N, Imagawa K, Takemoto Y, Asai O, Onoue K, Okayama S, Somekawa S, Kida Y, Takeda Y, Takaoka M, Kawata H, Horii M, Nakajima T, Doi N, Saito Y. Cardiac expression of placental growth factor predicts the improvement of chronic phase left ventricular function in patients with acute myocardial infarction. J Coll Cardiol. 2006; 47: 1559 and norfloxacin and oxsoralen, for example, methoxsalen.
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By: Stuart E. Trenholme, MD, FACC - Chapter Governor This will undoubtedly be my last column as Oregon Governor for the American College of Cardiology as my term ends in March 2004. Dr. Tony Furnary will be taking the helm at that point. I have enjoyed the last three years and learned a great deal about medical politics and the challenges that lie ahead for all those who will practice cardiology in the years to come. I want to thank Tony for stepping in and assuming the leadership responsibilities after the tragic loss of Bruce Shively. In terms of our accomplishments during the three years, I can say that we now have an excellent executive director in Alan Morasch, who has worked tirelessly on our behalf and continues to do so. We have this newsletter and we are in the process of forming a meeting of the state Councilors to focus the Chapter efforts in appropriate ways to help us all for the next three years. The web site is being reconstructed and is up and running-- you will hear more about this in the near future. We are also planning a symposium, the first, under the sole sponsorship of the Oregon Chapter of the ACC on April 30 and May 1, 2004. We will be using members of the Chapter as speakers as well as inviting national guest speakers. If any of you are interested in participating, please let Tony or myself know of your interest. The symposium will be directed to all practitioners in the hopes of reinforcing the practice guidelines.
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The following discussion and analysis should be read in conjunction with the Financial Statements and related Notes included in Item 8 of this Annual Report on Form 10-K. Except for the historical information contained herein the foregoing discussion contains forward-looking statements that involve risks and uncertainties. Our actual results could differ materially from those projected in the forward-looking statements discussed herein. Cautionary Note Regarding Forward-Looking Statements This Annual Report on Form 10-K contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as "expects", "anticipates", "intends", "believes", "will" and similar words are used to identify forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements, including, but not limited to, the statements in the Risk Factors and other sections in this Annual Report on Form 10-K, are not based on historical facts, but rather reflect our current expectations concerning future results and events. Although we believe that the expectations reflected in the forward-looking statements are reasonable, such statements involve known and unknown risks, uncertainties and other factors that may cause our actual results, performance or achievements to be different from any future results, performance and achievements expressed or implied by these statements, including the risks outlined in the Risk Factors section and elsewhere in this Annual Report on Form 10-K. You are cautioned not to place undue reliance on these forward-looking statements. We undertake no obligation to publicly update or revise any forward-looking statements, whether as the result of new information, future events or otherwise. Overview We are a specialty pharmaceutical company focused on: development, licensing and sales of generic and branded pharmaceutical products and active pharmaceutical ingredients and the manufacturing of pharmaceuticals for others in Spain, other parts of Europe and international markets, including the U.S. market; and research, development and licensing commercialization of advanced proprietary drug delivery technologies for new and existing pharmaceutical products and metoclopramide.
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Medical waste requires immediate attention in Tanzania. A factor which intensifies the medical waste generation rate is the occupancy rate which is alarmingly higher in Tanzania about 131% ; compared to other countries like Pakistani about 76% ; Manyele, 2004b ; . As a result of a wide spread in the medical waste generation rates, Tanzania has distributed the regions into two groups: priority and non priority areas, which produce above or below 800 kg day, respectively. This study emanated from a training programme on medical waste management that was carried out in Tanzania from 2003 to 2005. The purpose of this training was to introduce the health workers to the better means of managing medical waste starting from the generation point to the final disposal cradle to grave ; . Meanwhile, the health workers had an opportunity to participate physically in the step-bystep construction of De Montfort incinerator so that they can construct new ones in their respective health facilities. Materials and Methods Data on MWM systems were collected during training sessions for health workers which were conducted from 2003-2005 in three zones South, West and the Lake Zone ; covering a total of 8 regions in Tanzania. In the Southern zone, the regions covered were Mtwara and Lindi centred in Masasi at Mkomaindo Hospital. The Western zone was centred in Tabora at.
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