Aims: To determine the degree to which optical coherence tomography (OCT) can distinguish differences in retinal nerve fibre layer (RNFL) thickness between ey es with mild papilloedema, pseudopapilloedema, and normal ...Aims: To determine the degree to which optical coherence tomography (OCT) can distinguish differences in retinal nerve fibre layer (RNFL) thickness between ey es with mild papilloedema, pseudopapilloedema, and normal findings. Methods: 13 patients with mild papilloedema, 11 patients with congenitally crowded optic ner ves, and 17 normal subjects underwent neuro-ophthalmic examination, automated v isual field testing, and fundus photography. Spinal fluid pressure measurements were obtained in a subgroup of five patients with pseudopapilloedema and 11 pati ents with mild papilloedema. Circular OCT scans using a diameter of 3.38 mm surr ounding the optic disc were performed in each eye of patients and subjects. Fund us photographs were analysed by two observers who diagnosed crowding or papilloe dema and graded amounts of swelling. Findings were assessed by descriptive stati stics and variance analysis. Results: RNFL thickness was greater in me superior and inferior quadrants and showed a high degree of correlation between each grou p of patients and subjects. A statistically significant difference was found in mean RNFL thickness between both groups of patients with optic disc swelling and normal subjects. However, there was not a statistical difference in mean nerve fibre layer thickness between patients with papilloedema and those with congenit ally crowded optic nerves. Conclusions: OCT demonstrates measurable differences in nerve fibre layer thickness between normal subjects and patients with either papilloedema or pseudopapilloedema. However, OCT does not appear to differentiat e between those individuals with congenitally crowded optic nerves and those wit h mild papilloedema caused by increased intracranial pressure.展开更多
Objectives: The medical method of artificial abortion is established and well accepted in Switzerland. During the postabortion control period, however, issues arise concerning the interpretation of the results of the ...Objectives: The medical method of artificial abortion is established and well accepted in Switzerland. During the postabortion control period, however, issues arise concerning the interpretation of the results of the sonography as well as how to treat residual material in the uterus and when to begin with contraception. Particularly when switching to at home administration of Misoprostol, however, definite and evidencebased management is crucial. The present study’ s objective is to evaluate the medical abortions carried out at our clinic during one year with a special focus on the ultrasound findings two weeks after the administration of Mifepriston and Misoprostol, the therapeutical interventions in case of residuals and the subsequent contraception. Materials and Methods: The data of all 232 patients who underwent medical abortion in the period from March 1, 2002 to February 28, 2003 were retrospectively reviewed. The cases were evaluated with regard to success rate, frequency of expulsion within the first four hours, ultrasound findings, possible therapeutic intervention and subsequent contraception, if known. The data were evaluated using descriptive statistics; statistical significance was calculated by means of the chi- square test, where appropriate. Results: Ninety- five percent of the women had a successful medical abortion. With the applied dosage 60% of the expulsions took place within the first four hours. Only one third of the patients had no more vaginal bleeding at time of the postabortion control. In almost 40% of the cases residuals were suspected, in about two thirds the endometrium was thicker than 10mm. In those cases, where data on this matter were available, the endometrium returned to normal with and without administration of Misoprostol. For less than half of the patients, subsequent contraception had already been initiated or had already been planned. Conclusions: The presented data seem to justify a watchful wait without further therapeutic intervention in the case of suspected residuals and/or an endometrium thickness of maximally 16 mm. Based on our findings we assume that this management is applicable in the case of Misoprostol administered at home, as well. Further analysis of our results will have to be performed to assess their validity.展开更多
Background: Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further...Background: Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further treatment. Objective: Our aim was to describe characteristics of skin screening participants, clinical screening diagnoses, management following referral, and specificity and yield of screening examinations. Methods: Information collected from consent forms, referral forms, and histopathological reports of lesions that had been excised or undergone biopsy was analyzed by means of descriptive statistics. Results: A total of 16,383 whole-body skin examinations resulted in 2302 referrals (14.1% overall; 15.5% men, 18.2% ≥ 50 years of age) for 4129 suspect lesions (including 222 suspected melanoma, 1101 suspected basal cell carcinomas [BCCs], 265 suspected squamous cell carcinomas [SCCs]). Histopathologic results were available for 94.8% of 1417 lesions excised and confirmed 33 melanomas (23 in men; 24 in participants ≥ 50 years of age), 259 BCCs, and 97 SCCs. The probability of detecting skin cancer of any type within the programwas 2.4% . The estimated specificity of whole-body skin examinations for melanoma was 86.1% (95% confidence interval = 85.6- 86.6). The positive predictive value (number of confirmed/number of lesions excised or biopsied × 100) for melanoma was 2.5% , 19.3% for BCC, and 7.2% for SCC (overall positive predictive value for skin cancer, 28.9% ). Limitations: Follow-up of participants with a negative screening examination has not been conducted for the present investigation. Conclusions: The rate of skin cancer detected per 100 patients screened was higher than previously reported and men and attendees older than 50 years more frequently received a referral and diagnosis of melanoma. The specificity for detection of melanoma through whole-body skin examination by a primary care physician was comparable to that of other screening tests, including mammography.展开更多
文摘Aims: To determine the degree to which optical coherence tomography (OCT) can distinguish differences in retinal nerve fibre layer (RNFL) thickness between ey es with mild papilloedema, pseudopapilloedema, and normal findings. Methods: 13 patients with mild papilloedema, 11 patients with congenitally crowded optic ner ves, and 17 normal subjects underwent neuro-ophthalmic examination, automated v isual field testing, and fundus photography. Spinal fluid pressure measurements were obtained in a subgroup of five patients with pseudopapilloedema and 11 pati ents with mild papilloedema. Circular OCT scans using a diameter of 3.38 mm surr ounding the optic disc were performed in each eye of patients and subjects. Fund us photographs were analysed by two observers who diagnosed crowding or papilloe dema and graded amounts of swelling. Findings were assessed by descriptive stati stics and variance analysis. Results: RNFL thickness was greater in me superior and inferior quadrants and showed a high degree of correlation between each grou p of patients and subjects. A statistically significant difference was found in mean RNFL thickness between both groups of patients with optic disc swelling and normal subjects. However, there was not a statistical difference in mean nerve fibre layer thickness between patients with papilloedema and those with congenit ally crowded optic nerves. Conclusions: OCT demonstrates measurable differences in nerve fibre layer thickness between normal subjects and patients with either papilloedema or pseudopapilloedema. However, OCT does not appear to differentiat e between those individuals with congenitally crowded optic nerves and those wit h mild papilloedema caused by increased intracranial pressure.
文摘Objectives: The medical method of artificial abortion is established and well accepted in Switzerland. During the postabortion control period, however, issues arise concerning the interpretation of the results of the sonography as well as how to treat residual material in the uterus and when to begin with contraception. Particularly when switching to at home administration of Misoprostol, however, definite and evidencebased management is crucial. The present study’ s objective is to evaluate the medical abortions carried out at our clinic during one year with a special focus on the ultrasound findings two weeks after the administration of Mifepriston and Misoprostol, the therapeutical interventions in case of residuals and the subsequent contraception. Materials and Methods: The data of all 232 patients who underwent medical abortion in the period from March 1, 2002 to February 28, 2003 were retrospectively reviewed. The cases were evaluated with regard to success rate, frequency of expulsion within the first four hours, ultrasound findings, possible therapeutic intervention and subsequent contraception, if known. The data were evaluated using descriptive statistics; statistical significance was calculated by means of the chi- square test, where appropriate. Results: Ninety- five percent of the women had a successful medical abortion. With the applied dosage 60% of the expulsions took place within the first four hours. Only one third of the patients had no more vaginal bleeding at time of the postabortion control. In almost 40% of the cases residuals were suspected, in about two thirds the endometrium was thicker than 10mm. In those cases, where data on this matter were available, the endometrium returned to normal with and without administration of Misoprostol. For less than half of the patients, subsequent contraception had already been initiated or had already been planned. Conclusions: The presented data seem to justify a watchful wait without further therapeutic intervention in the case of suspected residuals and/or an endometrium thickness of maximally 16 mm. Based on our findings we assume that this management is applicable in the case of Misoprostol administered at home, as well. Further analysis of our results will have to be performed to assess their validity.
文摘Background: Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further treatment. Objective: Our aim was to describe characteristics of skin screening participants, clinical screening diagnoses, management following referral, and specificity and yield of screening examinations. Methods: Information collected from consent forms, referral forms, and histopathological reports of lesions that had been excised or undergone biopsy was analyzed by means of descriptive statistics. Results: A total of 16,383 whole-body skin examinations resulted in 2302 referrals (14.1% overall; 15.5% men, 18.2% ≥ 50 years of age) for 4129 suspect lesions (including 222 suspected melanoma, 1101 suspected basal cell carcinomas [BCCs], 265 suspected squamous cell carcinomas [SCCs]). Histopathologic results were available for 94.8% of 1417 lesions excised and confirmed 33 melanomas (23 in men; 24 in participants ≥ 50 years of age), 259 BCCs, and 97 SCCs. The probability of detecting skin cancer of any type within the programwas 2.4% . The estimated specificity of whole-body skin examinations for melanoma was 86.1% (95% confidence interval = 85.6- 86.6). The positive predictive value (number of confirmed/number of lesions excised or biopsied × 100) for melanoma was 2.5% , 19.3% for BCC, and 7.2% for SCC (overall positive predictive value for skin cancer, 28.9% ). Limitations: Follow-up of participants with a negative screening examination has not been conducted for the present investigation. Conclusions: The rate of skin cancer detected per 100 patients screened was higher than previously reported and men and attendees older than 50 years more frequently received a referral and diagnosis of melanoma. The specificity for detection of melanoma through whole-body skin examination by a primary care physician was comparable to that of other screening tests, including mammography.
