BACKGROUND: To prevent later developmental impairments, myringotomy with the i nsertion of tympanostomy tubes has often been undertaken in young children who h ave persistent otitis media with effusion. We previously ...BACKGROUND: To prevent later developmental impairments, myringotomy with the i nsertion of tympanostomy tubes has often been undertaken in young children who h ave persistent otitis media with effusion. We previously reported that prompt as compared with delayed insertion of tympanostomy tubes in children with persiste nt effusion who were younger than three years of age did not result in improved developmental outcomes at three or four years of age. However, the effect on the outcomes of schoolage children is unknown. METHODS: We enrolled 6350 healthy in fants younger than 62 days of age and evaluated them regularly for middle-ear e ffusion. Before three years of age, 429 children with persistent middle-ear eff usion were randomly assigned to have tympanostomy tubes inserted either promptly or up to nine months later if effusion persisted. We assessed developmental out comes in 395 of these children at six years of age. RESULTS: At six years of age , 85 percent of children in the early treatment group and 41 percent in the dela yed treatment group had received tympanostomy tubes. There were no significant d ifferences in mean (±SD) scores favoring early versus delayed treatment on any of 30 measures, including the Wechsler Full-Scale Intelligence Quotient (98±13 vs. 98±14); Number of Different Words test, a measure of word diversity (183± 36 vs. 175±36); Percentage of Consonants Correct-Revised test, a measure of sp eech-sound production (96±2 vs. 96±3); the SCAN test, a measure of central au ditory processing (95±15 vs. 96±14); and several measures of behavior and emot ion. CONCLUSIONS: In otherwise healthy children younger than three years of age who have persistent middle-ear effusion within the duration of effusion that we studied, prompt insertion of tympanostomy tubes does not improve developmental outcomes at six years of age.展开更多
Purpose: To evaluate the outcome of Acanthamoeba keratitis with respect to the delay in diagnosis Methods: A retrospective review of the records of 14 patient s treated for A canthamoeba keratitis was carried out. Del...Purpose: To evaluate the outcome of Acanthamoeba keratitis with respect to the delay in diagnosis Methods: A retrospective review of the records of 14 patient s treated for A canthamoeba keratitis was carried out. Delay in diagnosis was co rrelated with risk factors, clinical presentation, method of diagnosis, final vi sual acuity and need for penetrating keratoplasty. Results: Based on the time in terval between the first symptoms and the diagnosis of Acanthamoeba keratitis, i t appeared that patients could be divided into two groups: an early treatment gr oup (group I), consisting of six patients treated within 18 days of onset of sym ptoms, and a late treatment group (group II), composed of eight patients treated beyond that time. There were no statistically significant differences between t he two groups as far as risk factors, clinical presentation, accuracy of diagnos iof and method of diagnosis were concerned, although more extensive and deeper c orneal involvement was noted in group II. Improvement in visual acuity following medical therapy was seen in all six patients in the early group and in three (3 7%) of the eight patients in the late group. One patient in group I needed urge nt penetrating keratoplasty for corneal necrosis. In group II, two patients unde rwent penetrating keratoplasty chaud to prevent corneal perforation and three patients needed penetrating keratoplasty to restore functional visual acuity. Co nclusion: A diagnostic delay of less than 18 days between onset of symptoms and start of anti-amoebic treatment results in a better final VA after medical trea tment and obviates the need for urgent and elective penetrating keratoplasty.展开更多
Since Murakami defined early gastric cancer(EGC) as a "carcinoma limited to the gastric mucosa and/or submucosa regardless of the lymph node status", several authors have focused on the most influential hist...Since Murakami defined early gastric cancer(EGC) as a "carcinoma limited to the gastric mucosa and/or submucosa regardless of the lymph node status", several authors have focused on the most influential histopathological parameters for predicting the development of lymph node metastases by considering the lymph node status as an important prognostic factor. A few authors have also considered the depth of invasion as one of the keys to explaining the existence of subgroups of patients affected by EGC with poor prognoses. In any case, EGC is still considered an initial phase of tumor progression with good prognosis. The introduction of modern endoscopic devices has allowed a precise diagnosis of early lesions, which can lead to improved definitions of tumors that can be radically treated with endoscopic mucosal resection or endoscopic submucosal dissection(ESD). Given the widespread use of these techniques, the Japanese Gastric Cancer Association( JGCA) identified in 2011 the standard criteria that should exclude the presence of lymph node metastases. At that time, EGCs with nodal involvement should have been asserted as no longer fitting the definition of an early tumor. Some authors have also demonstrated that the morphological growth pattern of a tumor, according to Kodama's classification, is one of the most important prognostic factors, thereby suggesting the need to report it in histopathological drafts. Notwithstanding the acquired knowledge regarding the clinical behavior of EGC, Murakami's definition is still being used. This definition needs to be upgraded according to the modern staging of the disease so that the appropriate treatment would be selected.展开更多
文摘BACKGROUND: To prevent later developmental impairments, myringotomy with the i nsertion of tympanostomy tubes has often been undertaken in young children who h ave persistent otitis media with effusion. We previously reported that prompt as compared with delayed insertion of tympanostomy tubes in children with persiste nt effusion who were younger than three years of age did not result in improved developmental outcomes at three or four years of age. However, the effect on the outcomes of schoolage children is unknown. METHODS: We enrolled 6350 healthy in fants younger than 62 days of age and evaluated them regularly for middle-ear e ffusion. Before three years of age, 429 children with persistent middle-ear eff usion were randomly assigned to have tympanostomy tubes inserted either promptly or up to nine months later if effusion persisted. We assessed developmental out comes in 395 of these children at six years of age. RESULTS: At six years of age , 85 percent of children in the early treatment group and 41 percent in the dela yed treatment group had received tympanostomy tubes. There were no significant d ifferences in mean (±SD) scores favoring early versus delayed treatment on any of 30 measures, including the Wechsler Full-Scale Intelligence Quotient (98±13 vs. 98±14); Number of Different Words test, a measure of word diversity (183± 36 vs. 175±36); Percentage of Consonants Correct-Revised test, a measure of sp eech-sound production (96±2 vs. 96±3); the SCAN test, a measure of central au ditory processing (95±15 vs. 96±14); and several measures of behavior and emot ion. CONCLUSIONS: In otherwise healthy children younger than three years of age who have persistent middle-ear effusion within the duration of effusion that we studied, prompt insertion of tympanostomy tubes does not improve developmental outcomes at six years of age.
文摘Purpose: To evaluate the outcome of Acanthamoeba keratitis with respect to the delay in diagnosis Methods: A retrospective review of the records of 14 patient s treated for A canthamoeba keratitis was carried out. Delay in diagnosis was co rrelated with risk factors, clinical presentation, method of diagnosis, final vi sual acuity and need for penetrating keratoplasty. Results: Based on the time in terval between the first symptoms and the diagnosis of Acanthamoeba keratitis, i t appeared that patients could be divided into two groups: an early treatment gr oup (group I), consisting of six patients treated within 18 days of onset of sym ptoms, and a late treatment group (group II), composed of eight patients treated beyond that time. There were no statistically significant differences between t he two groups as far as risk factors, clinical presentation, accuracy of diagnos iof and method of diagnosis were concerned, although more extensive and deeper c orneal involvement was noted in group II. Improvement in visual acuity following medical therapy was seen in all six patients in the early group and in three (3 7%) of the eight patients in the late group. One patient in group I needed urge nt penetrating keratoplasty for corneal necrosis. In group II, two patients unde rwent penetrating keratoplasty chaud to prevent corneal perforation and three patients needed penetrating keratoplasty to restore functional visual acuity. Co nclusion: A diagnostic delay of less than 18 days between onset of symptoms and start of anti-amoebic treatment results in a better final VA after medical trea tment and obviates the need for urgent and elective penetrating keratoplasty.
文摘Since Murakami defined early gastric cancer(EGC) as a "carcinoma limited to the gastric mucosa and/or submucosa regardless of the lymph node status", several authors have focused on the most influential histopathological parameters for predicting the development of lymph node metastases by considering the lymph node status as an important prognostic factor. A few authors have also considered the depth of invasion as one of the keys to explaining the existence of subgroups of patients affected by EGC with poor prognoses. In any case, EGC is still considered an initial phase of tumor progression with good prognosis. The introduction of modern endoscopic devices has allowed a precise diagnosis of early lesions, which can lead to improved definitions of tumors that can be radically treated with endoscopic mucosal resection or endoscopic submucosal dissection(ESD). Given the widespread use of these techniques, the Japanese Gastric Cancer Association( JGCA) identified in 2011 the standard criteria that should exclude the presence of lymph node metastases. At that time, EGCs with nodal involvement should have been asserted as no longer fitting the definition of an early tumor. Some authors have also demonstrated that the morphological growth pattern of a tumor, according to Kodama's classification, is one of the most important prognostic factors, thereby suggesting the need to report it in histopathological drafts. Notwithstanding the acquired knowledge regarding the clinical behavior of EGC, Murakami's definition is still being used. This definition needs to be upgraded according to the modern staging of the disease so that the appropriate treatment would be selected.
