Mapping nerve deficits during a physical exam after trauma to the upper extremity can help determine not only if the brachial plexus was injured but also which nerve roots were involved. A 28-year-old male presented w...Mapping nerve deficits during a physical exam after trauma to the upper extremity can help determine not only if the brachial plexus was injured but also which nerve roots were involved. A 28-year-old male presented with simultaneous signs and symptoms of Erb's(C5) and Klumpke's(C8, T1) palsy, with sparing of the C6 and C7 roots. The patient presented several months ago to his local emergency room with shortness of breath, which was determined to be caused by left diaphragmatic paralysis through clinical and radiographical evidence. However, the etiology of the current nerve dysfunction in the upper extremity remained unknown. With persistent questioning and establishing the patient's trust in the caregivers, it was revealed that the patient had attempted suicidal hanging. We describe the clinical features and the likely mechanism of injury leading to this previously unreported combination of brachial plexus injuries. The unique injuries to this patient's brachial plexus can be explained by the sequence of events during the attempted suicidal hanging. The upper brachial plexus was injured during the initial moments where the neck was excessively stretched and the lower brachial plexus was injured due to the patient reaching up and holding himself by his arm for an extended period of time.展开更多
Data on the prevalence of depression in adult congenital heart disease(ACHD)patients differ widely.We aim to summarize the best available information on the prevalence of depression,its prognostic impact,and psychiatr...Data on the prevalence of depression in adult congenital heart disease(ACHD)patients differ widely.We aim to summarize the best available information on the prevalence of depression,its prognostic impact,and psychiatric interventions for depressed ACHD patients.We reviewed references in relevant publications up to October 17,2017.For homogeneity of data,studies in which depression was independently assessed in patients aged 18 years or older or with a mean/median age older than 18 years were included.Retrospective and postoperative evaluation studies were excluded.Twenty publications met these criteria.Study samples included ACHD patients followed up at ACHD-specialized hospitals in 13 countries.The prevalence of depression differed widely,ranging from 6 to 69%.Depression has been shown to be an independent predictor of adverse clinical outcomes.It is also frequently associated with other prognostic variables(i.e.,poor functional class,unfavorable perceived health status,and low quality of life).Currently,no randomized clinical trials on psychiatric interventions in ACHD are available.In summary,depression is highly prevalent in ACHD patients,yet it is often unrecognized and untreated.The adverse prognostic impact of depression calls for specialized psychiatric interventions,for which more research is needed in the ACHD patient population.展开更多
Introduction: High Grade Prostatic Intraepithelial Neoplasia (HGPIN) was originally thought to be a cancer precursor, but subsequent data has questioned its prognostic significance. We analyzed a large cohort of men d...Introduction: High Grade Prostatic Intraepithelial Neoplasia (HGPIN) was originally thought to be a cancer precursor, but subsequent data has questioned its prognostic significance. We analyzed a large cohort of men diagnosed with HGPIN for subsequent occurrence of prostate cancer. Methods: From 2001 to 2011, we identified 567 men with isolated HGPIN and followed them for subsequent diagnosis of prostate cancer. Results: Two hundred and five patients were followed (median 5.9 years) without biopsy and remained clinically free of prostate cancer. The remaining 362 men underwent repeat biopsies and 133 (37%) were diagnosed with prostate cancer. The number of cores of HGPIN and whether they were unilateral or bilateral was not predictive for subsequent diagnosis of cancer. Prostate specific antigen was the only statistically significant predictor for prostate cancer. Conclusions: We found the incidence of cancer after a diagnosis of HGPIN to be 37%, which is consistent with other published series. This is only marginally higher than in patients re-biopsied after a prior benign biopsy. It appears that isolated HGPIN has only a small predictive value for subsequent diagnosis of prostate cancer. Therefore the finding of HGPIN should be used only in conjunction with other risk factors and patient considerations in deciding whether to proceed with further prostate biopsies.展开更多
文摘Mapping nerve deficits during a physical exam after trauma to the upper extremity can help determine not only if the brachial plexus was injured but also which nerve roots were involved. A 28-year-old male presented with simultaneous signs and symptoms of Erb's(C5) and Klumpke's(C8, T1) palsy, with sparing of the C6 and C7 roots. The patient presented several months ago to his local emergency room with shortness of breath, which was determined to be caused by left diaphragmatic paralysis through clinical and radiographical evidence. However, the etiology of the current nerve dysfunction in the upper extremity remained unknown. With persistent questioning and establishing the patient's trust in the caregivers, it was revealed that the patient had attempted suicidal hanging. We describe the clinical features and the likely mechanism of injury leading to this previously unreported combination of brachial plexus injuries. The unique injuries to this patient's brachial plexus can be explained by the sequence of events during the attempted suicidal hanging. The upper brachial plexus was injured during the initial moments where the neck was excessively stretched and the lower brachial plexus was injured due to the patient reaching up and holding himself by his arm for an extended period of time.
文摘Data on the prevalence of depression in adult congenital heart disease(ACHD)patients differ widely.We aim to summarize the best available information on the prevalence of depression,its prognostic impact,and psychiatric interventions for depressed ACHD patients.We reviewed references in relevant publications up to October 17,2017.For homogeneity of data,studies in which depression was independently assessed in patients aged 18 years or older or with a mean/median age older than 18 years were included.Retrospective and postoperative evaluation studies were excluded.Twenty publications met these criteria.Study samples included ACHD patients followed up at ACHD-specialized hospitals in 13 countries.The prevalence of depression differed widely,ranging from 6 to 69%.Depression has been shown to be an independent predictor of adverse clinical outcomes.It is also frequently associated with other prognostic variables(i.e.,poor functional class,unfavorable perceived health status,and low quality of life).Currently,no randomized clinical trials on psychiatric interventions in ACHD are available.In summary,depression is highly prevalent in ACHD patients,yet it is often unrecognized and untreated.The adverse prognostic impact of depression calls for specialized psychiatric interventions,for which more research is needed in the ACHD patient population.
文摘Introduction: High Grade Prostatic Intraepithelial Neoplasia (HGPIN) was originally thought to be a cancer precursor, but subsequent data has questioned its prognostic significance. We analyzed a large cohort of men diagnosed with HGPIN for subsequent occurrence of prostate cancer. Methods: From 2001 to 2011, we identified 567 men with isolated HGPIN and followed them for subsequent diagnosis of prostate cancer. Results: Two hundred and five patients were followed (median 5.9 years) without biopsy and remained clinically free of prostate cancer. The remaining 362 men underwent repeat biopsies and 133 (37%) were diagnosed with prostate cancer. The number of cores of HGPIN and whether they were unilateral or bilateral was not predictive for subsequent diagnosis of cancer. Prostate specific antigen was the only statistically significant predictor for prostate cancer. Conclusions: We found the incidence of cancer after a diagnosis of HGPIN to be 37%, which is consistent with other published series. This is only marginally higher than in patients re-biopsied after a prior benign biopsy. It appears that isolated HGPIN has only a small predictive value for subsequent diagnosis of prostate cancer. Therefore the finding of HGPIN should be used only in conjunction with other risk factors and patient considerations in deciding whether to proceed with further prostate biopsies.
