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  1. Sep 9, Ocular histoplasmosis is a condition that occurs years after a histoplasmosis infection. Histoplasmosis infection is caused by a fungus Histoplasma capsulatum and commonly affects people living in the 'Histo belt', which includes Arkansas, Kentucky, Missouri, Tennessee and West Virginia. Histoplasmosis.:
    In fact, if you had histoplasmosis symptoms, you might dismiss them as those from a cold or flu, since the body's immune system normally overcomes the infection in a few days without treatment. However, histoplasmosis, even mild cases, can later cause a serious eye disease called ocular histoplasmosis syndrome (OHS). dug dun duo dup dye ear eat ebb ecg eeg eel eft egg ego eke elf elk ell elm emu enc end ene eon epa era ere erg ese esp est eta etc eve ewe ext eye fad fag crab crag cram crap craw cree cres crew crib crop crow crud crus crux cuba cube cubs cuds cued cues cuff cull culs cult cups curb curd cure curl curs curt cusp. Cunaxa Cuneo Cunera van Selm Cung Cunina Cunningham Cupavo Cupertino Cupid Cupid's-dart Cupo Curacao Curcio Cure Curetes Curhan Curiatii Curie .. Eads Eadwina Eadwine Eagle Eagle-Eye Cherry Eagles Eakins Ealasaid Ealing Eamon Eanes Eanore Earhart Earl Earla Earle Earleen Earlene Earley Earlie.
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Motorvisual priming studies have provided detailed insights into the processing of perceptual representations in action planning. One important finding is that such representations in action planning have a categorical format, whereas metric representations are not anticipated in planning. Further essential findings regard the processing mechanisms and the time course of ideomotor cognition.

Perceptual representations of action effects are first activated by action planning and then bound into a compound representation of the action plan.

This compound representation is stabilized throughout the course of the action by the shielding of all involved representations from other cognitive processes. Despite a rapid growth in the number of motorvisual priming studies in the current literature, there are still many aspects of ideomotor cognition which have not yet been investigated.

These aspects include the scope of ideomotor processing with regard to action types and stimulus types, as well as the exact nature of the binding and shielding mechanisms involved. Interprofessional social and emotional intelligence skills training: Frequently changing demands in health care systems have focused attention on the need for emotional competence EC - social and emotional intelligence skills, to adapt efficiently, responsively and productively.

This paper reports on findings from a workshop that introduced practical EC skills to nearly participants in education, medicine, mental health and substance abuse counseling.

The holistic EC presentations were designed to teach concepts and principles providing each participant with the opportunity for individualized learning. Ninety percent of the participants rated these presentations as valuable and useful.

Following this positive response, the approach was adapted to train health professionals serving diverse populations. This report shares our experience teaching various professionals and describes preliminarily testing of the adapted EC training program on a small group of health professionals, whose responsibilities included teamwork, program design, teaching clients and patients EC basics to support healthy practices and self-care.

Their positive response supports the need for expanded study and further investigation. Modelling the exposure of wildlife to radiation: The agreed objectives of the group were: On-going activities of the working group, which will be described, include the development of a database of dynamic parameters for wildlife dose assessment and exercises involving modelling the exposure of organisms in the marine coastal.

From struggles to resource gains in interprofessional service networks: Key findings from a multiple case study.

In interprofessional service networks, employees cross professional boundaries to collaborate with colleagues and clients with expertise and values different from their own. It can be a struggle to adopt shared work practices and deal with "multivoicedness. Intertwined network struggles and resource gains have received limited attention in the interprofessional care literature to date. The aim of the study was to investigate the learning potential of the co-existing struggles and resource gains.

This article reports findings from two interprofessional networks. Interviews were conducted with 19 employees and thematically analysed. Three types of struggles and six types of resource gains of networking were identified. The struggles relate, first, to the assumptions of networking following similar practices to those in a home organisation; second, to the challenges of dealing with the multivoicedness of networking; and, third, to the experienced gap between the networking ideals and the reality of cooperation.

At the same time, the network members experience gains in emotional resources e. Learning potential emerged from the dynamics between coexisting struggles and resource gains. The framing of politics as strategy and game: A key concept in research on the media coverage of politics is the game or strategy frame. Contrasted with coverage of politics as issues, the framing of politics as a strategic game is marked by features such as winning and losing as the central concern and a focus on how candidates or parties are.

Criminal Victimisation in International Perspective: Content and Language Integrated Learning CLIL represents an increasingly popular pedagogic approach that has evolved in response to the recognised need for plurilingual competence in Europe.

In this article, we present key findings from one of the first large-scale, multidimensional CLIL evaluation projects. We begin by outlining the emergence…. This paper is a report on the key findings of a region-wide monitoring study conducted in Dutch-speaking schools in Belgium.

First, we elaborate on the building blocks of the instrument, which has been updated and improved since its first deployment in In particular we focus on the core indicators, along with the multi-actor approach, the…. Face recognition systems are very sensitive to the quality and resolution of their input face images. This makes such systems unreliable when working with long surveillance video sequences without employing some selection and enhancement algorithms.

On the other hand, processing all the frames Thus, there is a need for a mechanism to summarize the input video sequence to a set of key -frames and then applying an enhancement algorithm to this subset. This paper presents a system doing exactly this. The suggested system that employs a linear associator face recognizer to evaluate the enhanced results has been tested on real surveillance video sequences and the experimental results Introduction Sex workers, people who use drugs, men who have sex with men, women who have sex with women and transgender people in South Africa frequently experience high levels of stigma, abuse and discrimination.

Evidence suggests that such abuse is sometimes committed by police officers, meaning that those charged with protection are perpetrators. This reinforces cycles of violence, increases the risk of HIV infection, undermines HIV prevention and treatment interventions and violates the constitutional prescriptions that the police are mandated to protect.

This paper explores how relationship building can create positive outcomes while taking into account the challenges associated with reforming police strategies in relation to key populations, and vice versa. Discussion We argue that relationships between law enforcement agencies and key populations need to be re-examined and reconstituted to enable appropriate responses and services.

In addressing these concerns, we argue that mediation based on consensual dialogue is required, and can be harnessed through a process that highlights points of familiarity that are often shared, but not understood, by both parties. Rather than laying blame, we argue that substantive changes need to be owned and executed by all role-players, informed by a common language that is cognisant of differing perspectives.

Conclusions Relational approaches can be used to identify programmes that align goals that are part of law enforcement, human rights and public health despite not always being seen as such. Law enforcement champions and representatives of key populations need to be identified and supported to promote interventions that are mutually reinforcing, and address perceived differences by highlighting commonality. Full Text Available Introduction: Sex workers, people who use drugs, men who have sex with men, women who have sex with women and transgender people in South Africa frequently experience high levels of stigma, abuse and discrimination.

We argue that relationships between law enforcement agencies and key populations need to be re-examined and reconstituted to enable appropriate responses and services. Relational approaches can be used to identify programmes that align goals that are part of law enforcement, human rights and public health despite not always being seen as such. Law enforcement champions and representatives of key populations need to be identified and supported to promote interventions that are mutually reinforcing, and address perceived differences by.

Key Users in Social Network. How to find them? The number of systems that collect vast amount of data about users rapidly grow during last few years. Many of these systems contain data not only about people characteristics but also about their relationships with other system users.

From this kind of data it is possible to extract a social network that reflects the connections between system's users. Moreover, the analysis of such social network enables to investigate different characteristics of its members and their linkages.

One of the types of examining such network is key users extraction. Key users are these who have the biggest impact on other network members as well as have big influence on network evolution.

The obtained about these users knowledge enables to investigate and predict changes within the network. So this knowledge is very important for the people or companies who make a profit from the network like telecommunication company. The second important thing is the ability to extract these users as quick as possible, i. Benchmarking is the process of using outcome data to identify high-performing centres and determine practices associated with their outstanding performance. The CFF benchmarking project analysed these registry data, adjusting for differences in patient case mix known to influence outcomes, and identified the top-performing US paediatric and adult CF care programmes for pulmonary and nutritional outcomes.

Separate multidisciplinary paediatric and adult benchmarking teams each visited 10 CF care programmes, five in the top quintile for pulmonary outcomes and five in the top quintile for nutritional outcomes.

In summary, assessment of practice patterns at CF care centres with top-quintile pulmonary and nutritional outcomes provides insight into characteristic practices that may aid in optimising patient outcomes. It will deliver not only a suite of domain-specific and multidisciplinary data and services in one platform, but also the legal, governance and financial frameworks to ensure the infrastructure future operation and sustainability EPOS ERIC.

Defined life cycle and milestones: Map of phases, deliverables, key milestones and sufficiency criteria for each group involved in the project using project management tools and software. Shared organization, systems, roles: Defined roles for team members and responsibilities for functional managers are crucial. Similarly, a system of communication and team involvement is essential to success. Quality dimension should be aligned to the project objectives and specific criteria should be identified for each phase of the project.

Tracking and variance analysis: Regular reports and periodic meetings of the teams are crucial to identify when things are off target. Schedule slips, cost overruns, open issues, new risks and problems must be dealt with as early as possible. Impact assessment by monitoring the achievement of results and socio-economic impact. Full Text Available This paper reviews recent and advanced studies on educational effectiveness.

Section on integrated school effectiveness research is followed by a section on conceptually integrated models. The subsequent two sections focus on more methodological limitations of past research: Finally, the last section sums up all relevant facts and research strands. Find a Cancer Doctor. The Find an Oncologist The database includes the names of physicians and other health professionals from certain ASCO membership Perceptions of key participants about Botswana adolescents' risks of unplanned pregnancy, sexually transmitted diseases, and HIV: The qualitative research findings are reported on the perceptions of key participants in Botswana about adolescent sexuality problems and the feasibility with suggestions of an adolescent prevention intervention.

Twenty adult key participants who were selected through purposive sampling from schools and youth centers responded to open-ended questions during face-to-face individual in-depth interviews that were conducted between December, and January, in Gaborone, Botswana. The data were analyzed by using an inductive content analysis. Five major themes and 12 subthemes emerged from the interviews.

The key participants discussed situations that exposed adolescents to HIV, sexually transmitted infections, and pregnancy. They also discussed unsafe sexual practices, the consequences of unprotected sex, poor parent-adolescent communication on sexuality, and the need for a sexuality education program.

Policy changes are needed to improve collaboration between adolescents, parents, teachers, and youth officers in order to address adolescent sexuality problems.

Further research is needed to explore the ways in which to improve sexuality communication between these groups. The results of the study provide valuable information on the sexuality risks that expose adolescents to HIV, pregnancy, and sexually transmitted infections and the strategies for the prevention of these risks, thus informing targeted interventions for risk reduction for adolescents.

Find a Massage Therapist. Key Findings from a Roadmapping Workshop. The workshop brought together over 70 members of the PHM community. The attendees included representatives from small, medium, and large manufacturers; technology developers and integrators; academic researchers; government organizations; trade associations; and standards bodies.

The attendees discussed the current and anticipated measurement science challenges to advance PHM methods and techniques for smart manufacturing systems; the associated research and development needed to implement condition monitoring, diagnostic, and prognostic technologies within manufacturing environments; and the priorities to meet the needs of PHM in manufacturing.

This paper will summarize the key findings of this workshop, and present some of the critical measurement science challenges and corresponding roadmaps, i. Milestones and targeted capabilities will be presented for each roadmap across three areas: An analysis of these roadmaps and crosscutting themes seen across the breakout sessions is also discussed.

Journal of Research on Educational Effectiveness 7 — Selection Bias The classical problem of generalizing experimental findings from the trial sample to the population as a whole, also known as the problem. Facts and figures on nuclear energy are presented to enable a discussion on the role of nuclear power in the transition to a sustainable energy supply for the Netherlands. The following issues are presented: Nuclear technology, safety and security including non-proliferation and protection against terrorism ; Environmental aspects including greenhouse gas emissions of the nuclear energy lifecycle ; Nuclear power and the power market including impact of nuclear power on electricity market prices ; Economic aspects including costs of nuclear power and external costs and benefits ; Policy issues including sustainable development ; Social acceptance of nuclear energy; Knowledge infrastructure for nuclear energy in the Netherlands; and Nuclear power in long term energy scenarios for the Netherlands and Europe.

Using two long-term energy scenarios the report also presents a social impact analysis of an increasing share of nuclear power in the Dutch electricity supply. Op basis van de fact- finding studie bereidt de SER een advies voor over de rol van kernenergie in de toekomstige nationale elektriciteitsproductie. In de eerste acht hoofdstukken worden feiten en gegevens gepresenteerd over verschillende onderwerpen die bij kernenergie van belang zijn. In Hoofdstuk 2 wordt de kernenergietechnologie beschreven, inclusiefde veiligheid van kernenergie besproken, omdat die nauw met de technologie samenhangt.

Hierbij gaat het om de technische veiligheid van de installaties, maar ook om beveiliging tegen misbruik van technologie en nucleair materiaal, waaronder beveiliging tegen terrorisme. De milieuaspecten door radioactiviteit en door emissies van kooldioxide die met het gebruik van kernenergie samenhangen. The methodology uses project-based and systems-engineering approaches, the concept of Technology Readiness Levels, and considers lessons learned from Fission reactor material development.

R and D programmes to address these risks are developed. Programme optimisation by the pre-testing with fission neutrons on isotopically- or chemically-doped steels and with ion-beams is discussed along with the minimum 14 MeV testing programme, and the key role which fundamental and mission-oriented modelling can play in orienting the research.

Hysterosalpingographic findings in infertility. Four hundred and fifty four cases of H. Most frequent age group was year old, and those number of patient were Most frequent abnormal uterine findings was intravasation cases , and malposition , irregular margin , filling defect 37 , and diverticulum 6 in decreasing order. Most frequent abnormal tubal finding was obstruction cases , and hydrosalpinx 99 , diverticulosis 22 , intravasation 17 , peritubal adhesion 13 , and beaded tube 10 in decreasing order.

Nagative findings was seen in cases Nagative findings in both uterus and fallopian tubes was seen only 87 cases Find a Physical Therapist. There are numerous benefits to treatment by a physical therapist. In addition, there was absence of left anterior inferior cerebellar artery AICA and absence of bilateral facial colliculi.

Clinical features, etiology, and imaging findings are discussed. Finding optimal exact reducts. The problem of attribute reduction is an important problem related to feature selection and knowledge discovery. The problem of finding reducts with minimum cardinality is NP-hard. This paper suggests a new algorithm for finding exact reducts with minimum cardinality.

This algorithm transforms the initial table to a decision table of a special kind, apply a set of simplification steps to this table, and use a dynamic programming algorithm to finish the construction of an optimal reduct. For many of the experimented tables, the simplification steps solved the problem. To evaluate the characteristic CT findings of neuroblastoma, we studied neuroblastomas.

We analysed CT findings of available 25 cases among pathologically proved 51 neuroblastomas from Jan. Characteristic CT findings are as follows: The most common organ or contiguous direct invasion is kidney in 6 cases and the next one is liver but intraspinal canal invasion is also noted in 2 cases.

We concluded that diagnosis of neuroblastoma would be easily obtained in masses of pediatric group from recognition of above characteristic findings. Medical Faculty, Kayseri Turkey. To evaluate the radiological, ultrasonographic, and magnetic resonance imaging MRI findings of idiopathic granulomatous mastitis. Between April and June , the mammography, ultrasound, color Doppler ultrasound, non enhanced MR, and dynamic MR findings of nine patients with the preliminary clinical diagnosis of malignancy and the final diagnosis of granulomatous mastitis were evaluated.

On mammography, asymmetrical focal densities with no distinct margins, ill-defined masses with spiculated contours, and bilateral multiple ill-defined nodules were seen. On ultrasound, in four patients a discrete, heterogenous hypoechoic mass, in two patients multiple abscesses, in one patient bilateral multiple central hypo peripheral hyperechoic lesions, in two patients heterogeneous hypo- and hyperechoic areas together with parenchymal distortion, and in one patient irregular hypoechoic masses with tubular extensions and abscess cavities were seen.

Five of the lesions were vascular on color Doppler ultrasound. On MR mammography, the most frequent finding was focal or diffuse asymmetrical signal intensity changes that were hypointense on T1W images and hyperintense on T2W images, without significant mass effect.

Nodular lesions were also seen. On dynamic contrast-enhanced mammography, mass-like enhancement, ring-like enhancement, and nodular enhancement were seen.

The time-intensity curves differed from patient to patient and from lesion to lesion. The imaging findings of idiopathic granulomatous mastitis have a wide spectrum, and they are inconclusive for differentiating malignant and benign lesions.

Finding Health Care Services. If you have been diagnosed with cancer, finding a doctor and treatment facility for your cancer care is an important step to getting the best treatment possible. Learn tips for choosing a doctor and treatment facility to manage your cancer care. Hepatic angiosarcoma is a rare malignant vascular tumor.

Accurate preoperative diagnosis of this tumor is very difficult if the patient does not have any history of exposure to specific carcinogens including thorotrast, arsenicals and vinyl chloride monomer. We describe CT findings in two cases of hepatic angiosarcoma in combination with a review of the literature. Findings are reported on a three year cross-age tutoring program in which undergraduate dental hygiene students and college students from other disciplines trained upper elementary students to tutor younger students in the techniques of dental hygiene.

Data includes pre-post scores on the Oral Hygiene Index of plaque for both experimental and…. CT and MR findings in two patients with hepatoerythropoietic porphyria are presented. CT scans showed atrophy and cortical mineralization at the same level.

MR examination performed in one of the two patients showed mainly frontal cortical atrophy and punctate bright signal on T1- and T2-weighted sequences. Schwannomas are peripheral nerve sheath tumors. We report a case of a year-old patient with a tongue schwannoma. Morphologic analysis and immunohistochemical findings strongly support the diagnosis. Surgical treatment is discussed. The Origin and Diversification of Osteichthyans and Sarcopterygians: All organisms,living or extinct,are related to each other by sharing common ancestors at different levels,like twigs and branches connected to each other at different nodes on the great tree of life.

One major task for paleontologists and evolutionary biologists is to find out how the diverse groups of organisms arose and how they are related to each other,thereby reconstructing the history of life and understanding the pattern and process of evolution.

To evaluate the sonographic findings of the heterotopic pregnancy which is increasing recently. They were diagnosed by ultrasonography and proved surgically afterwards. Sonographic findings were analyzed focusing on gestational week of intrauterine pregnancy and location of ectopic pregnancy. In particular, adnexal mass was evaluated with regard to size and the characteristic findings such as ectopic gestational sac echogenic ring. Also, overian cyst and fluid collection in cul-de-sac space were reviewed carefully.

Heterotopic pregnancy was proved surgically by salpingectomy in 33 cases and by resection of cornus in six cases. Sonographic diagnosis using transvaginal ultrasound was made from five weeks to nine weeks two days six weeks and four days in average from last menstral period in all 39 cases.

Ectopic pregnancy was identified in ampullary part in 29 cases, in the isthmic portion of tube in four cases and in the cornus of uterus in six cases. The intrauterine pregnancy was diagnosed by identifying the intrauterine gestational saccontaining a yolk sac in seven cases and the embryo with fetal heart beat in the remaining 32 cases.

A characteristic finding of ectopic mass was echogenic ring which was visible in 33 Six cases had pelvic hematosalpinx and two had pelvic hematoma. Ultrasonographic identification of the intrauterine pregnancy and the ectopic chorion ring is effective for the early diagnosis of the heterotopic pregnancy.

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis. The classic radiographic triad of small bowel obstruction, pneumobilia and ectopic gallstone on abdominal plain radiograph is described with CT imaging. Because of the better resolution of CT compared with abdominal radiography and its recent accession to emergency use, radiologists should be aware of CT findings of gallstone ileus.

We report a case in which gallstone ileus was initially diagnosed by CT. Key focal areas for bridging the fields of aging and disability: Five focal areas emerged: MR findings of ulegyria. School of Medicine ; Maezawa, Mariko. Magnetic resonance MR findings of the brains diagnosed to have ulegyria were reviewed.

The reviewed subjects comprised six epileptic children, ranged from 2 to 16 years of age. All patients had convulsion of tonic-clonic type of various severity and had histories of ischemic-hypoxic or hypoglycemic episode in the perinatal or postnatal period.

Although these findings were nearly pathognomonic to ulegyria, polymicrogyria could mimic it since both are characterized by abnormally diminutive cortical gyri seen in epileptic children. In polymicrogyria, however, affected gyri are uniformly diminutive and not mushroom-shaped, the cortex is rather thickened than atrophic, the underlying white matter shows no focal hyperintensity, subcortical cystic changes are not present, and affected cortex is not restricted to arterial border zones.

Even in one of our cases with extensive ulegyria, it was easy to differentiate it from polymicrogyria since parasagittal regions were most severely affected. Although the previous reports on ulegyria have been exclusively based on postmortem pathological examinations or experimental models, its easy recognition on MRI would contribute to further understanding of its clinical significance and mechanisms.

MR findings of spondylolysis. School of Medicine ; Toyoda, Keiko. We reviewed MR images of 50 patients with spondylolisthesis to disclose MR findings of spondylolysis. In almost half of our series, spondylolysis was detected as a low signal intensity band traversing in the pairs interarticularis on both T1 and T2 weighted images.

Sagittal images was superior to axial image in detection of the low signal intensity band. In some patients, a focal high signal intensity accompanying the low signal intensity band was considered to be fluid collection within pseudoarthrosis due to spondylolysis on T2-weighted image. To conduct a systematic literature review of selected major provisions of the Affordable Care Act ACA pertaining to expanded health insurance coverage.

We conclude with a summary and offer a research agenda for future studies. We identified relevant articles from peer-reviewed scholarly journals by performing a comprehensive search of major electronic databases. We also identified reports in the "gray literature" disseminated by government agencies and other organizations. Overall, research shows that the ACA has substantially decreased the number of uninsured individuals through the dependent coverage provision, Medicaid expansion, health insurance exchanges, availability of subsidies, and other policy changes.

Early evidence also indicates improvements in access to and affordability of health care. All of these changes are certain to ultimately impact state and federal budgets. The ACA will either directly or indirectly affect almost all Americans. As new and comprehensive data become available, more rigorous evaluations will provide further insights as to whether the ACA has been successful in achieving its goals.

Identifying and preventing medical errors in patients with limited English proficiency: In the content development phase, a comprehensive mixed-methods approach was used to identify common causes of errors for LEP patients, high-risk scenarios, and evidence-based strategies to address them.

A Guide for Hospitals contains recommendations to improve detection and prevention of medical errors across diverse populations, and TeamSTEPPS Enhancing Safety for Patients with Limited English Proficiency Module trains staff to improve safety through team communication and incorporating interpreters in the care process.

Both tools were found to be implementable, acceptable to their audiences, and conducive to learning. Further research on the impact of the combined use of the guide and module would shed light on their value as a multifaceted intervention. Yeom, Suk Keu, E-mail: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients.

CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients 5 women, 1 man; mean age, Medical records were also reviewed to determine each patient's clinical status and outcome. All patients were immunocompromised state: CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum.

Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis. Ultrasonographic findings of Epicondylitis. To evaluate the usefulness of ultrasonographic findings of the common extensor and flexor tendon in evaluation of patients with lateral and medial epicondylitis. Ultrasonographic examination was performed to evaluate lateral or medial epicondylitis.

Epicondylitis was divided into five groups according to the severity of disease: Change in the size of a tendon, bony change of the epicondylitis, presence or absence of calcification or echogenic foci in the common tendon and hypervascularity for each categories were also assessed.

In addition, these lesions were divided into the superficial and deep according to the location of lesions.

According to the severity, there were 15 cases of normal, 13 tendinopathies, 8 tendinopathies with a partial tear, 2 partial tears and 0 complete tear. Bony change was seen only in tendinopathy, tendinopathy with partial tear and partial tear. Calcification or echogenic foci were only observed in cases with tendinopathy and tendinopathy with partial tear. Hypervascularity was only seen in one case of tendinopathy. With thorough understanding of ultrasonographic findings of epicondylitis, ultrasonographic examination can be especially useful and effective in evaluating the severity and location of lesions.

Rhabdomyolysis is defined as skeletal muscle necrosis. Ultrasound assessment has recently become a useful tool for the diagnosis and monitoring of muscle diseases, including rhabdomyolysis. A case is presented on the ultrasound findings in a patient with rhabdomyolysis. To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings , and review the literature.

Ultrasound was performed using a Philips Sparq model with a high-frequency linear transducer MHz , in low-dimensional scanning mode 2D , in longitudinal and transverse sections at the level of both thighs. The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas.

Ultrasound is a useful tool in the evaluation of rhabdomyolysis. Can I Trust Your Findings? We provide suggestions for how to rule out alternative explanations, explaining key considerations not only in empirical analyses, but also in theory building and in research design. Our discussion covers both qualitative and quantitative studies Radiologic findings in neurofibromatosis. Neurofibromatosis is an uncommon but certainly not a rare hereditary disorder, probably of neuralcrest origin, involving not only neuroectoderm and mesoderm but also endoderm and characterized by cafe au lait spots and cutaneous and subcutaneous tumors, with secondary mesodermal defects responsible for protean osseous abnormalities and various manifestations in other systems.

This paper is a study of confirmed cases of neurofibromatosis collected for past 8 years. In this analysis, special attention was given to the selected 37 cases which showed abnormal findings on radiological examinations.

Overall male to female ratio was 1: The most frequent kind of abnormalities was vertebral kyphoscoliosis in 12 cases. Among the more pathognomonic but uncommon abnormalities to neurofibromatosis, we experienced each 2 cases of lambdoid defect, pseudoarthrosis and renovascular hypertension, and 1 cases of sphenoid bone absence.

Impacts of casinos on key pathways to health: Three decades ago, casino gaming on sovereign American Indian lands was legalized with differential economic and social implications. While casinos have improved the incomes of tribal communities, there have been both positive and negative findings in relation to health impacts. We sought to understand the perceived pathways by which casinos impact individual and community health through voices of the community.

We inductively analyzed textual data drawing from Grounded Theory, first using line-by-line coding to identify analytic categories from emergent themes in consideration of the study objective. Then, focused codes were applied to identify salient themes, which we represented through exemplar quotes and an overall conceptual framework. Data were managed and coded using Dedoose software.

American Indian-owned casinos are perceived to influence the health of tribal communities through three pathways: Forming these pathways are a series of interrelated health determinants. Improvement of the tribal economy, through both job creation for tribal members and improved tribal cash flow, was perceived by participants to both influence health.

Specifically, improved cash flow has resulted in new wellness programs, community centers, places for recreation, and improved social services.

Higher disposable incomes have led to better financial stability, increased access to healthy food, and more opportunities for physical activity. Yet, higher disposable incomes were perceived to also contribute to negative health behaviors, most notably increased drug and alcohol abuse.

Casinos were also perceived to alter built environments, resulting in increased availability and access to unhealthy. Analysis of Data as of July Key Findings and Analysis. YoungStar is a five-star quality rating system for child care providers based on education, learning environment, business methods, and practices around child health and well-being. Through this rating system, the state is addressing several key issues in Wisconsin's child care system.

The rating system will: This article presents findings on pupil attitudes towards learning foreign languages in Key Stage 2 ages in primary schools in England. As a consequence of the National Languages Strategy, the University of Warwick was commissioned by the then Department for Education and Skills to undertake an evaluation between and of 19….

Research from the First Half of the Study. Regional Issue Brief Number The study explores young people's decisions about their educational and job opportunities in rural northern New…. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus.

The most common symptoms were chest pain in In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. Peripheral expansion of the mass was observed in 12 Intraoperatively, pleural involvement was observed in 14 cases Comparative study of human and mouse postsynaptic proteomes finds high compositional conservation and abundance differences for key synaptic proteins.

Full Text Available Direct comparison of protein components from human and mouse excitatory synapses is important for determining the suitability of mice as models of human brain disease and to understand the evolution of the mammalian brain.

The postsynaptic density is a highly complex set of proteins organized into molecular networks that play a central role in behavior and disease. We report the first direct comparison of the proteome of triplicate isolates of mouse and human cortical postsynaptic densities.

The mouse postsynaptic density comprised proteins and the human one Quantitative analysis of postsynaptic density components in both species indicates a broadly similar profile of abundance but also shows that there is higher abundance variation between species than within species. Well known components of this synaptic structure are generally more abundant in the mouse postsynaptic density.

Significant inter-species abundance differences exist in some families of key postsynaptic density proteins including glutamatergic neurotransmitter receptors and adaptor proteins. Furthermore, we have identified a closely interacting set of molecules enriched in the human postsynaptic density that could be involved in dendrite and spine structural plasticity. Understanding synapse proteome diversity within and between species will be important to further our understanding of brain complexity and disease.

Immunological findings in autism. In measles virus infection, it has been postulated that there is immune suppression by inhibiting T-cell proliferation and maturation and downregulation MHC class II expression.

Cytokine alteration of TNF-alpha is increased in autistic populations. Toll-like-receptors are also involved in autistic development. High NO levels are associated with autism. Maternal antibodies may trigger autism as a mechanism of autoimmunity. MMR vaccination may increase risk for autism via an autoimmune mechanism in autism.

MMR antibodies are significantly higher in autistic children as compared to normal children, supporting a role of MMR in autism. Increase in Th2 may explain the increased autoimmunity, such as the findings of antibodies to MBP and neuronal axonal filaments in the brain.

There is further evidence that there are other participants in the autoimmune phenomenon. The possibility of its involvement in autism cannot be ruled out. Further investigations at immunological, cellular, molecular, and genetic levels will allow researchers to continue to unravel the immunopathogenic mechanisms' associated with autistic processes in the developing brain.

Her work could lead to new ways to treat chronic wounds like diabetic foot ulcers. Read Issue George Hightower, M. Modelling efforts needed to advance herpes simplex virus HSV vaccine development: Development of a vaccine against herpes simplex virus HSV is an important goal for global sexual and reproductive health.

In order to more precisely define the health and economic burden of HSV infection and the theoretical impact and cost-effectiveness of an HSV vaccine, in the World Health Organization convened an expert consultation meeting on HSV vaccine impact modelling. The experts reviewed existing model-based estimates and dynamic models of HSV infection to outline critical future modelling needs to inform development of a comprehensive business case and preferred product characteristics for an HSV vaccine.

This article summarizes key findings and discussions from the meeting on modelling needs related to HSV burden, costs, and vaccine impact, essential data needs to carry out those models, and important model components and parameters. Published by Elsevier Ltd. Key findings and potential next steps. The key findings from the issue's 10 articles are reviewed and organized here around three topics: Several potential next steps in improving effective research strategies are highlighted: The articles in this issue examined the general theme of including diverse population groups in genetic studies and offered potential strategies for addressing some common problems.

Am J Addict ; Computed tomographic findings of trichuriasis. In this report, we present computed tomographic findings of colonic trichuriasis. The patient was a year-old man who complained of abdominal pain, and weight loss. Diagnosis was achieved by colonoscopic biopsy.

Abdominal computed tomography showed irregular and nodular thickening of the wall of the cecum and ascending colon. Although these findings are nonspecific, they may be one of the findings of trichuriasis. These findings , confirmed by pathologic analysis of the biopsied tissue and KatoKatz parasitological stool flotation technique, revealed adult Trichuris. To our knowledge, this is the first report of colonic trichuriasis indicated by computed tomography. Full Text Available Neurological manifestations are rare in dengue fever.

Two cases with encephalopathy and systemic features of dengue fever with abnormal CSF and MR imaging are reported. Striking MRI finding was bilateral symmetrical thalamic lesions similar to those reported in Japanese encephalitis. This report highlights that MRI findings can be similar in dengue and Japanese encephalitis. Electroencephalographic Findings in Posthypoxic Myoclonus.

The physical examination findings of early posthypoxic myoclonus PHM are associated with poor prognosis. Recent findings indicate that patients with multifocal PHM, assumed to have a cortical origin, have a comparable outcome to resuscitated patients without PHM. Generalized PHM, assumed to have a. Knowledge translation of research findings. Full Text Available Abstract Background One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy.

As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research the translation of new clinical knowledge into improved health.

We structure the article around five key questions: Discussion We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups.

There are a large number of planned knowledge translation models, derived from different disciplinary, contextual i. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge. Ultrasonographic findings of testicular tumors: Correlation with pathologic findings. Scrotal sonography is a valuable tool for assessing the testis and surrounding structures, and has become the imaging modality of choice for evaluation of the scrotum.

Scrotal sonography is also helpful for differentiating cystic from slid mass and testicular from extratesticular mass, but is sometimes difficult in differentiating malignant tumor from various benign conditions such as epidermoid cyst, focal orchitis, testicular hematoma, and abscess. We demonstrate the sonographic findings of the various testicular mass, and correlation with pathologic findings. Finding Maximal Quasiperiodicities in Strings.

Our algorithm uses the suffix tree as the fundamental data structure combined with efficient methods for merging and performing multiple searches in search trees. Besides finding all maximal quasiperiodic substrings, our algorithm also marks the nodes Apostolico and Ehrenfeucht defined the notion of a maximal quasiperiodic substring and gave an algorithm that finds all maximal quasiperiodic substrings in a string of length n in time O n log2 n.

In this paper we give an algorithm that finds all maximal quasiperiodic substrings in a string Chest radiographic findings of leptospirosis. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed.

Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever.

CT findings of pulmonary aspergillosis. The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or cystic space. Invasive pulmonary aspergillosis is serious, usually fatal infection in patients being treated with immunosuppressants or who have chronic debilitating disease. Allergic bronchopulmonary aspergillosis is characterized clinically by asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen.

Awareness of the radiographic and CT findings of pulmonary aspergillosis is important in making the diagnosis of aspergillus-caused pulmonary disorders. In this pictorial essay, we illustrated various radiological findings of pulmonary aspergillosis focused on CT findings correlated with gross pathologic specimens. Imaging findings of sternal abnormalities. Radiographic findings in the sternal abnormalities are often nonspecific, showing appearances from a localized benign lesion to an aggressive lesion as seen with infections and malignant neoplasms.

A specific diagnosis of sternal abnormalities can be suggested on the basis of CT and MR characteristics. Familiarity with the presentation and variable appearance of sternal abnormalities may aid the radiologist is suggesting a specific diagnosis.

We present among others characteristic radiographic findings of hemangioma, chondrosarcoma, hydatid disease, and SAPHO syndrome. In those cases in which findings are not specific, cross-sectional imaging modalities may help the clinician in their management. Finding an Eye Care Professional. Dermoscopy Findings of Hidroacanthoma Simplex.

Full Text Available Hidroacanthoma simplex HAS, also known as intraepidermal eccrine poroma, is a rare eccrine adnexal tumor that tends to be misdiagnosed as other types of benign skin tumor, including clonal seborrheic keratosis. Notably, HAS is sometimes misdiagnosed and treated by cryosurgery as seborrheic keratosis, which could trigger the later development of porocarcinoma.

Therefore, accurate diagnosis of HAS is indispensable for dermatologists to avoid the development of malignant tumors by an unsuitable treatment. In this report, we present the characteristic dermoscopy findings of HAS.

Indeed, the dermoscopy findings might be related to the melanin-rich necrotic cells in the epidermis, which are quite different from dermoscopy findings of clonal seborrheic keratosis.

As a previous report suggested, it is difficult for a dermatologist to differentiate HAS from clonal seborrheic keratosis by the naked eye. Our findings might be supportive for the early diagnosis of HAS. Finding Relief from Allergy's Grip. A Family Finds Its Way. Past Issues Cover Story: Photo courtesy of Stefan Radtke, www. Radiographic findings in liveborn triploidy. The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported.

Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: Harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis. Sixteen other less specific findings showed many similarities to those found in trisomy Radiologic findings of granulomatous mastitis. The describe the radiologic findings of granulomatous mastitis of the breast.

This study included 19 patients age range: All the patients underwent a breast ultrasonography and 13 patients underwent a mammography. In the case of granulomatous mastitis, the mammography results indicate a lack of specificity between normal findings and focal asymmetry.

The sonographic findings indicate that ill-defined heterogeneously low echoic lesions or irregular shaped, ill-defined low echoic masses are difficult to differentiate from breast cancer. The sonographic findings of abscesses indicate a difficulty in differentiating them from cases of pyogenic mastitis.

However, multiple tubular and nodular low echoic lesions, especially with a continuous appearance, should point to granulomatous mastitis, and is helpful in its differential diagnosis and treatment. The RNA world in the 21st century-a systems approach to finding non-coding keys to clinical questions. There was evidence that RNAs are a functionally rich class of molecules not only since the arrival of the next-generation sequencing technology.

Non-coding RNAs ncRNA could be the key to accelerated diagnosis and enhanced prediction of disease and therapy outcomes as well as the design of advanced therapeutic strategies to overcome yet unsatisfactory approaches. In this review, we discuss the state of the art in RNA systems biology with focus on the application in the systems biomedicine field.

We introduce RNA expression profiling and network approaches for the identification of stable and effective RNomics-based biomarkers, providing insights into the role of ncRNAs in disease regulation.

Towards this, we discuss ways to model the dynamics of gene regulatory networks and signalling pathways that involve ncRNAs. Since OHS rarely affects side, or peripheral vision, the disease does not cause total blindness. Although only a tiny fraction of the people infected with the histo fungus ever develops OHS, any person who has had histoplasmosis should be alert for any changes in vision similar to those described above. Studies have shown the OHS patients usually test positive for previous exposure to histoplasmosis.

Since most cases of histoplasmosis are undiagnosed, anyone who has ever lived in an area known to have a high rate of histoplasmosis should consider having their eyes examined for histo spots.

OHS usually has no symptoms in its early stages; the initial OHS infection usually subsides without the need for treatment. Histo spots do not generally affect vision, but for reasons that are still not well understood, they can result in complications years—sometimes even decades—after the original eye infection.

Histo spots have been associated with the growth of the abnormal blood vessels underneath the retina. In later stages, OHS symptoms may appear if the abnormal blood vessels cause changes in vision. For example, straight lines may appear crooked or wavy, or a blind spot may appear in the field of vision.

Because these symptoms indicate that OHS has already progressed enough to affect vision, anyone who has been exposed to histoplasmosis and perceives even slight changes in vision should consult an eye care professional. An eye care professional will usually diagnose OHS if a careful eye examination reveals two conditions: To confirm the diagnosis, a dilated eye examination must be performed.

This means that the pupils are enlarged temporarily with special drops, allowing the eye care professional to better examine the retina. If fluid, blood, or abnormal blood vessels are present, an eye care professional may want to perform a diagnostic procedure called fluorescein angiography.

The dye allows a better view of the CNV lesion, and photographs can document the location and extent to which it has spread. Particular attention is paid to how close the abnormal blood vessels are to the fovea.

The only proven treatment for OHS is a form of laser surgery called photocoagulation. A small, powerful beam of light destroys the fragile, abnormal blood vessels, as well as a small amount of the overlying retinal tissue.

Although the destruction of retinal tissue during the procedure can itself cause some loss of vision, this is done in the hope of protecting the fovea and preserving the finely-tuned vision it provides. Controlled clinical trials, sponsored by the National Eye Institute, have shown that photocoagulation can reduce future vision loss from OHS by more than half.

The treatment is most effective when:. Laser photocoagulation usually does not restore lost vision. However, it does reduce the chance of further CNV growth and any resulting vision loss.

OHS cannot be cured. Each recurrence can damage vision and may require additional laser therapy. It is crucial to detect and treat OHS as early as possible before it causes significant visual impairment. A person can check for signs of damage to the macula by looking at a printed pattern called an Amsler grid. If the macula has been damaged, the vertical and horizontal lines of the grid may appear curved, or a blank spot may seem to appear.

Many eye care professionals advise patients who have received treatment for OHS, as well as those with histo spots, to check their vision daily with the Amsler grid one eye at a time.

todays society

Twenty adult key participants who were selected through purposive sampling from schools and youth centers responded to open-ended questions during face-to-face individual in-depth interviews that were conducted between December, and January, in Gaborone, Botswana.

The data were analyzed by using an inductive content analysis. Five major themes and 12 subthemes emerged from the interviews. The key participants discussed situations that exposed adolescents to HIV, sexually transmitted infections, and pregnancy.

They also discussed unsafe sexual practices, the consequences of unprotected sex, poor parent-adolescent communication on sexuality, and the need for a sexuality education program. Policy changes are needed to improve collaboration between adolescents, parents, teachers, and youth officers in order to address adolescent sexuality problems.

Further research is needed to explore the ways in which to improve sexuality communication between these groups. The results of the study provide valuable information on the sexuality risks that expose adolescents to HIV, pregnancy, and sexually transmitted infections and the strategies for the prevention of these risks, thus informing targeted interventions for risk reduction for adolescents. Find a Massage Therapist.

Key Findings from a Roadmapping Workshop. The workshop brought together over 70 members of the PHM community. The attendees included representatives from small, medium, and large manufacturers; technology developers and integrators; academic researchers; government organizations; trade associations; and standards bodies. The attendees discussed the current and anticipated measurement science challenges to advance PHM methods and techniques for smart manufacturing systems; the associated research and development needed to implement condition monitoring, diagnostic, and prognostic technologies within manufacturing environments; and the priorities to meet the needs of PHM in manufacturing.

This paper will summarize the key findings of this workshop, and present some of the critical measurement science challenges and corresponding roadmaps, i. Milestones and targeted capabilities will be presented for each roadmap across three areas: An analysis of these roadmaps and crosscutting themes seen across the breakout sessions is also discussed. Journal of Research on Educational Effectiveness 7 — Selection Bias The classical problem of generalizing experimental findings from the trial sample to the population as a whole, also known as the problem.

Facts and figures on nuclear energy are presented to enable a discussion on the role of nuclear power in the transition to a sustainable energy supply for the Netherlands. The following issues are presented: Nuclear technology, safety and security including non-proliferation and protection against terrorism ; Environmental aspects including greenhouse gas emissions of the nuclear energy lifecycle ; Nuclear power and the power market including impact of nuclear power on electricity market prices ; Economic aspects including costs of nuclear power and external costs and benefits ; Policy issues including sustainable development ; Social acceptance of nuclear energy; Knowledge infrastructure for nuclear energy in the Netherlands; and Nuclear power in long term energy scenarios for the Netherlands and Europe.

Using two long-term energy scenarios the report also presents a social impact analysis of an increasing share of nuclear power in the Dutch electricity supply. Op basis van de fact- finding studie bereidt de SER een advies voor over de rol van kernenergie in de toekomstige nationale elektriciteitsproductie. In de eerste acht hoofdstukken worden feiten en gegevens gepresenteerd over verschillende onderwerpen die bij kernenergie van belang zijn.

In Hoofdstuk 2 wordt de kernenergietechnologie beschreven, inclusiefde veiligheid van kernenergie besproken, omdat die nauw met de technologie samenhangt. Hierbij gaat het om de technische veiligheid van de installaties, maar ook om beveiliging tegen misbruik van technologie en nucleair materiaal, waaronder beveiliging tegen terrorisme.

De milieuaspecten door radioactiviteit en door emissies van kooldioxide die met het gebruik van kernenergie samenhangen. The methodology uses project-based and systems-engineering approaches, the concept of Technology Readiness Levels, and considers lessons learned from Fission reactor material development. R and D programmes to address these risks are developed. Programme optimisation by the pre-testing with fission neutrons on isotopically- or chemically-doped steels and with ion-beams is discussed along with the minimum 14 MeV testing programme, and the key role which fundamental and mission-oriented modelling can play in orienting the research.

Hysterosalpingographic findings in infertility. Four hundred and fifty four cases of H. Most frequent age group was year old, and those number of patient were Most frequent abnormal uterine findings was intravasation cases , and malposition , irregular margin , filling defect 37 , and diverticulum 6 in decreasing order. Most frequent abnormal tubal finding was obstruction cases , and hydrosalpinx 99 , diverticulosis 22 , intravasation 17 , peritubal adhesion 13 , and beaded tube 10 in decreasing order.

Nagative findings was seen in cases Nagative findings in both uterus and fallopian tubes was seen only 87 cases Find a Physical Therapist. There are numerous benefits to treatment by a physical therapist. In addition, there was absence of left anterior inferior cerebellar artery AICA and absence of bilateral facial colliculi. Clinical features, etiology, and imaging findings are discussed.

Finding optimal exact reducts. The problem of attribute reduction is an important problem related to feature selection and knowledge discovery. The problem of finding reducts with minimum cardinality is NP-hard. This paper suggests a new algorithm for finding exact reducts with minimum cardinality. This algorithm transforms the initial table to a decision table of a special kind, apply a set of simplification steps to this table, and use a dynamic programming algorithm to finish the construction of an optimal reduct.

For many of the experimented tables, the simplification steps solved the problem. To evaluate the characteristic CT findings of neuroblastoma, we studied neuroblastomas. We analysed CT findings of available 25 cases among pathologically proved 51 neuroblastomas from Jan. Characteristic CT findings are as follows: The most common organ or contiguous direct invasion is kidney in 6 cases and the next one is liver but intraspinal canal invasion is also noted in 2 cases. We concluded that diagnosis of neuroblastoma would be easily obtained in masses of pediatric group from recognition of above characteristic findings.

Medical Faculty, Kayseri Turkey. To evaluate the radiological, ultrasonographic, and magnetic resonance imaging MRI findings of idiopathic granulomatous mastitis.

Between April and June , the mammography, ultrasound, color Doppler ultrasound, non enhanced MR, and dynamic MR findings of nine patients with the preliminary clinical diagnosis of malignancy and the final diagnosis of granulomatous mastitis were evaluated. On mammography, asymmetrical focal densities with no distinct margins, ill-defined masses with spiculated contours, and bilateral multiple ill-defined nodules were seen.

On ultrasound, in four patients a discrete, heterogenous hypoechoic mass, in two patients multiple abscesses, in one patient bilateral multiple central hypo peripheral hyperechoic lesions, in two patients heterogeneous hypo- and hyperechoic areas together with parenchymal distortion, and in one patient irregular hypoechoic masses with tubular extensions and abscess cavities were seen.

Five of the lesions were vascular on color Doppler ultrasound. On MR mammography, the most frequent finding was focal or diffuse asymmetrical signal intensity changes that were hypointense on T1W images and hyperintense on T2W images, without significant mass effect. Nodular lesions were also seen. On dynamic contrast-enhanced mammography, mass-like enhancement, ring-like enhancement, and nodular enhancement were seen.

The time-intensity curves differed from patient to patient and from lesion to lesion. The imaging findings of idiopathic granulomatous mastitis have a wide spectrum, and they are inconclusive for differentiating malignant and benign lesions. Finding Health Care Services. If you have been diagnosed with cancer, finding a doctor and treatment facility for your cancer care is an important step to getting the best treatment possible. Learn tips for choosing a doctor and treatment facility to manage your cancer care.

Hepatic angiosarcoma is a rare malignant vascular tumor. Accurate preoperative diagnosis of this tumor is very difficult if the patient does not have any history of exposure to specific carcinogens including thorotrast, arsenicals and vinyl chloride monomer.

We describe CT findings in two cases of hepatic angiosarcoma in combination with a review of the literature. Findings are reported on a three year cross-age tutoring program in which undergraduate dental hygiene students and college students from other disciplines trained upper elementary students to tutor younger students in the techniques of dental hygiene.

Data includes pre-post scores on the Oral Hygiene Index of plaque for both experimental and…. CT and MR findings in two patients with hepatoerythropoietic porphyria are presented. CT scans showed atrophy and cortical mineralization at the same level. MR examination performed in one of the two patients showed mainly frontal cortical atrophy and punctate bright signal on T1- and T2-weighted sequences.

Schwannomas are peripheral nerve sheath tumors. We report a case of a year-old patient with a tongue schwannoma.

Morphologic analysis and immunohistochemical findings strongly support the diagnosis. Surgical treatment is discussed. The Origin and Diversification of Osteichthyans and Sarcopterygians: All organisms,living or extinct,are related to each other by sharing common ancestors at different levels,like twigs and branches connected to each other at different nodes on the great tree of life. One major task for paleontologists and evolutionary biologists is to find out how the diverse groups of organisms arose and how they are related to each other,thereby reconstructing the history of life and understanding the pattern and process of evolution.

To evaluate the sonographic findings of the heterotopic pregnancy which is increasing recently. They were diagnosed by ultrasonography and proved surgically afterwards. Sonographic findings were analyzed focusing on gestational week of intrauterine pregnancy and location of ectopic pregnancy. In particular, adnexal mass was evaluated with regard to size and the characteristic findings such as ectopic gestational sac echogenic ring.

Also, overian cyst and fluid collection in cul-de-sac space were reviewed carefully. Heterotopic pregnancy was proved surgically by salpingectomy in 33 cases and by resection of cornus in six cases. Sonographic diagnosis using transvaginal ultrasound was made from five weeks to nine weeks two days six weeks and four days in average from last menstral period in all 39 cases.

Ectopic pregnancy was identified in ampullary part in 29 cases, in the isthmic portion of tube in four cases and in the cornus of uterus in six cases. The intrauterine pregnancy was diagnosed by identifying the intrauterine gestational saccontaining a yolk sac in seven cases and the embryo with fetal heart beat in the remaining 32 cases. A characteristic finding of ectopic mass was echogenic ring which was visible in 33 Six cases had pelvic hematosalpinx and two had pelvic hematoma.

Ultrasonographic identification of the intrauterine pregnancy and the ectopic chorion ring is effective for the early diagnosis of the heterotopic pregnancy. Gallstone ileus is a rare complication of recurrent gallstone cholecystitis. The classic radiographic triad of small bowel obstruction, pneumobilia and ectopic gallstone on abdominal plain radiograph is described with CT imaging. Because of the better resolution of CT compared with abdominal radiography and its recent accession to emergency use, radiologists should be aware of CT findings of gallstone ileus.

We report a case in which gallstone ileus was initially diagnosed by CT. Key focal areas for bridging the fields of aging and disability: Five focal areas emerged: MR findings of ulegyria. School of Medicine ; Maezawa, Mariko.

Magnetic resonance MR findings of the brains diagnosed to have ulegyria were reviewed. The reviewed subjects comprised six epileptic children, ranged from 2 to 16 years of age. All patients had convulsion of tonic-clonic type of various severity and had histories of ischemic-hypoxic or hypoglycemic episode in the perinatal or postnatal period. Although these findings were nearly pathognomonic to ulegyria, polymicrogyria could mimic it since both are characterized by abnormally diminutive cortical gyri seen in epileptic children.

In polymicrogyria, however, affected gyri are uniformly diminutive and not mushroom-shaped, the cortex is rather thickened than atrophic, the underlying white matter shows no focal hyperintensity, subcortical cystic changes are not present, and affected cortex is not restricted to arterial border zones. Even in one of our cases with extensive ulegyria, it was easy to differentiate it from polymicrogyria since parasagittal regions were most severely affected.

Although the previous reports on ulegyria have been exclusively based on postmortem pathological examinations or experimental models, its easy recognition on MRI would contribute to further understanding of its clinical significance and mechanisms.

MR findings of spondylolysis. School of Medicine ; Toyoda, Keiko. We reviewed MR images of 50 patients with spondylolisthesis to disclose MR findings of spondylolysis. In almost half of our series, spondylolysis was detected as a low signal intensity band traversing in the pairs interarticularis on both T1 and T2 weighted images. Sagittal images was superior to axial image in detection of the low signal intensity band.

In some patients, a focal high signal intensity accompanying the low signal intensity band was considered to be fluid collection within pseudoarthrosis due to spondylolysis on T2-weighted image. To conduct a systematic literature review of selected major provisions of the Affordable Care Act ACA pertaining to expanded health insurance coverage.

We conclude with a summary and offer a research agenda for future studies. We identified relevant articles from peer-reviewed scholarly journals by performing a comprehensive search of major electronic databases. We also identified reports in the "gray literature" disseminated by government agencies and other organizations. Overall, research shows that the ACA has substantially decreased the number of uninsured individuals through the dependent coverage provision, Medicaid expansion, health insurance exchanges, availability of subsidies, and other policy changes.

Early evidence also indicates improvements in access to and affordability of health care. All of these changes are certain to ultimately impact state and federal budgets. The ACA will either directly or indirectly affect almost all Americans. As new and comprehensive data become available, more rigorous evaluations will provide further insights as to whether the ACA has been successful in achieving its goals. Identifying and preventing medical errors in patients with limited English proficiency: In the content development phase, a comprehensive mixed-methods approach was used to identify common causes of errors for LEP patients, high-risk scenarios, and evidence-based strategies to address them.

A Guide for Hospitals contains recommendations to improve detection and prevention of medical errors across diverse populations, and TeamSTEPPS Enhancing Safety for Patients with Limited English Proficiency Module trains staff to improve safety through team communication and incorporating interpreters in the care process.

Both tools were found to be implementable, acceptable to their audiences, and conducive to learning. Further research on the impact of the combined use of the guide and module would shed light on their value as a multifaceted intervention.

Yeom, Suk Keu, E-mail: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients 5 women, 1 man; mean age, Medical records were also reviewed to determine each patient's clinical status and outcome.

All patients were immunocompromised state: CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum.

Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis. Ultrasonographic findings of Epicondylitis. To evaluate the usefulness of ultrasonographic findings of the common extensor and flexor tendon in evaluation of patients with lateral and medial epicondylitis.

Ultrasonographic examination was performed to evaluate lateral or medial epicondylitis. Epicondylitis was divided into five groups according to the severity of disease: Change in the size of a tendon, bony change of the epicondylitis, presence or absence of calcification or echogenic foci in the common tendon and hypervascularity for each categories were also assessed. In addition, these lesions were divided into the superficial and deep according to the location of lesions.

According to the severity, there were 15 cases of normal, 13 tendinopathies, 8 tendinopathies with a partial tear, 2 partial tears and 0 complete tear. Bony change was seen only in tendinopathy, tendinopathy with partial tear and partial tear. Calcification or echogenic foci were only observed in cases with tendinopathy and tendinopathy with partial tear. Hypervascularity was only seen in one case of tendinopathy.

With thorough understanding of ultrasonographic findings of epicondylitis, ultrasonographic examination can be especially useful and effective in evaluating the severity and location of lesions.

Rhabdomyolysis is defined as skeletal muscle necrosis. Ultrasound assessment has recently become a useful tool for the diagnosis and monitoring of muscle diseases, including rhabdomyolysis. A case is presented on the ultrasound findings in a patient with rhabdomyolysis. To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings , and review the literature.

Ultrasound was performed using a Philips Sparq model with a high-frequency linear transducer MHz , in low-dimensional scanning mode 2D , in longitudinal and transverse sections at the level of both thighs. The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas.

Ultrasound is a useful tool in the evaluation of rhabdomyolysis. Can I Trust Your Findings? We provide suggestions for how to rule out alternative explanations, explaining key considerations not only in empirical analyses, but also in theory building and in research design. Our discussion covers both qualitative and quantitative studies Radiologic findings in neurofibromatosis.

Neurofibromatosis is an uncommon but certainly not a rare hereditary disorder, probably of neuralcrest origin, involving not only neuroectoderm and mesoderm but also endoderm and characterized by cafe au lait spots and cutaneous and subcutaneous tumors, with secondary mesodermal defects responsible for protean osseous abnormalities and various manifestations in other systems. This paper is a study of confirmed cases of neurofibromatosis collected for past 8 years.

In this analysis, special attention was given to the selected 37 cases which showed abnormal findings on radiological examinations. Overall male to female ratio was 1: The most frequent kind of abnormalities was vertebral kyphoscoliosis in 12 cases.

Among the more pathognomonic but uncommon abnormalities to neurofibromatosis, we experienced each 2 cases of lambdoid defect, pseudoarthrosis and renovascular hypertension, and 1 cases of sphenoid bone absence. Impacts of casinos on key pathways to health: Three decades ago, casino gaming on sovereign American Indian lands was legalized with differential economic and social implications.

While casinos have improved the incomes of tribal communities, there have been both positive and negative findings in relation to health impacts. We sought to understand the perceived pathways by which casinos impact individual and community health through voices of the community.

We inductively analyzed textual data drawing from Grounded Theory, first using line-by-line coding to identify analytic categories from emergent themes in consideration of the study objective. Then, focused codes were applied to identify salient themes, which we represented through exemplar quotes and an overall conceptual framework. Data were managed and coded using Dedoose software.

American Indian-owned casinos are perceived to influence the health of tribal communities through three pathways: Forming these pathways are a series of interrelated health determinants.

Improvement of the tribal economy, through both job creation for tribal members and improved tribal cash flow, was perceived by participants to both influence health. Specifically, improved cash flow has resulted in new wellness programs, community centers, places for recreation, and improved social services.

Higher disposable incomes have led to better financial stability, increased access to healthy food, and more opportunities for physical activity. Yet, higher disposable incomes were perceived to also contribute to negative health behaviors, most notably increased drug and alcohol abuse. Casinos were also perceived to alter built environments, resulting in increased availability and access to unhealthy. Analysis of Data as of July Key Findings and Analysis. YoungStar is a five-star quality rating system for child care providers based on education, learning environment, business methods, and practices around child health and well-being.

Through this rating system, the state is addressing several key issues in Wisconsin's child care system. The rating system will: This article presents findings on pupil attitudes towards learning foreign languages in Key Stage 2 ages in primary schools in England. As a consequence of the National Languages Strategy, the University of Warwick was commissioned by the then Department for Education and Skills to undertake an evaluation between and of 19….

Research from the First Half of the Study. Regional Issue Brief Number The study explores young people's decisions about their educational and job opportunities in rural northern New….

The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. The most common symptoms were chest pain in In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left.

Peripheral expansion of the mass was observed in 12 Intraoperatively, pleural involvement was observed in 14 cases Comparative study of human and mouse postsynaptic proteomes finds high compositional conservation and abundance differences for key synaptic proteins.

Full Text Available Direct comparison of protein components from human and mouse excitatory synapses is important for determining the suitability of mice as models of human brain disease and to understand the evolution of the mammalian brain. The postsynaptic density is a highly complex set of proteins organized into molecular networks that play a central role in behavior and disease.

We report the first direct comparison of the proteome of triplicate isolates of mouse and human cortical postsynaptic densities.

The mouse postsynaptic density comprised proteins and the human one Quantitative analysis of postsynaptic density components in both species indicates a broadly similar profile of abundance but also shows that there is higher abundance variation between species than within species.

Well known components of this synaptic structure are generally more abundant in the mouse postsynaptic density. Significant inter-species abundance differences exist in some families of key postsynaptic density proteins including glutamatergic neurotransmitter receptors and adaptor proteins.

Furthermore, we have identified a closely interacting set of molecules enriched in the human postsynaptic density that could be involved in dendrite and spine structural plasticity. Understanding synapse proteome diversity within and between species will be important to further our understanding of brain complexity and disease. Immunological findings in autism.

In measles virus infection, it has been postulated that there is immune suppression by inhibiting T-cell proliferation and maturation and downregulation MHC class II expression.

Cytokine alteration of TNF-alpha is increased in autistic populations. Toll-like-receptors are also involved in autistic development. High NO levels are associated with autism. Maternal antibodies may trigger autism as a mechanism of autoimmunity. MMR vaccination may increase risk for autism via an autoimmune mechanism in autism.

MMR antibodies are significantly higher in autistic children as compared to normal children, supporting a role of MMR in autism. Increase in Th2 may explain the increased autoimmunity, such as the findings of antibodies to MBP and neuronal axonal filaments in the brain. There is further evidence that there are other participants in the autoimmune phenomenon. The possibility of its involvement in autism cannot be ruled out. Further investigations at immunological, cellular, molecular, and genetic levels will allow researchers to continue to unravel the immunopathogenic mechanisms' associated with autistic processes in the developing brain.

Her work could lead to new ways to treat chronic wounds like diabetic foot ulcers. Read Issue George Hightower, M. Modelling efforts needed to advance herpes simplex virus HSV vaccine development: Development of a vaccine against herpes simplex virus HSV is an important goal for global sexual and reproductive health.

In order to more precisely define the health and economic burden of HSV infection and the theoretical impact and cost-effectiveness of an HSV vaccine, in the World Health Organization convened an expert consultation meeting on HSV vaccine impact modelling.

The experts reviewed existing model-based estimates and dynamic models of HSV infection to outline critical future modelling needs to inform development of a comprehensive business case and preferred product characteristics for an HSV vaccine.

This article summarizes key findings and discussions from the meeting on modelling needs related to HSV burden, costs, and vaccine impact, essential data needs to carry out those models, and important model components and parameters.

Published by Elsevier Ltd. Key findings and potential next steps. The key findings from the issue's 10 articles are reviewed and organized here around three topics: Several potential next steps in improving effective research strategies are highlighted: The articles in this issue examined the general theme of including diverse population groups in genetic studies and offered potential strategies for addressing some common problems.

Am J Addict ; Computed tomographic findings of trichuriasis. In this report, we present computed tomographic findings of colonic trichuriasis. The patient was a year-old man who complained of abdominal pain, and weight loss.

Diagnosis was achieved by colonoscopic biopsy. Abdominal computed tomography showed irregular and nodular thickening of the wall of the cecum and ascending colon. Although these findings are nonspecific, they may be one of the findings of trichuriasis. These findings , confirmed by pathologic analysis of the biopsied tissue and KatoKatz parasitological stool flotation technique, revealed adult Trichuris.

To our knowledge, this is the first report of colonic trichuriasis indicated by computed tomography. Full Text Available Neurological manifestations are rare in dengue fever. Two cases with encephalopathy and systemic features of dengue fever with abnormal CSF and MR imaging are reported. Striking MRI finding was bilateral symmetrical thalamic lesions similar to those reported in Japanese encephalitis. This report highlights that MRI findings can be similar in dengue and Japanese encephalitis.

Electroencephalographic Findings in Posthypoxic Myoclonus. The physical examination findings of early posthypoxic myoclonus PHM are associated with poor prognosis. Recent findings indicate that patients with multifocal PHM, assumed to have a cortical origin, have a comparable outcome to resuscitated patients without PHM.

Generalized PHM, assumed to have a. Knowledge translation of research findings. Full Text Available Abstract Background One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs.

Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research the translation of new clinical knowledge into improved health. We structure the article around five key questions: Discussion We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings.

Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups.

There are a large number of planned knowledge translation models, derived from different disciplinary, contextual i. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge.

Ultrasonographic findings of testicular tumors: Correlation with pathologic findings. Scrotal sonography is a valuable tool for assessing the testis and surrounding structures, and has become the imaging modality of choice for evaluation of the scrotum. Scrotal sonography is also helpful for differentiating cystic from slid mass and testicular from extratesticular mass, but is sometimes difficult in differentiating malignant tumor from various benign conditions such as epidermoid cyst, focal orchitis, testicular hematoma, and abscess.

We demonstrate the sonographic findings of the various testicular mass, and correlation with pathologic findings. Finding Maximal Quasiperiodicities in Strings. Our algorithm uses the suffix tree as the fundamental data structure combined with efficient methods for merging and performing multiple searches in search trees. Besides finding all maximal quasiperiodic substrings, our algorithm also marks the nodes Apostolico and Ehrenfeucht defined the notion of a maximal quasiperiodic substring and gave an algorithm that finds all maximal quasiperiodic substrings in a string of length n in time O n log2 n.

In this paper we give an algorithm that finds all maximal quasiperiodic substrings in a string Chest radiographic findings of leptospirosis. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever.

Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever. CT findings of pulmonary aspergillosis.

The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or cystic space. Laser photocoagulation also does not cure ocular histoplasmosis.

The risk of vision loss due to ocular histoplasmosis remains for lifetime. There may be recurrence of CNVs that may require additional laser therapy. Each time the damage should be detected as early as possible to prevent vision loss. Eyes should be regularly checked using an Amsler Grid to monitor central vision and recurrence of CNV and histospots. For those who have lost significant vision special visual aids like special lenses or electronics to create enlarged visual images may be prescribed.

Sometimes steroid medicines are used to reduce inflammation. In patients with an identified active infection with the fungus, antifungal agents may be used. Newer agents like Avastin have been tried in ocular histoplasmosis. These agents help by reducing the formation of the abnormal blood vessels within the retina and prevent CNV formation. They may be given as injections into the eyes several times. Other similar agents that are being tried are Macugen and Lucentis.

These have also been tried in combination with photodynamic therapy. I have recently been diagnosed with ocular histoplasmosis after noticing lines in my vision and an occasional black spot appearing on things as well as constant blurred vision.

How does the doctor know which is the best treatment? Is it common for one who has been diagnosed and has vision impairments to fully heal? And if not, is vision loss typical? Any help and info is greatly appreciated. My son has just been recently diagnosed. What has been your medical treatment? Has your vision gotten any better? The early, acute granulomatous lesions of OHS are rarely observed but may be treated with oral or regional periocular corticosteroids Fig In the early stages of FA, foci of active choroiditis block the dye and appear hypofluorescent; later in the study, these lesions stain, becoming hyperfluorescent.

In contrast, areas of active CNV appear hyperfluorescent early in the angiogram and leak later in the study. Choroidal neovascular membranes may arise outside the vascular arcades, but typically do not reduce vision and may be safely managed with observation only.

Treatment options for vision-threatening juxtafoveal or subfoveal CNV include thermal laser photocoagulation Fig , photodynamic therapy PDT using verteporfin with or without intravitreal triamcinolone, submacular surgery for membrane removal, and intravitreal injection of anti—vascular endothelial growth factor anti-VEGF agents. The Macular Photocoagulation Study MPS group conducted 2 multicenter, randomized, controlled clinical trials that showed a beneficial effect of argon blue-green and krypton red laser photocoagulation for well-defined, classic extrafoveal, juxtafoveal, and peripapillary CNV secondary to OHS see Fig The proportion of eyes experiencing severe visual loss was significantly reduced with photocoagulation.

Thermal laser photocoagulation is not used in the treatment of subfoveal CNV in the context of OHS, given the profound and immediate loss of central vision that results from the destructive effects of this modality. There were no serious adverse events. Similarly, intravitreal triamcinolone was shown to be relatively safe and effective in the management of OHS-associated juxtafoveal and subfoveal CNV in small retrospective case studies.

These include the ribonucleic acid aptamer pegaptanib; ranibizumab, the active fragment of a humanized anti-VEGF monoclonal antibody; and the related full-length molecule, bevacizumab.

As with neovascular AMD, combination approaches with PDT and intravitreal corticosteroids or anti-VEGF agents may prove fruitful, especially in treating entities with an underlying inflammatory etiology.

Selected patients with an active subretinal neovascular membrane located under the foveal avascular zone may benefit from submacular surgery and removal of the membrane Fig In selected cases of extensive peripapillary CNV associated with OHS, surgical removal may provide a more definitive visual benefit with low recurrence rates and be preferable to photoablation, given the likelihood of multiple PDT and anti-VEGF treatments.

For a discussion of the ocular manifestations of candidiasis, aspergillosis, cryptococcosis, and coccidioidomycosis and their treatments, please see Chapter 8. Long-term follow-up of surgical removal of extensive peripapillary choroidal neovascularization in presumed ocular histoplasmosis syndrome. Ranibizumab versus verteporfin for neovascular age-related macular degeneration.

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For the purposes of this discussion, the two conditions will be both considered "atrial septal defects". Atrial septal defects predispose individuals to several conditions. The known frequency of the condition in our age group and the relative lack of demonstrated pathology however argue against any significant effect. Valvular dysfunction can occur and pulmonary hypertension may develop.

Hemodynamically stable is defined as: Designated aviators with surgically corrected ASD may be considered for waiver. Cardiological consultation to include contrast echocardiography is required.

NOMI evaluation may be required. There is a risk of atrial dysrhythmias following surgical repair of an ASD. Waiver recommendations for this group must include: Waiver is possible after surgical closure of ASD. The requirement for permanent pacing is disqualifying. Atrial septal defects are extremely common. As mentioned previously, pressure gradients determine flow across ASDs. Elevations in right sided pressures such as those caused either by positive pressure breathing or Valsalva maneuvers can raise the right atrial pressures over the left atrial pressures and flow across the septum can occur.

NOMI has studied over 50 cases of altitude DCS with contrast echocardiography, and we have been unable to demonstrate an increased prevalence of ASD in affected individuals.

Paradoxical embolism from right to left has been well documented in hospitalized patients, and theoretically gas bubbles can cross as well, leading to arterial gas emboli AGE. The diving community is concerned about this possibility, and continues to exclude known ASD [PFO] cases from diving duty. They do not, however, pursue cases with anything remotely approaching zeal.

Patients who have had repair of ASD may be more prone to arrhythmias. First degree A-V block: Local evaluation should include a rhythm strip performed during exercise, which may be calisthenics.

The heart rate may need to be increased over bpm. Up to this stage, the aviator may remain on flying status during evaluation. If the tests are normal, no further evaluation is needed. Cardiology evaluation, including treadmill and Holter monitor. Pacing is incompatible with flying status. Most cases of first degree and Mobitz type I second degree heart block are related to increased vagal tone.

Exercise reduces vagal tone and often reverses the block. Recent evidence suggests that in patients with Mobitz type I block refractory to exercise or atropine, syncope is common and the prognosis is similar to that for patients with Mobitz type II block.

Syncope the classic Adams-Stokes attack caused by transient asystole or ventricular fibrillation occurs without warning. When the rhythm disturbance is short lived, some patients experience "near-syncope" or a feeling of dizziness. The presence of atherosclerotic coronary artery disease CAD is nearly universal in adults in modern cultures when unselected populations are studied carefully.

CAD remains the leading cause of death in the United States and the leading cause of permanent disqualification for aviation duty. The manifestations and associated terminology for CAD are numerous. Current or history of coronary heart disease 2. History or clinical diagnosis of: Atherosclerotic heart disease associated with: The major concern is the risk of sudden death or incapacitation in flight — acute coronary syndromes are unpredictable and often catastrophic at initial presentation.

Characterization of two hazards is important in minimizing this risk — the presence of hemodynamically significant stenosis coronary artery narrowing and the total burden of disease or plaque most commonly atherosclerosis. Prevention either primary or secondary of excess hazards depends upon adequate identification of aviators at risk followed by treatment of modifiable factors.

The risk control measures for CAD are revascularization of any significant lesions and aggressive risk factor modification. Advances in screening, diagnostic modalities, and treatment of CAD increase the likelihood that aviators with asymptomatic CAD not strictly disqualified by the above standards will present for aeromedical disposition. Advances in the treatment of symptomatic CAD also open the potential for recommending aviators to return to aviation duty when both the lesion and underlying disease process can be controlled to acceptable levels of risk.

Effective treatment requires long term medications. Medications used have potential adverse effects or toxicities. Effects of the aviation environment on medication toxicity are generally unknown. Monitoring of treatment may require periodic testing not commonly available in operational settings. Waiver recommendations may be made only after cardiovascular evaluation and careful consideration of aeromedical risk.

Risk assessment will be based on but not exclusively the following: The presence or absence of significant lesions or plaque burden. History of acute coronary syndrome ACS. Effective risk factor modification. Local board of flight surgeons: NO provisional clearances for any class. Initial waivers at NAMI: The consultation should include recommendations on optimal management of modifiable risk factors.

NAMI may request additional studies. Address waiver requirements for medication. Maximal exercise stress testing to include imaging modality. Laboratory results to include Lipid profile, Liver profile, Fasting glucose, Electrolytes, Creatine kinase, high sensitivity C-Reactive protein 3. History and physical examination studies documenting full achievement of risk factor control. BMI goal should be attained within 12 months of diagnosis.

Noncompliance with medications 3. Unwillingness to comply with exercise program or tobacco cessation 4. Failure to promptly report recurrence of symptoms Waiver continuation: Submit physical examination annually with Cardiology consultation, unless waiver recommendation states otherwise.

The risk of cardiac events in aviators has been characterized in careful studies by the USAF. Risk of ischemic heart disease with increased plasma cholesterol and with increased low density lipoprotein LDL.

The fibric acids, fenofibrate Tricor and gemfibrozil Lopid require a waiver, but recommendations are universally made for all Service Groups. Fenofibrate use should be considered before using gemfibrozil due to a more favorable side-effect profile. Caution is necessary when using any fibric acid in combination therapies i. Patients requiring drug therapy should be grounded for a period of 14 days to assess response and observe for side effects.

Before any therapy is initiated, exclude all causes of secondary hyperlipidemia such as hypothyroidism, diabetes, cholestasis, alcohol abuse, gout, renal failure, nephrotic syndrome, myeloma and systemic lupus erythematosus. Treatment with fibric acids require: Report of all lab reports is to be submitted with the annual physical report. Liver enzyme elevations above three times normal is considered disqualifying.

The first line treatment for mild cases is Therapeutic Lifestyle Changes TLC including dietary control, weight loss, and increasing aerobic exercise.

Statins are generally the first drug of choice and then adding ezetimibe Zetia if required. Fibric acid use is generally reserved for cases with significant hypertriglyceridemia. The incidence of heterozygous familial hypercholesterolemia in the USA is 1 in ; in South Africans of Dutch descent it is 1 in The treatment of severe hypercholesterolemia has been shown to reduce the incidence of a first myocardial infarct. Untreated hypertension is associated with long term changes in the cardiovascular system that in toto have the effect of significantly reducing life span.

Untreated hypertension also predisposes individuals to cerebrovascular accident, myocardial infarction, ophthalmologic disease and renal failure. The magnitude of the blood pressure elevation is directly proportional to the risk of developing complications and is increased by other risk factors such as hyperlipidemia or cigarette smoking. White Coat Hypertension is not an acceptable diagnosis.

If the blood pressure exceeds standards at the time of exam, three day blood pressure checks at two different times each day are indicated. Previously high readings which are then normal on three day follow-up DOES NOT relieve the examining flight surgeon from re-evaluation if the blood pressure is high during subsequent physical exams or sick-call visits.

Any blood pressure exceeding mmHg systolic or 89 mmHg diastolic is disqualifying and waiver will not be recommended. Applicants requiring medication for control of blood pressure will not be recommended for a waiver.

The rational medical approach is to attempt non-pharmacological therapy first. This allows for a trial of weight reduction, diet modification, exercise, etc Clearance Notice should clearly state the three month limitation and the reason pending blood pressure reduction measures. If not within standards, member is NPQ, and grounded for any remaining work-up and the initiation of therapy.

Blood pressure out of standards will not be waivered; the medications used to control it are as outlined below. Documentation of good blood pressure control 2. Documentation of an absence of end organ damage 3. Initial evaluation should include: CHEM 7 serum electrolytes, glucose, urea nitrogen and creatinine c. An echocardiogram may be required if there is any suggestion of ventricular hypertrophy by exam or ECG h. Any pathology detected will require specialist evaluation i.

The Hypertension AMS template may simplify satisfying all submission requirements 4. The cornerstone of blood pressure management begins with lifestyle modification. Proper diet and adequate aerobic exercise will improve cardiovascular fitness and decrease the effects that hypertension can cause. Hypertension controlled by diet and exercise alone does not require a waiver. If patient has previously required medication for control, waiver will remain in effect, even if medications are subsequently no longer required.

This will permit long-term tracking of aviation personnel with a history of hypertension. Medication recommendations for the aviation community differ from the general population and should not be used as a guide for treating non-aviation personnel.

ACE inhibitors are preferred as they have a low incidence of aeromedically significant side effects and are generally well tolerated. There are no dose restrictions on these medications as long as manufacturer recommended maximum doses are not exceeded. Air controllers are usually waivered.

We don't want them pulling more than 2. Secondary hypertension that has been surgically or medically corrected may also be considered for a waiver. There should be no complications or side effects from the treatment, no permanent sequelae from the hypertension and the patient should be normotensive prior to a waiver being requested.

In the Framingham study, the mortality of individuals with hypertension was more than double that of the normotensive population, with most of the deaths occurring suddenly. The risk of cardiovascular events increases with age, tobacco use, male gender, U. Navy Aeromedical Reference and Waiver Guide Cardiology - 20 positive family history, excess alcohol intake and high blood lipid levels; the presence of one or more of these risk factors will be considered in the final aviation disposition of the case.

Several studies have demonstrated a reduction in mortality and morbidity resulting from the treatment of hypertensive patients.

Beta blockers may cause sedation, affect Gz tolerance and have other side effects. One study has demonstrated a reduction in G tolerance in normotensive individuals given captopril. Our experience has not suggested that this is a significant problem in the population in whom its use is indicated. These patients have significant risk of developing dysrhythmias. Angina may also be a complicating factor, and can be due either to superimposed coronary artery disease or ischemia from extrinsic compression of the penetrating branches of the major epicardial vessels.

If the hypertrophic changes involve the LV outflow tract, a functional outflow tract obstruction can result, with the attendant reduction in cardiac output and exercise tolerance.

There is an annual mortality of 3. True primary hypertrophic cardiomyopathy e. This condition is disqualifying for general duty, and no waivers are recommended either for accession to general duty or special duty. Waiver will only be considered in the very mildest of cases with no hemodynamic and minimal echocardiographic abnormalities and after the exclusion of underlying pathology. If the myopathy is secondary to other pathology, that condition is the basis of disqualification.

If the hypertrophic changes are documented to have resolved after treatment, a waiver recommendation may be considered. The majority of patients with idiopathic cardiomyopathy are disqualified from military flying. If a waiver is requested, refer to NOMI for evaluation. Cardiology consultation is required, which should include: Echocardiography and cardiac catheterization if indicated b. Exclusion of underlying secondary causes for hypertrophic cardiomyopathy such as hypertension, pulmonary hypertension, valvular disorders, and hyperthyroidism TREATMENT: Treatment, either medical or surgical, is CD, no waiver.

True hypertrophic cardiomyopathy is uncommon in the aviation population. Echo remains the gold standard, and any questions can usually be resolved by a quick referral. Unfortunately, accurate standards for the diagnosis of pathologic LVH do not exist for our population, so we generally take several factors into account in deciding how much myocardium is too much. A "physiologic" form of LVH can be seen in some athletes, particularly those who engage in weight training. Runners and swimmers generally do not manifest significant LVH, even at Olympic levels of training.

We are frequently asked to make decisions on LVH in athletic, but not world class, individuals. These hypertrophic changes can be usually be distinguished from primary forms in that they are concentric, and diastolic function is well preserved. The end diastolic dimension of the ventricle is either normal or increased in size.

In pathologic LVH the ventricular cavity is obliterated at end systole, and diastolic dysfunction is the rule. In a military population it is important to exclude athletic heart syndrome. The level of hypertrophy and the severity of U. Navy Aeromedical Reference and Waiver Guide Cardiology - 22 the hemodynamic changes do not help to determine the prognosis. Poor prognosticators are a family history of sudden death, diagnosis in childhood and a history of blackouts.

Left bundle branch block LBBB is usually associated with coronary artery disease. Right bundle branch block RBBB , especially as a new finding, may also be associated with heart disease, particularly atrial septal defects. No waiver recommended for non-designated personnel. A waiver is possible for designated aviators with LBBB in the documented absence of coronary artery disease and if asymptomatic.

Please refrain from using the term "Non specific intraventricular conduction delay". If LAH is found: If younger than 35 years and no previous recordings are available, an echocardiogram should be performed to rule out congenital heart disease.

If older than 35 with no previous ECGs available, a treadmill test as well as an echocardiogram should be performed. Pending these evaluations, persons with LAH may remain on flying status. If the studies are normal, no further evaluation is required. If LAH develops slowly over some years as a result of progressive left axis deviation, no further evaluation is required.

A standard treadmill in any patient with any conduction defect may be unreliable. Stress echocardiography or thallium stress test is preferred.

It is often congenital check earlier ECGs or develops at high heart rates. If it has been present for years, is not associated with symptoms, and is accompanied by an otherwise normal cardiac examination, RBBB carries no known adverse risk or prognostic significance. One report states that the risk of RBBB progressing to complete block is "a few percent a year.

In the absence of heart disease, acquired RBBB carries the same risk for death or syncope as the general population. Similarly, isolated left anterior fascicular block carries no known increased risk; not enough is known about isolated left posterior fascicular block to prognosticate with certainty.

In the absence of demonstrable pathology there is no justification for disqualification. An increase in left ventricular mass has been shown in several series to be associated with dysrhythmias, angina or sudden death.

Idiopathic or secondary cardiomyopathies are discussed separately. Current criteria, based on the general population, are not valid for our young, athletic population. The electrocardiograph criteria established by the U. It is not required that the aviator be grounded pending echocardiogram interpretation. Designated Aviators- True LVH in designated aviators CD, with waiver recommended if the aviator is normotensive with or without antihypertensive medication and has a normal ejection fraction.

Please submit the information required below with an Aeromedical Summary. Serial Blood Pressures Follow-up Evaluation: Serial Blood Pressures 4.

If there are any changes in the above data from the original evaluation, an echocardiogram should be obtained. In young individuals, the precordial voltages tend to be higher than in older individuals. If voltage criteria alone are used to diagnose LVH, many false positives will result.

The training limitations for aviators and flight candidates, as well as the burden on the aeromedical system, makes a overly sensitive criteria operationally intolerable. In historical studies of the U. Air Force, true left ventricular hypertrophy occurred in only 5 of , aviators 0. By using a more specific screening criteria we are able to diagnose true U.

If left ventricular hypertrophy is present, an Echocardiogram will exclude aortic stenosis and hypertrophic cardiomyopathy as causes. Serial blood pressure measurements will further exclude hypertension. In differentiating the normal athletic heart from cardiomyopathy, exercise abstinence can be useful. Pericardial effusion can lead to acute cardiovascular compromise secondary to cardiac tamponade.

Less severe cases can produce pain and shortness of breath that can be distracting in flight. The flier should be grounded during the acute illness. Idiopathic pericarditis can be considered for waiver after the acute episode resolves provided there has been no recurrence or sequelae.

The disposition of cases secondary to underlying disease will depend on the disease concerned. Any pericardial effusions must be resolved by echocardiography before waiver recommendations will be made. Cardiac consultation is necessary to exclude connective tissue disorder, myocardial infarction, neoplasm or other disease processes.

The workup should include: Echocardiography to rule out sequelae such as pericardial effusion or constrictive pericarditis. Idiopathic pericarditis is usually self limiting. Rest and aspirin or nonsteroidal anti-inflammatory agents are all that are required for treatment. If maintenance medication is required, then a waiver will not be considered.

Waiver recommendations for secondary pericarditis will be based on the underlying disease process. A small minority of cases may progress to pericardial constriction or tamponade.

Some patients will be left with minor, nonspecific ECG abnormalities. Individuals with short PR and no symptoms have the same risk of adverse cardiac events as the general population. Pre-excitation syndromes are associated with other types of heart disease, such as hypertrophic cardiomyopathy or Ebstein's malformation. Applicants or Designated 1. If a dysrhythmia is induced by EPS and ablated, the patient must be retested with EPS immediately after the ablation during that same procedure to ensure dysrhythmias are no longer inducible.

Waiver requests to SG 1 or SG 2 may be submitted six months post-ablation with documentation indicating they had no recurrence of dysrhythmias or symptoms. Waivers are considered six months post-ablation, with documentation indicating no recurrence of dysrhythmias or symptoms. Ablation is required for U. Waiver recommendation is on a case-by-case basis, and local board of flight surgeons LBFS action is prohibited. Waivers are considered on a case-bycase basis.

Applicant or Designated 1. Asymptomatic WPW pattern requires cardiology consultation, echocardiogram, hour Holter monitor, and exercise stress testing. If cardiology studies determine that EPS is indicated and the EPS causes inducible dysrhythmias, then ablation is required. During ablation procedure, retesting is required to demonstrate that the dysrythmia is non-inducible.

Waivers are considered on a case-by-case basis. Notation on report of annual flight physical examination indicating no signs or symptoms of dysrhythmia recurrences. An electrocardiogram will be completed and compared to prior studies. In some cases, a U. If dysrhythmias or symptoms recur, personnel are NPQ and waivers are terminated.

Cryoablation is also acceptable for waiver requests, but is not used as commonly as RFA. The lowest incidence of dysrhythmia is in young adults without histories of signs or symptoms. It is not possible to predict which EPS-inducible patients will develop SVT with or without catastrophic rapid ventricular responses. Extreme sinus bradycardia may be a reflection of an underlying conduction system abnormality.

There may be an inability to increase the heart rate in response to increased demand. If the heart rate increases with exercise, the bradycardia is NCD, and no waiver is required. No treatment is indicated if the rate increases with exercise; the condition is NCD. Sinus tachycardia may be a reflection of a significant metabolic abnormality.

In candidates, consider anxiety as the root problem. Other causes include fever, hyperthyroidism, dehydration, anemia, hypoxia, pulmonary emboli, and pain. The waiver recommendation will stem from the reason for the tachycardia. Persistent sinus tachycardia is unusual, and its etiology must be determined. Holter monitoring to determine average heart rate and sleeping rate is extremely helpful.

Recurrent is defined as occurring more than once in any test or during any evaluation. Sustained tachycardia is defined as lasting more than 10 minutes. The major concern in supraventricular tachycardia SVT is hemodynamic decompensation in flight leading to lightheadedness, dizziness, presyncope and loss of consciousness. Only asymptomatic with the exclusion of the sensation of palpitations as a symptom cases will be considered for waiver as symptoms are an indication of hemodynamic compromise.

Service Group I waiver recommendations can be considered for those with the following: No evidence of CAD can be present if a waiver is requested. Waivers are not recommended for students or candidates.

Complete cardiology consultation looking for secondary causes is required to include: Three Holters during a 6 month grounding period 2. For cases of a single, asymptomatic, beat run of SVT, only local evaluation is required. Thyroid function testing b. Standard treadmill test d. Three, hour Holters at monthly intervals to identify cardiovascular risk factors e.

These studies will be forwarded to NOMI with the waiver request for review. If there is any abnormality, further cardiology evaluation will be required. Preferred studies are stress echocardiogram, thallium stress test or Sestamibi. Supraventricular tachycardia is characterized by a narrow complex rhythm except with aberrant conduction in which the QRS will be wide , and P waves are usually hidden.

An irregularly irregular rhythm and a narrow QRS complex are seen. MAT is often clinically significant and heart disease has to be excluded. Air Force has reviewed individuals with SVT. Three of these individuals were initially found to have recurrent, sustained SVT and the fourth had a single, sustained SVT. Pain and swelling secondary to deep venous thrombosis DVT can be distracting in flight. The major risk is a pulmonary embolism producing chest pain, shortness of breath, hypoxia, cardiac arrhythmias or sudden death.

The development of pulmonary hypertension, the need for continued anticoagulation, or surgical procedures such as plication of the vena cava or insertion of filter devices is CD, no waiver. Superficial thrombophlebitis is NCD. Confirmation of normal exercise tolerance and pulmonary function is necessary.

In cases of pulmonary embolism, internal medicine consultation may be necessary to exclude underlying malignancy or other hypercoagulable states. The aviator should be grounded for the full duration of anticoagulant therapy. Risk factors related to hypercoagulability e. The vast majority of patients who survive pulmonary embolism will recover to normal or nearly normal cardiac and pulmonary function within weeks.

Recurrence is defined as occurring more than once in any Holter monitor or period of workup, or more than once in any subsequent evaluation. Hemodynamic changes can result in a fall in blood pressure and a reduction in cerebral blood flow. The condition is often associated with underlying heart disease. There is also a risk of sudden death associated with the condition, usually from ventricular fibrillation. Non-Designated and Designated Personnel: Complete cardiology evaluation is required to include: Echo treadmill test with thallium or Sestamibi b.

Three monthly Holter monitors d. Cardiac catheterization must be performed if there is any evidence of ischemia. Electrophysiologic studies may be required if there is uncertainty regarding the origin of the tachycardia VT vs.

SVT with aberrant conduction. Anti-arrhythmic drugs impair cardiac function and are incompatible with flying duties. Pacing is also incompatible with flying status. The symptoms of ventricular tachycardia are incompatible with duty involving flying. Typically the hands are primarily effected. During an episode skin changes that occur include: Pallor-caused by lack of oxygenated blood 2.

Cyanosis-caused by pooling of poorly oxygenated blood 3. Rubor-occurs as the vasospasm ends During a severe episode the vascular changes and associated pain can effect hand usage in the cockpit see discussion.

Underlying pathology must be excluded and symptoms must be manageable in the performance of flight duties. The following information is used to help rule out secondary underlying causes and must be included: CBC with differential c.

Antinuclear antibodies ANA e. Though not required, nailfold capillary morphology studies may be included. Class I aviators must have their waiver package reviewed by NOMI internal medicine prior to being allowed to return to the cockpit. As more advanced tests become available, please include them with the waiver request. Drug therapy is discouraged because of the side effects of the drugs in common use.

Behavioral adaptations such as stopping tobacco usage, cold avoidance, and layered clothing are acceptable. Thoracic sympathectomy is not waiverable. In women, onset typically occurs between 15 and 40 years; in men the onset is typically later.

The lesions on the face may interfere with mask seal and helmet wear. Those over the shoulders may cause discomfort when wearing safety restraints or parachute harnesses. Patients with severe cystic acne may also have psychological problems relevant to military aviation duties. Candidates with severe cystic acne are CD, no waiver. Detailed full-body skin exam 2.

Details of current therapy 3. Treatment with oral erythromycin, doxycycline, or tetracycline is NCD following a period of grounding to screen for side effects. Minocycline is not acceptable because of the risk of CNS side effects such as light-headedness, dizziness and vertigo. Accutane is CD, no waiver. Accutane use requires grounding for the duration of therapy, plus 3 months after drug cessation.

Slit lamp exam and triglyceride levels three months post therapy must be normal. LFT abnormalities while on Accutane must be resolved prior to requesting a waiver. Depending on the location of lesions, there can be interference with the wearing of flight gear. The symptoms, particularly itching, can be distracting in flight. Patients with atopic dermatitis are more susceptible to contact dermatitis due to irritants found in a military environment.

Symptom severity and the requirement for therapy will determine the aeromedical disposition. Patients controlled on topical therapy over small areas and patients who are asymptomatic on stable doses of loratadine Claritin OR fexofenadine Allegra may be considered for waiver. An initial seven day grounding period is required for loratadine and fexofenadine to document no adverse effects.

A one time separate waiver submission is required for loratadine or fexofenadine. Intermittent use of topical steroids over a limited area is compatible with waiver. The use of other medications besides loratadine or fexofenadine is CD, no waiver.

The disease process does not interfere with aviation duties and is only a cosmetic concern. Treatment is potentially toxic, expensive, has high relapse rates and often requires adjuvant therapy. Not required for the disease. Treatment with terbinafine is NCD provided the following guidelines. Documentation of baseline liver function tests. Monthly liver function tests for duration of treatment.

Terbinafine is the only approved medication for use in aviators. A three day grounding period is required when initiating therapy with terbinafine. Ketaconazole is not recommended for waiver. A positive culture is required prior to the initiation of treatment following the standard of care. Clinically, microscopic diagnosis is sufficient to guide therapy in most cases.

Susceptibility to onychomycosis appears to be genetically determined. Susceptible individuals have frequent recurrences and a less than optimal response to treatment. The relapsing nature of the condition together with the requirement for therapy makes it difficult for the military aviator to satisfy operational responsibilities. Some cases are exacerbated by physically and emotionally strenuous work. Some of the forms of treatment have side effects incompatible with flying.

Waiver may be considered for mild cases, including those needing occasional topical steroids. More severe cases will be found NPQ, with no waiver recommended. A history of psoriasis is disqualifying for entry into aviation. What has been your medical treatment? Has your vision gotten any better? Cancel reply to comment. An interview with Dr Gareth Evans about the future of breast cancer screening and the implementation of single nucleotide polymorphism SNP profiling.

Data science is a marriage between statistical science and informatics, using statistical principals of math and logic on huge volumes of data.

This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. August 7, at December 12, at 6: The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical. Post a new comment. After polyps are detected, patients may no longer qualify for free colonoscopies.

Vitamin D3 could prevent and repair cardiovascular damage, finds study. Administration of two proteins shown to counteract neurodegeneration in Parkinson's disease. Children born with Down's syndrome have superior genome that compensates for disability. Scientists develop genetically engineered probiotic that targets and kills cancer cells in the gut.

Rajat Mukherjee Data science is a marriage between statistical science and informatics, using statistical principals of math and logic on huge volumes of data.

Gut-brain Axis and Psychobiotics. Gut-Brain Axis and Neuropsychological Disorders. Gut-Brain Axis and Neurodegenerative Disorders. Hackensack Meridian Health offers cutting-edge treatment option for patients with carotid artery disease. Finding Maximal Quasiperiodicities in Strings. Our algorithm uses the suffix tree as the fundamental data structure combined with efficient methods for merging and performing multiple searches in search trees. Besides finding all maximal quasiperiodic substrings, our algorithm also marks the nodes Apostolico and Ehrenfeucht defined the notion of a maximal quasiperiodic substring and gave an algorithm that finds all maximal quasiperiodic substrings in a string of length n in time O n log2 n.

In this paper we give an algorithm that finds all maximal quasiperiodic substrings in a string Chest radiographic findings of leptospirosis. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever.

CT findings of pulmonary aspergillosis. The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or cystic space.

Invasive pulmonary aspergillosis is serious, usually fatal infection in patients being treated with immunosuppressants or who have chronic debilitating disease.

Allergic bronchopulmonary aspergillosis is characterized clinically by asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Awareness of the radiographic and CT findings of pulmonary aspergillosis is important in making the diagnosis of aspergillus-caused pulmonary disorders. In this pictorial essay, we illustrated various radiological findings of pulmonary aspergillosis focused on CT findings correlated with gross pathologic specimens. Imaging findings of sternal abnormalities.

Radiographic findings in the sternal abnormalities are often nonspecific, showing appearances from a localized benign lesion to an aggressive lesion as seen with infections and malignant neoplasms.

A specific diagnosis of sternal abnormalities can be suggested on the basis of CT and MR characteristics. Familiarity with the presentation and variable appearance of sternal abnormalities may aid the radiologist is suggesting a specific diagnosis. We present among others characteristic radiographic findings of hemangioma, chondrosarcoma, hydatid disease, and SAPHO syndrome. In those cases in which findings are not specific, cross-sectional imaging modalities may help the clinician in their management.

Finding an Eye Care Professional. Dermoscopy Findings of Hidroacanthoma Simplex. Full Text Available Hidroacanthoma simplex HAS, also known as intraepidermal eccrine poroma, is a rare eccrine adnexal tumor that tends to be misdiagnosed as other types of benign skin tumor, including clonal seborrheic keratosis. Notably, HAS is sometimes misdiagnosed and treated by cryosurgery as seborrheic keratosis, which could trigger the later development of porocarcinoma.

Therefore, accurate diagnosis of HAS is indispensable for dermatologists to avoid the development of malignant tumors by an unsuitable treatment. In this report, we present the characteristic dermoscopy findings of HAS. Indeed, the dermoscopy findings might be related to the melanin-rich necrotic cells in the epidermis, which are quite different from dermoscopy findings of clonal seborrheic keratosis. As a previous report suggested, it is difficult for a dermatologist to differentiate HAS from clonal seborrheic keratosis by the naked eye.

Our findings might be supportive for the early diagnosis of HAS. Finding Relief from Allergy's Grip. A Family Finds Its Way.

Past Issues Cover Story: Photo courtesy of Stefan Radtke, www. Radiographic findings in liveborn triploidy. The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported. Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: Harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis.

Sixteen other less specific findings showed many similarities to those found in trisomy Radiologic findings of granulomatous mastitis. The describe the radiologic findings of granulomatous mastitis of the breast.

This study included 19 patients age range: All the patients underwent a breast ultrasonography and 13 patients underwent a mammography. In the case of granulomatous mastitis, the mammography results indicate a lack of specificity between normal findings and focal asymmetry.

The sonographic findings indicate that ill-defined heterogeneously low echoic lesions or irregular shaped, ill-defined low echoic masses are difficult to differentiate from breast cancer. The sonographic findings of abscesses indicate a difficulty in differentiating them from cases of pyogenic mastitis.

However, multiple tubular and nodular low echoic lesions, especially with a continuous appearance, should point to granulomatous mastitis, and is helpful in its differential diagnosis and treatment. The RNA world in the 21st century-a systems approach to finding non-coding keys to clinical questions.

There was evidence that RNAs are a functionally rich class of molecules not only since the arrival of the next-generation sequencing technology. Non-coding RNAs ncRNA could be the key to accelerated diagnosis and enhanced prediction of disease and therapy outcomes as well as the design of advanced therapeutic strategies to overcome yet unsatisfactory approaches.

In this review, we discuss the state of the art in RNA systems biology with focus on the application in the systems biomedicine field. We introduce RNA expression profiling and network approaches for the identification of stable and effective RNomics-based biomarkers, providing insights into the role of ncRNAs in disease regulation. Towards this, we discuss ways to model the dynamics of gene regulatory networks and signalling pathways that involve ncRNAs. We also describe data resources and computational methods for finding putative mechanisms of action of ncRNAs.

Finally, we discuss avenues for the computer-aided design of novel RNA-based therapeutics. Near-Earth objects finding them before they find us. Of all the natural disasters that could befall us, only an Earth impact by a large comet or asteroid has the potential to end civilization in a single blow.

Yet these near-Earth objects also offer tantalizing clues to our solar system's origins, and someday could even serve as stepping-stones for space exploration. In this book, Donald Yeomans introduces readers to the science of near-Earth objects--its history, applications, and ongoing quest to find near-Earth objects before they find us.

In its course around the sun, the Earth passes through a veritable shooting gallery of million. Imaging findings of xanthogranulomatous pyelonephritis. To define the imaging patterns of xanthogranulomatous pyelonephritis XGP. The demographic, clinical, and imaging findings of 21 cases of pathologically proven XGP in 20 patients bilateral in one were evaluated. The findings of ultrasonography and CT were retrospectively evaluated with regard to distribution and extent of the disease, kidney size, the presence of calculi, hydronephrosis, and renal function.

The findings were assessed by two radiologists, who established a consensus. Imaging and pathologic findings were compared. Sixteen of the 20 patients were female, and 19 were adults. Their age ranged from 3 to 16 mean, 45 years. In all patients except one, the disease was unilateral right: In one patient, XGP was bilateral, and there were thus 21 cases. Clinical findings of inflammation such as fever, pyuria, bacteriuria, or leucocytosis were noted in all patients.

In addition to nephromegaly, renal function impairment, and urinary obstruction due to calculi, which are typical features of XGP, the condition may also show variable imaging findings. If the images obtained in the case of a middle-aged woman with clinical findings of urinary infection are atypical, we believe that XGP should be included in the differential diagnosis.

MR findings of cerebral palsy. To evaluate the MR findings of brain damage in cerebral palised patients and to correlate it with gestational age and the time of damage.

A retrospective analysis was performed in 40 patients who underwent MR scanning for evaluation of brain lesion in clinically diagnosed cerebral palsy. Authors classified the patients into two groups as premature and full-term and compared MR findings of the two groups. Five out of 6 patients who had been born prematurely showed isolate periventricular white matter lesions. Twenty-three out of 34 patients who had been born at full-term showed abnormal MR findings.

Of these 23 patients, migration anomalies in 7 patients, isolate periventricular white matter lesions in 3 patients, and other combined periventricular subcortical white matter and deep gray matter lesions in 14 patients were seen. MRI is thought to be very useful in the assessment of brain damage for the patients with cerebral palsy by recognizing the location of the lesion and estimating the time of damage. CT finding of cryptococcal meningitis. Ohkawara Neurosurgical Hospital, Muroran Japan.

We have experienced 14 cases of cryptococcal meningitis in the last 6 years. Their neurological signs, CT findings , and prognoses were studied. They fall into three types: The first type 6 cases revealed mainly cerebellar signs, eye-movement damage, and so forth. The second type 5 cases demonstrated ''Personality'' changes, chiefly aphasia.

The third type 5 cases did not show any focal signs. In the survivors, also, clinical signs did not disappear for a long time. Repeated CT was performed in 13 among the 14 cases; abnormal CT findings were revealed in 5 cases because of cryptococcal infection. Granuloma shadow and ventriculitis shadow were observed in 3 cases each. These abnormal findings disappeared upon treatment except in one case. The clinical signs are not completely related with the CT finding , but it is useful that the site which has been infiltrated by the cryptococcus can be observed.

Abnormal CT findings were observed in the 4 cases of the brain-stem-encephalitis type among the 5 abnormal cases. It is very useful to know the severity of the condition. Primary hepatic sarcomas are rare tumors that are difficult to diagnose clinically. Different primary hepatic sarcomas may have different clinical, morphologic, and radiological features. In this pictorial review, we summarized computed tomography CT findings of some relatively common types of hepatic sarcomas, including angiosarcoma, epithelioid hemangioendothelioma EHE , liposarcoma, undifferentiated embryonal sarcoma UES , leiomyosarcoma, malignant fibrous histiocytoma MFH , and carcinosarcoma including cystadenocarcinosarcoma.

To our knowledge, hepatic cystadenocarcinosarcoma has not been described in the English literature. The CT findings in our case are similar to that of cystadenocarcinoma, a huge, multilocular cystic mass with a large mural nodule and solid portion. The advent of CT has allowed earlier detection of primary hepatic sarcomas as well as more accurate diagnosis and characterization. In addition, we briefly discuss the MRI findings and diagnostic value of primary hepatic sarcomas.

Imaging findings of avalanche victims. Skiing and hiking outside the boundaries remains an attractive wilderness activity despite the danger of avalanches. Avalanches occur on a relatively frequent basis and may be devastating. Musculoskeletal radiologists should be acquainted with these injuries. Fourteen avalanche victims 11 men and 3 women; age range years, mean age Radiographs, CT and MR images were prospectively evaluated by two observers in consensus.

Fractures were most commonly seen Blunt abdominal and thoracic trauma were the most frequent extraskeletal findings. A wide spectrum of injuries can be found in avalanche victims, ranging from extremity fractures to massive polytrauma. Asphyxia remains the main cause of death along with hypoxic brain injury and hypothermia.

Radiologic findings of neonatal sepsis. To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants preterm: With neonatal sepsis diagnosed by blood culture and clinical manifestations. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage.

In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment. CT findings of the thymus. In 14 cases of normal and abnormal thymus proved surgically and histopathologically in korea University Hae Wha Hospital during recent 6 years, the clinical and CT findings were analyzed.

Of 14 cases, 2 cases were normal thymus, 5 cases were thymic hyperplasia, 4 cases were benign thymoma, 2 case were malignant thymoma and 1 case was thymic cyst. Of 14 cases, 10 cases were associated with myasthenia gravis, and 7 of these 10 cases were 3rd to 5th decades females. Among 10 cases with myasthenia gravis.

All 5 thymic hyperplasia were associated with myasthenia gravis. CT findings of thymic hyperplasia were normal in 4 cases and increased lobe thickness in 1 case. Of 4 cases of benign thymoma, only 1 case was associated with myasthenia gravis, and all 4 cases were positive findings in CT scan. CT findings of benign thymoma were round or oval soft tissue mass in anterior mediastinum, and 1 case had punctuate calcifications.

Of 2 cases of malignant thymoma, all 2 cases were associated with myasthenia gravis and positive findings in CT scan. CT findings of malignant thymoma were anterior mediastinal soft tissue mass with obliteration of the normal fat planes surrounding great vessels.

SVC compression, and pleural tumor implants. CT yielded significant diagnostic information of differential diagnosis between thymoma and thymoma hyperplasia in myasthenia gravis patients.

Also CT was highly sensitive test in detection of thymoma and determined the extent and invasiveness of thymoma. Scintigraphic findings in ankylosing spondylitis. A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. Increased uptake of radiotracer in the spine has also been found both diffusely and focally.

We present the MR imaging findings of diffuse white-matter hyperintensity and pallidal curvilinear streak hyperintensity in a 6-year-old Caucasian girl with a diagnosis of fucosidosis based on cDNA isolated from skin fibroblasts.

Musculoskeletal Findings in Behcet's Disease. Full Text Available Behcet's disease is a multisystem disease characterized by recurrent oral and genital ulcers, relapsing uveitis, mucocutaneous, articular, gastrointestinal, neurologic, and vascular manifestations.

Rheumatologic manifestations may also occur in Behcet's disease, and arthritis and arthralgia are the most common musculoskeletal findings followed by enthesopathy, avascular necrosis, myalgia, and myositis. Although the main pathology of Behcet's disease has been known to be the underlying vasculitis, the etiology and exact pathogenesis of the disease are still unclear. Musculoskeletal findings of Behcet's disease, the relationship between Behcet's disease and spondyloarthropathy disease complex, and the status of bone metabolism in patients with Behcet's disease were discussed in this paper.

CT findings of colonic diverticulitis. Medical School; Mizutani, Masaru [and others. Although colonic diverticulitis has no indication for operation, but in some mistaken cases were operated with a diagnosis of acute appendicitis. We evaluated the CT findings of colonic diverticulitis about 19 cases and of asymptomatic colonic diverticula about 15 cases retrospectively.

Diagnosis was confirmed of barium enema and operation. CT are complementary methods of examination that can delineated the range of thickening of the colon and the extension of inflammatory changes around the colon. We also believe that CT findings of colonic diverticulitis are useful for differentiating from a diagnosis of appendicitis. Neurological findings of Lyme disease. Neurologic involvement of Lyme disease typically consists of meningitis, cranial neuropathy, and radiculoneuritis, alone or in combination, lasting for months.

From to , we studied 38 patients with Lyme meningitis. Headache and mild neck stiffness, which fluctuated in intensity, and lymphocytic pleocytosis were the common findings. Half of the patients also had facial palsies, which were unilateral in 12 and bilateral in seven. Although incomplete presentations of neurologic involvement of Lyme disease may be confused with other entities, the typical constellation of neurologic symptoms represents a unique clinical picture.

Motivated by applications that arise in online social media and collaboration networks, there has been a lot of work on community-search and team-formation problems.

In the former class of problems, the goal is to find a subgraph that satisfies a certain connectivity requirement and contains a given collection of seed nodes. In the latter class of problems, on the other hand, the goal is to find individuals who collectively have the skills required for a task and form a connected subgraph wit CT findings of kikuchi disease: To evaluate by means of retrospective analysis of neck CT scans the CT findings which suggest kikuchi disease.

The authors evaluated the CT findings of seven cases of Kikuchi disease histologically confirmed by excisional biopsy. Four males and three females aged between 12 and 43 mean;28 years were included.

The authors retrospectively analyzed distribution, bilaterality, the presence of aggregation, the presence of intranodal low density after contrast enhancement, the number,size, shape and location of areas of intranodal low density, and the presence of extracapsular extension in involved nodes, as seen on pre-and post-contrast CT scans.

Attempts were then made to correlate the CT with the pathologic findings. The CT findings which suggest Kikuchi disease in cervical lymphadenopathy were 1 involvement varying from no intranodal low density to prominent intranodal low densities; 2 intranodal low densities, with the number, size and shape of varying degree and predominantly peripheral location, which were correlated with pathologic findings , including variable intranodal.

Find a STEM solution! The school is involved in many projects concerning STEM education. Pisa results make evident that students' knowledge is poor and motivation for math and similar subjects is low. Implying priorities of European Commission, like e-learning, raises motivation and also develops basic skills and improves knowledge in science, math, physic, ICT.

Main objectives are to increase students' interest in STEM education and careers and introduce them to all available new trends in technology, engineering and science in their region by visiting clean technology industries and strengthening links with them, to introduce some future digital jobs and prepare students for rapid technological changes by integrating ICT into classroom practice more, to highlight the importance of global environmental issues and improve the knowledge in the areas of sustainable development and renewable energy, to develop collaborative partnership between schools and the wider community in formal, non-formal and informal learning, to support multilingualism by publishing Open Educational Resources in 8 different languages and to strengthen the professional profile of the teaching profession.

The project brings together teachers and students from five different European countries in learning to think globally and work on activities that contribute to the community's well-being. There are altogether 33 activities, divided in 4 categories. STEM activities are focused on students building the devices for measuring air, light and noise pollution in their school and homes. They use the scientific method to analyze the data and compare the results with their peers to find a solution.

Eskills, digital literacy and digital jobs are focused on introducing career. Transfusional hemosiderosis; correlation of MR findings with clinical findings. Parenchymal iron deposition occurs in hemochromatosis, while iron is deposited in reticuloendothelial cells after blood transfusions Hemosiderosis.

In all of 13 patients 17 cases , the liver revealed low signal intensity equal to background noise. In 4 cases with serum ferritin level between and , pancreas was involved in 2 cases, and other organ was involved in 1 case. Electroencephalographic findings in panic disorder. Some studies have reported the importance of electroencephalography EEG as a method for investigating abnormal parameters in psychiatric disorders.

Different findings in time and frequency domain analysis with regard to central nervous system arousal during acute panic states have already been obtained. This study aimed to systematically review the EEG findings in panic disorder PD , discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies.

Literature search was conducted in the databases PubMed and ISI Web of Knowledge, using the keywords electroencephalography and panic disorder; 16 articles were selected. Despite the inconsistency of EEG findings in PD, the major conclusions about the absolute power of alpha and beta bands point to a decreased alpha power, while beta power tends to increase.

Different asymmetry patterns were found between studies. Coherence studies pointed to a lower degree of inter-hemispheric functional connectivity at the frontal region and intra-hemispheric at the bilateral temporal region. Studies on possible related events showed changes in memory processing in PD patients when exposed to aversive stimuli. It was noticed that most findings reflect the current neurobiological hypothesis of PD, where inhibitory deficits of the prefrontal cortex related to the modulation of amygdala activity, and the subsequent activation of subcortical regions, may be responsible to trigger anxiety responses.

We approached some important issues that need to be considered in further researches, especially the use of different methods for analyzing EEG signals. Radiological findings in NAO syndrome. Diseases exhibiting osteolysis in children are rare hereditary conditions. Several types have been recognised with different clinical manifestations.

One type includes subcutaneous nodules, arthropathy and osteolysis and has been termed NAO syndrome. Previous radiological reports have described the affected bones, usually the carpal and tarsal regions, but a detailed analysis of the radiological findings of both the axial as well as the appendicular skeleton has not been reported.

To describe the radiological findings in a large group of children with an autosomal recessive disease characterized by nodules, familial arthropathy and osteolysis. The study comprises 14 patients from 9 families and all patients had the triad of nodulosis, arthropathy and osteolysis NAO.

The most common radiological manifestations were osteopenia, undertubulation of long bones, arthritic changes, sclerotic sutures of the calvaria, osteolysis and muscle contractures. Other common findings were squared vertebrae, broad medial clavicles and brachycephaly.

Progress of disease was documented in more than half of the patients. Our study is the first report of the detailed radiological findings of NAO syndrome. In NAO syndrome, both the axial and appendicular skeleton are involved orig. Learning as way- finding. Finding Reliable Health Information Online. Finding Rising and Falling Words. We examine two different methods for finding rising words among which neologisms and falling words among which archaisms in decades of magazine texts millions of words and in years of tweets billions of words: MRI findings in cranial eumycetoma.

Full Text Available Cranial eumycetoma CE due to direct inoculation of Madurella grisea into the scalp is extremely rare. We describe a case of CE caused by direct inoculation of M.

Finding Cryptography in Object Code. Finding and identifying Cryptography is a growing concern in the malware analysis community. In this paper, a heuristic method for determining the likelihood that a given function contains a cryptographic algorithm is discussed and the results of applying this method in various environments is shown.

The algorithm is based on frequency analysis of opcodes that make up each function within a binary. How to Find Bed Bugs. Find and correctly identify an infestation early before it becomes widespread. Look for rusty or reddish stains and pinpoint dark spots on bed sheets or mattresses, and search for bugs near the piping, seams and tags of the mattress and box spring. MRI findings of enteroviral encephalomyelitis.

Enterovirus encephalomyelitis has characteristic lesion locations in the posterior portions of the brain stem, substantia nigra, dentate nucleus and within the anterior horns of spinal cord. Recognition of these findings in the presence of suggestive clinical presentation can help to establish the diagnosis of enterovirus encephalomyelitis. Finding related functional neuroimaging volumes. We describe a content-based image retrieval technique for finding related functional neuroimaging experiments by voxelization of sets of stereotactic coordinates in Talairach space, comparing the volumes and reporting related volumes in a sorted list.

Voxelization is accomplished by convolving each Sonographic findings of xanthogranulomatous pyelonephritis. Thirty-five cases of pathologically proven XGP in 32 patients bilateral in three patients were analyzed for preoperative US findings. Compared with findings of computed tomography CT and pathology, US findings were retrospectively analyzed for the appearance and size of the kidney, extent and pattern of the disease, and presence and characteristics of calculi, by three radiologists who made a consensus.

The mean age of the patients was 46 range 3 to 62 years. Hypoechoic or anechoic inflammatory lesions of XGP were found on US in 28 cases, but the lesions were not detected on US due to the echo pattern similar to the normal renal parenchyma in two cases and due to marked acoustic shadowing of staghorn calculi in five cases. Acoustic shadowing of renal calculi was minimal due to the dense peripelvic fibrosis in two cases.

All of the 12 staghorn calculi were detected in US. XGP had variable US findings in addition to the classic ones. In spite of advantages of US, US also had some limitations in the evaluation of renal function, extrarenal extension, and renal parenchyma with large staghorn stone. CT and excretory urography may compensate for these US limitations.

Interesting bone scans - unusual findings. A year-old female with carcinoma of the colon and known liver metastatic disease was referred for bone scan to evaluate for bone metastases. Although no bone metastases were found, there was abnormal uptake noted in the liver corresponding to a metastatic calcified lesion.

The only other findings were of degenerative disease in the cervical spine, right shoulder and small joints of the hands. A year-old male with carcinoma of the prostate and right side low back pain was referred for bone scan.

No focal abnormalities to suggest metastatic disease were identified; findings within the cervical spine, lumber spine and knees were presumed secondary to degenerative disease. Intermittent pain persisted and the patient was referred for a repeat bone scan six months later.

Previous scan findings of degenerative disease and no metastatic disease were confirmed; however, closer inspection revealed an enlarged right kidney with significant retention of tracer in the pelvicalyceal system suggesting possible obstruction.

A Retrograde pyelogram was performed, and no obvious obstruction demonstrated. As bone scan findings were very suggestive of obstruction, a DTPA scan with lasix was performed showing a dilated right collecting system with no functional obstruction.

Given the degree of dilation, it is possible that the patient experiences intermittent PUJ obstruction causing his symptoms. A year-old male with insulin dependent diabetes mellitus and viral arthritis was referred for a bone scan. A three phase revealed increased uptake in the region of the knee and leR proximal tibia. Delayed whole body images revealed multiple focal areas of osteoblastic activity in the leR tibia.

Abnormal uptake was also seen in the upper third of the leR femur. The remainder of the skeletal survey was normal. X-ray correlation of the leR tibia and femoral findings was undertaken.

Combinating unilateral changes on bone scan and X-ray although very suggestive of sclerotic polyostotic. Paths to Work in Rural Places: Helping low-income families in rural areas find gainful employment and achieve economic self-sufficiency is an ongoing policy concern. The Rural Welfare-to-Work Strategies demonstration is using rigorous experimental designs to build knowledge about how to help low-income families in rural areas strive toward sustained employment and….

This paper aims at selecting findings in the Atlas-ID that can be used as a tool for advocacy, human rights awareness, development planning, and…. Canada ; Cardinal, E. Canada ; Beauregard, C. Canada ; Braunstein, E. To describe radiographic features of gout that may mimic infection. We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis.

Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment.

The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals. In this paper learning is regarded as a multi-level and multi complex concept. In this regard the concept The data collection methods is based on eighteen focus-group interview collected in a period of the first two years of students enrolment in radiography The empirical investigation, which is the basis of the presented assumptions Radiological Findings of Michel Aplasia.

Congenital abnormalities of the inner ear is the most common cause of neurosensory hearing loss. Michel inner ear deformity is a rare developmental anomaly refers to the total aplasia of the inner ear.

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Men and women are affected equally, and the vast majority of patients are of northern European extraction. The diagnosis of OHS is based on the clinical triad of multiple white, atrophic choroidal scars so-called histo spots ; peripapillary pigment changes; and a maculopathy caused by CNV in the absence of vitreous cells.

Histo spots may appear in the macula or periphery, are discrete and punched out arising from a variable degree of scarring in the choroid and adjacent outer retina , and are typically asymptomatic Fig In contrast, metamorphopsia and a profound reduction in central vision herald macular involvement from CNV and bring the patient to the attention of the ophthalmologist.

The mean age of patients presenting with vision-threatening maculopathy is 41 years. Funduscopy of active neovascular lesions reveals a yellow-green subretinal membrane typically surrounded by a pigment ring; overlying neurosensory detachment; and subretinal hemorrhage, frequently arising at the border of a histo scar in the disc—macula area.

Cicatricial changes characterize advanced disease, with subretinal fibrosis and disciform scarring of the macula. The pathogenesis of OHS is thought to involve a focal infection of the choroid at the time of initial systemic infection. This choroiditis may subside and leave an atrophic scar and depigmentation of the RPE, or it may result in disruption of the Bruch membrane, choriocapillaris, and RPE, with subsequent proliferation of subretinal vessels originating from the choroid.

Lacking tight junctions, these neovascular complexes leak fluid, lipid, and blood, resulting in loss of macular function. The initiating stimulus for the growth of new subretinal vessels is unknown; however, immune mechanisms in patients with an underlying genetic predisposition for the development of this disease have been implicated.

The differential diagnosis includes entities other than age-related macular degeneration AMD that are frequently associated with CNV, including angioid streaks, choroidal rupture, idiopathic CNV, MCP, punctate inner choroidopathy, and granulomatous fundus lesions that may mimic the scarring seen in OHS as in toxoplasmosis, tuberculosis, coccidioidomycosis, syphilis, sarcoidosis, and toxocariasis.

The atrophic spots and maculopathy of myopic degeneration and disciform scarring in AMD may also be confused with OHS. Massive subretinal exudation and hemorrhagic retinal detachments may occur and result in permanent loss of macular function. The early, acute granulomatous lesions of OHS are rarely observed but may be treated with oral or regional periocular corticosteroids Fig In the early stages of FA, foci of active choroiditis block the dye and appear hypofluorescent; later in the study, these lesions stain, becoming hyperfluorescent.

In contrast, areas of active CNV appear hyperfluorescent early in the angiogram and leak later in the study. Idiopathic or secondary cardiomyopathies are discussed separately.

Current criteria, based on the general population, are not valid for our young, athletic population. The electrocardiograph criteria established by the U.

It is not required that the aviator be grounded pending echocardiogram interpretation. Designated Aviators- True LVH in designated aviators CD, with waiver recommended if the aviator is normotensive with or without antihypertensive medication and has a normal ejection fraction.

Please submit the information required below with an Aeromedical Summary. Serial Blood Pressures Follow-up Evaluation: Serial Blood Pressures 4. If there are any changes in the above data from the original evaluation, an echocardiogram should be obtained. In young individuals, the precordial voltages tend to be higher than in older individuals.

If voltage criteria alone are used to diagnose LVH, many false positives will result. The training limitations for aviators and flight candidates, as well as the burden on the aeromedical system, makes a overly sensitive criteria operationally intolerable. In historical studies of the U. Air Force, true left ventricular hypertrophy occurred in only 5 of , aviators 0.

By using a more specific screening criteria we are able to diagnose true U. If left ventricular hypertrophy is present, an Echocardiogram will exclude aortic stenosis and hypertrophic cardiomyopathy as causes. Serial blood pressure measurements will further exclude hypertension. In differentiating the normal athletic heart from cardiomyopathy, exercise abstinence can be useful.

Pericardial effusion can lead to acute cardiovascular compromise secondary to cardiac tamponade. Less severe cases can produce pain and shortness of breath that can be distracting in flight. The flier should be grounded during the acute illness. Idiopathic pericarditis can be considered for waiver after the acute episode resolves provided there has been no recurrence or sequelae. The disposition of cases secondary to underlying disease will depend on the disease concerned.

Any pericardial effusions must be resolved by echocardiography before waiver recommendations will be made. Cardiac consultation is necessary to exclude connective tissue disorder, myocardial infarction, neoplasm or other disease processes.

The workup should include: Echocardiography to rule out sequelae such as pericardial effusion or constrictive pericarditis. Idiopathic pericarditis is usually self limiting. Rest and aspirin or nonsteroidal anti-inflammatory agents are all that are required for treatment.

If maintenance medication is required, then a waiver will not be considered. Waiver recommendations for secondary pericarditis will be based on the underlying disease process. A small minority of cases may progress to pericardial constriction or tamponade. Some patients will be left with minor, nonspecific ECG abnormalities.

Individuals with short PR and no symptoms have the same risk of adverse cardiac events as the general population. Pre-excitation syndromes are associated with other types of heart disease, such as hypertrophic cardiomyopathy or Ebstein's malformation. Applicants or Designated 1. If a dysrhythmia is induced by EPS and ablated, the patient must be retested with EPS immediately after the ablation during that same procedure to ensure dysrhythmias are no longer inducible. Waiver requests to SG 1 or SG 2 may be submitted six months post-ablation with documentation indicating they had no recurrence of dysrhythmias or symptoms.

Waivers are considered six months post-ablation, with documentation indicating no recurrence of dysrhythmias or symptoms. Ablation is required for U. Waiver recommendation is on a case-by-case basis, and local board of flight surgeons LBFS action is prohibited.

Waivers are considered on a case-bycase basis. Applicant or Designated 1. Asymptomatic WPW pattern requires cardiology consultation, echocardiogram, hour Holter monitor, and exercise stress testing. If cardiology studies determine that EPS is indicated and the EPS causes inducible dysrhythmias, then ablation is required. During ablation procedure, retesting is required to demonstrate that the dysrythmia is non-inducible.

Waivers are considered on a case-by-case basis. Notation on report of annual flight physical examination indicating no signs or symptoms of dysrhythmia recurrences. An electrocardiogram will be completed and compared to prior studies. In some cases, a U. If dysrhythmias or symptoms recur, personnel are NPQ and waivers are terminated.

Cryoablation is also acceptable for waiver requests, but is not used as commonly as RFA. The lowest incidence of dysrhythmia is in young adults without histories of signs or symptoms. It is not possible to predict which EPS-inducible patients will develop SVT with or without catastrophic rapid ventricular responses. Extreme sinus bradycardia may be a reflection of an underlying conduction system abnormality. There may be an inability to increase the heart rate in response to increased demand.

If the heart rate increases with exercise, the bradycardia is NCD, and no waiver is required. No treatment is indicated if the rate increases with exercise; the condition is NCD. Sinus tachycardia may be a reflection of a significant metabolic abnormality. In candidates, consider anxiety as the root problem. Other causes include fever, hyperthyroidism, dehydration, anemia, hypoxia, pulmonary emboli, and pain. The waiver recommendation will stem from the reason for the tachycardia. Persistent sinus tachycardia is unusual, and its etiology must be determined.

Holter monitoring to determine average heart rate and sleeping rate is extremely helpful. Recurrent is defined as occurring more than once in any test or during any evaluation. Sustained tachycardia is defined as lasting more than 10 minutes. The major concern in supraventricular tachycardia SVT is hemodynamic decompensation in flight leading to lightheadedness, dizziness, presyncope and loss of consciousness.

Only asymptomatic with the exclusion of the sensation of palpitations as a symptom cases will be considered for waiver as symptoms are an indication of hemodynamic compromise. Service Group I waiver recommendations can be considered for those with the following: No evidence of CAD can be present if a waiver is requested.

Waivers are not recommended for students or candidates. Complete cardiology consultation looking for secondary causes is required to include: Three Holters during a 6 month grounding period 2. For cases of a single, asymptomatic, beat run of SVT, only local evaluation is required. Thyroid function testing b. Standard treadmill test d. Three, hour Holters at monthly intervals to identify cardiovascular risk factors e. These studies will be forwarded to NOMI with the waiver request for review.

If there is any abnormality, further cardiology evaluation will be required. Preferred studies are stress echocardiogram, thallium stress test or Sestamibi. Supraventricular tachycardia is characterized by a narrow complex rhythm except with aberrant conduction in which the QRS will be wide , and P waves are usually hidden. An irregularly irregular rhythm and a narrow QRS complex are seen. MAT is often clinically significant and heart disease has to be excluded. Air Force has reviewed individuals with SVT.

Three of these individuals were initially found to have recurrent, sustained SVT and the fourth had a single, sustained SVT. Pain and swelling secondary to deep venous thrombosis DVT can be distracting in flight. The major risk is a pulmonary embolism producing chest pain, shortness of breath, hypoxia, cardiac arrhythmias or sudden death. The development of pulmonary hypertension, the need for continued anticoagulation, or surgical procedures such as plication of the vena cava or insertion of filter devices is CD, no waiver.

Superficial thrombophlebitis is NCD. Confirmation of normal exercise tolerance and pulmonary function is necessary. In cases of pulmonary embolism, internal medicine consultation may be necessary to exclude underlying malignancy or other hypercoagulable states.

The aviator should be grounded for the full duration of anticoagulant therapy. Risk factors related to hypercoagulability e. The vast majority of patients who survive pulmonary embolism will recover to normal or nearly normal cardiac and pulmonary function within weeks.

Recurrence is defined as occurring more than once in any Holter monitor or period of workup, or more than once in any subsequent evaluation. Hemodynamic changes can result in a fall in blood pressure and a reduction in cerebral blood flow.

The condition is often associated with underlying heart disease. There is also a risk of sudden death associated with the condition, usually from ventricular fibrillation. Non-Designated and Designated Personnel: Complete cardiology evaluation is required to include: Echo treadmill test with thallium or Sestamibi b. Three monthly Holter monitors d. Cardiac catheterization must be performed if there is any evidence of ischemia.

Electrophysiologic studies may be required if there is uncertainty regarding the origin of the tachycardia VT vs. SVT with aberrant conduction. Anti-arrhythmic drugs impair cardiac function and are incompatible with flying duties. Pacing is also incompatible with flying status. The symptoms of ventricular tachycardia are incompatible with duty involving flying.

Typically the hands are primarily effected. During an episode skin changes that occur include: Pallor-caused by lack of oxygenated blood 2.

Cyanosis-caused by pooling of poorly oxygenated blood 3. Rubor-occurs as the vasospasm ends During a severe episode the vascular changes and associated pain can effect hand usage in the cockpit see discussion. Underlying pathology must be excluded and symptoms must be manageable in the performance of flight duties. The following information is used to help rule out secondary underlying causes and must be included: CBC with differential c. Antinuclear antibodies ANA e.

Though not required, nailfold capillary morphology studies may be included. Class I aviators must have their waiver package reviewed by NOMI internal medicine prior to being allowed to return to the cockpit.

As more advanced tests become available, please include them with the waiver request. Drug therapy is discouraged because of the side effects of the drugs in common use. Behavioral adaptations such as stopping tobacco usage, cold avoidance, and layered clothing are acceptable. Thoracic sympathectomy is not waiverable. In women, onset typically occurs between 15 and 40 years; in men the onset is typically later. The lesions on the face may interfere with mask seal and helmet wear. Those over the shoulders may cause discomfort when wearing safety restraints or parachute harnesses.

Patients with severe cystic acne may also have psychological problems relevant to military aviation duties. Candidates with severe cystic acne are CD, no waiver. Detailed full-body skin exam 2. Details of current therapy 3. Treatment with oral erythromycin, doxycycline, or tetracycline is NCD following a period of grounding to screen for side effects.

Minocycline is not acceptable because of the risk of CNS side effects such as light-headedness, dizziness and vertigo. Accutane is CD, no waiver. Accutane use requires grounding for the duration of therapy, plus 3 months after drug cessation.

Slit lamp exam and triglyceride levels three months post therapy must be normal. LFT abnormalities while on Accutane must be resolved prior to requesting a waiver. Depending on the location of lesions, there can be interference with the wearing of flight gear.

The symptoms, particularly itching, can be distracting in flight. Patients with atopic dermatitis are more susceptible to contact dermatitis due to irritants found in a military environment. Symptom severity and the requirement for therapy will determine the aeromedical disposition. Patients controlled on topical therapy over small areas and patients who are asymptomatic on stable doses of loratadine Claritin OR fexofenadine Allegra may be considered for waiver.

An initial seven day grounding period is required for loratadine and fexofenadine to document no adverse effects. A one time separate waiver submission is required for loratadine or fexofenadine. Intermittent use of topical steroids over a limited area is compatible with waiver. The use of other medications besides loratadine or fexofenadine is CD, no waiver.

The disease process does not interfere with aviation duties and is only a cosmetic concern. Treatment is potentially toxic, expensive, has high relapse rates and often requires adjuvant therapy. Not required for the disease. Treatment with terbinafine is NCD provided the following guidelines.

Documentation of baseline liver function tests. Monthly liver function tests for duration of treatment. Terbinafine is the only approved medication for use in aviators.

A three day grounding period is required when initiating therapy with terbinafine. Ketaconazole is not recommended for waiver. A positive culture is required prior to the initiation of treatment following the standard of care. Clinically, microscopic diagnosis is sufficient to guide therapy in most cases. Susceptibility to onychomycosis appears to be genetically determined.

Susceptible individuals have frequent recurrences and a less than optimal response to treatment. The relapsing nature of the condition together with the requirement for therapy makes it difficult for the military aviator to satisfy operational responsibilities. Some cases are exacerbated by physically and emotionally strenuous work. Some of the forms of treatment have side effects incompatible with flying.

Waiver may be considered for mild cases, including those needing occasional topical steroids. More severe cases will be found NPQ, with no waiver recommended. A history of psoriasis is disqualifying for entry into aviation. Topical steroids in mild cases will control the condition in one third of cases within 2 weeks, even when the steroid is withdrawn.

A second third will respond to continued applications of steroid times weekly. The remainder of cases do not respond. Other topical applications such as tar products and dithranol are unacceptable in aviation. Anti-mitotic drugs such as methotrexate side effects including ataxia, hallucinations and retinoic acid liver toxicity, dry mouth, sore lips, conjunctivitis are also unacceptable within aviation.

It is less common in sunny climates and in those with darker skins. Psoriasis is a fluctuating condition of spontaneous remissions and relapses; up to one third of cases go into remission each year. The primary concern in a diabetic patient, acutely, is the possibility of unexpected hypoglycemia and associated risk of sudden loss of consciousness.

This risk is greatest among those with Type 1 diabetes mellitus, but may also occur in diabetics controlled with oral anti-diabetic medications. The long-term complications of diabetes include renal, cardiovascular, neurological and visual problems. Deployment frequently decreases control secondary to uncontrolled diet, long work hours and environmental stressors. Both Type 1 and Type 2 diabetes mellitus is disqualifying for all aviation duties.

Type 1 Diabetes mellitus: Waiver will not be considered. Type 2 Diabetes mellitus: Candidate or student status in: Controlled without medication diet and weight control: All classes, waiver will be considered. Service group 1 or 2, waiver will not be considered. Service group 3, waiver will be considered on a case by case basis but will generally not be recommended. Class 2 or 3, waiver is generally recommended. Controlled with insulin or other medications other than Metformin or TZDs: However, weight and Hgb A1C shall be submitted annually with physical exam for monitoring of disease progression.

Neurological exam with attention to peripheral neuropathies may be done by Flight Surgeon 4. Chem 7 lytes, BUN, creatinine, glucose c. Anti-glutamic acid decarboxylase anti-GAD, a marker for Type 1 diabetes 8. Weight and height for baseline body mass index BMI 9. BMI at baseline or below 7. Documentation by Flight Surgeon to include: Level of control summary of before meal Accuchecks, blood sugars between visits, changes in weight b.

Neurological exam Waiver terminated if: Lack of understanding of disease process 2. Non-compliant with medications 3. Unwilling to perform Accuchecks 4. Metformin and thiazolidinedione waivers are meant for Type 2 diabetics who require additional assistance in controlling serum glucose. Waivers are not meant for the individual who is extremely hard to control, or who is non-compliant with medical recommendations.

Waivers should only be recommended for those individuals that demonstrate the motivation to learn about their disease process and participate in their care. For aviation personnel, the following are approved methods of treatment: A limited number of oral anti-diabetic medications as listed above Impaired Glucose Tolerance: Diet, exercise, and weight reduction are primary therapies. These individuals need aggressive cardiac risk factors modification.

The major concern for most oral anti-diabetic medications is the precipitation of hypoglycemia. Due to their mechanisms of action, the risk of hypoglycemia is present but extremely rare.

Therefore, they are the most suitable oral anti-diabetic agents available for controlling type 2 diabetics in the aviation environment. They were chosen as the only oral antihyperglycemic agents allowed for use in the aviation community due to their well-established efficacy and safety profile. The unique mechanism of action minimizes the risk of hypoglycemia except under the most extreme circumstances ex.

Compared to healthy aviators, poorly controlled diabetics are twice as likely to have a stroke, 2 to 10 times more likely to suffer a myocardial infarction, and 5 to 10 times more likely to suffer U. NAMI emphasizes tight control of blood sugar over the entire aviation career. Screening FBG is strongly recommended annually for all individuals at higher risk for developing diabetes.

Gout may present as an acute severe arthritis without warning. It may be associated with atherosclerosis, diabetes, hypertension, and renal disease. Both gout and the medications used for treatment are CD. Waivers to SG1 will be considered after 3 months if member remains asymptomatic and on a stable dose of medication if required. Serum Uric Acid with at least one value obtained on current treatment regimen, if prescribed 3.

Medical treatment and dosage if prophylactic medications are prescribed 4. Confirmation of absence of renal stones within the collecting system plain film KUB is adequate 5. Parenchymal renolithiasis is CD as well but may considered for waiver See chapter on renal stones. The first episode of presumed gout is usually treated with a non-steroidal antiinflammatory agent.

Should the patient have a reoccurrence, a joint aspiration should be considered to confirm the diagnosis. Allopurinol or Probenecid may be necessary to control the symptoms. Starting treatment with Probenecid can precipitate stone formation in the kidney and the maintenance of an alkali diuresis at the start of treatment is recommended.

Of relevance to aircrew is the association of gout with increased alcohol consumption. An atypical presentation, with cardiac or psychiatric symptoms, is common in men. Patients with thyroid ophthalmopathy frequently have difficulty in upward gaze. Corneal damage and optic neuropathy can also occur. Waiver may be considered once the patient is euthyroid on a stable dose of replacement medication if required.

Patients with ophthalmopathy will need to be grounded while undergoing treatment and may need to be disqualified permanently if treatment is unsuccessful. Waivers are not granted for the use of propylthiouracil. Laboratory studies as indicated or ordered by endocrinologist 3. Treatment summary to include method of ablation if performed 4. Ophthalmology consultation is also required if exophthalmos or other eye conditions are suspected 5. There are three primary forms of therapy: Methimazole may cause side effects including vertigo and drowsiness, as well as agranulocytosis.

Surgery is declining in popularity but may be the treatment of choice in females of childbearing age. A small number of cases will require eye surgery. Bulbar involvement can occur. A third of patients undergoing surgery will be hypothyroid within 10 years. The insidious onset of many signs and symptoms of hypothyroidism reduces the aviator's ability to recognize abnormalities. It can foster complacency or an unwillingness to seek medical advice until performance is significantly degraded.

Fatigue, lethargy, muscle weakness, decreased cognitive function, motor weakness, delayed reflexes, bradycardia, first degree heart block, cardiomegaly, pericardial effusion, depression, sensorineural hearing loss and anemia are all complications relevant to aviation. The flight surgeon must know and observe their aviators for the subtle onset of any of these signs and symptoms. All other categories of applicants will be considered on a case-bycase basis. A waiver for designated personnel may be recommended for uncomplicated hypothyroidism when the patient is clinically and chemically euthyroid on a stable dose of replacement levothyroxine at least 6 weeks , with the TSH stable and in normal range.

Annual evaluation of member's thyroid status with thyroid function studies TSH at a minimum 4. Synthroid levothyroxine use is waiverable in designated personnel. The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis Hashimoto's thyroiditis. Other causes include radioactive iodine thyroid gland ablation, surgical removal of the thyroid gland, and external irradiation. Full dose replacement with levothyroxine can be instituted immediately in most patients, the exceptions being geriatric or cardiac patients.

The ratio of female to male patients is approximately 5: Symptoms that include airway compromise discomfort, and ear and sinus barotraumas, along with the use of medications with unacceptable side effects, have the potential for in-flight incapacitation, and prolonged periods of grounding. Vasomotor rhinitis may be CD if symptoms interfere with aviation, although this is a rare occurrence. For more information on VR, see the Discussion section below. In evaluating a member with a history of allergic rhinitis, the following conditions must all apply before determining that he or she is PQ: Symptoms, if present or expected to recur, must be controllable with any combination of topical nasal steroid sprays, approved antihistamines, montelukast Singulair , or nasal cromolyn.

A Waters' view x-ray of the sinuses must show no evidence of acute or chronic mucosal disease mucus retention cysts are the exception 3.

A nasal examination using a hand-held magnifying otoscope with large speculum must show no evidence of mucosal disease such as polyp s or purulent drainage. If in doubt, seek ENT consultation. Your nasal examination is best done several minutes after spraying both nasal cavities with a decongestant nasal spray. There has been no use of allergy immunotherapy AIT within the past 12 months.

It is the severity of the condition that requires the waiver, not the medication. Nasal speculum exam 3. Depending on the reason for disqualification, a waiver may or may not be considered. In these cases, the following information is also required for waiver consideration: Results of any further tests that have been performed, such as sinus CT U. Navy Aeromedical Reference and Waiver Guide ENT - 1 Vasomotor rhinitis, which causes significant disability, will require the same documentation as for allergic rhinitis.

If the member is felt to be NPQ, then the Allergic Rhinitis Worksheet see below may be helpful in assuring that all useful information is collected for waiver consideration. The non-sedating antihistamines Claritin, Clarinex, and Allegra and the leukotriene receptor antagonist montelukast Singulair are approved for use in all aviation personnel, with no waiver required providing the above conditions are met. If the Flight Surgeon chooses to start a member on one of these medications, a seven-day grounding period is mandatory in order to observe for any untoward effects.

This period does not need to be repeated with subsequent use of that drug. However, If the member switches to another antihistamine, another grounding period is then necessary as two of the three approved medications are chemically dissimilar from the third.

Note that only the plain forms of these antihistamines are approved and not the ones containing decongestants. Singulair is not generally considered first line therapy. It is generally used as a medication that provides benefit in conjunction with topical nasal steroids or antihistamines.

Inhaled nasal steroids and cromolyn do not require a waiver. AIT is difficult to administer 12 hour grounding after shot, refrigeration required, loss of serum potency, and difficulty obtaining refills and should not be undertaken if topical sprays or non-sedating antihistamines are effective. Applicants on a stable dose of AIT may be considered for waiver. There has been success with an accelerated method of reaching maintenance Rush technique , and, if available, this should be considered when grounding time must be minimized.

Etiology is inhaled allergens and on rare occasions, food in PAR. Nasal inhaled steroids and cromolyn have minimal side effects and are approved for use in aviation personnel, as are three non-sedating antihistamines Claritin, Clarinex, and Allegra. Allergic rhinitis may be mimicked by Vasomotor Rhinitis, which may consist of rhinorrhea, sneezing, and congestion. The congestion is often seen as alternating, sometimes severe, nasal obstruction. Inciting factors include temperature and humidity changes, odors, irritants, recumbency, and emotion.

Treatment of vasomotor rhinitis with inhaled nasal steroids can be effective, and, if symptoms aren't disabling, no waiver is required. The potential for VR to cause barotrauma is nil. Typical duration of sx: This is of particular concern because sinus barotrauma has the potential for in-flight incapacitation, prolonged periods of grounding, and other symptoms affecting performance. Civilian applicants with a history of chronic sinusitis are NPQ. A waiver shouldn't be requested unless he or she is free of disease, as indicated by a recent ENT consultation and in most cases a sinus CT.

If surgery has been done, enclose any pre- and postoperative notes as well as the operation report. In addition, some evidence of the applicant's ability to handle pressure changes should be documented. Low pressure chambers are not generally accessible to civilians, so look for a history of recent successful SCUBA diving or aerobatic flying. If the applicant is military, make every attempt to have him or her perform a barofunction run in a low pressure chamber.

Students and designated aviation personnel who are diagnosed with chronic sinusitis while on active duty are also NPQ, and a waiver will only be considered after the disease has been successfully treated. The surgeon should state that the patient is cleared for evaluation in a low-pressure chamber before the flight surgeon schedules a chamber run.

If the patient successfully completes the run without pain or significant facial pressure, a waiver is generally recommended and usually granted. A common waiver stipulation is that the patient must have an ENT consultation for the first 3 years after surgery before waiver continuation can be recommended. Detailed information on the events that led to the diagnosis Physical examination findings X-ray studies including CT scan if performed Details on the operation performed Surgeon's postoperative findings and recommendations Copies of the pre- and post-op notes and dictated operation report if available Post-op CT report if performed Documentation of a successful post-surgical barofunction run in a low pressure chamber In many cases it is appropriate for a Local Board of Flight Surgeons to return the member to a flying status while awaiting the waiver, but it is best to consult with the NAMI Otolaryngology Department before doing so.

Chronic sinusitis can be relatively asymptomatic, and may only come to the attention of the flight surgeon because the member suffers an episode of sinus barotrauma. On the other hand there may be persistent cough, purulent postnasal drainage, facial pressure, nasal congestion, and low-grade malaise for many months without history of barotraumas before the flight surgeon is consulted. The symptoms may date back to a particularly severe upper respiratory infection, or even to an episode of acute sinusitis.

The symptoms may be dismissed as allergic although sneezing, clear rhinorrhea, and lacrimation are usually absent and the patient may have been treated for allergies on multiple occasions, usually with little or no relief. Navy Aeromedical Reference and Waiver Guide ENT - 4 By definition, chronic sinusitis is a condition that is present for more than three months, although in reality most patients have a considerably longer history of waxing and waning symptoms that often are mistakenly treated as multiple episodes of acute sinusitis.

Broad spectrum antibiotic therapy with activity against anaerobes is recommended for three weeks. Decongestants, mucolytics, nasal saline, and topical steroid sprays are often prescribed, but there is no consensus as to their effectiveness in shortening the course of chronic sinusitis. If antibiotics fail to eliminate the symptoms and the x-rays don't improve, surgery is often the next step.

Surgery may be done sooner in aircrew than in others because flying personnel are unable to do their jobs until the disease is eliminated. Although early surgery may seem a bit extreme, it is quite effective in eliminating disease and returning aircrew to flying. Not all ENT surgeons are comfortable with doing early surgery, especially if the patient is asymptomatic and the CT shows only minimally diseased mucosa, but when the "minimal" disease is in the area of the osteomeatal complex, it can have a profound effect on the sinuses ability to ventilate.

The Air Force studied 50 pilots and navigators who were found to have chronic sinusitis during an evaluation following an episode of sinus barotrauma. They all underwent FESS, and 47 returned to flying without further problems. The other three, because of barotrauma in the chamber post-op, needed a minor revision of the original surgery.

They eventually returned to flying too. The post-op chamber run is invaluable in proving that the member will do well upon returning to flying. Although it seems obvious that the chamber run is necessary in someone who had suffered barotrauma previously, it is also necessary in post-op patients who never had barotraumas since it is possible for the surgery itself to cause scarring that can compromise sinus ventilation.

An uneventful chamber run puts those concerns to rest. Chronic sinusitis can recur in spite of successful treatment in the past, so the flight surgeon should have a relatively low threshold for treatment or for referral back to ENT if typical symptoms or barotrauma should resurface.

There is one circumstance in which neither a waiver nor a chamber run would be necessary for an aircrew who has undergone FESS. Occasionally this surgery is done to open a maxillary sinus in order to decompress a mucus retention cyst. In such a case there is no chronic sinusitis, and the surgery itself has little chance of leading to barotraumas, but virtually all other patients who undergo FESS will need a waiver. Sinus barotraumas, which has the potential for in-flight incapacitation, and prolonged periods of grounding.

Civilian applicants with nasal polyps present at the time of examination are CD, no waiver. They may be considered for waiver if the polyps were surgically removed more than three years earlier, have required no subsequent surgical treatment, and have not recurred.

For military, if surgery is done see the exception to surgery in the treatment section below , waivers are considered if the condition is controlled postoperatively and a barofunction run in a low pressure chamber is completed successfully. Some polyp patients have a past history of treatment with systemic steroids. Use of topical nasal steroids is approved, and is encouraged as needed to control polyp recurrences.

As a general rule, if polyps are diagnosed and treated, a post-treatment barofunction run in the chamber will be necessary. ENT evaluation All surgical reports Sinus Films to rule out sinusitis Results of post-op barofunction chamber flight s If polyps are currently present, the following additional information is also required: Resection of nasal polyps is advisable in most cases. This is a must if a waiver is to be considered with one exception. We present among others characteristic radiographic findings of hemangioma, chondrosarcoma, hydatid disease, and SAPHO syndrome.

In those cases in which findings are not specific, cross-sectional imaging modalities may help the clinician in their management. Finding an Eye Care Professional. Dermoscopy Findings of Hidroacanthoma Simplex.

Full Text Available Hidroacanthoma simplex HAS, also known as intraepidermal eccrine poroma, is a rare eccrine adnexal tumor that tends to be misdiagnosed as other types of benign skin tumor, including clonal seborrheic keratosis. Notably, HAS is sometimes misdiagnosed and treated by cryosurgery as seborrheic keratosis, which could trigger the later development of porocarcinoma.

Therefore, accurate diagnosis of HAS is indispensable for dermatologists to avoid the development of malignant tumors by an unsuitable treatment. In this report, we present the characteristic dermoscopy findings of HAS.

Indeed, the dermoscopy findings might be related to the melanin-rich necrotic cells in the epidermis, which are quite different from dermoscopy findings of clonal seborrheic keratosis. As a previous report suggested, it is difficult for a dermatologist to differentiate HAS from clonal seborrheic keratosis by the naked eye. Our findings might be supportive for the early diagnosis of HAS. Finding Relief from Allergy's Grip.

A Family Finds Its Way. Past Issues Cover Story: Photo courtesy of Stefan Radtke, www. Radiographic findings in liveborn triploidy. The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported. Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: Harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis.

Sixteen other less specific findings showed many similarities to those found in trisomy Radiologic findings of granulomatous mastitis. The describe the radiologic findings of granulomatous mastitis of the breast. This study included 19 patients age range: All the patients underwent a breast ultrasonography and 13 patients underwent a mammography.

In the case of granulomatous mastitis, the mammography results indicate a lack of specificity between normal findings and focal asymmetry. The sonographic findings indicate that ill-defined heterogeneously low echoic lesions or irregular shaped, ill-defined low echoic masses are difficult to differentiate from breast cancer. The sonographic findings of abscesses indicate a difficulty in differentiating them from cases of pyogenic mastitis. However, multiple tubular and nodular low echoic lesions, especially with a continuous appearance, should point to granulomatous mastitis, and is helpful in its differential diagnosis and treatment.

The RNA world in the 21st century-a systems approach to finding non-coding keys to clinical questions. There was evidence that RNAs are a functionally rich class of molecules not only since the arrival of the next-generation sequencing technology. Non-coding RNAs ncRNA could be the key to accelerated diagnosis and enhanced prediction of disease and therapy outcomes as well as the design of advanced therapeutic strategies to overcome yet unsatisfactory approaches.

In this review, we discuss the state of the art in RNA systems biology with focus on the application in the systems biomedicine field. We introduce RNA expression profiling and network approaches for the identification of stable and effective RNomics-based biomarkers, providing insights into the role of ncRNAs in disease regulation.

Towards this, we discuss ways to model the dynamics of gene regulatory networks and signalling pathways that involve ncRNAs. We also describe data resources and computational methods for finding putative mechanisms of action of ncRNAs.

Finally, we discuss avenues for the computer-aided design of novel RNA-based therapeutics. Near-Earth objects finding them before they find us. Of all the natural disasters that could befall us, only an Earth impact by a large comet or asteroid has the potential to end civilization in a single blow. Yet these near-Earth objects also offer tantalizing clues to our solar system's origins, and someday could even serve as stepping-stones for space exploration.

In this book, Donald Yeomans introduces readers to the science of near-Earth objects--its history, applications, and ongoing quest to find near-Earth objects before they find us. In its course around the sun, the Earth passes through a veritable shooting gallery of million. Imaging findings of xanthogranulomatous pyelonephritis. To define the imaging patterns of xanthogranulomatous pyelonephritis XGP.

The demographic, clinical, and imaging findings of 21 cases of pathologically proven XGP in 20 patients bilateral in one were evaluated. The findings of ultrasonography and CT were retrospectively evaluated with regard to distribution and extent of the disease, kidney size, the presence of calculi, hydronephrosis, and renal function. The findings were assessed by two radiologists, who established a consensus.

Imaging and pathologic findings were compared. Sixteen of the 20 patients were female, and 19 were adults. Their age ranged from 3 to 16 mean, 45 years. In all patients except one, the disease was unilateral right: In one patient, XGP was bilateral, and there were thus 21 cases. Clinical findings of inflammation such as fever, pyuria, bacteriuria, or leucocytosis were noted in all patients.

In addition to nephromegaly, renal function impairment, and urinary obstruction due to calculi, which are typical features of XGP, the condition may also show variable imaging findings. If the images obtained in the case of a middle-aged woman with clinical findings of urinary infection are atypical, we believe that XGP should be included in the differential diagnosis. MR findings of cerebral palsy.

To evaluate the MR findings of brain damage in cerebral palised patients and to correlate it with gestational age and the time of damage. A retrospective analysis was performed in 40 patients who underwent MR scanning for evaluation of brain lesion in clinically diagnosed cerebral palsy. Authors classified the patients into two groups as premature and full-term and compared MR findings of the two groups.

Five out of 6 patients who had been born prematurely showed isolate periventricular white matter lesions. Twenty-three out of 34 patients who had been born at full-term showed abnormal MR findings. Of these 23 patients, migration anomalies in 7 patients, isolate periventricular white matter lesions in 3 patients, and other combined periventricular subcortical white matter and deep gray matter lesions in 14 patients were seen.

MRI is thought to be very useful in the assessment of brain damage for the patients with cerebral palsy by recognizing the location of the lesion and estimating the time of damage. CT finding of cryptococcal meningitis. Ohkawara Neurosurgical Hospital, Muroran Japan. We have experienced 14 cases of cryptococcal meningitis in the last 6 years. Their neurological signs, CT findings , and prognoses were studied. They fall into three types: The first type 6 cases revealed mainly cerebellar signs, eye-movement damage, and so forth.

The second type 5 cases demonstrated ''Personality'' changes, chiefly aphasia. The third type 5 cases did not show any focal signs. In the survivors, also, clinical signs did not disappear for a long time. Repeated CT was performed in 13 among the 14 cases; abnormal CT findings were revealed in 5 cases because of cryptococcal infection. Granuloma shadow and ventriculitis shadow were observed in 3 cases each.

These abnormal findings disappeared upon treatment except in one case. The clinical signs are not completely related with the CT finding , but it is useful that the site which has been infiltrated by the cryptococcus can be observed. Abnormal CT findings were observed in the 4 cases of the brain-stem-encephalitis type among the 5 abnormal cases. It is very useful to know the severity of the condition. Primary hepatic sarcomas are rare tumors that are difficult to diagnose clinically.

Different primary hepatic sarcomas may have different clinical, morphologic, and radiological features. In this pictorial review, we summarized computed tomography CT findings of some relatively common types of hepatic sarcomas, including angiosarcoma, epithelioid hemangioendothelioma EHE , liposarcoma, undifferentiated embryonal sarcoma UES , leiomyosarcoma, malignant fibrous histiocytoma MFH , and carcinosarcoma including cystadenocarcinosarcoma.

To our knowledge, hepatic cystadenocarcinosarcoma has not been described in the English literature. The CT findings in our case are similar to that of cystadenocarcinoma, a huge, multilocular cystic mass with a large mural nodule and solid portion.

The advent of CT has allowed earlier detection of primary hepatic sarcomas as well as more accurate diagnosis and characterization. In addition, we briefly discuss the MRI findings and diagnostic value of primary hepatic sarcomas. Imaging findings of avalanche victims. Skiing and hiking outside the boundaries remains an attractive wilderness activity despite the danger of avalanches.

Avalanches occur on a relatively frequent basis and may be devastating. Musculoskeletal radiologists should be acquainted with these injuries. Fourteen avalanche victims 11 men and 3 women; age range years, mean age Radiographs, CT and MR images were prospectively evaluated by two observers in consensus. Fractures were most commonly seen Blunt abdominal and thoracic trauma were the most frequent extraskeletal findings. A wide spectrum of injuries can be found in avalanche victims, ranging from extremity fractures to massive polytrauma.

Asphyxia remains the main cause of death along with hypoxic brain injury and hypothermia. Radiologic findings of neonatal sepsis. To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants preterm: With neonatal sepsis diagnosed by blood culture and clinical manifestations. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage.

In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment.

CT findings of the thymus. In 14 cases of normal and abnormal thymus proved surgically and histopathologically in korea University Hae Wha Hospital during recent 6 years, the clinical and CT findings were analyzed.

Of 14 cases, 2 cases were normal thymus, 5 cases were thymic hyperplasia, 4 cases were benign thymoma, 2 case were malignant thymoma and 1 case was thymic cyst. Of 14 cases, 10 cases were associated with myasthenia gravis, and 7 of these 10 cases were 3rd to 5th decades females. Among 10 cases with myasthenia gravis.

All 5 thymic hyperplasia were associated with myasthenia gravis. CT findings of thymic hyperplasia were normal in 4 cases and increased lobe thickness in 1 case. Of 4 cases of benign thymoma, only 1 case was associated with myasthenia gravis, and all 4 cases were positive findings in CT scan.

CT findings of benign thymoma were round or oval soft tissue mass in anterior mediastinum, and 1 case had punctuate calcifications. Of 2 cases of malignant thymoma, all 2 cases were associated with myasthenia gravis and positive findings in CT scan. CT findings of malignant thymoma were anterior mediastinal soft tissue mass with obliteration of the normal fat planes surrounding great vessels.

SVC compression, and pleural tumor implants. CT yielded significant diagnostic information of differential diagnosis between thymoma and thymoma hyperplasia in myasthenia gravis patients.

Also CT was highly sensitive test in detection of thymoma and determined the extent and invasiveness of thymoma. Scintigraphic findings in ankylosing spondylitis. A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. Increased uptake of radiotracer in the spine has also been found both diffusely and focally. We present the MR imaging findings of diffuse white-matter hyperintensity and pallidal curvilinear streak hyperintensity in a 6-year-old Caucasian girl with a diagnosis of fucosidosis based on cDNA isolated from skin fibroblasts.

Musculoskeletal Findings in Behcet's Disease. Full Text Available Behcet's disease is a multisystem disease characterized by recurrent oral and genital ulcers, relapsing uveitis, mucocutaneous, articular, gastrointestinal, neurologic, and vascular manifestations.

Rheumatologic manifestations may also occur in Behcet's disease, and arthritis and arthralgia are the most common musculoskeletal findings followed by enthesopathy, avascular necrosis, myalgia, and myositis. Although the main pathology of Behcet's disease has been known to be the underlying vasculitis, the etiology and exact pathogenesis of the disease are still unclear.

Musculoskeletal findings of Behcet's disease, the relationship between Behcet's disease and spondyloarthropathy disease complex, and the status of bone metabolism in patients with Behcet's disease were discussed in this paper. CT findings of colonic diverticulitis. Medical School; Mizutani, Masaru [and others. Although colonic diverticulitis has no indication for operation, but in some mistaken cases were operated with a diagnosis of acute appendicitis.

We evaluated the CT findings of colonic diverticulitis about 19 cases and of asymptomatic colonic diverticula about 15 cases retrospectively. Diagnosis was confirmed of barium enema and operation. CT are complementary methods of examination that can delineated the range of thickening of the colon and the extension of inflammatory changes around the colon.

We also believe that CT findings of colonic diverticulitis are useful for differentiating from a diagnosis of appendicitis. Neurological findings of Lyme disease.

Neurologic involvement of Lyme disease typically consists of meningitis, cranial neuropathy, and radiculoneuritis, alone or in combination, lasting for months. From to , we studied 38 patients with Lyme meningitis. Headache and mild neck stiffness, which fluctuated in intensity, and lymphocytic pleocytosis were the common findings.

Half of the patients also had facial palsies, which were unilateral in 12 and bilateral in seven. Although incomplete presentations of neurologic involvement of Lyme disease may be confused with other entities, the typical constellation of neurologic symptoms represents a unique clinical picture. Motivated by applications that arise in online social media and collaboration networks, there has been a lot of work on community-search and team-formation problems. In the former class of problems, the goal is to find a subgraph that satisfies a certain connectivity requirement and contains a given collection of seed nodes.

In the latter class of problems, on the other hand, the goal is to find individuals who collectively have the skills required for a task and form a connected subgraph wit CT findings of kikuchi disease: To evaluate by means of retrospective analysis of neck CT scans the CT findings which suggest kikuchi disease.

The authors evaluated the CT findings of seven cases of Kikuchi disease histologically confirmed by excisional biopsy. Four males and three females aged between 12 and 43 mean;28 years were included. The authors retrospectively analyzed distribution, bilaterality, the presence of aggregation, the presence of intranodal low density after contrast enhancement, the number,size, shape and location of areas of intranodal low density, and the presence of extracapsular extension in involved nodes, as seen on pre-and post-contrast CT scans.

Attempts were then made to correlate the CT with the pathologic findings. The CT findings which suggest Kikuchi disease in cervical lymphadenopathy were 1 involvement varying from no intranodal low density to prominent intranodal low densities; 2 intranodal low densities, with the number, size and shape of varying degree and predominantly peripheral location, which were correlated with pathologic findings , including variable intranodal.

Find a STEM solution! The school is involved in many projects concerning STEM education. Pisa results make evident that students' knowledge is poor and motivation for math and similar subjects is low. Implying priorities of European Commission, like e-learning, raises motivation and also develops basic skills and improves knowledge in science, math, physic, ICT. Main objectives are to increase students' interest in STEM education and careers and introduce them to all available new trends in technology, engineering and science in their region by visiting clean technology industries and strengthening links with them, to introduce some future digital jobs and prepare students for rapid technological changes by integrating ICT into classroom practice more, to highlight the importance of global environmental issues and improve the knowledge in the areas of sustainable development and renewable energy, to develop collaborative partnership between schools and the wider community in formal, non-formal and informal learning, to support multilingualism by publishing Open Educational Resources in 8 different languages and to strengthen the professional profile of the teaching profession.

The project brings together teachers and students from five different European countries in learning to think globally and work on activities that contribute to the community's well-being. There are altogether 33 activities, divided in 4 categories. STEM activities are focused on students building the devices for measuring air, light and noise pollution in their school and homes. They use the scientific method to analyze the data and compare the results with their peers to find a solution.

Eskills, digital literacy and digital jobs are focused on introducing career. Transfusional hemosiderosis; correlation of MR findings with clinical findings. Parenchymal iron deposition occurs in hemochromatosis, while iron is deposited in reticuloendothelial cells after blood transfusions Hemosiderosis. In all of 13 patients 17 cases , the liver revealed low signal intensity equal to background noise. In 4 cases with serum ferritin level between and , pancreas was involved in 2 cases, and other organ was involved in 1 case.

Electroencephalographic findings in panic disorder. Some studies have reported the importance of electroencephalography EEG as a method for investigating abnormal parameters in psychiatric disorders.

Different findings in time and frequency domain analysis with regard to central nervous system arousal during acute panic states have already been obtained. This study aimed to systematically review the EEG findings in panic disorder PD , discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies. Literature search was conducted in the databases PubMed and ISI Web of Knowledge, using the keywords electroencephalography and panic disorder; 16 articles were selected.

Despite the inconsistency of EEG findings in PD, the major conclusions about the absolute power of alpha and beta bands point to a decreased alpha power, while beta power tends to increase. Different asymmetry patterns were found between studies. Coherence studies pointed to a lower degree of inter-hemispheric functional connectivity at the frontal region and intra-hemispheric at the bilateral temporal region. Studies on possible related events showed changes in memory processing in PD patients when exposed to aversive stimuli.

It was noticed that most findings reflect the current neurobiological hypothesis of PD, where inhibitory deficits of the prefrontal cortex related to the modulation of amygdala activity, and the subsequent activation of subcortical regions, may be responsible to trigger anxiety responses. We approached some important issues that need to be considered in further researches, especially the use of different methods for analyzing EEG signals.

Radiological findings in NAO syndrome. Diseases exhibiting osteolysis in children are rare hereditary conditions. Several types have been recognised with different clinical manifestations. One type includes subcutaneous nodules, arthropathy and osteolysis and has been termed NAO syndrome. Previous radiological reports have described the affected bones, usually the carpal and tarsal regions, but a detailed analysis of the radiological findings of both the axial as well as the appendicular skeleton has not been reported.

To describe the radiological findings in a large group of children with an autosomal recessive disease characterized by nodules, familial arthropathy and osteolysis. The study comprises 14 patients from 9 families and all patients had the triad of nodulosis, arthropathy and osteolysis NAO. The most common radiological manifestations were osteopenia, undertubulation of long bones, arthritic changes, sclerotic sutures of the calvaria, osteolysis and muscle contractures.

Other common findings were squared vertebrae, broad medial clavicles and brachycephaly. Progress of disease was documented in more than half of the patients.

Our study is the first report of the detailed radiological findings of NAO syndrome. In NAO syndrome, both the axial and appendicular skeleton are involved orig. Learning as way- finding. Finding Reliable Health Information Online. Finding Rising and Falling Words.

We examine two different methods for finding rising words among which neologisms and falling words among which archaisms in decades of magazine texts millions of words and in years of tweets billions of words: MRI findings in cranial eumycetoma. Full Text Available Cranial eumycetoma CE due to direct inoculation of Madurella grisea into the scalp is extremely rare. We describe a case of CE caused by direct inoculation of M. Finding Cryptography in Object Code.

Finding and identifying Cryptography is a growing concern in the malware analysis community. In this paper, a heuristic method for determining the likelihood that a given function contains a cryptographic algorithm is discussed and the results of applying this method in various environments is shown. The algorithm is based on frequency analysis of opcodes that make up each function within a binary. How to Find Bed Bugs.

Find and correctly identify an infestation early before it becomes widespread. Look for rusty or reddish stains and pinpoint dark spots on bed sheets or mattresses, and search for bugs near the piping, seams and tags of the mattress and box spring.

MRI findings of enteroviral encephalomyelitis. Enterovirus encephalomyelitis has characteristic lesion locations in the posterior portions of the brain stem, substantia nigra, dentate nucleus and within the anterior horns of spinal cord. Recognition of these findings in the presence of suggestive clinical presentation can help to establish the diagnosis of enterovirus encephalomyelitis. Finding related functional neuroimaging volumes. We describe a content-based image retrieval technique for finding related functional neuroimaging experiments by voxelization of sets of stereotactic coordinates in Talairach space, comparing the volumes and reporting related volumes in a sorted list.

Voxelization is accomplished by convolving each Sonographic findings of xanthogranulomatous pyelonephritis. Thirty-five cases of pathologically proven XGP in 32 patients bilateral in three patients were analyzed for preoperative US findings.

Compared with findings of computed tomography CT and pathology, US findings were retrospectively analyzed for the appearance and size of the kidney, extent and pattern of the disease, and presence and characteristics of calculi, by three radiologists who made a consensus. The mean age of the patients was 46 range 3 to 62 years. Hypoechoic or anechoic inflammatory lesions of XGP were found on US in 28 cases, but the lesions were not detected on US due to the echo pattern similar to the normal renal parenchyma in two cases and due to marked acoustic shadowing of staghorn calculi in five cases.

Acoustic shadowing of renal calculi was minimal due to the dense peripelvic fibrosis in two cases. All of the 12 staghorn calculi were detected in US. XGP had variable US findings in addition to the classic ones. In spite of advantages of US, US also had some limitations in the evaluation of renal function, extrarenal extension, and renal parenchyma with large staghorn stone.

CT and excretory urography may compensate for these US limitations. Interesting bone scans - unusual findings. A year-old female with carcinoma of the colon and known liver metastatic disease was referred for bone scan to evaluate for bone metastases.

Although no bone metastases were found, there was abnormal uptake noted in the liver corresponding to a metastatic calcified lesion. The only other findings were of degenerative disease in the cervical spine, right shoulder and small joints of the hands. A year-old male with carcinoma of the prostate and right side low back pain was referred for bone scan.

No focal abnormalities to suggest metastatic disease were identified; findings within the cervical spine, lumber spine and knees were presumed secondary to degenerative disease. Intermittent pain persisted and the patient was referred for a repeat bone scan six months later.

Previous scan findings of degenerative disease and no metastatic disease were confirmed; however, closer inspection revealed an enlarged right kidney with significant retention of tracer in the pelvicalyceal system suggesting possible obstruction. A Retrograde pyelogram was performed, and no obvious obstruction demonstrated. As bone scan findings were very suggestive of obstruction, a DTPA scan with lasix was performed showing a dilated right collecting system with no functional obstruction.

Given the degree of dilation, it is possible that the patient experiences intermittent PUJ obstruction causing his symptoms. A year-old male with insulin dependent diabetes mellitus and viral arthritis was referred for a bone scan. A three phase revealed increased uptake in the region of the knee and leR proximal tibia. Delayed whole body images revealed multiple focal areas of osteoblastic activity in the leR tibia. Abnormal uptake was also seen in the upper third of the leR femur.

The remainder of the skeletal survey was normal. X-ray correlation of the leR tibia and femoral findings was undertaken. Combinating unilateral changes on bone scan and X-ray although very suggestive of sclerotic polyostotic. Paths to Work in Rural Places: Helping low-income families in rural areas find gainful employment and achieve economic self-sufficiency is an ongoing policy concern. The Rural Welfare-to-Work Strategies demonstration is using rigorous experimental designs to build knowledge about how to help low-income families in rural areas strive toward sustained employment and….

This paper aims at selecting findings in the Atlas-ID that can be used as a tool for advocacy, human rights awareness, development planning, and…. Canada ; Cardinal, E. Canada ; Beauregard, C. Canada ; Braunstein, E. To describe radiographic features of gout that may mimic infection.

We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis.

Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment.

The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals. In this paper learning is regarded as a multi-level and multi complex concept. In this regard the concept The data collection methods is based on eighteen focus-group interview collected in a period of the first two years of students enrolment in radiography The empirical investigation, which is the basis of the presented assumptions Radiological Findings of Michel Aplasia.

Congenital abnormalities of the inner ear is the most common cause of neurosensory hearing loss. Michel inner ear deformity is a rare developmental anomaly refers to the total aplasia of the inner ear. It is caused by developmental arrest of otic placode early during the third week of gestational age.

We have discussed here that three year old girl diagnosed Michel aplasia with temporal bone computed tomography CT and temporal magnetic resonance imaging MRI findings. CT findings of sternal masses. College of Medicine, Seoul Korea, Republic of.

To describe and characterize the CT findings of the sternal masses. We retrospectively reviewed the medical records, pathologic reports, and CT findings of 16 patients whose chest CT revealed sternal masses. Two primary tumors were found, namely chondrosarcomas. Chondrosarcomas were large expansile osteolytic masses showing a variable degree of cortical breakthrough and containing punctuate chondroid calcifications. Metastatic tumors were nonspecific osteolytic soft tissue masses showing homogeneous or inhomogeneous enhancement, except for those which arose from an osteosarcoma and a lung cancer, and showed osteoblastic lesions.

Castleman's disease was seen as an ill-defined enhanced soft tissue mass involving the sternum and adjacent soft tissue. Inflammatory pseudotumor appeared as an infiltrating lesion around the sternoclavicular joint and was accompanied by sclerosis and the erosion of opposing sternal and clavicular ends.

Most of the sternal masses are due to malignant neoplasms, among which metastatic tumors are more common than primary ones.

Metastatic tumors affect the manubrium more commonly than the body portion, and most also affect other bones in the thorax. CT findings of metastatic tumors are non-specific and thus do not suggest their origin.

Non-neoplastic masses are not readily differentiated from malignant tumors on the basis of CT findings alone and require pathological confirmation. Full Text Available Some studies have reported the importance of electroencephalography EEG as a method for investigating abnormal parameters in psychiatric disorders.

This study aimed to systematically review the EEG findings in panic disorder PD, discuss them having a currently accepted neuroanatomical hypothesis for this pathology as a basis, and identify limitations in the selected studies. Electroencephalography, panic disorder, neurobiology, brain mapping. Finding Proofs in Tarskian Geometry. We report on a project to use a theorem prover to find proofs of the theorems in Tarskian geometry. These theorems start with fundamental properties of betweenness, proceed through the derivations of several famous theorems due to Gupta and end with the derivation from Tarski's axioms of Hilbert's axioms for geometry.

CT findings following diphenylhydantoin intoxication.