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1. Family studies of PCOS. Familial aggregation of PCOS suggesting a genetic etiology has been clearly established 1, 212214 ; . Cooper et al. 212 ; reported that a history of oligomenorrhea was more common in the mothers and sisters of PCOS women than in controls. Probands reported that male relatives had increased "pilosity" 212 ; . The proposed mechanism of inheritance was autosomal dominant with decreased penetrance. Givens and colleagues have reported multiple kindreds showing affected women in several generations and have examined some males in considerable detail 1, 215 ; . Diagnostic criteria for PCOS were hirsutism and enlarged ovaries. There was a high frequency of metabolic disorders, such as NIDDM and hyperlipidemia, in both male and female pedigree members. In one kindred there were several males with oligospermia and one with Klinefelter's syndrome 47, XXY ; . Elevated LH FSH ratios were present in some males and 89% of their daughters had PCOS. This would suggest inheritance in either an autosomal or X-linked dominant manner. Ferriman and Purdie 216 ; studied 700 women; affected status was assigned on the basis of hirsutism and enlarged ovaries assessed by gynecography ; . The frequency of various abnormalities in relatives was determined by history provided by the proband; no relatives were examined. Oligomenorrhea and infertility were most common in women who had both hirsutism and enlarged ovaries. Forty-six percent of female relatives were reported to be similarly affected. There was an increased incidence of baldness reported in male relatives. Similar results were found in a study of 132 Norwegian PCOS probands identified by ovarian wedge resection 217 ; . Information on pedigree members was obtained by questionnaire. Female first-degree relatives had a significantly increased frequency of PCOS symptoms i.e., hirsutism, oligomenorrhea, infertility ; , and male first-degree relatives had a significantly increased frequency of early baldness or "excessive hairiness" compared with controls. Human leukocyte antigen typing in PCOS has had conflicting results; an initial report showed no human leukocyte antigen association, whereas a follow-up study reported an association with DQA1 * 0501 218, 219 ; . There have been case reports of polyploidies and X-chromosome aneuploidies in PCOS 220, 221 ; . Larger studies, however, have found normal karyotypes 222 ; . Studies from the United Kingdom have phenotyped women on the basis of polycystic ovarian morphology detected by ultrasound 223 ; . Familial polycystic ovary morphology was observed in 51 of pedigrees 92% ; . The proportion of females affected in all sibships was 80.5% 107 of 133 ; , which would exceed the expected ratios for either an autosomal dominant or an X-linked dominant mode of inheritance. However, not all women in each kindred were examined and, thus, an accurate ratio of affected to unaffected women could not be established for segregation analysis. Further, the male phenotype was not sought.
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Much of the success of our work depends on volunteers. If you can help in any of the following ways, please fill out the form below and return it to us. Feel free to suggest other ways to volunteer, as well. You can send the form in the enclosed envelope or fax it to 412-365-2089. We are also glad to hear from you via phone, at 412-365-2086, or e-mail, at info ParkinsonPittsburgh . Thank you! I want to help with: Planning conducting fund-raising events Soliciting donations Representing the Chapter at health fairs Compiling a PD resource guide Offering my contacts for fundraising Public speaking about PD and the Parkinson Chapter Assisting with the wellness exercise program Writing articles for The Torch.
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For further information on segregation in this era refer to Marsot, 1995; and Tucker, 1985. An Egyptian lawyer who at the turn of the century published two tracts arguing for the liberation of women. For a good critique of Amin, refer to Ahmed, 1993. Ahmed asserts that in 21 years of service, the Mubarrat treated 13 million people. In 1964 its hospitals were nationalized. Ahmed, 1993: 172-173. Baron, 1994: 184. Ibid: 184. Badran, 1996: 58-59. Baron, 1989: 376.
Etiology t 95% due to atherosclerosis t others - trauma, infection, connective tissue disease t high risk groups 65 years old male: female 3.8: 1 peripheral vascular disease, CAD, CVD family history AAA Clinical Presentation t 75% asymptomatic often discovered incidentally ; t symptoms due to acute expansion or disruption of wall syncope, pain abdominal, flank, back ; t partial bowel obstruction t duodenal mucosal hemorrhage-- GI bleed t erosion of aortic and duodenal walls-- aortoduodenal fistula t erosion into IVC-- aortocaval fistula t distal embolization t signs hypotension palpable mass felt at above umbilicus bounding femoral pulses distal pulses may be intact t investigations U S confirm AAA with initially ; CT accurate visualization ; Treatment and Prognosis t indication for operation is to prevent rupture t risk of rupture depends on size 4-5 cm - 5% 5-6 cm - 20% 6 cm-50% rate of growth 0.4 cm yr ; presence of symptoms, hypertension, COPD t operate at 5-6 cm since risk of rupture risk of surgery mortality of elective repair 3-5% mostly due to MI ; t consider revascularization for patients with CAD before elective repair.
Tumor volume, with nonweighted linear regression with SigmaPlot SPSS, Chicago, IL ; . Normal Tissue Treatment and Response. Non-tumor-bearing C3H HeJCr mice were restrained in Plexiglas holders designed to expose only the right hind foot to laser light. For these combination studies, Photofrin was injected i.v. at a dose of either 1.5 or 4 mg kg 1 24 h before applying the laser light whereas DMXAA was administered i.p. at a dose of 20 mg kg 1 2 h before light exposure. Each treated foot was always compared with the contralateral hind foot. The feet were observed daily and graded according to the following scale: 0, no reaction; 0.1, very slight edema; 0.2, slight erythema; 0.3, slight edema; 0.4, slight edema slight erythema; 0.5, moderate edema; 0.6, moderate edema slight erythema; 0.7, large edema; 0.8, moderate erythema; 1.0, erythema edema and or slight epilation; 1.1, large edema erythema slight epilation; 1.2, large erythema slight epilation and or edema; and 1.3, moderate epilation and or moderate edema. This grading system is subjective and non-linear with dose. Normal tissue response was compared between groups with the Mann-Whitney test and pilocarpine.
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Anthrax is a disease of antiquity, associated with the origins of microbiology, immunology, and vaccinology. The long acknowledged potential use of Bacillus anthracis, the etiologic agent of anthrax, as a biological weapon was given credence by revelations during the 1990 Gulf War. This led for the first time in history to vaccinating a population, not against a naturally occurring disease but against the threat of using a microorganism to intentionally cause disease. The cases of anthrax that occurred in the fall of 2001 confirmed our worst fears and altered the practice of medicine. In this presentation I will review aspects of the pathogenesis of anthrax as it relates to vaccination and then discuss the use of the current licensed vaccine, evidence for its efficacy and research to modify the current regimen and develop new candidate vaccines.
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The following table presents an overview of axcan's principal products approved or under development, setting forth for each product, 1 ; the indication for which each product in a product line is approved or under development, 2 ; the territory where axcan is focusing its marketing of the product and 3 ; the regulatory status of the product: product indication territory regulatory status carafate sulcrate active duodenal ulcers canada, united states marketed bentyl bentylol irritable bowel syndrome canada, united states marketed proctosedyl hemorrhoids and rectal lesions canada marketed itax itopride ; functional dyspepsia canada, europe, latin america, united states phase iii studies ultrase exocrine pancreatic insufficiency canada, united states, latin america non-exclusive basis ; marketed united states phase iii studies to comply with fda requirement ; viokase exocrine pancreatic insufficiency united states, canada marketed united states phase iii studies to comply with fda requirement ; 6 ex-99 8th page of 39 toc 1st previous next bottom just 8th product indication territory regulatory status urso and related products urso, urso 250, urso ds, urso forte cholestatic liver diseases including primary biliary cirrhosis and primary sclerosing cholangitis ; primary biliary cirrhosis canada united states marketed marketed ursodiol disulfate prevention of the recurrence of colorectal polyps canada, europe, united states phase i studies planned ncx-1000 ursodiol derivative ; portal hypertension canada, france, poland, united states under option ; phase iia studies planned salofalk tablets, suspensions, suppositories ; salofalk inflammatory bowel diseases distal ulcerative colitis, ulcerative proctitis, ulcerative colitis and crohn's disease ; canada marketed salofalk 750 mg tablets ulcerative colitis canada snds filed canasa canasa 1000 mg suppositories ulcerative proctitis united states marketed canasa 500 mg suppositories ulcerative proctitis united states marketed canasa salofalk rectal gel distal ulcerative colitis canada, united states phase iii studies 7 ex-99 9th page of 39 toc 1st previous next bottom just 9th product indication territory regulatory status photofrin photofrin esophageal cancer austria, bulgaria, canada, denmark, france, greece, ireland, israel, japan, korea, poland, portugal, taiwan, united kingdom, united states marketed belgium, czech republic, finland, hungary, iceland, italy, netherlands, norway, luxembourg, sweden approved high-grade dysplasia associated with barrett's esophagus canada, united states marketed bladder cancer canada approved gastric and cervical cancers and cervical dysplasia japan marketed lung cancer austria, bulgaria, canada, denmark, france, germany, greece, israel, japan, poland, portugal, taiwan, united kingdom, united states marketed belgium, czech republic, finland, hungary, iceland, ireland, italy, luxembourg, netherlands, norway, sweden approved photobarr high-grade dysplasia associated with barrett's esophagus europe marketed 8 ex-99 10th page of 39 toc 1st previous next bottom just 10th product indication territory regulatory status panzytrat exocrine pancreatic insufficiency and pancreatic enzyme deficiency argentina, brazil, bulgaria, columbia, czech republic, germany, greece, hungary, italy, luxembourg, netherlands, poland, romania, russian federation, slovak republic, switzerland marketed ecuador, dominican republic, mexico, panama, peru, venezuela marketing authorization application submitted delursan cholestatic liver diseases including primary biliary cirrhosis and primary sclerosing cholangitis ; france marketed lacteol diarrhea china, denmark, egypt, france, french-speaking black africa, germany, italy, latin america, hong kong, island, korea, lebanon, madagascar, maurice morocco, singapore, south africa, tunisia, vietnam marketed helizide helicobacter pylori eradication united states canada europe nda re-submission planned approved phase iii studies completed nmk 150 pancreatitis canada, europe, united states phase ii studies planned 9 ex-99 11th page of 39 toc 1st previous next bottom just 11th market sizes appearing in the descriptions below refer to actual or potential annual aggregate sales for the relevant drug and not axcan’ s actual or potential annual sales and pindolol.
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Tures 9, 1115, 17, ; , recognizing that such patients are at the highest short-term risk of additional fractures during the study period. Clinical guidelines, based on cost-effectiveness strategies, fully support the use of therapies proven to reduce fracture risk when they are prescribed for those patients who are at highest risk for osteoporotic fractures 4 ; . Unfortunately, it has become apparent that the medical community is largely ignoring this recommendation in precisely those patients with the greatest need for intervention, i.e. in individuals who have already sustained an osteoporotic fracture. A low trauma fracture is a powerful predictor of future fractures 21 ; . A distal radial Colles's ; fracture, a common fracture in women in their 60s, doubles the risk of a future hip fracture 22 the presence of a vertebral fracture deformity on a radiograph, often an asymptomatic finding noted incidentally, increases the risk of additional vertebral fractures by 4- to 5-fold, as well as doubling the risk of hip fracture 23 among untreated patients with a new vertebral fracture, the risk of an additional vertebral fracture during the next year is nearly 20% 24 ; . Indeed, the presence of any fracture after age 50 increases the risk of hip fracture 25 ; . Among patients who sustain a hip fracture, the risk of a second hip fracture is increased 6-fold 26 ; . Based on these data and a cost-effectiveness analysis, the National Osteoporosis Foundation NOF ; calls for BMD testing in all postmenopausal women who present with fractures to confirm the diagnosis of osteoporosis and recommends treatment with a U.S. Food and Drug Administration-approved agent when that is clinically indicated 4 ; . Although the release of the NOF guidelines was associated with a small increase in osteoporosis treatment in patients with fractures, from 11% to 29% 27 ; , these numbers are still notably inadequate. Despite these powerful statistics and the medical strategies that they support, it is apparent that most physicians who are responsible for the management of osteoporotic fractures are not pursuing the indicated evaluation and the subsequent treatment with the effective therapies that are now available. In virtually all the reports that have been published in the past few years, physicians who deal directly with the fracture event rarely take appropriate action. This includes radiologists who review x-rays that include the spine, orthopedic surgeons who treat acute fractures, physiatrists who oversee rehabilitation after the fracture, and primary care doctors to whom the patient returns for overall care once the fracture has healed. Standards of care for further evaluation and medical management of these high-risk patients are, unfortunately, neither recognized nor practiced. In one study, Gehlbach et al. 28 ; examined the recognition of vertebral fractures in the clinical setting by radiologists and primary care physicians. Over a 2-yr period, 934 women over age 60 who were hospitalized in the New England area had routine chest x-rays that were later reviewed by two study radiologists. Moderate or severe vertebral fractures, diagnosed according to a protocol adapted from the semiquantitative technique of Genant et al. 29 ; , were identified by the study team in 132 of the women 14.1% ; . However, in only 1.8% of the 934 patients was a vertebral fracture noted as a discharge diagnosis by the primary physician. Of those with fractures, only 17% had the fracture mentioned by their.
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One of the first steps being recommended by the National Research Council of the National Academies NRC NAS ; is to strengthen the national informational technology infrastructure through which the data pertinent to health disparities may be documented and tracked for future progress. A recent report of the NRC entitled Eliminating Health Disparities: Measurement and Data Needs26 has called attention to the need for individuallevel data on race, ethnicity, socio-economic position, and acculturation e.g., language use, place of birth, generational status ; , which are essential to documenting the nature of disparities in healthcare and to developing strategies for intervention. Not only are individual-level data severely limited, but the data that are available suffer from limited accuracy, completeness, and detail. State governmental data collection in programs like Medicaid, the State Children's Health Insurance Program S-CHIP ; , and various registry systems, are potentially valuable for tracking health disparities, but data from these programs are collected in non-standardized ways. Hence, the NRC report.
Occasionally occur in reservoirs and in lock and dam operations. However the third author summarized that, "Little interest or incentive was perceived in elevating the state-of-the-art at the district level. Field personnel are open to new suggestions and or procedures for managing debris, however, there will be resistance to implementation if there is an impact to their limited maintenance resources. It is evident that each district perceives debris management from a different perspective. Debris management received considerable attention in the south-central U. S., particularly where ice is not considered a major concern. However, debris management is a secondary concern compared to ice in the north and eastern U. S." Although the managers of individual structures cannot perhaps see the benefit of or afford measures suggested, run-of-river structures threatened by debris build-up would almost certainly benefit from debris monitoring studies and management strategies that were co-ordinated and funded at the District leveL and pram.
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The treatment groups differed making comparisons difficult. For example, patients treated with RT alone were less likely to have had chemotherapy 6% ; compared to all other groups 27%-56% ; . The median dose and fractionation of RT was 60Gy range 45-65 Gy ; in 32 fractions for patients treated with curative intent by RT alone n 32 ; . Patients treated with RT + UHF with curative intent had a lower median dose 51Gy, range, 24-55Gy ; n 8 ; in a median of 35 fractions see Table 42 ; . Bladder carcinoma For patients with bladder cancers, treatment intent was curative for 94% of Group A RT alone ; , 92% for group B RT + UHF ; and 78% for group C UHF + GBA ; . In order to understand the `tumour volume' prior to therapy, the extent of residual macroscopic disease was extracted from the records. Residual macroscopic disease was present in 56%, 33% and 22% of patients with invasive bladder carcinomas treated by RT alone Group A ; , RT + UHF Group B ; or UHF + GBA Group C ; respectively.
Steroid and off-steroid psychological states in 21 amateur athletes using the Buss-Durke Inventory and a feeling state questionnaire. All subjects were using high doses of AAS in 6- to 14-week cycles. On average, subjects reported significantly elevated feelings of aggression, aggression towards objects, verbal aggression and aggression during training during on-steroid periods. Conversely, these individuals did not report increased aggression towards other people, which may or may not have reflected a reporting bias.[63] In a study of 75 female athletes, 25 reported steroid use.[77] Of these, 13 52% ; reported irritability and 10 40% ; reported behaviour perceived as aggressive. However, none of these women reported irritability at a level consistent with a diagnosis of irritable mood, based on standardised criteria for psychosomatic research outlined by Fava et al.[78] Furthermore, the presence of these symptoms was not compared with that in non-users, and individuals with premorbid psychiatric syndromes were not included in this analysis.[77] In another study, Pope et al.[79] performed forensic evaluations of prisoners at a corrections facility in Massachusetts, USA. It is standard procedure for all men who present to the facility to undergo psychological evaluation by the prison's Corrections Department of Mental Health. A consecutive sample of 133 subjects age range 1757 years ; was obtained from prisoners presenting for this evaluation, after approximately half declined participation. Of these 133, two were believed to have used steroids, based on greatly elevated fat-free mass index. The authors had used this formula, which is based on weight, percentage body fat and height, in a previous study and had consistently found that non-users rarely exceed a certain threshold of FFMI. However, both subjects in this study with significantly elevated fat-free mass index denied steroid use at interview. While the reliability of fat-free mass index as a method of determining steroid use has not been rigorously established, the utility of urine testing would have been limited in this study in which the emphasis was on prior steroid use. An additional seven participants 5% ; in this study admitted to significant steroid use; of these, four reported little or no psychiatric change and three described clear changes in mood and levels of irritability in associaCNS Drugs 2005; 19 7 and praziquantel.
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These two subgroups have remained a therapeutic challenge to physicians and surgeons alike and naturally have constituted the primary target for PDT, as well as other endobronchial therapy, such as Nd YAG laser, EC, cryotherapy and brachytherapy. It should be emphasised that, to date, there has been no randomised comparative study to evaluate the relative efficacy and treatment outcome of these different therapies for cases with early or advanced disease. Therefore, it follows that many interventional bronchoscopy units carry out methods that they are more accustomed to. As such, there is no evidence-based consensus on the relative value of the individual procedure compared with the alternatives. However, there have been a few trials comparing bronchoscopic PDT and Nd YAG laser application in patients with advanced disease with substantial endobronchial obstruction, to which reference has been made [11, 19, 21]. There has also been one nonrandomised study to evaluate the pathological healing sequellae with PDT, Nd YAG and EC therapy in patients with early stage lung cancer, previously referred to [24]. In another review article based on meta-analysis the authors reviewed evidence for the use of PDT, brachytherapy, electrocautery, cryotherapy and Nd YAG laser therapy as treatment options in the management of early lung cancer [26]. Based on the level of evidence and benefit, the authors made graded recommendations that indicated PDT as grade B, electrocautery, brachytherapy and cryotherapy as grade C and Nd YAG laser therapy as the least recommended treatment. This review of 24 articles covering 1159 patients and extending over a period of 18 yrs shows that bronchoscopic PDT has been thought by many throughout the world to have an important therapeutic role in both subgroups of patients, provided that tumours can be identified bronchoscopically. Although, because of referral patterns, almost all studies were concerned with NSCLC, PDT has also been shown to be effective in the treatment of small cell histological type cancer [2, 22]. However, it is relevant to draw attention to the fact that since PDT is dependent on the interaction between a chemical photosensitiser drug ; and light of an appropriate wavelength in the presence of oxygen ; its effect is subject to a number of variables. These include the type and dose of the drug, the time required from its administration to its therapeutic dose retention in target tissues, the type and dose of the light and its transmission through normal and abnormal tissues. These factors are responsible for an apparent variation in PDT methods by different authors, which is partly reflected on table 1 and 2. Nevertheless, there is now some measure of agreement amongst the practitioners and hence standardisation, at least for Photofrin Porfimer Sodium ; , which is currently the licensed drug most commonly used for broncho-pulmonary cancer. This is reflected in the most recent publications and is presented in table 1 and 2. In early stage disease the role of PDT is one of curative intent. Detailed analysis of table 2 articles suggests that, in the presence of early stage cancer TIS and stage I ; , CR of variable duration was achieved in the overwhelming majority of patients. In some cases CR was of long duration amounting to cure of the disease. In EDELL et al. [6] in a series of 38 patients, CR lasted for 54 months for over one third of patients. The Japanese experience [2, 27] suggests CR of w90% can be expected in those early cancers where the tumour size is v1 cm. In such patients post-PDT survival appears comparable to surgical resection at a similar stage. In this context it is important to note that the notion of CR refers to the local effect of therapy and is much dependent on the time at which a patient had been examined bronchoscopically. However, it reflects the effect of treatment in function of time duration ; , which in turn is dependent on the initial accuracy of the evaluation of extent and depth of the lesion.
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