Turning a stroke into a TIA: curative thrombolysis with combined intravenous and intra-arterial tPA.

Intravenous tissue plasminogen activator (tPA) is standard treatment for eligible patients with acute ischemic stroke, but may be less effective for very severe strokes caused by proximal intracranial artery occlusions. We report the case of a woman with a devastating stroke who recovered completely following emergency revascularization of an occluded proximal middle cerebral artery using a novel treatment approach that combines both intravenous (i.v.

Radiosurgical treatment for rolandic arteriovenous malformations.

Object: The authors reviewed the radiosurgical outcomes in patients with arteriovenous malformations (AVMs) located in the rolandic area, including the primary motor and sensory gyri.

Methods: The study population consisted of 38 patients with rolandic-area AVMs who underwent linear accelerator radiosurgery at the University of Toronto between 1989 and 2000. Obliteration rate, risk of hemorrhage during the latency period, radiation-induced complications, seizure control, and functional status were evaluated.

Identification of different clonal complexes and diverse amino acid substitutions in penicillin-binding protein 2 (PBP2) associated with borderline oxacillin resistance in Canadian Staphylococcus aureus isolates.

Borderline oxacillin-resistant Staphylococcus aureus (BORSA) exhibit oxacillin MIC values of 1-8 microg ml(-1), but lack mecA, which encodes the low-affinity penicillin-binding protein (PBP)2a. The relationship of the BORSA phenotype with specific genetic backgrounds was assessed, as well as amino acid sequence variation in the normal PBP2. Among 38 BORSA, 26 had a common PFGE profile of genomic DNA, and were multilocus sequence type (ST)25.

Guillain-Barré syndrome after influenza vaccination in adults: a population-based study.

Background: Whether influenza vaccination is associated with Guillain-Barré syndrome (GBS) remains uncertain.

Methods: We conducted 2 studies using population-based health care data from the province of Ontario, Canada. In the first study, we used the self-matched case-series method to explore the temporal association between probable influenza vaccination (adults vaccinated during October and November) and subsequent hospitalization because of GBS.

Traumatic abdominal wall hernia: epidemiology and clinical implications.

Background: Traumatic abdominal wall hernias (TAWHs) are uncommon, and it remains controversial whether such patients require urgent laparotomy. As such, this study was undertaken to assess the clinical sequelae of operative versus nonoperative management of TAWH, and whether certain patient or injury characteristics are predictive of the need for early surgery.

Methods: Retrospective review of all patients presenting acutely with a TAWH at a Regional Trauma Center from January 2000 to December 2004.

Safe and successful restriction of transfusion in burn patients.

An acceptable strategy for transfusion of burn patients has not been specifically identified. In 1999, we empirically adopted a hemoglobin (Hb) transfusion trigger of 7.0 g/dl or greater in our burn center.

Development and dissemination of potentially better practices for the provision of family-centered care in neonatology: the family-centered care map.

Objective: Family-centered care has become integral to the provision of quality neonatal intensive care. However, practices that reflect the core principles of family-centered care have not been described fully in the literature or implemented and evaluated consistently within newborn intensive care. The objective of this study was to create a family-centered care map that enhances the ability of the health care team to work with families to coordinate and deliver care in a holistic manner to meet the developmental, physical, and psychosocial needs of NICU patients and their families.

The feminist approach in the decision-making process for treatment of women with breast cancer.

Introduction: The principal aim of this review was to investigate a feminist approach to the decision-making process for women with breast cancer. Empirical research into patient preferences for being informed about and participating in healthcare decisions has some limitations because it is mostly quantitative and designed within the dominant medical culture. Indigenous medical knowledge and alternative medical treatments are not widely accepted because of the lack of confirmed efficacy of such treatments in evidence-based literature.

Spatial patterns of cortical thinning in mild cognitive impairment and Alzheimer's disease.

Cortical thickness is a more reliable measure of atrophy than volume due to the low variability in the cytoarchitectural structure of the grey matter. However, this more desirable measure of disease-related alterations is not fully evaluated in early dementia. The study presented here is the first to report the spatial patterns of cortical thickness in the pre-clinical stages of Alzheimer's disease, namely mild cognitive impairment (MCI).

Rise in prostate-specific antigen in men with untreated low-grade prostate cancer is slower during spring-summer.

To test the hypothesis that the rate of rise in prostate-specific antigen (PSA) is slower during the spring-summer than during the rest of the year, we used PSA data from a prospective single-arm cohort study of men who had been followed to characterize a watchful observation protocol with selective delayed intervention for clinically localized, low-to-intermediate grade prostate adenocarcinoma. The rate of PSA increase was calculated as the visit-to-visit slope of log (PSA) against time, from 1 calendar-quarter visit to the next. The nonparametric Friedman test confirmed differences in rate of PSA rise among the calendar quarters (P = 0.

Lag and ghosting in a clinical flat-panel selenium digital mammography system.

We present measurements of lag and ghosting in a FDA-approved digital mammography system that uses a dielectric/selenium based detector structure. Lag is the carryover of signal from a previous image, whereas ghosting is the reduction of sensitivity caused by previous exposure history of the detector. Data from six selenium units were acquired.

Cross-reactions to desoximetasone and mometasone furoate in a patient with multiple topical corticosteroid allergies.

A 60-year-old man developed a bullous contact dermatitis after topical corticosteroid treatment of dermatitis on his lower leg. Subsequent patch testing showed cross-reactions to numerous group B and group D corticosteroids as well as cross-reactions to group C desoximetasone and group D1 mometasone furoate. His patch-test result was negative for the group A corticosteroids hydrocortisone and tixocortol pivalate.

Modeling prostate specific antigen kinetics in patients on active surveillance.

Purpose: Prostate specific antigen doubling time was used to stratify patients into groups at low and high risk for progression. The prostate specific antigen kinetics in these 2 groups were modeled.

Materials And Methods: In this prospective, single-arm cohort study patients with favorable clinical parameters (stage T1b-T2b N0M0, Gleason score 7 or less, prostate specific antigen 15 ng/ml or less) were conservatively treated with watchful waiting.

Does the chorda tympani nerve confer general sensation from the tongue?

Objective: Patients often complain of numbness of the tongue after otologic procedures; this symptom may occur with or without taste alterations. The purpose of this study was to objectively assess possible changes in the general sensation of the tongue in patients undergoing middle ear surgery.

Study Design And Setting: Thirty-three individuals were included in this prospective controlled clinical study conducted at a tertiary referral center.

A randomized comparison of intraoperative indocyanine green angiography and transit-time flow measurement to detect technical errors in coronary bypass grafts.

Background: Early coronary bypass graft failures may be preventable if identified intraoperatively. The purpose of this investigation was to compare the diagnostic accuracy of two intraoperative graft assessment techniques, transit-time ultrasound flow measurement and indocyanine green fluorescent-dye graft angiography.

Methods: Patents undergoing isolated coronary artery bypass grafting with no contraindications for postoperative angiography were enrolled in the study.

Characterizing coronary motion and its effect on MR coronary angiography--initial experience.

Purpose: To characterize coronary artery motion as a prescan procedure to select the optimum scan setting that will produce high-resolution images.

Materials And Methods: A 2D real-time scan was used to image the major coronary arteries during breath-holding and free-breathing conditions. With the use of the 2D images, motion displacement of each artery was measured along three axes.

Contextual factors in clinical decision making: national survey of Canadian family physicians.

Objective: Many factors are at play in the process of clinical decision making, but to date, the interaction of these factors has not been well understood. Such information could have important implications for teaching and promoting evidence-based medicine (EBM) in primary care. This study was designed to explore the relationship between physician-related variables and management of patient-related contextual factors in clinical decision making.

Patients' anxiety and expectations: how they influence family physicians' decisions to order cancer screening tests.

Objective: To compare the influence of physicians' recommendations and patients' anxiety or expectations on the decision to order four cancer screening tests in clinical situations where guidelines were equivocal: screening for prostate cancer with prostate-specific antigen for men older than 50; breast cancer screening with mammography for women 40 to 49; colorectal cancer screening with fecal occult blood testing; and colorectal cancer screening with colonoscopy for patients older than 40.

Design: Cross-sectional mailed survey with clinical vignettes.

Setting: British Columbia, Alberta, Ontario, Quebec, and Prince Edward Island.

Can academic and clinical journals be in financial conflict of interest situations? The case of evidence-based incorporated.

The hypothesis is advanced that scholarly journals can find themselves in conflict of interest positions when they operate business strategies which for commercial reasons may militate against the publication of articles which question the usefulness of the products being sold. It is suggested on the basis of probabilistic reasoning that the more extensive the merchandizing and the greater the commercial profits, the greater is the potential for conflict of interest. The alternative hypothesis is advanced that such a conflict of interest position cannot possibly exist.

Adaptive bilateral breast MRI using projection reconstruction time-resolved imaging of contrast kinetics.

Purpose: To introduce a bilateral implementation of an adaptive imaging technique in which both dynamic and high resolution breast MR images are acquired simultaneously.

Materials And Methods: Adaptive three-dimensional bilateral breast imaging in the sagittal plane was achieved by combining two elements: a projection reconstruction time-resolved imaging of contrast kinetics (PR-TRICKS) k-space trajectory and a slab interleaved sequence that imaged alternate breasts every TR. A pilot study was performed to evaluate image quality and contrast uptake behavior, using eight patients with previously identified benign lesions.

Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest.

Background: We prospectively evaluated a clinical prediction rule to be used by emergency medical technicians (EMTs) trained in the use of an automated external defibrillator for the termination of basic life support resuscitative efforts during out-of-hospital cardiac arrest. The rule recommends termination when there is no return of spontaneous circulation, no shocks are administered, and the arrest is not witnessed by emergency medical-services personnel. Otherwise, the rule recommends transportation to the hospital, in accordance with routine practice.