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  • 2000-2004  (26)
  • 1905-1909
  • 1850-1859
  • Epidemiology  (26)
  • 1
    ISSN: 1573-7284
    Keywords: Biliary and pancreatic neoplasms – diagnosis ; Epidemiology ; Multicentre studies ; Validity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The aim was to analyse the magnitude, direction and predictors of change in the main hospital discharge diagnosis (HDD) after a clinical expert review, among patients included in a multicentre molecular epidemiologic study of biliopancreatic diseases. Methods: A total of 602 patients with a suspicion diagnosis of pancreas cancer (PC), cancer of the extrahepatic biliary system (CEBS) or benign biliopancreatic pathologies (BPP) were prospectively recruited at five general hospitals. A structured form was used to collect information from medical records. A panel of experts revised all diagnostic information and established the main clinico-pathological diagnosis (CPD) by consensus. Results: Of the 204 cases with a HDD of PC, 176 (86%) were deemed to have a CPD of PC, eight of CEBS, twelve a neoplasm of different origin, four BPP and four syndromic diagnoses. Thus, 28 cases (14%) were false positives. Of the 129 patients with a HDD of CEBS, 15 (12%) were false positives. Nine of the 396 cases with a HDD of non-PC (2%) had a CPD of PC (false negatives), whilst 14 of 471 patients with a HDD of non-CEBS (3%) were deemed to have CEBS. Overall, sensitivity and specificity of HDD for PC were, respectively, 95 and 93%, and for CEBS, 89 and 97%. Cytohistological confirmation and laparotomy were independent predictors of diagnostic change. Conclusions: Validity of the HDD was high, but its association with some clinical variables suggests that sole reliance on HDD can significantly bias results, and highlights the need to review all HDDs. Alternatively, only patients at high risk of misdiagnosis could be reviewed: primarily, those lacking a cytohistological diagnosis or a laparotomy. No exclusions appear warranted solely on the basis of age, gender or tumour spread.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1437-160X
    Keywords: Key words Rheumatoid arthritis ; Extra-articular manifestations ; Epidemiology ; Sjögren's syndrome ; Rheumatoid nodules ; Italy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the study was to evaluate the frequency of extra-articular manifestations (EAMs) of rheumatoid arthritis (RA) in a series of patients from nine Italian rheumatology clinics. A total of 587 patients underwent direct questioning, complete physical evaluation, and review of medical records and laboratory data. The relationships between EAMs and the eosinophilic count, IgM rheumatoid factor (RF), and antinuclear antibodies (ANA) were studied. EAMs were present in 240/587 (40.9%) patients. The most common features were sicca syndrome (17.5%) and rheumatoid nodules (16.7%). EAMs were significantly more frequent in male patients (OR=1.68), patients with ANA positivity (OR=2.82), high anatomical class (OR=2.3), and rheumatoid factor seropositivity (OR=2.22). EAMs were more common in patients from southern Italy than in those from northern Italy (P 〈 0.001). EAMs seem to be rarer in Italy than in the Anglo-Saxon populations of northern Europe and the USA. Differences in prevalence of EAMs can exist even within the same country.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1300-1308 
    ISSN: 1530-0358
    Keywords: Epidemiology ; Fournier's gangrene ; Necrotizing infection ; Perineal gangrene
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Our experience with ten cases of Fournier's gangrene prompted us to review the related literature to highlight the current status of the disease. METHODS: Data from ten patients with the diagnosis of Fournier's gangrene treated at our center from January 1997 until December 1998 were analyzed. These patients were treated by aggressive resuscitation, triple antibiotics, and urgent surgery. The English-language medical literature for the past 30 years was reviewed. RESULTS: The epidemiologic features of our patients were similar to those reported in other recent studies. Mortality rate was 20 percent. Currently, the disease affects both genders and a wide range of ages, has a more insidious onset than in the past, and is not idiopathic. Associated systemic disorders (diabetes, alcoholism, and immunosuppression) are common. Perianal infection is the commonest cause and is associated with more moribund features. CONCLUSION: The epidemiology of Fournier's gangrene is changing from its original description. Population aging worldwide—as a result of improving health care—and therefore the increasing prevalence of associated medical disorders may explain these changes. These factors may also explain the consistently high mortality rate during more recent years, masking any survival benefits from improved medical care. Better understanding of the pathophysiology has reduced the ratio of idiopathic cases to a minimum.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1534-4681
    Keywords: Soft tissue sarcoma ; Liposarcoma ; Epidemiology ; Treatment ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In general, although biological behavior and prognosis of liposarcomas (LPS) are more favorable compared with most other soft tissue sarcomas (STS), prognosis can vary widely depending on tumor characteristics, especially histological subtype and tumor grade. Patients and Methods: All consecutive, completely resected stage I-III LPS (as determined by the American Joint Committee on Cancer staging guidelines), treated at the Groningen University Hospital from 1977–2000, were analyzed. Results: A total of 69 patients, 35 males and 34 females, median age 51 (range 11–80) years, were reviewed. After a median follow-up of 71 (range 5–231) months, the overall local recurrence and metastasis rate at five years after diagnosis were 27% and 16%, respectively. Retroperitoneal localization was a significant negative prognostic factor regarding local recurrence; dedifferentiation, grade II-III, and deep location regarding distant metastasis; and dedifferentiation, grade II-III, stage II-III, size .20 cm and non-radical resection regarding survival. Conclusions: LPS have a relatively mild biologic behavior, with the exception of very large, deeply located, dedifferentiated and/or grade II-III LPS. Radical resection is important for diseasespecific survival. LPS have a relatively mild biologic behavior, with the exception of very large, deeply located, dedifferentiated and/or grade II-III LPS.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    International journal of legal medicine 113 (2000), S. 283-287 
    ISSN: 1437-1596
    Keywords: Key words Pressure sore ; Epidemiology ; External ¶examination ; Cremation ; Malpractice ; Negligence ; Iatrogenic injury ; Septicemia ; Geriatrics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract The aim of the present investigation was to identify the frequency and grading of pressure sores in a large series of unselected consecutive deceased subjects before cremation and to discuss aspects of the forensic argumentation concerning causality. A total of 10222 corpses were examined prospectively over a 1-year-period (1998) for the occurrence, localization and grading of pressure sores. Epidemiological aspects (e.g. age, sex, underlying and contributing causes of death, place of death etc.) were taken from the death certificate. The mean prevalence of pressure sores was 11.2% (87.1% isolated sores; predominant localization of advanced grades on the sacrum in 69.6%). There was a positive correlation between the prevalence of sores and advanced age resulting in a clear female predominance in the age group of 80 years and over because of differences in life expectancy. A significant correlation was found between the prevalence of pressure sores and certain underlying diseases, e.g. trauma, senile dementia, neurological diseases, apoplexy and marasmus. Pressure sores of all grades were more frequently found in the deceased when a senior citizen’s or nursing home was given on the death certificate as the domicile in the last period of life. The forensic argumentation for the causal relationship of a pressure sore as the focus of fatal infectious complications or septicemia has to be based on the results of clinical expertises and forensic investigations (evaluation of the institutional documentation of the patient’s course, autopsy findings, histology, immunohistochemistry). The vast majority of physicians seem to pay only little attention to the potentially fatal outcome of pressure sores and fatalities associated with this condition are clearly underreported. From the point of view of social medicine, the prevalence of pressure sores in a defined population can be seen as a parameter for the quality of nursing and medical care. In bringing these fatalities to light, the field of legal medicine contributes to a general quality control of standards of nursing and medical care.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Notfall + Rettungsmedizin 3 (2000), S. 309-317 
    ISSN: 1436-0578
    Keywords: Schlüsselwörter Traumaregister ; Polytrauma ; Epidemiologie ; Thoraxtrauma ; Letalität ; Keywords Trauma registry ; Polytrauma ; Epidemiology ; Thoracic trauma ; Lethality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The severe multiple trauma is of extraordinary medical and social and economical importance. Nevertheless there exist only a few german data to describe these patients. The aim of the study was an epidemiological analysis of 2069 patients of the Trauma Registry of the German Society of Trauma Surgery, recorded from 1993–1997. A descriptive kind of analysis of the incidence of injuries and complications of this collective was done and the amount of therapeutic means examined. Most patients (56.7%) were traffic victims, almost all patients suffered from blunt trauma. The relation male to female was 2.6:1, the average Injury Severity Score 22.2±13.1 points, the average age was 38.5±18.7 years. Chest trauma was the most frequent significant injury (AIS ≥3 points, 44.5%), followed by severe head injury (39.2%) which was the most important reason for early lethality (death ≤24 h after trauma, 51.7% of all deceased) and the total hospital lethality (18.6%). 68.9% of the patients showed injuries of the extremities. Patients were admitted to hospital in 71.7% in times of stand-by service (between 4 p.m. and 8 a.m., weekends, holidays) and required (median) 4 days ventilation, 6 days ICU treatment and stayed in hospital 19 days. Complications recorded were organ failure (lung 22.0%, circulation 18.7%, liver 9.6%, kidney 3.1%) and sepsis (11.6%). The presented epidemiological analysis is a comprehensive description of a large collective of multiple traumatized patients. The current data of the Trauma Registry of the German Trauma Society can be used to answer scientifical, clinical and economical questions and for quality management.
    Notes: Zusammenfassung Trotz der großen medizinischen und sozioökonomischer Bedeutung der schweren Mehrfachverletzung existieren nur wenige aktuelle Daten zur Beschreibung dieses Kollektivs. Ziel der Untersuchung war es, die von 1993–1997 prospektiv und multizentrisch erfaßten 2069 Patienten des DGU-Traumaregisters epidemiologisch zu untersuchen. Es erfolgte eine deskriptive Analyse der Inzidenz der Verletzungen und Komplikationen im Patientenkollektiv und des Umfanges therapeutischer Maßnahmen. Der Verkehrsunfall war mit 56,7% die häufigste Unfallursache, das Durchschnittsalter betrug 38,5±18,7 Jahre, das Verhältnis männlich zu weiblich 2,6:1. Bei einem “Injury Severity Score” (ISS) von durchschnittlich 22,2±13,1 Punkten war bei fast ausschließlich stumpfen Verletzungen das Thoraxtrauma die häufigste relevante Verletzung (AIS der Region Thorax ≥3 Punkte, 44,5%). Das Schädel-Hirn-Trauma (SHT) mit einem AIS ≥3 (39,2%) beeinflußte die Frühletalität (Tod ≤24 h nach Trauma, 51,7% der Verstorbenen) und die Gesamtklinikletalität (18,6%); 68,9% der Patienten zeigten Extremitätenverletzungen; 71,7% der Patienten wurden im Bereitschaftsdienst aufgenommen (16–8 Uhr werktags, Wochenenden und Feiertage). Die Verletzten wurden im Median 4 Tage beatmet, 6 Tage intensivstationär behandelt und verweilten 19 Tage im Krankenhaus. An Komplikationen wurden Organversagen (Lunge 22%, Kreislauf 18,7%, Leber 9,6%, Niere 3,1%) und Sepsis (11,6%) erfaßt. Die durchgeführte epidemiologische Analyse stellt eine umfassende Beschreibung eines großen Kollektivs schwer Mehrfachverletzter dar. Die aktuellen Daten des DGU-Traumaregisters sind nutzbar zur Beantwortung wissenschaftlicher, klinischer und ökonomischer Fragen und zum Qualitätsmanagement.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1279-8509
    Keywords: Non-Hodgkin lymphoma ; Epidemiology ; Hepatitis C virus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From January 1995 to June 1998, 136 new cases of non-Hodgkin lymphomas (NHLs) were seen in our center which serves all the French Basque Country (300000 inhabitants). The crude and standardized incidence rates were respectively 13.2 and 7.6 cases/100000/year. The distribution of histologic subtypes according to the REAL classification showed a good correlation with the previous published data. Eleven patients (8%) were HIV-positive and two (1.4%) were HCV carriers. Hence, in our region, contrary to Italy, there is no evidence of relationship between HCV and NHLs.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Supportive care in cancer 8 (2000), S. 192-197 
    ISSN: 1433-7339
    Keywords: Key words Hyponatraemia ; Cancer ; Epidemiology ; Supportive care ; Paraneoplastic syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The frequency of hyponatraemia varies from less than 1% to more than 40% in series reported from general hospitals. We performed a prospective study to evaluate its incidence and to determine the types of hyponatraemia in a dedicated cancer hospital. All patients admitted to the Department of Medicine were prospectively studied over 11 months. Hyponatraemia was defined as a serum Na level ≤130 mEq/l. Urine and blood samples were collected at baseline, and all consecutive hyponatraemic episodes were studied. One hundred and six patients developed 123 episodes of hyponatraemia. The observed incidence of hyponatraemia was 3.7%. Sodium depletion and syndrome of inappropriate antidiuretic hormone secretion (SIADH) each accounted for almost one third of all aetiologies. Serum urea and uric acid, urinary Na and fractional excretions of Na and urea were most useful for the differential diagnosis. The percentage of deaths observed in the hyponatraemic group, 19.5%, was higher than in the whole cancer population (6.3%) although no death was apparently due directly to hyponatraemia. Hyponatraemia is regularly diagnosed in cancer patients, but it was related to SIADH in only about one third of the cases. A higher mortality was observed in hyponatraemic patients than in normonatraemic patients.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Traumaregister ; Polytrauma ; Epidemiologie ; Thoraxtrauma ; Letalität ; Key words Trauma registry ; Polytrauma ; Epidemiology ; Thoracic trauma ; Lethality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The severe multiple trauma is of extraordinary medical and social and economical importance. Nevertheless there exist only a few german data to describe these patients. The aim of the study was an epidemiological analysis of 2069 patients of the Trauma Registry of the German Society of Trauma Surgery, recorded from 1993 – 1997. A descriptive kind of analysis of the incidence of injuries and complications of theis collective was done and the amount of therapeutic means examined. Most patients (56.7%) were traffic victims, almost all patients suffered from blunt trauma. The relation male to female was 2.6:1, the average Injury Severity Score 22.2 ± 13.1 points, the average age was 38.5 ± 18.7 years. Chest trauma was the most frequent significant injury (AIS ≥ 3 points, 44.5%), followed by severe head injury (39.2%) which was the most important reason for early lethality (death ≤ 24 h after trauma, 51.7% of all deceased) and the total hospital lethality (18.6%). 68.9% of the patients showed injuries of the extremities. Patients were admitted to hospital in 71.7% in times of stand-by service (between 4 p.m. and 8 a.m., weekends, holidays) and required (median) 4 days ventilation, 6 days ICU treatment and stayed in hospital 19 days. Complications recorded were organ failure (lung 22.0%, circulation 18.7%, liver 9.6%, kidney 3.1%) and sepsis (11.6%). The presented epidemiological analysis is comprehensive description of a large collective of multiple traumatized patients. The current data of the Trauma Registry of the German Trauma Society can be used to answer scientifical, clinical and economical questions and for quality management.
    Notes: Zusammenfassung Trotz der großen medizinischen und sozioökonomischer Bedeutung der schweren Mehrfachverletzung existieren nur wenige aktuelle Daten zur Beschreibung dieses Kollektivs. Ziel der Untersuchung war es, die von 1993 – 1997 prospektiv und multizentrisch erfaßten 2069 Patienten des DGU-Traumaregisters epidemiologisch zu untersuchen. Es erfolgte eine deskriptive Analyse der Inzidenz der Verletzungen und Komplikationen im Patientenkollektiv und des Umfanges therapeutischer Maßnahmen. Der Verkehrsunfall war mit 56,7% die häufigste Unfallursache, das Durchschnittsalter betrug 38,5 ± 18,7 Jahre, das Verhältnis männlich zu weiblich 2,6:1. Bei einem “Injury Severity Score” (ISS) von durchschnittlich 22,2 ± 13,1 Punkten war bei fast ausschließlich stumpfen Verletzungen das Thoraxtrauma die häufigste relevante Verletzung (AIS der Region Thorax ≥ 3 Punkte, 44,5%). Das Schädel-Hirn-Trauma (SHT) mit einem AIS ≥ 3 (39,2%) beeinflußte die Frühletalität (Tod ≤ 24 h nach Trauma, 51,7% der Verstorbenen) und die Gesamtklinikletalität (18,6%); 68,9% der Patienten zeigten Extremitätenverletzungen; 71,7% der Patienten wurden im Bereitschaftsdienst aufgenommen (16–8 Uhr werktags, Wochenenden und Feiertage). Die Verletzten wurden Median 4 Tage beatmet, 6 Tage intensivstationär behandelt und verweilten 19 Tage im Krankenhaus. An Komplikationen wurden Organversagen (Lunge 22%, Kreislauf 18,7%, Leber 9,6%, Niere 3,1%) und Sepsis (11,6%) erfaßt. Die durchgeführte epidemiologische Analyse stellt eine umfassende Beschreibung eines großen Kollektivs schwer Mehrfachverletzter dar. Die aktuellen Daten des DGU-Traumaregisters sind nutzbar zur Beantwortung wissenschaftlicher, klinischer und ökonomischer Fragen zum Qualitätsmanagement.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Social psychiatry and psychiatric epidemiology 35 (2000), S. 5-11 
    ISSN: 1433-9285
    Keywords: Key words Child/adolescent mental health ; Persistence of deviance ; Epidemiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Background: Earlier research has shown that psychiatric problems in children tend to persist over years. This investigation assessed the persistence of psychiatric deviance among children over a 7-year period from the age of 8 to the age of 15 years. We also explored the relationship between problems leading to special attention at the well-baby clinics before school age and future psychiatric deviance. Methods: The study material consisted of three questionnaires filled out by the parents, teachers and children themselves (N =  1268) at three time points, together with data concerning the children gathered from the records of well-baby clinics. Results: At the age of 15 years, girls scored higher than boys on the parental scale and on the Beck's Depression Inventory (BDI), while boys scored higher than girls on the teachers' scale. Parental ratings had a high correlation over 3 years and a moderate correlation over 7 years. Teachers' and children's ratings correlated moderately over 3 years, but did not correlate significantly over 7 years. The probability of being deviant at the age of 15 years was elevated if the child scored high on the parents' or teachers' scale at the age of 8 or 12 years, or on the Children's Depression Inventory (CDI) at the age of 12 years. Problems noted by health professionals (problems in growth, somatic diseases, emotional/behavioural problems of the child, psychosocial problems of the family) before school age were related to future deviance on the parental scale. Emotional/behavioural problems before school age elevated the probability of scoring high on the teachers' scale at the age of 15, and problems in psychomotor development elevated the probability of scoring high on the BDI. Conclusions: Psychiatric deviance is persistent over several years in children. Primary health care professionals can identify children who are at risk for future psychiatric problems.
    Type of Medium: Electronic Resource
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