Medical Treatment

Background: If medical treatment of obesity fails and if surgical gastroplasty is not indicated, insertion of an intragastric balloon may represent an intermedi-ate modality. Methods: Two patients are reported in whom a bal-loon was placed for weight reduction before elective surgery: 1) ...

The aim of the present study is to compare the diagnostic performance of CT and MR imaging in detecting aldosterone-producing adenoma and to compare the interobserver variability in the detection of an aldosterone-producing adenoma on CT and MR. A retrospective study of 34 patients with primary hyperaldosteronism was performed. A total of 17 cases of aldosterone-producing adenoma and 17 cases of bilateral adrenal hyperplasia were included. The final diagnosis of an adenoma was made by surgery with histological confirmation, whereas that of bilateral adrenal hyperplasia was made on adrenal venous sampling or a good biochemical and clinical response following medical treatment alone and in the absence of a unilateral radiological abnormality. The CT (n=30) and MR (n=24) scans were reviewed independently by two radiologists experienced in adrenal imaging, who were unaware of the cause of the primary hyperaldosteronism. The diagnostic performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging were compared. The 16 adenomatous nodules that were detected on imaging ranged from 1 to 4.75 cm in diameter. The calculated sensitivity and specificity for detecting aldosterone-producing adenoma were 87 and 93% for one observer and 85 and 82% for the other observer on CT, and 83 and 83% for one observer and 92 and 92% for the other observer on MR, respectively. Receptor operating characteristics curve analysis showed similar performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging. There was good interobserver agreement on CT (k=0.71) and on MR (k=0.67). We have demonstrated comparable diagnostic performance and good interobserver agreement on CT and MR imaging for the detection of aldosterone-producing adenoma.

This explorative study assesses perceptions of mental health and help-seeking behavior among adults in Vietnam. Methods included questionnaires (200) and focus group discussions (eight). Respondents were often unable to name specific mental illnesses. Frequently mentioned symptoms of mental illness were talking nonsense, talking/laughing alone and wandering. Pressure/stress and studying/thinking too much were often identified causes. Most respondents showed a preference for medical treatment options, often in combination with family care. The results show that perceptions of mental health and help-seeking behaviour are influenced by a lack of knowledge and a mix of traditional and modern views.

Eales disease, first described by Henry Eales in 1880, remains an enigma. The disease, observed more commonly in the Indian subcontinent than in the rest of the world, occurs in young healthy adult males, initially presenting as retinal periphlebitis and later as retinal ischemia that may lead to vascular alterations and neovascularization. Recurrent vitreous hemorrhage with or without retinal detachment is the common sequelae. In recent years, immunological, molecular biological, and biochemical studies have indicated the role of human leukocyte antigen, retinal autoimmunity, mycobacterium tuberculosis genome, and free radical mediated damage in the etiopathogenesis of this disease. However, its etiology appears to be multifactorial. The management depends on the stage of the disease and consists of medical treatment with oral corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages. The results of vitreoretinal surgery have been found to be satisfactory in case of vitreous hemorrhage with or without retinal detachment.

Address: Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK Email: Jan Mitchell* - j.mitchell@rhul.ac.uk; Clare Bradley - c.bradley@rhul.ac.uk * Corresponding author ... Abstract Background: The Age-related Macular Degeneration Alliance ...

Goals of work  Based on meta-analyses regarding the preparation of patients for potentially threatening medical procedures, a DVD, incorporating behavioral role modelling, was developed to prepare patients for chemotherapy and assist them to self-manage side effects. It was hypothesized that patients who watched the DVD (vs those who did not) would report (1) lower anxiety; (2) higher self-efficacy related to coping

ÖZET
Hekimlerin tıbbi tedavi yöntemlerinden birini seçme hakkı, özel hukuktan doğan sorumluluk hukuku içerisinde incelenen kavramlardandır. Hekimin tıbbi takdir yetkisi kavramı ise, hekimin tedavi yöntemlerinden birini seçmesi kavramından daha geniş kapsamlı olarak düşünülmelidir. Hekimin tıbbi takdir yetkisi sınırsız olarak yorumlanmamalıdır. Hekimin yapmış olması gereken yöntem ve uygulamanın, özel durum koşullarına ve somut olaya uygun olması gözetilmelidir. Somut olayın koşulları ve hekimin buna ilişkin karar süreci gözlemlenmek suretiyle, hekimin tıp bilimince kabul edilen verilere uygun bir tedavi gerçekleştirip gerçekleştirmediği anlaşılabilir. Hasta ile arasında doğrudan sözleşme ilişkisi olan hekimin, somut olay koşulları içerisinde hukuka uygun olmayan uygulamaları için tazminat sorumluluğu söz konusu olacaktır.
Anahtar Kelimeler: Tıbbi Müdahale, Hekimlerin Sorumluluğu, Hekimin Tedaviyi Belirlemesi, Hukuki Sorumluluk

MEDICAL DISCRETIONARY POWER OF THE PHYSICIAN

ABSTRACT
The right of physicians to choose one of the medical treatment methods is a concept that is examined within the law of liability arising from private law. The concept of medical discretionary authority of the physician should be considered more broadly than the concept of selection one of the treatment methods by the physician. The medical discretion of the physician should not be construed as unlimited. It should be borne in mind that the method and practice the physician should have performed is appropriate for the special circumstances and concrete events. By observing the conditions of the specific event and the decision process of the physician, it can be deduced whether the physician has performed a treatment according to the accepted definition by the medical science. The physician, who has a direct contractual relationship with the patient, will be liable for compensation for unlawful practices within the context of the circumstances of the concrete case.
Keywords: Medical Treatment, Responsibility of Physician, Physician to Determine Treatment, Legal Responsibility

Purpose: To describe the outcome of a series of Acanthamoeba keratitis treated with a similar regimen. Meth-ods: All cases diagnosed with Acanthamoeba keratitis in a referral centre from June 1994 through June 1997 were included. Diagnosis of Acanthamoeba keratitis was ...

Stroke is a cardiovascular accident within the brain resulting in motor and sensory impairment in most of the survivors. A stroke can produce complete paralysis of the limb although sensory abilities are normally preserved. Functional electrical stimulation (FES), robotics and brain computer interfaces (BCIs) have been used to induce motor rehabilitation. In this work we measured the brain activity of healthy volunteers using electroencephalography (EEG) during FES, passive movements, active movements, motor imagery of the hand and resting to compare afferent and efferent brain signals produced during these motor related activities and to define possible features for an online FES-BCI. In the conditions in which the hand was moved we limited the movement range in order to control the afferent flow. Although we observed that there is a subject dependent frequency and spatial distribution of efferent and afferent signals, common patterns between conditions and subjects were present ma...

The aim of this study was to investigate the beliefs that patients with advanced cancer held about the curability of their cancer, their use of alternatives to conventional medical treatment, and their need to have control over decisions about treatment. Of 149 patients who fulfilled the criteria for participation and completed a self-administered questionnaire, 45 patients (31%) believed their cancer was incurable, 61 (42%) were uncertain and 39 (27%) believed their cancer was curable. The index of need for control over treatment decisions was low in 53 patients (35.6%) and high in only 17 patients (11.4%). Committed users of alternatives to conventional medical treatments were more likely to believe that their cancer was curable (P<0.001) and to have a higher need for control over decisions about treatment (P<0.004). The mean need for control scores were highest in patients who believed that their cancer was curable, or who were uncertain about the curability of their cancer...

Temporal lobe epilepsy (TLE), the most common form of partial epilepsy in adults is often refractory to medical treatment and in these patients epilepsy surgery is considered. Successful surgery is dependent on accurate localisation and lateralisation of the epileptogenic zone. The preoperative evaluation involves a series of assessments and investigations including detailed clinical history, interictal EEG, video-EEG monitoring, MRI, PET,

Morbid obesity is refractory to medical treatment. The introduction of laparoscopic linear staplers in the early 1990s contributed to the development of the laparoscopic Roux-en-Y gastric bypass technique. Many series have compared different brands of circular and linear staplers. The purpose of this study was to evaluate the 4-row versus 6-row endoscopic staplers in laparoscopic Roux-en-Y gastric bypass for creation of the anastomosis. Between July 2000 and April 2004, 1240 patients underwent laparoscopic Roux-en-Y gastric bypass. The 4-row linear stapler was used in the first 664 cases (group 1) and the 6-row stapler in the latter 576 patients (group 2) to create the anastomosis. The medical records of those patients who developed leaks, gastrogastric fistulas, strictures, or bleeding were reviewed. Strictures were diagnosed using radiologic or endoscopic techniques. Leaks were more frequent in group 2 than in group 1 (1.56% versus 1.05%, respectively, P = .46). Documented bleedin...