Therapeutic Options for the Treatment of Hypertension in Children and Adolescents

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%–5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Primary malignant mesenchymoma of the heart

PubMedID: 11788281Primary malignant cardiac tumours are uncommon, and cardiac malignant mesenchymoma is extremely rare. A case of primary malignant mesenchymoma in a 41-year-old woman arousing from the left atrial septum, obstructing the mitral orifice by passing through it into the left ventricle is described. The tumour was fully resected, and adjuvant chemotherapy was applied, but the patient had died by tumour recurrence in 8 months. © 2002 Elsevier Science B.V. All rights reserved

Matchline dosimetry of half beam technique at fixed SSD using Co-60 and 4 MV photons in the treatment of head and neck tumors

The problem of beam divergence and overlapping of adjacent fields in the conventional treatment of cancer of the head and neck is well known. The use half beam technique has been suggested as one way of solving this problem. This work reports a matchline dosimetry of this technique using Co-60 beam and 4 MV photons beam and fixed SSD technique