<p>Syftet med denna C-uppsats har varit att få en ökad förståelse i hur vårdgivare arbetar med människor i ett mellanrum mellan två kategorier samt att belysa den problematik som finns med att kategorisera människor som dubbeldiagnos. Dubbeldiagnos är en kategorisering som ibland skapar problem som gör att dessa klienter hamnar i ett mellanrum mellan kommunen och landstinget. Denna studie är baserad på en kvalitativ metod med grundad teori som forskningsdesign. Intervjuer har gjorts med respondenter från psykiatrin, boendeverksamhet, öppenvårdsverksamhet och socialtjänsten. Resultatet tyder bland annat på att det som är viktigast i arbetet med dubbeldiagnoser är samverkan mellan vårdgivarna. Diagnosen kan även medföra att klienterna känner sig stämplade. Den viktiga eftervården brister i kvalité som bottnar i de bristande resurser som finns. Detta resultat diskuteras i diskussionen med hjälp av teorier om social kategorisering och typifiering.</p>

<p>The purpose of this research has been to study and find out if a diagnose AD/HD is of importance. Does a diagnostic significance matter for how to support and respond to children in school? Are diagnosed children with signs of AD/HD treated differently than children without diagnosis? My study is based on input from teachers, special educators, from two different schools and also one doctor and one parent.</p><p>I have interviewed teachers, special educators, one physician and one parent. I have been using qualitative interviews with tape recorders and emailed them with open questions. I have been using literature; see bibliography. And my own experiences with the meeting of these children have meant a lot to me when I typed. First of all, I have focused on what AD/HD is, the diagnosis, medication and treatment of AD/HD. After that I continued to analyze my questions to see what emerges from the interviews made. Are they treated the same, does the diagnose make a difference to how these children are treated? Or do they need special medication to see a difference or other methods.</p><p>The result is that the diagnosis does not mean so much to a child with AD/HD in today's schools. It may be a response to something that is different and there is often a relief to have that confirmed. That it reduces the guilt of parents, teachers and even the child.  What matters is how the child responds, and the support provided to the child. I can also see a difference in the children who taking medication, both positively and negatively.</p>

<p><strong>Background</strong> Subarachnoid hemorrhage is a condition with high rates of mortality and morbidity. The diagnosis requires an urgent cerebral computed tomography scan and also a lumbar puncture if the scan fails to demonstrate intracranial blood. In Sweden the cerebrospinal fluid (CSF) is analyzed by spectrophotometric scanning for the presence of hemoglobin and bilirubin. The aim of the study was to develop a quantitative diazo reagent based analysis of cerebrospinal fluid bilirubin as a replacement for spectrophotometric scanning.</p><p><strong>Methods</strong> The CSF bilirubin assay on an Architect C8000 chemistry analyzer was compared with spectrophotometry using patient samples.</p><p><strong>Results</strong> The method correlates with spectrophotometry, has a good linearity and precision.</p><p><strong>Conclusions</strong> Quantitative bilirubin measurement offers shorter turnaround times, simplifies the interpretation of the results and reduces work load in comparison with spectrophotometry.</p>

A unique tumor targeted method, which may be able to deliver a molecule to the surface of a tumor cell using the pH gradient between hypoxic tumor cells and normal tissue has recently been developed. Since solid tumors have been found to have a lower extra cellular pH compared to normal tissue (6.5 to 6.9 for tumors verses an average 7.4 for normal tissue), the pH gradient is used as a source of power to activate a strategically designed "molecular engine" capable of delivering a diagnostic or therapeutic agent to tumor cells. To test this hypothesis, a 22- sequence amino acid, which reorganizes to alpha helical form at pH 6.9 causing the molecule to become lipophilic and embed into the plasma membrane of nearby cells was synthesized. The molecule was then attached to 99mTc via a MAG-3 chelating molecule. In-vivo nuclear imaging was performed and showed apparent significant uptake in primary tumors as well as lung and liver in Lewis lung cell model C57blk-J6 mice with confirmed primary tumors at the base of the tail or lungs. This study shows significant promise for early diagnosis and treatment of cancer on a molecular level. / Graduation date: 2006

Thesis (Ph. D.)--University of Chicago, Dept. of Radiology, June 1997. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph.D.)--University of Delaware, 2006. / Principal faculty advisor: Jeremy S. Edwards, Dept. of Chemical Engineering.. Includes bibliographical references.

La galectine-3 (Gal-3), protéine de type lectine, de 29-35 kDa, étudiée comme marqueur d’aggressivité dans les gliomes, présente des caractéristiques biologiques importantes justifiant son étude dans le domaine du mélanome. En effet, la Gal-3 est une protéine qui peut se lier à la laminine, tout comme l’intégrine α6/β1 dont l’expression est réduite dans le mélanome. L’expression de cette intégrine peut d’ailleurs être modulée par la Gal-3 comme récemment montré dans des lignées cellulaires de cancer du sein (BT-549) et de glioblastome (U373). Le mélanome, véritable problème de santé publique qui est susceptible d’atteindre 1 individu sur 75 dans nos contrées, reste un tumeur mal comprise avec des évolutions parfois incertaines, et des traitements dont l’efficacité est limitée. Le diagnostic histologique du mélanome lui-même peut parfois représenter une difficulté pour le clinicien et l’expert pathologiste ou dermatopathologiste. La couleur (hyperpigmentation d’un lésion pigmentée), dont l’évaluation d’ailleurs reste subjective à défaut de standardisation, ne peut à elle seule signer la malignité d’une lésion pigmentée. Globalement l’évolution d’un patient est prédite par l’indice de Breslow qui traduit en mm l’épaisseur de la tumeur. Si cet indice dépasse 1mm, le risque métastatique augmente, justifiant la réalisation de bilans extensifs de suivi. Ceci dit, certains mélanomes épais peuvent ne pas présenter de caractéristiques d’aggressivité, alors que des mélanomes fins sont parfois mortels. L’identification de marqueurs moléculaires est donc impérative, tant pour développer des stratégies thérapeutiques ciblées, que pour affiner le diagnostic et le pronostic d’un patient. Après avoir mis en évidence par immunohistochimie une expression de Gal-3 par les mélanocytes, nous avons démontré une surexpression de cette protéine par les mélanocytes tumoraux. Nous avons démontré également sur des lésions primitives qu’à l’aggressivité mesurée selon l’indice de Breslow correspondait une diminution de cette surexpression. Cette observation a pu être confirmée par un modèle de greffe orthotopique chez la souris nude. Nous nous somme intéressés par la suite à la détection de la protéine dans le sérum, et nous avons constaté, un taux élevé de Gal-3 dans le sérum de patients en stade métastatique avancé, ce taux élevé pouvant s’expliquer tant par la charge tumorale que par la présence d’une inflammation, d’ailleurs bien connue chez le patient cancéreux en stade avancé. Le rôle antiapoptotique de la Gal-3 nous a alors amené à préciser la valeur prédictive et pronostique de cette protéine. L’hypothèse d’une potentielle action bénéfique sur la réponse immunitaire des patients atteints de mélanome qui ont été vaccinés a été rejetée. La Gal-3 sérique s’est révélée comme facteur de mauvais pronostic chez les patients métastatiques, et une analyse multivariée avec la définition d’une valeur « cut-off » de 10 ng/ml a permis de montrer une valeur pronostique indépendante, supérieure à la S100B et à la CRP.

Pulmonary embolism (PE) is a severe frequent disease with lack of specific symptoms and represents a major diagnostic challenge. In the past few years, single-slice spiral CT angiography has gained acceptance as a minimally invasive method of evaluating patients with suspicion of PE. The main limitation of single-slice spiral CT resides in the poor detection of subsegmental or more distal PE. This limited detection is not explained by an insufficient vascular distension during spiral CT acquisition but probably by an insufficient spatial resolution. Moreover, in some situations spiral CT is penalized by pulmonary angiography which is an imperfect gold standard. Today Multislice CT can acquire 2 up to 64 slices in a single rotation with isotropic resolution. This technique can cover the entire chest in 1-mm slice thickness or less, in one short breath-hold and allows a better analysis of peripheral pulmonary arteries with a better depiction of sub-segmental and peripheral clots. It also reduces or eliminates artefacts produced by patient movement and decreases the x-ray tube heating that can constrain singleslice scanning parameters. Acquisition of the lower extremities can be performed after chest CT, allowing detection of deep vein thrombosis and one stop shopping of the venous thromboembolic disease. The diagnostic accuracy of multislice CT is probably similar or superior to pulmonary angiography with an inferior delivered radiation dose, a better detection of alternative diagnoses and a continuous decrease of contrast medium injected. Last refinements in CT technology opens new frontiers for a functional approach of PE and predict its prognosis. For all the above-mentioned reasons, it seems obvious that multislice CT will definitively replace pulmonary angiography for diagnostic purposes and will represent a superb tool to better understand the physiopathology of this frequent and potentially life-threatening disorder.

Background Subarachnoid hemorrhage is a condition with high rates of mortality and morbidity. The diagnosis requires an urgent cerebral computed tomography scan and also a lumbar puncture if the scan fails to demonstrate intracranial blood. In Sweden the cerebrospinal fluid (CSF) is analyzed by spectrophotometric scanning for the presence of hemoglobin and bilirubin. The aim of the study was to develop a quantitative diazo reagent based analysis of cerebrospinal fluid bilirubin as a replacement for spectrophotometric scanning. Methods The CSF bilirubin assay on an Architect C8000 chemistry analyzer was compared with spectrophotometry using patient samples. Results The method correlates with spectrophotometry, has a good linearity and precision. Conclusions Quantitative bilirubin measurement offers shorter turnaround times, simplifies the interpretation of the results and reduces work load in comparison with spectrophotometry.

Syftet med denna C-uppsats har varit att få en ökad förståelse i hur vårdgivare arbetar med människor i ett mellanrum mellan två kategorier samt att belysa den problematik som finns med att kategorisera människor som dubbeldiagnos. Dubbeldiagnos är en kategorisering som ibland skapar problem som gör att dessa klienter hamnar i ett mellanrum mellan kommunen och landstinget. Denna studie är baserad på en kvalitativ metod med grundad teori som forskningsdesign. Intervjuer har gjorts med respondenter från psykiatrin, boendeverksamhet, öppenvårdsverksamhet och socialtjänsten. Resultatet tyder bland annat på att det som är viktigast i arbetet med dubbeldiagnoser är samverkan mellan vårdgivarna. Diagnosen kan även medföra att klienterna känner sig stämplade. Den viktiga eftervården brister i kvalité som bottnar i de bristande resurser som finns. Detta resultat diskuteras i diskussionen med hjälp av teorier om social kategorisering och typifiering.