[The reference price system for drugs saves 5 billions crowns in Germany].
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Biomedical subjects
Publications and source records attributed to J Lind.
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The effect of a three-phase comprehensive rehabilitation programme on the quality of life during the first postoperative year after coronary artery bypass surgery was studied in 205 male patients randomly allocated into a rehabilitation (R) and a hospital-based treatment (H) group. The rehabilitation programme included physical exercise, relaxation training, psychological group sessions, dietary advice and discussions about postoperative treatment of coronary disease. There was no difference between R and H groups in the frequency of postoperative complaints, number of hospital admissions and satisfaction of sexual life. An almost significantly greater number of subjects in R group than in H group perceived their health as good 12 months after surgery. The Beck Depression Index score decreased significantly in R group but not in H group during follow-up. A greater increase in hobby activities was observed in R group than in H group. More subjects in R group than in H group considered rehabilitation important for recovery, whereas more patients in H group considered support by the spouse and family, the subjective mental strength and a secure income as important.
Cancer cells differ from normal cells in many ways, but most importantly by not responding to normal growth-control mechanisms. Whereas the growth and division of normal cells is carefully regulated to meet the needs of the body, tumor cells proliferate autonomously and continually, eventually interfering with and destroying the functions of normal tissue. Knowledge of molecular cell biology has grown exponentially over the last decade. Yet much remains to be understood before there can be a significant impact on our ability to design more effective therapeutic strategies for cancer patients, thereby decreasing mortality.
A 39-year-old male with follicular non-Hodgkin's lymphoma was repeatedly studied with respect to DNA rearrangements with the two probes pFL-1 and pFL-2, representing two segments of chromosome 18. The oncogene BCL2, detected by pFL-1, was as expected translocated to the J region of the immunoglobulin locus. The standard BCL2 translocation was found in three samples, one obtained at diagnosis, one ten months later, and one after 5 years. Another translocation was found with the probe pFL-2 hybridizing with a region located about 20 kb 3' from BCL2. This latter rearrangement was found only in the first biopsy, which was obtained at the time of diagnosis, but not in the two later samples, when the morphology of the lymphoma was unchanged. No cytotoxic therapy had been given in the interval from diagnosis to disappearance of the latter rearrangement. Thus, one of the observed translocations (pFL-2) was detected only in the first biopsy, while the other (pFL-1) was a clonal marker in all three biopsies. The finding suggests that clonal evolution does not necessarily mean clinical progression.
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Arthroscopy was performed on 18 patients (19 joints) with temporomandibular joint arthropathy. Arthroscopic investigation revealed that 12 patients had disk derangement, including 3 patients with rheumatoid arthritis. Six patients had osteoarthrosis, including one patient with rheumatoid arthritis. Synovial fluid content of substance P-like immunoreactivity (SP-LI), neurokinin A (NKA-LI), calcitonin gene-related peptide (CGRP-LI), neuropeptide Y (NPY-LI) and vasoactive intestinal polypeptide (VIP-LI) were analysed using radioimmunoassay technique. All peptides analysed were found, although in various concentrations, in the different joints. There were no significant differences in concentrations of the peptides in the synovial fluid between patients in the various groups. No significant correlation was found between clinical symptoms and signs, arthroscopic findings, or use of analgesic/anti-inflammatory medication versus concentrations of peptides in the synovial fluid. In comparison with earlier findings in the knee joint significantly higher concentrations of SP-LI, CGRP-LI and NPY-LI were found in the TMJ.
The aetiology of avascular necrosis of the carpal lunate remains unknown. Kienböck's disease was long misinterpreted as gout, tendinitis or a sequela of subluxation. The diagnosis is obtained by x-ray of the wrist, which should not be delayed in cases of diffuse wrist pain, limitation of motion, or reduced strength in the hand. A good prognosis is closely correlated to early diagnosis. This review is focused on new biomechanical analyses and treatment methods for use in cases of Kienböck's disease.
A total of 165 primary above-the-knee (AK) and below-the-knee (BK) amputations in 137 patients were reviewed retrospectively. Of the 77 patients who smoked, 44 smoked cigarettes, 30 cheroots, and three a pipe. There were 88 nonsmokers. At the time of surgery, the smokers were on average 6.4 years younger than the nonsmokers. The review revealed no discrepancy between smokers and nonsmokers with regard to amputation level, the BK to AK ratio being 2:1. In cigarette smokers the risk of infection and reamputation was 2:5 times higher than in cheroot smokers or nonsmokers. The poor results obtained in cigarette smokers may be ascribed to the fact that this group of patients smoked during the phase of healing and that only cigarette smokers tend to inhale. Inhalation of smoke leads to high concentrations of nicotine, which compromise the cutaneous blood-flow velocity and increase the risk of the formation of microthrombi. Consequently, amputees should abstain from cigarette smoking during the phase of healing. Preferably, the habit should be broken one week before surgery, which is the requisite period for the process of coagulation and the fibrinogen level to normalize and for free radicals to be eliminated.
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In a one-year prospective investigation in 1985, all bicycle accidents in Denmark were registered. The circumstances of the accident were recorded. All injuries were classified in the AIS and the ISS scales. After one year, the patients were contacted and sick leave and sequelae were registered. A total of 576 patients (320 men and 256 women), were treated after bicycle accidents. Bicycle accidents were seen most frequently in the ages from 5 to 19 years. The accidents were distributed uniformly over the week and occurred most frequently in the summer. 392 of the accidents were single-accidents, and the majority had used a bicycle-track if possible. Collision with other road users and bad road conditions were responsible for 41%, and defects in the bicycle for 9%, mainly on handlebars, front fork, front wheel, gear and chain. Two were admitted dead, and 114 were admitted to hospital (20%) for median four days. Eleven per cent had sustained serious lesions (fractures or lesions of the head). 556 had an AIS-score less or equal to three and un 387 the AIS-score was one. 561 had an ISS-score less than ten, five between ten and 75 and two had 75. Eight patients could not be classified. The patients AIS score is determined as the highest score of an injured region. AIS score of 6 is fatal. The ISS score is the addition of the square of the 3 highest AIS values. ISS of 75 is fatal. AIS is thus a value of the most serious lesion and ISS is a value of how traumatized the patient is.(ABSTRACT TRUNCATED AT 250 WORDS)
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The method of spatial power-spectrum analysis has been applied to measurements of the distribution of rms alpha-band potential on the scalp. Data was recorded using the 31-Electrode System and spatial power-spectrum estimates (PSEs) were obtained from Mercator projections of the potential interpolated using the triangular method. PSEs were calculated using the Lim and Malik algorithm for maximum-entropy power-spectrum estimation. In order to investigate the utility of spatial power-spectrum analysis, PSEs were obtained from subjects in two conditions; resting with eyes closed (EC) and resting with eyes open and fixed on a single point (EO). A stepwise discriminant analysis was performed with features from the PSEs and the resultant discriminant function was applied to data not considered in the formulation of the function. Over 92% of test data was correctly classified. The features used in the discriminant function identify spatial waves which are most useful in separating data. The results demonstrate that waves oriented along front-back and right-left lines are most important in separating data into EC and EO groups.
A new system for responding to Codes, or resuscitations of patients with cardiopulmonary arrest, was implemented at St Luke's Medical Center, Milwaukee. A teaching program was begun to establish the Advanced Cardiac Life Support (ACLS) guidelines as the standard of care. A task force defined the composition of the Code team and was then designated the Code Review Committee, meeting monthly to review all Codes. Indicators for review were established. Code review is followed by a letter to the physician Code team leader and/or registered nurse. Data for 18 months, still preliminary, show improved compliance with indicators for documentation and for adherence to ACLS guidelines.
The applicability of body composition as estimated by the bioimpedance method to predict energy expenditure (EE) was studied. Ten healthy subjects underwent measurement of body composition and 24-h energy expenditure (24-h EE) twice in a respiration chamber on a fixed program. The 24-h EE and its components, sleeping EE (SEE), basal EE (BEE), and daytime EE, for an individual were very reproducible (coefficient of variation 2.3%, 1.4%, 5.0%, & 3.1%, respectively). The variability of 24-h EE among subjects was 11.4% but only 4.1% when adjusted for differences in lean body mass (LBM). LBM was the best determinant of 24-h EE, BEE, and SEE and accounted for 91-93% of the interindividual variance of EE. The prediction equations were 24EE (kcal/d) = 390 + 33.3 LBM (r2 = 0.93, P = 0.000001), SEE (kcal/h) = 9.8 + 1.1 LBM (r2 = 0.92, P = 0.000001), and BEE (kcal/h) = -3.1 + 1.35 LBM (r2 = 0.91, P = 0.000002). In conclusion, 24EE, BEE, and SEE can be predicted with a high degree of precision from LBM as estimated by bioimpedance in normal-weight subjects.
In a one year prospective investigation, the circumstances and sequelae of 75 moped accidents were registered. The patients were aged mainly between 14 and 18 years and the accidents happened mainly in the afternoon hours. The majority of the injuries were on the head and the extremities. Twenty-one of the patients were admitted to hospital for median 4.8 days, 50 were treated as outpatients and four were dead on admission. The patients were contacted one year after the accident and one had severe sequelae and five had minor sequelae.
The reaction between the phenoxyl radical of Trolox C, a water-soluble vitamin E analogue, and superoxide anion radical was examined by using the pulse radiolysis technique. The results indicate that the Trolox C phenoxyl radical may undergo a rapid one-electron transfer from superoxide radical [k = (4.5 +/- 0.5) x 10(8) M-1.S-1] to its reduced form. This finding indicates that superoxide radical might play a role in the repair of vitamin e phenoxyl radical.
An old, but hitherto unpublished, method for surgical correction of chronic mallet finger was carried out in 42 patients. In the abbrevatio operation, the elongated tendon is transected and resutured, after which the developing fibrous scar tissue usually causes adequate shrinkage for correcting the drop-deformity. The D.I.P. joint is transfixed with a K wire in slight hyperextension for six weeks. Forty patients were studied. The result was excellent in 16 patients (40%), good in 20%, fair in 17.5% and poor in 22.5%. On average, the extension defect was decreased from 38.2% to 11.8%. The method is a suitable alternative in patients with annoying chronic mallet finger who refuse arthrodesis or further conservative treatment.
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