A memoir to medical teaching in midcentury.
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Anecdotes as Topic↗
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Do the topics in rehabilitation research correspond with the frequencies of rehabilitation cases?
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Persons with Disabilities↗
Using common ophthalmologic jargon in correspondence can lead to miscommunication.
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Abbreviations as Topic↗
Some letters on Jewish Medical Ethics.
Specializing in Jewish Medical Ethics--a term, I believe, first used as the title of my doctor's thesis (1955) subsequently condensed and revised in book form (1959)--I frequently receive inquiries from individuals and organizations seeking guidance on the Jewish attitude to moral issues in medicine. After a review of my voluminous correspondence on many phases of this subject, I have made a small selection on a variety of topics. The correspondence on the last of the four topics, 'Medical Experimentation on Animals', is the longest, because it contains an element of polemics. Since this might make it of special interest to the Journal's readers, and since this subject is infrequently discussed in the literature of Medical Ethics, I decided to include it in this brief selection.
Abortion, Induced↗
Thoughts on health supervision: learning-focused primary care.
Primary care clinicians confront a long list of topics that are supposed to be covered during well-child visits, but evidence for the effectiveness of preventive counseling for most issues is limited, and it is doubtful that covering more topics confers correspondingly enhanced clinical benefits. Amid growing professional interest in rethinking primary care, 3 ideas that would facilitate constructive change are proposed. First, face-to-face time between doctors and parents should be allocated as a scarce resource, with priority given to topics that are both important and uniquely responsive to in-office intervention. Second, to maximize the educational value of anticipatory guidance, visits could focus on experiential, as opposed to merely didactic, learning. Finally, recommendations for primary care should be based on evidence, rather than expert opinion. Competing protocols for preventive care ought to be subjected to large-scale, coordinated research. The unit of analysis should be the visit or series of visits, rather than a single intervention. A crucial first step would be the definition of universal outcome measures.
Child↗
Is there a reciprocal connection between the red nucleus and the interposed cerebellar nuclei? Conclusions based on observations of anterograde and retrograde transport of peroxidase-labelled lectin in the same animal.
The rubrointerposital projection was studied in cats where wheat germ agglutinin-horseradish peroxidase (WGA-HRP) was implanted in various parts of the interposed nuclei. No retrogradely labelled rubral cells were observed following implantations in the posterior interposed nucleus, and only very few such cells were identified in the contralateral red nucleus after implantations restricted to the anterior interposed nucleus with no contamination of cerebellar white matter or cortex. However, when WGA-HRP was delivered by a pressure injection, which in addition to the anterior interposed nucleus included the adjacent white cerebellar matter along the needle track and the overlying cortex, many retrogradely labelled cells were present contralaterally in the magnocellular red nucleus, with some also found in its rostral parvicellular part. The same observation was made when injection of free HRP exceeded the boundaries of the anterior interposed nucleus. These observations indicate that there is a negligible projection from the red nucleus to the contralateral interposed cerebellar nuclei. What has been considered to be rubrointerposital cerebellar fibres probably is the projection to the cerebellar cortex (Exp. Brain Res., 50 (1983) 353-358). Anterogradely labelled fibres could be followed from the implantations in the posterior interposed nucleus to a medial crescent of the entire contralateral red nucleus. Caudal as well as rostral parts of the posterior interposed nucleus project into the same area of the red nucleus. Implantations restricted to the anterior interposed nucleus label a projection to the contralateral magnocellular red nucleus which is topographically organized. The caudal part of the anterior interposed nucleus projects to the dorsomedial portion of the magnocellular red nucleus, the rostral part to its ventrolateral portion. In addition, a mediolateral organization in the anterior interposed nucleus coincides with a caudorostral arrangement in the red nucleus. This topical arrangement corresponds to what has previously been observed in cat and monkey, but due to the small implantation sites used in the present study a more precise mapping of the projection has been obtained. Furthermore, our implantations of WGA-HRP into the red nucleus show especially well the latter topical arrangement in the projection. The observations mentioned above are discussed and related to previous studies of the rubrocerebellar and cerebellorubral projections.
Animals↗
Percutaneous absorption of clioquinol (Vioform).
The percutaneous absorption of clioquinol from three different preparations for skin treatment (Vioform cream, Locacorten-Vioform cream and Vioform-Hydrocortisone cream) was evaluated. After topical dosages corresponding to 30 mg clioquinol, concentrations in the blood were below the detection limit of the analytical procedure, i.e., smaller than 0.02 micrograms/ml; therefore the percutaneous absorption was evaluated by measuring cumulative urinary excretion of clioquinol and was compared to that found after an equivalent oral dose. The study was carried out in 4 healthy volunteers. The topical preparations were applied under occlusive dressings. Following epicutaneous application of the three topicals in quantities containing 30 mg clioquinol each, the urinary excretion of the drug was between 1.2 and 3.6% of the applied dose. When the same dose of clioquinol was administered orally to two volunteers, 52.4 and 92.9% of the dose was excreted in the urine. Taking the urinary elimination as the minimal amount of drug absorbed, the extent of percutaneous absorption from the three dermatological preparations amounted to 1.2-3.6% of the applied dose. There was no difference in the pattern of urinary excretion products among the three topicals and the oral formulation. The bulk of clioquinol was excreted as glucuronide (mean: 96 +/- 3%) and only a small fraction was excreted as sulfate (mean: 3.8 +/- 3%). A small amount of free clioquinol (1.1%) was measured in 1 subject only after the oral dose.
Administration, Oral↗
Pediatric emergency medicine research: a critical evaluation.
OBJECTIVE: A measure of research activity is an important way to gauge knowledge advances. We designed this study to analyze trends in pediatric emergency medicine (PEM) research, particularly focusing on the amount of research presented, topics investigated, location of research presentation, study design, and use of statistical analysis. METHODS: Every abstract presented between January 1987 and December 1999 from 4 national scientific meetings [Ambulatory Pediatric Association (APA), American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), and Society for Academic Emergency Medicine (SAEM)] was evaluated. Those abstracts that met study criteria were evaluated for research topic, year of presentation, and sponsoring organization. Abstracts from the first and last 5 years of the study period were assessed for study design and use of statistical analysis. Trends over time were examined. RESULTS: There were 1675 abstracts presented over the 13-year study period: 41% at APA, 27% at AAP, 7% at ACEP, and 25% at AEM. Medical topics were most frequently investigated (36%) followed by trauma (20%), administrative (17%), procedural (14%), life-threatening emergencies (12%), and surgical (3%). Two percent of abstracts was presented in the first year and the greatest proportion (14%) was presented in 1999 (P < 0.001). Eighty percent of the abstracts was assessed for study design and use of statistics. There was no change in the proportion of abstracts that were prospective [odds ratio (OR) = 0.98 (95% confidence interval (CI) = 0.76-1.26)] or analytic [OR = 1.06 (95% CI = 0.83-1.35)] between the early and the later years. Descriptive surveys increased in frequency from the early to the later years [OR = 1.92 (95% CI = 1.29-2.92)] as did multicentered clinical trials [OR = 7.71 (95% CI = 1.97-66.38)]. Case series decreased in frequency [OR = 0.71 (95% CI = 0.54-0.93)] as did bench research [OR = 0.21 (95% CI = 0.11-0.40)]. The use of statistics increased with time [OR = 1.99 (95% CI = 1.54-2.58)] as did the use of CIs [OR = 4.40 (95% CI = 2.76-7.29)]. CONCLUSIONS: There was a substantial increase in the amount of research conducted in PEM. The topics investigated correspond to national recommendations. There was not an increase in the amount of research that was prospective or analytic in nature; however, there was increased statistical sophistication with time.
Bibliometrics↗
Azelaic acid.
This review is an update on the literature accumulated over the past 10 years following the original observation that azelaic acid, a naturally occurring and nontoxic C9 dicarboxylic acid, possesses significant biologic properties and a potential as a therapeutic agent. These studies have shown that azelaic acid is a reversible inhibitor of tyrosinase and other oxidoreductases in vitro and that it inhibits mitochondrial respiration. It can also inhibit anaerobic glycolysis. Both in vitro and in vivo it has an antimicrobial effect on both aerobic and anaerobic (Propionibacterium acnes) microorganisms. In tissue culture it exerts a dose- and time-dependent cytotoxic effect on malignant melanocytes, associated with mitochondrial damage and inhibition of deoxyribonucleic acid (DNA) synthesis. Tumoral cell lines not containing tyrosinase are equally affected. Normal cells in culture exposed to the same concentrations of the diacid that are toxic for tumoral cells are in general not damaged. Radioactive azelaic acid has been shown to penetrate tumoral cells at a higher level than normal cells of the corresponding line. Topically applied (a 20% cream), it has been shown to be of therapeutic value in skin disorders of different etiologies. Its beneficial effect on various forms of acne (comedogenic, papulopustular, nodulocystic) has been clearly demonstrated. Particularly important is its action on abnormal melanocytes, which has led to the possibility of obtaining good results on melasma and highly durable therapeutic responses on lentigo maligna. It is also capable of causing regression of cutaneous malignant melanoma, but its role in melanoma therapy remains to be investigated.(ABSTRACT TRUNCATED AT 250 WORDS)
Acne Vulgaris↗
Principles of recruitment and retention in clinical trials.
Efficient and effective recruitment and retention of participants is the largest single component of the study workload and forms an essential component in the conduct of clinical trials. In this paper, we present five principles to guide the processes of both recruitment and retention. These principles include the selection of an appropriate population to adequately answer the research question, followed by the establishment of a sampling process that accurately represents that population. Creation of systematic and effective recruitment mechanisms should be supported by implementation of follow-up mechanisms that promote participant retention. Finally, all activities related to recruitment and retention must be conducted within the framework of ethics and privacy regulations. Adherence to these principles will assist the researcher in achieving the goals of the study within the available resources.
Advertising↗
Arterial morphology and blood volumes of rats following 10-14 weeks of tail suspension.
We hypothesized that the structure of systemic arteries would be altered following 10-14 wk of hindlimb unloading (tail suspension) in female Sprague-Dawley rats. Tail suspension resulted in atrophy of the soleus muscle (P < or = 0.01) but no significant differences in the mass of the extensor digitorum muscle, heart, or adrenal glands. In anesthetized rats, there was no difference between groups in arterial pressure (approximately 60 mm Hg). The corresponding maximal (topical papaverine) external diameter (ED) of femoral arteries (N = 5 per group) was reduced (P < or = 0.05) in tail suspended (TS, 511 +/- 47 microm, mean +/- SD) compared with cage sedentary (CS, 615 +/- 89 microm) and food restricted weight-paired (FR, 643 +/- 61 microm) groups. Neither hematocrit, red cell, plasma, nor total blood volume differed among groups. Following systemic vasodilation with papaverine, progressive arterial inflation with liquid silicon rubber (Microfil) revealed a reduction in both ED and distensibility of the femoral artery (P < or = 0.05). To determine the effects of tail suspension on systemic arterial morphology, the vasculature of additional rats was perfusion fixed at 80 mm Hg during vasodilation. Cross sections (thickness, 8 microm) of the carotid, axillary, iliac, and femoral arteries were then evaluated. Whereas the internal diameter of femoral arteries was smaller in TS than in CS (P < 0.05), no differences were observed for other vessels among groups. Further, arterial wall thickness increased systemically (overall, P < 0.05; carotid, 24%, P < 0.01; femoral, 28%, P < 0.01) following tail suspension. These findings illustrate adaptation in the structure of conduit arteries to prolonged tail suspension, with diameter altered regionally and wall thickness increased systemically. We suggest that chronic changes in activity patterns can influence arterial structure.
Analysis of Variance↗
ATE evolution: becoming your resource.
The Health Physics Society (HPS) Web site was created in 1996 to further the HPS mission of promoting communication among people who conduct radiation safety activities; to encourage scientific, professional, and public education; and to disseminate sound scientific information. In 1999, a new feature called "Ask the Experts" (ATE) was added allowing individuals from around the world to pose questions concerning radiological protection. With the help of four editors, 20 topic editors, and 125 subject experts, nearly 5,000 questions have been answered. Response to questions submitted is rapid with the topic editor corresponding directly with the questioner. Most responses involve only one interaction although there may be follow-up interactions to fully resolve issues in the questioner's mind. Experts must provide prompt, valuable, and sound scientific answers in an easy-to-understand manner. The ATE feature is the most popular on the HPS Web site. With a current average of three questions submitted each day (including weekends), it became increasingly difficult for a person browsing the Web site to find information among the many posted questions and answers. Because of this difficulty, some questions were being asked repeatedly. It was decided to redesign the ATE feature to make the process of finding information easier. Answer categories were merged, eliminated, added, or reduced in size. "Frequently Asked Questions" (FAQs) or information sheets were developed. As a result, 36 categories became 25, and 18 FAQs, 22 information sheets, and 8 reference sheets were created to provide useful information resources for HPS members, radiation safety professionals, and the public.
Health Physics↗
Frederic Wood Jones: his major books and how they were reviewed.
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Anatomy↗
Canadian consensus conference on the management of viral hepatitis. Canadian Association for the Study of the Liver.
These proceedings of a consensus conference on the management of viral hepatitis were sponsored by the Canadian Association for Study of the Liver (CASL) and Health Canada. Experts in various aspects of viral hepatitis presented a review of the medical literature on assigned topics. Three expert panels were convened; they debated assigned topics, which corresponded to the reviews presented earlier. Attempts were made to reach consensus on a number of recommendations about the management of viral hepatitis. The content of the literature reviews, the debates and consensus statements were synthesized into a preliminary document. The report gives some background and offers recommendations aimed at both the general practitioner and the specialist.
Adult↗
[Correspondence-study units on the topic teaching of medicine. German Society for Medical Education, inc].
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Curriculum↗
The molecular basis of glucocorticoid-induced skin atrophy: topical glucocorticoid apparently decreases both collagen synthesis and the corresponding collagen mRNA level in human skin in vivo.
The effects of topical betamethasone-17-valerate on collagen propeptide levels, collagen mRNA level, lysyl oxidase mRNA and matrix metalloproteinase (MMP)-1 and MMP-2 mRNA levels were studied in human skin. Three days' treatment of healthy skin with topical betamethasone caused a 70-80% decrease in type I and III collagen propeptides in suction blister fluid. A similar decrease was found in type I collagen mRNA when assayed by either slot-blot hybridization or a quantitative polymerase chain reaction method, indicating that the decrease in collagen synthesis after topical glucocorticoid treatment is apparently due to a decrease in corresponding mRNA. mRNA of lysyl oxidase, which is an important enzyme catalysing the cross-linking of collagen chains, and collagen-degrading enzyme MMP-1 and MMP-2 mRNAs were not decreased in the same skin samples. This suggests that in vivo, glucocorticoids modulate variably the genes involved in collagen synthesis and degradation. Our study provides a solid molecular basis for glucocorticoid-induced dermal atrophy, which results from the decrease in functional collagen mRNA in the skin.
Administration, Topical↗
"The orang lives almost next door" the correspondence between John Fulton (New Haven) and Willem Verhaart (Java).
Between 1937 and 1959 John Fulton (1899-1960), Sterling Professor of Physiology at Yale University (New Haven) and Willem Verhaart (1889-1983), neuropsychiatrist at Batavia Medical School (Java, Dutch East Indies) corresponded on neuroanatomical topics. Verhaart had easy access to primate brains in Batavia and stayed at Fulton's lab as a Rockefeller fellow (1938-1939), learning techniques of surgery and histology of the primate brain in order to apply it in his own lab. The correspondence relates of their undertakings in research, the preparations for Verhaart's stay in New Haven, the failure of subsequent research plans because of World War II, the camp experiences in Asia by Verhaart, the period of restoration after the war, helped by Fulton, and the political changes (independence) in Indonesia that finally lead to Verhaart's return to the Netherlands in 1950, where he became professor of histology and Director of the Neurological Institute at Leiden University. The correspondence shows how neuroscientists from different parts of the world cooperated. Moreover it is an example of the gradual change from a German (like his teacher Winkler) to an Anglo-American orientation in medical science that started in the beginning of the nineteenth century.
Animals↗