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PubMed1998

[Labrum lesions and residual dysplasia of the hip joint. Definition and prospectives].

Labral lesions are a sign of biomechanical decompensation of the hip joint and often represent the first clinical symptom of residual hip dysplasia (RHD) in the adult. Provocation tests (impingement, apprehension) are typical but not specific. Labral lesions and concomitant findings (intra- and extraosseous ganglia, stress bone marrow oedema) can be detected by magnetic resonance arthrography (MRA) with an accuracy of 91%. Primary therapeutic goal is the normalization of the underlying pathomorphology and instability by a redirectional acetabular osteotomy. There are several concepts concerning simultaneous arthrotomy at the time of osteotomy: no arthrotomy at all, selective arthrotomy, routine arthrotomy in every case. There are more clinical studies necessary before one of these concepts can be widely accepted and recommended. Based on preliminary results, palliative arthrotomy with partial labral resection but without corrective osteotomy in osteoarthritis secondary to residual hip dysplasia gives poor results; we therefore urgently dissuade from palliative labral surgery via arthrotomy. Whether labral surgery via arthroscopy might be a useful concept in symptomatic residual hip dysplasia, is still an open question. In this review article, the "state of the art" presented at the "Vienna Labral Symposium 1997" is reflected and summarized. At the end of this article, a "common statement" of the experts is published in English and German language.

Acetabulum↗
PubMed1998

'Killing the angel in the house': creativity, femininity and aggression.

The author brings to bear an art historical perspective on the psychoanalytic understanding of creativity as an object relationship, proposing that the creative endeavour is determined by a wider, more complex network of internal and external object relationships than is usually assumed. The workings of tradition, language, contemporary practices, methods and materials are explored. Creative block is considered in the context of the determining relationships, with particular reference to the role of aggression. The position of the latter within psychoanalytic theories of creativity is surveyed and it is proposed that aggression has a pivotal place not primarily in instituting sublimation, reparation or reaction formation but simply because the processes of creativity demand it. Virginia Woolf's image of 'Killing the Angel in the House' is analysed and used to track the implications of gender, focusing on the concept of the muse. It is pointed out that traditionally, the fear, guilt and anxiety associated with aggressive creativity has been mediated by the muse, which is compared to the internal good object. Drawing on art history, artists' statements, and clinical material, the author illustrates the disparate means by which the presence of 'muse' can be internalised to infuse the relationships that constitute creativity.

Adult↗
PubMedDate not supplied

Intestinal perforation in typhoid fever: a historical and state-of-the-art review.

The appropriate therapy for intestinal perforation in typhoid fever has been controversial since the late 1880s. Around the turn of the century, surgery became the established mode of therapy, with a mortality of 69% based on 166 patients in the English-language medical literature, and continued to be the preferred treatment until the advent of chloramphenicol in 1948. At this time the surgical mortality was approximately 50%. Following the recovery of a few patients with perforation treated only with antimicrobial agents (six initially, then eventually 22), nonsurgical therapy became the accepted mode of treatment. This change was never justified and this review demonstrates this. Appropriate therapy is virtually always surgical, usually consisting of simple closure and irrigation. Chloramphenicol alone is inadequate antimicrobial therapy in a patient with perforation and must be supplemented by other antimicrobials directed against enteric aerobic gram-negative bacilli and enteric anaerobes.

Anesthesia↗
PubMed2001

Quality of life in children and adolescents: a European public health perspective.

OBJECTIVES: The measurement of health-related quality of life (HRQOL) is increasingly important as a means of monitoring population health status over time, of detecting sub-groups within the general population with poor HRQOL, and of assessing the impact of public health interventions within a given population. At present, no standardised instrument exists which can be applied with equal relevance in pediatric populations in different European populations. The collaborative European KIDSCREEN project aims to develop a standardised screening instrument for children's quality of life which will be used in representative national and European health surveys. Participants of the project are centres from Austria, France, Germany, Netherlands, Spain, Switzerland, and United Kingdom. By including the instrument in health services research and health reporting, it also aims at identifying children at risk in terms of their subjective health, thereby allowing the possibility of early intervention. METHODS: Instrument development will be based on constructing a psychometrically sound HRQOL instrument taking into account the existing state of the art. Development will centre on literature searches, expert consultation (Delphi Methods) and focus groups with children and adolescents (8-17 years). According to international guidelines, items will be translated into the languages of the seven participating countries for a pilot test with 2,100 children and their parents in Europe. The final instrument will be used in representative mail and telephone surveys of HRQOL in 1,800 children and their parents per country (total n = 25,200) and normative data will be produced. The potential for implementing the measurement tool in health services and health reporting will also be evaluated in several different research and public health settings. The final analysis will involve national and cross cultural-analysis of the instrument. RESULTS: The international, collaborative nature of the KIDSCREEN project means it is likely to provide many challenges in terms of producing an instrument which is conceptually and linguistically appropriate for use in many different countries, but it will also provide the opportunity to develop, test and implement the first truly cross-national HRQOL instrument developed for use in children and adolescents. This will help to contribute to a better understanding of perceived health in children and adolescents and to identify populations at risk.

Adolescent↗
PubMed2000

Evaluation of professional singers.

Professional voice users present interesting challenges for laryngologists and speech-language pathologists. Many of these patients place olympic demands on their voices and must meet standards of near-perfection to succeed as vocal artists. Through systematic treatment combining the traditional art of medicine with modern technology, the physician should generally be able to care for the premier voice professional. The expertise gained improves the standard of care for all voice patients.

Humans↗
PubMed2001

The management of irritable bowel syndrome: a European, primary and secondary care collaboration.

OBJECTIVE: To develop recommendations for the diagnosis and management of irritable bowel syndrome for European doctors delivering primary care. These recommendations can be adapted by local medical groups according to their language, custom and health-care systems. METHODS: Twenty-one general practitioners and gastroenterologists from Europe attended a workshop planned by a steering committee. After a state-of-the-art symposium, four working groups considered the following aspects of irritable bowel syndrome management: what to tell the patient, diagnosis, non-medical treatment and psychosocial management. Current and future drug management was reviewed by the steering committee. The resulting recommendations were considered at two plenary sessions during the meeting, and by circulation of the material during development of the manuscript. RESULTS: The process permitted a unique dialogue between general practitioners and gastroenterologists, in which it was necessary to reconcile the specialists' emphasis on thoroughness with the practical, epidemiological and economic realities of primary care. Despite this dichotomy, consensus was achieved. CONCLUSIONS: European general practitioners and gastroenterologists have produced recommendations that emphasize education of the patient, a positive symptom-based diagnosis, diet and lifestyle advice, psychological support and a critical analysis of current specific psychological and pharmacological treatments.

Colonic Diseases, Functional↗
PubMed1989

Assessment of mood, affect, and personality.

Changes in mood, affect, and personality may herald the onset of neurologic disturbances and may precede alterations in intellect and other cognitive operations. Reliance on traditional methods of assessment, especially in the elderly, will often produce misleading results and fail to measure critical constructs such as inappropriateness, indifference, and pragnosia. Evaluation of mood in elderly and cognitively impaired subjects is complicated by the high frequency of physical symptoms in these patients that also occur in depression and may inflate rating scale scores. Newer instruments tend to avoid items reflecting physical illness and utilize a caregiver or significant other as a rater. More research is required to develop better instruments for this population, but useful tools are becoming available for the practitioner and the researcher. From the findings reviewed above, we believe that a careful evaluation of mood, affect, and personality should be standard practice in the neuropsychological evaluation of any older adult as brain-behavior relationships are being explored. These data should stand beside data from the cognitive domains, such as attention, language, visuospatial abilities, and motor performance. Simple reliance on more traditional personality/affective measures developed for other populations (for example, psychiatric patients) is no longer sufficient, and a state-of-the-art examination calls for novel and recently devised instruments which measure constructs relevant to neuropsychological syndromes. Such an approach, we believe, will yield greater sensitivity in the early stages of incipient conditions and aid in detecting neuropsychological sequelae that may not appear in the cognitive domain.

Affect↗
PubMed2001

The role of prospective randomized clinical trials in pediatric surgery: state of the art?

PURPOSE: This study sought to determine the role of randomized controlled trials (RCT) in the evolution of pediatric surgical practice. METHODS: The authors used a computer-assisted literature search to identify all clinical trials related to pediatric surgery published in the English-language literature from 1966 through 1999. Each article was reviewed in detail for purpose, content, conduct, and quality of the trial. The authors assessed quality with a previously validated instrument (Chalmers Qualitative Assessment). RESULTS: The authors identified 134 RCTs related to pediatric surgery over the past 33 years. This accounts for 0.17% of 80,377 articles published in the field. The areas of surgery studied were analgesia 65 (49%), antibiotics 17 (13%), extracorporeal membrane oxygenation (ECMO) 9 (7%), gastrointestinal, burns, oncology, minimally invasive surgery, vascular access, congenital anomalies, and trauma (each <5%). Only 16 (12%) trials compared 2 surgical therapies, 9 (7%) compared a medical versus a surgical therapy, and 109 (81%) compared 2 medical therapies in surgical patients. Fourteen (10%) RCTs were funded by peer-reviewed agencies. Only 17 (13%) RCTs included a biostatistician as an author or a consultant. Trial design included calculation of sample size and statistical power in 21 (16%) RCTs. Method of randomization was reported in only 51 (38%). The test statistic and observed probability value was reported in 15 (11%). CONCLUSIONS: Clinical trials are used infrequently to answer questions related to pediatric surgery. When RCTs are utilized, they often suffer from poor trial design, inadequate statistical analysis, and incomplete reporting. Pediatric surgery could benefit from increased expertise, funding, and participation in clinical trials.

California↗
PubMed2005

[Mulomedicina Chironis--set to music].

The Hungarian composer L. Melis set some parts of the Mulomedicina Chironis to music. The Mulomedicina Chironis is a well known document of the ancient veterinary medicine written in Latin language. Only 12 of the 183 paragraphs of the third volume were used to set to music. The piece is a trial of the composer to compromise the common demand on the art through the modern science.

Animals↗
PubMed2002

Science and ministry: confusion and reality.

The professional pastoral care community generates a great deal of heat but precious little light during its debate about the use of scientific process in the practice of ministry. This result is due in large part to confusion about the basic tasks and processes of science and its role in both organized religion and the current health care environment. Clergy have often not understood that science and faith are different enterprises, that science and art are overlapping processes, and that both science and ministry are means and not ends in themselves. In the current health care environment, the ability to use scientific processes and speak its language are not only essential to the survival of professional pastoral care but are necessary to promote the goals of pastoral care and enhance our ministry.

Chaplaincy Service, Hospital↗
PubMed1997

Genetics of cutaneous melanoma and nevi.

To provide a state-of-the-art summary of currently available data about the genetics of cutaneous melanoma and nevi, we reviewed the pertinent literature and outlined the important findings on genetic analyses. Although the first English-language report of melanoma in 1820 contained a description of a melanoma-prone family, seminal studies by investigators at the National Cancer Institute and the University of Pennsylvania identified dysplastic nevi (DN) as an important melanoma precursor, suggested an autosomal dominant mode of inheritance for both melanoma and DN, and proposed that a melanoma-susceptibility gene (CMM1) was located on chromosome 1p36. This gene assignment has not yet been confirmed by independent investigators. A second melanoma gene, designated CMM2, has been mapped to chromosome 9p21. This gene assignment has been confirmed independently, and the cell cycle regulator p16INK4a has been proposed as a candidate gene; germline mutations in this gene have been identified in about half of melanoma-prone families. Germline mutations in the cyclin-dependent kinase gene CDK4 (chromosome 12q14) have recently been described in two melanoma kindreds; this finding likely represents a third melanoma gene. A heritable determinant for total nevus number has been suggested, as has the presence of a major gene responsible for total nevus density in melanoma-prone families. An autosomal dominant mode of inheritance for DN has been proposed, and evidence suggests that DN may be a pleiotropic manifestation of the 1p36 familial melanoma gene. Several studies have shown a surprisingly high prevalence of DN on the skin of family members of probands with DN. In light of the extensive evidence documenting that persons with DN (both sporadic and familial) have an increased prospective risk for melanoma, these family studies suggest that relatives of persons with DN should be examined for DN and for melanoma. Overall, genetic determinants have a major role in the pathogenesis of normal nevi, DN, and melanoma. Elucidating the molecular basis of these genetic events promises to enhance melanoma risk reduction strategies and thereby reduce melanoma-associated mortality.

Case-Control Studies↗
PubMed2006

Interpreting the protein language using proteomics.

Post-translational modifications define the functional and structural plasticity of proteins in archaea, prokaryotes and eukaryotes. Multi-site protein modification modulates protein activity and macromolecular interactions and is involved in a range of fundamental molecular processes. Combining state-of-the-art technologies in molecular cell biology, protein mass spectrometry and bioinformatics, it is now feasible to discover and study the structural and functional roles of distinct protein post-translational modifications.

Animals↗
PubMed2003

Postmortem parenthood and the need for a protocol with posthumous sperm procurement.

OBJECTIVE: Posthumous sperm procurement involves harvesting gametes from a recently deceased man for cryopreservation and future use in ART. This paper discusses the practical and ethical role of posthumous sperm procurement in medical practice and society and submits possible solutions, including the establishment of formal policies and protocols. DESIGN: English-language literature review and bioethical discussion. RESULT(S): In the United States, an increase in requests and protocols has been documented. International requests and regulation are variable. CONCLUSION(S): Posthumous sperm procurement is fraught with ethical dilemmas, including informed consent, privacy, inheritance, and child welfare. To establish appropriate medical practice, it is important to consider all stakeholders in the decision-making process. We believe that an acceptable and ethical resolution can be obtained only through the collaborative input of all involved parties. We have looked to U.S. and international sources for guidance in current practice and to gain insight into the formulation of future policies.

Cadaver↗
PubMed2001

Précis of How children learn the meanings of words.

Normal children learn tens of thousands of words, and do so quickly and efficiently, often in highly impoverished environments. In How Children Learn the Meanings of Words, I argue that word learning is the product of certain cognitive and linguistic abilities that include the ability to acquire concepts, an appreciation of syntactic cues to meaning, and a rich understanding of the mental states of other people. These capacities are powerful, early emerging, and to some extent uniquely human, but they are not special to word learning. This proposal is an alternative to the view that word learning is the result of simple associative learning mechanisms, and it rejects as well the notion that children possess constraints, either innate or learned, that are specifically earmarked for word learning. This theory is extended to account for how children learn names for objects, substances, and abstract entities, pronouns and proper names, verbs, determiners, prepositions, and number words. Several related topics are also discussed, including naïve essentialism, children's understanding of representational art, the nature of numerical and spatial reasoning, and the role of words in the shaping of mental life.

Child Language↗