[First International Congress on Internal Medicine, Paris, 11-14 September 1950].
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Congresses as Topic↗
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An International Code of Ethics for midwives. International Confederation of Midwives.
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Codes of Ethics↗
Radical mastectomy versus radical mastectomy plus internal mammary dissection. Five-year results of an international cooperative study.
From 1963 to 1968, the international group collected 1580 cases of breast cancer, randomized into two therapeutic groups: radical mastectomy and extended mastectomy. The data were processed on the UNIVAC 1107 computer of the I.N.S.E.R.M. Computing Center. No significant difference was observed between the two groups in the overall five-year survival rate. However, a more detailed analysis, according to certain prognostic features, showed that extended mastectomy improved the results in one subgroup: cancers of inner or medial quadrants, axillary N+. Within this group the difference was highly significant for a smaller subgroup (190 patients) including only tumors T1 and T2. In conclusion, there is no indication for extended mastectomy in any cancers of the outer quadrants or in those of the inner or medial quadrants without axillary involvement. A limited indication for extended mastectomy may be provisionally retained for T1 and T2 cancers of the inner or medial quadrants with axillary involvement.
Breast Neoplasms↗
Fallacy of thoracic side-branch steal from the internal mammary artery: analysis of left internal mammary artery coronary flow during thoracic side-branch occlusion with pharmacologic and exercise-induced hyperemia.
In some patients, myocardial ischemia after coronary artery bypass graft surgery has been attributed to a coronary steal phenomenon through a thoracic side branch originating from the left internal mammary artery (LIMA), even in the absence of subclavian or LIMA stenosis. To demonstrate that coronary flow through the LIMA is unchanged by occlusion of a LIMA side branch, we examined LIMA coronary flow velocity measurements (0.014" Doppler flow wire) in three patients at rest, during adenosine hyperemia, and again during hyperemia induced by left arm exercise before and again after the balloon occlusion of the thoracic side branch. For the three patients, no significant changes in resting or hyperemic flow were noted due to side-branch occlusion. Before side-branch occlusion, pharmacologic intra-arterial (adenosine) coronary flow reserve (hyperemic-to-basal flow velocity ratio) was 2.6, 1.5, and 3.2 and exercise flow reserve was 2.1, 1.3, and 1.2, respectively. After side-branch occlusion, pharmacologic coronary flow reserve was 2.5, 1.8, and 2.7 with exercise flow reserve of 1.8, 1.1, and 1.3, respectively. Under most ordinary circumstances, thoracic side-branch steal does not exist and that side-branch occlusion does not alter LIMA flow at rest or during pharmacologic or exercise-induced hyperemia. These data further suggest that a demonstration of the physiologic value of side-branch occlusion should precede surgical or percutaneous interruption of the thoracic artery in such patients.
Angina Pectoris↗
Internal market reforms of health care systems and the allied health professions: an international perspective.
Fundamental reshaping of the organization of health services is occurring in publically funded health care systems introducing internal market reforms. Management of clinical activity and the introduction of competition through contract-based processes has concentrated on the impacts on medicine and nursing. This article reports early experiences of the consequences of restructuring on the allied health professions from a five-country fieldwork study. Data suggest that decisions on new organizational structures for allied health professions are likely to effect their potential to participate competitively in the market reforms of health care systems.
Allied Health Personnel↗
An attempt to use a common staging system in rhabdomyosarcoma: a report of an international workshop initiated by the International Society of Pediatric Oncology (SIOP).
One hundred medical records of children with rhabdomyosarcoma were reviewed independently by ten European and American specialists primarily concerned with pediatric cancer patients. Each specialist assessed the stage of disease using a pre-treatment staging system (International Society of Pediatric Oncology-Union Internationale Contre le Cancer TNM [SIOP-UICC TNM] and a post-surgical staging system (Inter-group Rhabdomyosarcoma [IRS] grouping system). These two prognostic systems are based on different criteria, and there is no simple correspondence between them. The reliability of the two systems, based on patients' characteristics extracted from medical records, was similar and satisfactory (Kappa index: 0.78 and 0.82 with the TNM system and with the IRS system, respectively). Nevertheless, the IRS grouping system, which considers a primary method of treatment: Surgery, is dependent upon the surgeon, the institution, and the current concept of treatment. We believe that the TNM system provides the best description of extent of disease and should be used for determining therapeutic options and comparing therapeutic results.
Child↗
An international multicenter study of blood culture practices. The International Collaborative Blood Culture Study Group.
An international study was organized to review blood culture practices in 67 medical centers, most of which were teaching hospitals with a total of over 58,000 active hospital beds. The number of blood cultures per admission was generally greater than 0.5 in the USA and less than 0.5 in other countries. Criteria varied for defining a septic episode, as well as for ascribing clinical importance to isolates of coagulase-negative staphylococci; however, septicemia rates tended to be lower in centers in which clinical evaluation was included among these criteria. Staphylococci were ranked first or second among etiologic agents of septicemia in the USA, whereas Escherichia coli was most frequently ranked first among European and Asian centers. All USA centers recommended collection of two blood cultures per septic episode and all but one recommended a maximum number of blood cultures per septic episode, whereas similar recommendations were less common in Europe and Asia. Collection of more than 10 ml per blood culture was more common in the USA than in Europe or Asia. A variety of broth-based systems were used, often in combination with lysis-centrifugation for special (fungal, mycobacterial) or, on occasion, routine purposes.
Bacteremia↗
International variation in the management of infants hospitalized with respiratory syncytial virus. International RSV Study Group.
UNLABELLED: Respiratory syncytial virus (RSV) is a frequent cause of hospitalization among infants. To compare patient management in Europe, the United States, and Australia, we analyzed the charts of 1,563 pediatric patients hospitalized with laboratory-confirmed RSV lower respiratory infections during recent RSV seasons. Half of patients had been seen initially as outpatients. Median duration of hospitalization was 4 days in Australia, Finland, the United Kingdom, and the United States, and 8 or 9 days in Belgium, France, Germany, Italy, and the Netherlands. In a linear regression model that included clinical findings, underlying conditions, prematurity, and age, the leading variable associated with length of stay was "hospitalization in continental Europe". This geographic factor conferred a 1.8-fold longer stay (95% CI: 1.7-1.9) than hospitalization elsewhere. Utilization of nine supportive therapies for RSV varied widely among hospitals, even within the same country. The individual hospital was strongly associated with the use of every therapy studied, independent of patient characteristics and clinical status. CONCLUSION: Management of RSV patients varies markedly by country and hospital. Multicenter RSV trials that measure length of stay should standardize criteria for "readiness for discharge". It may be appropriate to limit international trials to countries with similar median stays for RSV. Variability within multicenter trials could be further controlled by standardizing the use of other therapies and the diagnosis of complications.
Ambulatory Care↗
Internal thoracic artery malperfusion syndrome after bilateral internal thoracic artery grafting: report of a case.
A 58-year-old man with postinfarction unstable angina was referred to the Department of Cardiovascular Surgery at the Saiseikai Kitakami Hospital for urgent coronary revascularization. The bilateral internal thoracic arteries (ITAs) were subsequently utilized to revascularize the myocardium. The left anterior descending artery (LAD) was revascularized with the in situ right ITA and the obtuse marginal artery was revascularized with the in situ left ITA. Although he was successfully weaned from cardiopulmonary bypass, he collapsed hemodynamically 15 min later. Thus, he underwent supplementary vein bypass grafting to the distal LAD and the diagonal artery. Postoperatively, his course was uneventful, apart from the perioperative infarction, and a coronary arteriogram demonstrated patent bilateral ITAs and vein graft. This case report emphasizes the importance of early recognition of this rare syndrome and advocates surgical treatment consisting of supplementary vein grafting.
Coronary Disease↗
Vaginal delivery following cesarean section: use of oxytocin augmentation and epidural anesthesia with internal tocodynamic and internal fetal monitoring.
The cesarean section rate continues to rise, and, as new indications for the operation continue to be proposed, a method for safely decreasing the rate is truly needed. Less than 1% of patients in the United States are allowed a trial of labor after a cesarean section, in spite of the thousands of (safe) vaginal deliveries after cesarean section now reported in the literature. Few reports in the literature mention the use of oxytocin or regional anesthesia in these patients. We present our experience with 230 trials of labor after primary low transverse cesarean section. One hundred eighty-one patients (79%) were delivered vaginally, 73 patients (32%) received epidural anesthesia, and 94 patients (41%) received oxytocin augmentation of labor. Internal tocodynamic and fetal heart monitoring was used in all patients. Our rationale for this controversial management is discussed.
Anesthesia, Epidural↗
An international comparison of different laboratory tests for the diagnosis of bovine leukosis: suggestions for international standardization.
A collaborative study was conducted to compare the detection limit of different laboratory tests for antibodies against bovine leukemia virus (BLV). Serum and milk samples were tested in agar gel immunodiffusion (AGID), different modifications of indirect ELISA, blocking ELISA and ELISA procedures using monoclonal antibodies to BLV gp51 or BLV p24. The detection limit of reference serum E4 diluted 2-fold in negative serum gave a median value of 1:16 in AGID, indirect ELISA, and monoclonal ELISA p24, 1:128 in monoclonal ELISA gp51, and 1:1024 in blocking ELISA. The detection limit of a 4% immunoglobulin preparation of E4 diluted in negative milk showed median values of 1:800 in indirect ELISA, 1:1000 in monoclonal ELISA, and 1:2400 in blocking ELISA. None of the ELISA procedures could detect all the positive individual milk samples diluted 1:50. The AGID test is the official reference test for detection of antibodies against BLV. Reference serum E4 diluted 1:10 in negative serum must be scored positive in the AGID test. It is suggested that an international reference serum standard be established rather than an official recommendation of a particular ELISA test.
Animals↗
Comparative case fatality analysis of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial: variation by country beyond predictive profile. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial.
OBJECTIVES: This study was designed to examine the variation in mortality rates among countries participating in the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. BACKGROUND: Despite uniform inclusion and exclusion criteria and protocol in this trial, 30-day mortality rates (irrespective of treatment allocation) ranged from 4.2% to 14.8% among the participating countries. METHODS: With use of the risk factors identified by a multi-variate logistic model, the total study group was classified into deciles on the basis of each patient's risk profile and individual probability of dying within 30 days. Expected mortality rates were then calculated and compared with actual mortality for each decile of the total study group, as well as for patients from each country. RESULTS: Independent risk factors for mortality were older age (odds ratio 1.97 for each 10-year increment), systolic hypotension (blood pressure < 95 mm Hg) at entry (odds ratio 3.7), Killip class > 1 at entry (odds ratio 3.5), history of antecedent angina (odds ratio 1.23 to 1.49), history of diabetes mellitus (odds ratio 1.64), previous infarction (odds ratio 1.23) and history of never smoking (odds ratio 1.37). The overall mortality rate among the 1,612 patients in risk deciles 9 and 10 was 26%; for the 1,606 patients in deciles 1 and 2 it was 1.2%, with a sensitivity of 58.6% and a specificity of 83.7%. The logistic model closely predicted and explained the different mortality rates for most countries (the differences between expected and actual mortality were nonsignificant). However, in the total study group, the difference between the expected and actual mortality was significant (p < 0.001). This difference was mainly ascribed to the two countries with the highest and lowest mortality rates. When the patients from these two countries were excluded from the analysis, the overall difference became nonsignificant. CONCLUSIONS: These findings suggest that the recognized risk factors associated with increased case fatality in acute myocardial infarction account only in part for mortality differences across or within populations.
Aged↗
Quality of life measures for patients receiving adjuvant therapy for breast cancer: an international trial. The International Breast Cancer Study Group.
Serial quality of life (QL) assessments are being obtained every 3 months for 2 years from patients with operable breast cancer in two ongoing International Breast Cancer Study Group (IBCSG) randomised clinical trials of adjuvant treatment. The QL-assessments include patient-derived perceived coping (PACIS, personal adjustment to chronic illness scale), well-being (Bf-S, Befindlichkeitsskala von Zerssen), mood, physical well-being and appetite (LASA, linear analogue self assessments). The first assessment within 6 weeks of surgery was performed by 70% of the patients. The analysis of serial assessments for 265 patients with each of the first four assessments completed showed that all measures improved with increasing time from study entry; that the degrees of improvement for the four major language groups were similar; and that measures were sensitive to treatment difference. In conclusion, measurement of QL related aspects in a multicultural clinical trial is feasible and possibly relevant for the evaluation of treatment results.
Antineoplastic Combined Chemotherapy Protocols↗
Raman spectrum, conformational stability, barriers to internal rotations and DFT calculations of 1,1,1-trifluoro-propane-2-thione with double-internal-symmetric rotor.
The Raman spectrum (3500-100 cm-1) of 1,1,1-trifluoro-propane-2-thione (TFPT), CF3C(S)CH3 of the solid phase has been recorded. The internal rotation of CH3 and/or CF3 moieties around CC bonds in TFPT allow five hypothetical conformers (Cs and C1 point groups). Aided by quantum chemical (QC) calculations, the Cc conformer is the only stable form (CF3 and CH3 groups are eclipsing the CS bond) which contains a planar FCC(S)CH backbone and possess intramolecular hydrogen sulfur interactions. However, other conformations (with the orientation of sulfur atom being trans to either hydrogen or fluorine atom) are either transition states or not fully converged geometry with "gauche" orientation. Moreover, the calculation were carried out at the level of Becke three Lee-Yan-Parr (B3LYP) parameters up to 6-311++G(d,p) basis sets. The torsional barriers are adequately described by a three-fold potential, V3 which have been determined utilizing the optimized structural parameters from the B3LYP/6-31G(d) basis set along with potential surface scan. Barriers of 1.28 kcal/mol (448 cm-1) and 1.94 kcal/mol (678 cm-1) were calculated for CH3 and CF3 symmetric rotors, respectively. Complete vibrational assignments have been reported for the stable Cc isomer which is supported by normal coordinate analysis and potential energy distributions (PEDs) for all fundamentals. Moreover, equilibrium geometries, vibrational frequencies are compared to the corresponding experimental values of acetone, 1,1,1-trifluoroacetone (TFA), hexafluoroacetone (HFA) and other molecules having the CF3 moiety whenever appropriate.
Fluorine↗
Increases in internal Ca2+ and decreases in internal H+ are induced by general anesthetics in squid axons.
Squid axons were injected with arsenazo III and treated with sea water containing compounds usually classified as general anesthetics, (pentanol-decanol and a variety of hydrocarbons and their derivatives). Such treatment led to an increase in absorbance by arsenazo III at wavelengths sensitive to [Ca]i. The effect was independent of the presence or absence of Ca++ in sea water and it was not modified by substances that release Ca from internal stores. The effect was easily reversible. In axons injected with phenol red or impaled with a glass electrode sensitive to H+, a similar treatment led to an alkalinization that was also readily reversible. Both Ca release and the change to an alkaline pH had identical time courses. The dose required for action by all of the chemical agents studied could be predicted from a knowledge of their fractional saturation in sea water, i.e. from their thermodynamic activity. For compounds with 8-10 carbon atoms, Ca-release effects can occur at concentration less than those necessary to block either conduction or Na/Ca exchange. A special chemical agent was octylamine, which induced a marked rise in pHi and in addition its nonionic form produced the typical Ca release associated with general anesthetics.
Anesthetics↗
Binding studies on internal immunodeterminants: synthesis of beta-(1----6)-linked oligosaccharide methyl glycosides having one to four internal D-galactopyranosyl residues flanked by gentiobiose residues.
The oligosaccharide glycosides beta-D-Glcp-(1----6)-beta-D-Glcp-(1----6)-[beta-D-Galp-(1----6)]n-beta-D - Glcp-(1----6)-beta-D-Glcp-1----OMe (n = 1-4) were prepared by a convergent block synthesis. Haloacetyl, tert-butyldiphenylsilyl, and dimethylthexylsilyl groups were used as temporary protective groups for the preparation of the intermediate glycosyl donors and acceptors. The deoxygenated trisaccharide glycosides beta-D-Glcp-(1----6)-beta-D-Galp-(1----6)-4-deoxy-beta-D-xylo-Hexp -1----OMe and beta-D-Glcp-(1----6)-4-deoxy-beta-D-xylo-Hexp-(1----6)-beta-D-Galp -1----OMe were also synthesized. The binding of each glycoside to the monoclonal antigalactan antibody IgA J539 was studied and the results support the previous finding that J539 can bind to internal antigenic epitopes. The data are consistent with the interpretation that subsite C of that antibody binds glucose with a Ka of approximately 6 (cf. 10.9 for galactose).
Antibodies, Monoclonal↗
International Federation of Clinical Chemistry and International Union of Pure and Applied Chemistry 2. Properties and Units in the Clinical Laboratory Sciences. VI. Properties and Units in IOC Prohibited Drugs (IFCC-IUPAC Recommendations 1997).
The term designating a substance being an active ingredient of a drug may be a generic name, a nonproprietary name, a registered trade name, a fantasy name or other. This causes difficulties in the transmission of request and report on such substances to and from the clinical laboratories, and in the collating of this information from different sources. The document comprises a list of properties of drugs of abuse in biological fluids as defined by the International Olympic Committee Medical Code for use in electronic transmission systems. Standard systematic names are presented with a code value for each. The coding schemes thus prepared are accessible on Internet from C-NPU Home page address: http://inet.uni-c.dk/ qukb7642.
Pharmaceutical Preparations↗
Congenital idiopathic growth hormone deficiency associated with prenatal and early postnatal growth failure. The International Board of the Kabi Pharmacia International Growth Study.
To assess the role of growth hormone in fetal and infant growth, we analyzed the pretreatment data on 52 patients with a diagnosis of congenital growth hormone deficiency before 2 years of age, obtained from the Kabi Pharmacia International Growth Study. These infants had reduced birth-length standard deviation scores, an excess of birth weight relative to length, and progressive growth failure. We conclude that congenital growth hormone deficiency may cause impaired growth in utero and early infancy, and that growth hormone plays an important role in perinatal and infantile growth.
Analysis of Variance↗