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PubMed2005

Recognition of cemetery remains in a forensic context.

The purpose of this paper is to provide guidelines for the recognition of human remains from modem and historic cemeteries found in a forensic context. Three avenues of evidence may be pursued to confirm the origin of cemetery remains: context, condition of the body, and associated artifacts. This article outlines types of North American cemeteries, demonstrating how land use over time has resulted in many being closed, moved, or forgotten, leaving only the context to indicate their presence. The condition of human cemetery remains varies considerably depending on cultural practices and burial environment, but many exhibit combinations of the following traits: dried or embalmed tissue; erosion of bony pressure points; cortical bone flaking; and bone damage due to autopsy or embalming. Examples of artifact types useful in recognizing cemetery remains are also provided. Two cases from British Columbia, Canada are presented to demonstrate the diagnostic features of a disturbed cemetery burial.

Autopsy↗

PubMedDate not supplied

[The state-of-the-art of surgical treatment of congenital cataract in prematures].

Described in the paper are results of a clinical treatment of 127 children (174 eyes), aged 2 to 15 years, with different-type congenital cataract; the treatment was based on modem technologies including tunnel limbic incision, continuous anterior round capsulorhexis, aspiration-irrigation of the contents of the capsular sac, implantation of soft Acrysof SA30A1 IOLs by forceps or "Monarch" injector and suturing of incision. The anterior continuous capsulotomy was found to be the most complicated surgery stage in removal of congenital cataract in children it could be made without errors in 75.3% of cases. Intracapsular implantation of IOL in different-type cataract in children was possible in 97.7% of cases. The single-unit Acrysof IOL stays stable inside the capsular sac for as long as 24 months. A combination of primary capsulorhexis with "dry" anterior vitrectomy is most effective in the prevention of secondary cataract.

Adolescent↗

PubMed2004

The integration of the computer advisory system together with neuroimaging procedures, neurophysiological markers and psychological cognitive tests in order to obtain evidence based system for the physician treating affective disturbance.

WHO has classified depression disturbances--due to widespread existence and serious medical consequences and resulting social and economic effects--as a priority health problem in all the developed countries. The significance of the depression disturbances is fully comparable to such illnesses as heart diseases, cancer and HIV infection. The research made in the USA (NIMH programmer) shows that first contact doctors are not able to detect depression in relation to 50-70% of the people ill with it. Also the research made in other countries shows that a doctor properly identifies only one out of four persons with clear indications of depression. The wrong choice of the antidepressant drug may result in inefficient therapy and in growing risk of suicide. In 1993 the analysis of 50 best selling medicines in the EU made by two Italian pharmacologists showed that in France and Italy in over 45% of the cases the medicines with doubtful efficiency are applied. The aim of our project is to build a European network, which will integrate the research capabilities of a group of research institutes and university departments to provide an infrastructure for creation of the computer advisory system for diagnostics of affective disorders. This network will integrate our original computer expert advisory system called "Salomon" with modem brain imaging techniques and neurophysiological methods, which allows for the delineation of specific subtypes and particular episodes of mental disorders and their neural bases will be studied by state-of-the art (high tech) imaging techniques. This approach will lead to new investigatory, diagnostic and therapeutic techniques.

Antidepressive Agents↗

PubMed2005

Physicians' liability in obstetric and gynecology practice.

PURPOSE: Litigation in obstetric and gynecologic practice has arisen as an important issue. This article aims to highlight issues related to malpractice in obstetrics and gynecology in order to point out several important aspects of medical practice, which may offer adequate professional protection. METHODS AND MATERIAL: Search of the current relevant literature. RESULTS: The four most common clinical causes of medical litigation in obstetrics and gynecology are cases involving fetal distress, uterine rupture after a vaginal birth in a woman with a previous Cesarean section, shoulder dystocia, and misdiagnosis of breast cancer. Litigation raised in most of the cases is driven by bad outcomes and not by malpractice. Additionally, both juries and the public often expect perfection as the natural result of pregnancy and any deviation from this expectation has to be the result of someone's negligence. For this reason it has become mandatory for doctors in hospitals and private practices to acquire a sufficient knowledge relating to modem management, to document carefully in writing their procedural and management plans and to become familiar with the legal aspects of medical practice. Adequate communication and a written patient's consent form are of paramount importance. CONCLUSION: Maintenance of high standards in daily practice with continuous training, clear communication and a signed Patient's Informed Consent Form along with the appropriate documentation of any procedure carried out may provide professional safety to practicing obstetricians and gynecologists in case of medical litigation.

Europe↗

PubMed2005

[The development of the gene pool in the microevolution of Sus scrofa and the role of heterozygosity in the breed-forming process].

The gene pool formation of the modem domestic breeds of pig Sus scrofa domestica and their genesis based on hybridization of wild ancestral forms of the European and Asian origin were studied using molecular immunogenetic methods. Males of the European and Central Asian S. scrofa subspecies (S. s. scrofa and S. s. nigripes were hybridized with domestic pigs of the Swedish Landrace and Vietnamese Black Masked breeds. In addition, we examined the genotypic structure of 65 wild, aboriginal, and local populations as well as cultured breeds, including the stock breeds with different levels of selection. Frequencies of alleles and suballelles of the chromosome 4 locus controlling antigens of the L blood group system were analyzed. The origin of marker suballeles of the European and Asian origin was estimated in the most widespread world pig breeds. Unexpectedly, a strikingly high frequency of the Asian elements was found in the most productive European and American breeds, as well as in the best breeds of Russia and other CIS countries. Only one form of heterozygosity (bcgi/bdfi) was found in a population of wild European ancestors, whereas domestic pig breeds displayed heterozygosity for far more numerous suballeles of the locus studied. Animals heterozygous for alleles of the European and Asian origin showed higher adaptivity and fertility.

Animals↗

PubMed1992

CAD/CAM in dentistry: a historical perspective and view of the future.

What can we look forward too? Lots of fun with new CAD/CAM systems that will enhance dentistry, providing quality restorations quickly. The evolution of an array of new versions of already available systems as well as altogether new systems will provide improved quality, expanded capabilities, and increasing user friendliness. And new materials will be more esthetic, wear more nearly like enamel, and strong enough for full crowns and bridges. We can also look forward to lots of change. Because of the cost of CAD/CAM systems, many clinicians are likely to collaborate by sharing a single system. Laboratories and clinicians may collaborate as well, with data being gathered in the operatory and sent to a laboratory via modem. The fabrication would then be done by the laboratory. Other changes that we cannot even predict are likely to occur in dentistry. Exciting times are here. Automation through dental CAD/CAM systems will, most certainly, change the profession. The impact of that change will only be known in the future. But as the future approaches, the systems and materials available to us will continue to evolve, improve, and enhance dentistry.

Artificial Intelligence↗

PubMed2005

[Research on the transformation of GBC-918 spectrophotometric data into text data].

This paper introduces the principle of designing resident program which can be used to obtain GBCUV screen pictures. First, the spectrophotometric data of refinery waste water, phenol and aniline were obtained by using GBCUV software. Second, the data mentioned above were transformed into text data with TXTSR.COM and TXZH.EXE. Finally, after the text data of refinery waste water were processed by Kalman filtering, the recoveries of phenol and aniline were in the range of 99.0%-103.8% and 97.8%-100.6% respectively. In conclusion, using this software can enlarge the application of GBC-918 and meet the need of modem spectral analysis.

Algorithms↗

PubMed2004

[Cost of pharmacologic treatment and their determinants in ambulatory care of cystic fibrosis patients].

Life expectancy of cystic fibrosis (CF) patients has improved following the introduction of modem therapies. Length of life has been most important determinant of cost of medical care in each population. The aim of this study was to evaluate the cost of pharmacologic treatment and their determinants served by patients and medical insurance. Medical records of our CF center patients from year 2003 were analysed. The annual cost of pharmacologic treatment in our patients in 2003 averaged PLN 26595.91; of total costs 74% were from DNase, 7% from drugs classified as "other", 6.2% from pancreatic enzymes. Individual annual costs served by patients averaged from PLN 979.67 to 10805.57 (mean PLN 6059.63). Mean annual cost "per patient" served by medical insurance averaged PLN 26595.91; 70% of costs were from DNase, 15% from inhaled corticosteroids and bronchodilators. 68% of drug costs were served by medical insurance, 32% by patient. We found significant correlation between cost served by patients (p1), by medical insurance (p2) and age (p1, p2<0.0001) and severity of disease--defined based on percent expected FEV1 (p1=0.006; p2=0.001). Severity of disease and patients age were important determinants of pharmacologic treatment cost in CF patients.

Ambulatory Care↗

PubMed2005

[The modern role of stomach cancer radiodiagnostics].

The authors' main purpose was to assess the role of stomach cancer radiodiagnostics, considering the changes in the morphology of the disease within the last decades of the 20th century. The results of radiodiagnostic and morphological study of 1258 cases of verified stomach cancer were compared. This methodical approach allowed correction of radiodiagnostic methods and stomach cancer semiotics, directed towards detection of endophytic tumors. The radiologic examination included conventional radiologic imaging, ultrasonography, computed tomography, and magnetic resonance imaging of the stomach. The morphologic examination included a method of studying endophytic stomach cancer, specially designed for this research. According to the authors of the article, the prevalence of diffuse and mixed stomach cancer has increased substantially within the last 34 years; the incidence of the stomach upper part involvement has increased 2.4 times. The modem radiodiagnostics and semiotics of stomach cancer are based on the principles of endophytic tumor detection. The authors conclude that modern radiodiagnostics and endoscopy are two main methods of stomach cancer diagnostics.

Adult↗

PubMed2005

[Pharmacogenomical aspects of gastroesophageal reflux disease].

The article covers the modem concept of gastroesophageal reflux disease (GERD) pharmacogenomics. Special attention is payed to polymorphism of CYP2C19 gene and its influence on the metabolism of modern antisecretory agents, such as proton pump inhibitors (PPI). The authors summarize data which demonstrate that the differences in the pharmacodynamics and clinical effects of PPI are caused by CYP2C19 gene polymorphism. The paper shows that this factor should be considered when planning GERD therapy with PPI in order to achieve a complete remission and make the therapy economically rational.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2005

[Miniinvasive laparoscopic or retroperitoneoscopic radical nephrectomy for the parenchymal tumor].

INTRODUCTION: Laparoscopic (LRNE) or retroperitoneoscopic (RRNE) radical nefrectomy originally published in 1991, respectively in 1993, began to be introduced in common practice at the end of the 20th century. In this work we summarize our findings gathered upon introduction of these methods. SUBJECTS AND METHODOLOGY: We present a group of 50 miniinvasive nephrectomies conducted during 2003-2004 (46 LRNE and 4 RRNE). LRNE was combined with ipsilateral adrenalectomy in five cases and with cholecystectomy in three cases (in all cases the LRNE was on the right side). RESULTS: The mean age of the patient subjects was 65 +/- 11 years (34-81). The blood loss was 134 +/- 201 ml (30-1200). The tumor size according to the CT was 50 +/- 13 mm (30-82). Histologically, 45x renal carcinomas, 4x oncocytomas, 1 x urothelial carcinomas were diagnosed. The drain was removed 2.1 +/- 0.9 days following the surgery. The mean hospitalization time was 6.1 +/- 1.6 days (4-9). Only a single major, however lethal, complication arised: In a 74-year old female, the left-sided LRNE due to the carcinoma pT3bG2 and at the same time vaginal hysterectomy, extraction of the renal preparation through the vagina and anterior and posterior vaginoplasty (for a prolaps) were conducted. The patient was repeatedly revised for haemoperitoneum and she exited on the 18th postoperative day due to pneumonia. The mean duration of the LRNE was 168 +/- 40 minutes (80-265). The combined LRNE and cholecystomic procedure lasted 265 minutes. The mean duration of the LRNE with CHE was 213 minutes, and of the LRNE with adrenalectomy was 170 minutes. In 4 cases of the RRNE (indicated three times due to preceeding major surgical procedures in the abdominal cavity and once for the Crohn's disease) the mean duration was 203 minutes. CONCLUSION: Miniinvasive RNE in TI tumors is a modem reproducible methodology suitable for application in clinical practice. The laparoscopic approach appears more appropriate. The retroperitoneoscopic approach is indicated mainly in cases of postoperative adhesions in the abdominal cavity.

Adult↗

PubMed2005

Admissibility of scientific evidence in courts.

In its 1993 Daubert v. Merrell Dow opinion, the United States Supreme Court articulated an entirely new set of criteria for the admissibility of scientific expert testimony. In its 1999 Kumho Tire v. Carmichael opinion, the Court extended Daubert's general holding to include non-scientific expert testimony as well. Most modem litigation relies upon the testimony of experts and this testimony can play a dispositive role in litigation. In all parts of the case, liability, causation and damages, lawyers are winning cases by using newly available techniques, suggested by Daubert and Kumho Tire, to exclude the expert testimony that links damages to the act or omission for which their client has been found liable. Our article contains medico-legal analysis of cases, beginning in the application of Israeli case law which discusses the Daubert Court's holding and explaining the scientific principles that the Court cites. The Daubert introduction links to a brief discussion of the Court's 1999 extension of Daubert to non-scientific testimony. We present a two-part model for evaluating the admissibility of scientific evidence--internal and external--in the Israeli courts. The internal examination of the scientific evidence evaluates its reliability by examining the content of the evidence and by checking that its conclusions correspond to the research methods of scientific literature. The court also has to review the abilities and skills of the expert witness. If the evidence passes the internal evaluation, the court will apply an external evaluation by examining whether the scientific evidence coincides with the other evidence presented to the court according to the specific rules of the law applied to the particular case.

Disclosure↗

PubMed2005

[CroDiab NET--electronic diabetes registry].

INTRODUCTION AND AIM: National diabetes registry has been an important aim of Croatian diabetology for a long time. Currently, efforts are made to define a national registry based upon Cro Diab NET, a computer software designed as a patient record form and suitable for automatic extraction of data for the registry. METHODS: Diagnostic entities captured are defined by the International Classification of Diseases and Related Health Problems, 10th rev. (E10--E14, G63.2, and H36) and ICF (b540, b279, b298, b2108). Central CroDiabNET module is BIS (Basic Informatic Sheet), recognized by the international diabetology community as optimal data collection form for the follow-up and improvement of diabetes care. There are several ways of data collection: secondary and tertiary health centers with diabetes care within their scope of activities send BIS on their patients to the central base by a modem, other secondary and tertiary health centers as well as primary health care will send data on their diabetic patients either via the Internet or by mail (interactive BIS will be available on the registry www page). The preferred method of data collection is the electronic one. The central base automatically links records of uniquely identified patients. Other records are checked separately, compared with the existing records and linked manually. Data confidentiality is ensured by double password protection of excess at the level of both users and registry. Unauthorised access is highly unlikely. RESULTS: So far, most of the secondary and tertiary health centers dealing with diabetology have been active in data collection. Inclusion of primary care (family physicians) is in progress. The last report covered data from 13 centers. Besides data on the number of patients, the reports contained analyses of BIS patient data availability. This is a tool for the analysis of the quality of registry and it can also provide basic data for planned actions aimed at quality of care improvement. Regular data collection from all levels of health care with concomitant connection of the registry to the national death registry started in 2004. With complete implementation of these processes a unique national diabetes database will be defined. CONCLUSION: Results of the use of CroDiabNET so far confirm its potency as a valuable tool for population registry of diabetes as well as for improvement of diabetes health care. Regular periodic reports reveal an increasing number of centers involved. With continuation of this trend the registry will become a national, population-based database.

Croatia↗

PubMed2005

Hearing native voices: contraceptive use in Matemwe Village, East Africa.

Although fertility declines have been documented in various parts of Africa, fertility rates remain high in Tanzania. Widespread resistance to modern contraception is one factor associated with high fertility in Tanzania. The aim of this study was to identify cultural barriers to modem contraceptive use in Matemwe village, Zanzibar. In May 2003, more than 50 in-depth interviews were conducted with community leaders, health care workers and couples in Matemwe. Despite free and easy access to contraceptives, only 2% of Matemwe women participated in the village's family planning programme. Several factors were found to influence contraceptive use, including strong Muslim beliefs, male dominance over females (especially in polygynous relationships), and limited exposure to modern ideas via education and travel. Interviews indicated that in order to lower fertility in Matemwe, cultural barriers to family planning must be confronted. Successful implementation of a family planning programme hinges on the ability of policymakers to integrate modern ideas about contraception with Matemwe's traditional religious and political culture.

Adolescent↗

PubMedDate not supplied

[The reconstruction of the oral and maxillofacial defects with free vascularized flaps and microsurgical anastomoses].

The reconstruction of the oral and maxillofacial defects is difficult, because of the high specialisation of the tissues. In cancer resection, the post-operatory defects are quite important, because of the oncological principle of assuring free margins. The free flap is a modem and nowadays very used method in oral and maxillofacial reconstruction, after the removal of the malignant tumors with this localisation. These flaps are indicated for large defects, when the reconstruction with local or regional flaps is not possible. The wide variety of the raised tissues allows better results, making them the flaps of choice for large defects of the lip and cheek. The main advantages are related to the tri-dimensional extension of the free margins, assuring the quality of life and allowing early initiation of the radiotherapy in oncological patients.

Adult↗

PubMed2005

[Thoracic paravertebral blockade--history or present time?].

This article discusses thoracic paravertebral blockade (TPVB)--a popular in early XX-th century method of local anaesthesia used also for diagnosis and treatment--being revitalized lately. Authors present modem indications for TPVB comparing it to other methods of regional anaesthesia.

Anesthesia, Local↗

PubMedDate not supplied

[Methods for increasing the reliability and noise protection of arterial pressure measurement channel].

Noninvasive measurement of arterial blood pressure is an important function of modem monitoring systems. Presently, most arterial pressure measurement channels implement oscillometric method. This method is based on detection of small-amplitude pulsation of limb volume below occlusion cuff during compression/decompression. The main goal of the upgrade to the oscillometric method is to increase the accuracy, reliability, and noise protection of detection of arterial pressure parameters. This work describes a possible approach to improvement of reliability of the oscillographic method based on synchronous detection of several signals (e.g., volume signal, tachosignal and its derivatives with simultaneous correction of signal processing data on the bases of a priori information about signal, and processing adaptation of data processing algorithm to given signal realization).

Arteries↗

PubMed2005

Like No. 1 Mike Leavitt, most atop the 100 Most Powerful wield their influence from D.C., and help determine how money is spent.

Modem Healthcare's fourth annual ranking of the 100 Most Powerful People in Healthcare boasts an eclectic group. Those who practice medicine and teach it to others share the list with presidents of companies and the president of the country. Lawmakers and information technology risk-takers round out a roster that mirrors the industry's diversity and highlights the many ways people contribute to healthcare.

Health Care Sector↗