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PubMed1992

The effects of decentralization on substance P-immunoreactivity in the anterior major pelvic ganglion of the male guinea pig.

The anterior major pelvic ganglion (AMPG) of the male guinea pig possesses a substance P (SP)-immunoreactive peri-neuronal plexus. Selective nerve transections involving the principal inputs of the AMPG, the hypogastric and pelvic nerves, indicate that the SP-immunoreactive peri-neuronal plexus is derived from multiple sources: an extrinsic source involving both the hypogastric and pelvic nerves, and another source (possibly the projections of small intensely fluorescent cells). SP-immunoreactivity (IR) is not normally present in the neuronal perikarya of the AMPG. Evidence is presented that suggests the absence of SP-IR is due to an active suppression of SP-synthesis. This seems to be achieved by a trans-synaptic mechanism involving the hypogastric nerve which, after transection, leads to the appearance of neuronal perikarya exhibiting SP-IR (less than 1% of the total neuronal population of the AMPG). Up to 65% of the neuronal perikarya of the AMPG have the ability to synthesize SP, as demonstrated by SP-IR after 24 h in vitro. A more potent factor in the down-regulation of SP synthesis seems to be exerted by the pelvic genito-urinary organs, especially the prostate.

Animals↗
PubMed2006

Ab externo scleral suture loop fixation for posterior chamber intraocular lens decentration: clinical results.

PURPOSE: To evaluate the efficacy and safety of an ab externo suture retrieval and scleral fixation technique in the treatment of subluxated posterior chamber intraocular lenses (PC IOLs). SETTING: Academic tertiary care centers. METHODS: Surgical databases from 2 surgeons were reviewed for consecutive cases from March 2000 to April 2004 in which the ab externo scleral suture fixation technique was used and a minimum follow-up of 3 months was completed. Patient charts were reviewed for 15 eyes that had decentered in-the-bag PC IOLs, 12 eyes with subluxated sulcus or bag-sulcus positioned PC IOLs, and 3 eyes with PC IOLs dislocated into the vitreous. RESULTS: The mean time from cataract extraction to PC IOL stabilization was 3.4 years (range 2 days to 10.9 years). Surgical repositioning was successfully performed in all patients. After a mean follow-up of 14.7 months, the mean best corrected visual acuity (BCVA) improved from 20/140 to 20/40 (P = .0001). All patients had stable or improved BCVA. All patients with a successfully completed procedure achieved an adequately centered PC IOL postoperatively. One patient (3.3%) developed a significant intraoperative vitreous hemorrhage requiring the procedure to be aborted, but reoperation 3 months later was successful. Postoperative complications included persistent elevated intraocular pressure in 2 eyes (6.7%) and chronic cystoid macular edema in 1 eye (3.3%) that resolved with medication. CONCLUSION: The ab externo suture loop retrieval and scleral fixation technique was effective in repositioning decentered, subluxated, or dislocated PC IOLs with excellent visual outcomes.

Adolescent↗
PubMed2001

Chest pain unit and decentralized testing of cardiac markers.

Chest pain is one of the most important reasons of Emergency Department arrivals (5% of total). As it is not possible to rule-in all patients claiming chest pain, it has been proposed to create new departments to monitor these patients during some hours, in order to exclude or confirm an acute coronary syndrome. These departments are named Chest Pain Units (CPUs). The Chest Pain Unit has been created since June 1998 in Alessandria Hospital "SS. Antonio e Biagio e C. Arrigo". Chest Pain Unit patients presenting in Emergency Department with an unclear defined chest pain are submitted to a continuous ECG monitoring of S-T trend for 24 h. Moreover, cardiac markers such as myoglobin, mass CK-MB and Troponin-I are tested at arrival and Troponin-I is tested again serially 3, 6, 9, 18 h after the first sampling. It is really important to be able to measure these markers of myocardial damage with robust and quick methods. A point-of-care analyzer is available in our chest pain unit and enables our department to obtain results in a very short time at low cost and with quality similar to that of clinical chemistry laboratories' instruments. This easy-to-use analyzer can be run by nurses without interfering in their normal activities. The presentation of our experience will be completed by describing all patients admitted in our Chest Pain Units from January to June 1998.

Biomarkers↗
PubMed1993

Control of detrusor stiffness in the chronic decentralized feline bladder.

The neuropharmacology of increased bladder stiffness, which may contribute to upper tract damage and incontinence, was investigated in 76 cats. beta-blockade increased but combined alpha 1-adrenergic with muscarinic blockade decreased filling phase stiffness in normal cats. Bladder wall stiffness during the early filling phase was unaffected by chronic S2 ventrodorsal rhizotomy or L7-S3 ventral rhizotomy, but was decreased when L7-S3 dorsal rhizotomy or total sympathectomy was combined with the ventral root lesion, implying that sacral dorsal roots and sympathetic efferents maintain normal detrusor stiffness. Acute sympathectomy increased stiffness in all the former 3 chronic groups, implying that a tonic or reflex sympathetic inhibition operates independently of the L7-S3 dorsal roots. Stiffness during early filling phase decreased with acute ventral rhizotomy. This change persisted with chronic sympathectomy but returned to normal if sympathetic nerves were left intact. These results suggest that bladder stiffness is modulated by tonic or reflexic sympathetic activity, which is influenced by L7-S3 afferents. Detrusor stiffness during the later stages of filling, which was decreased by acute sympathectomy in chronic groups but increased by chronic sympathectomy, was reduced by interference with adrenergic or muscarinic mechanisms after either lesion. Therefore, a peripheral pathway with facilitatory alpha 1-adrenergic and muscarinic receptors is involved in the production of increased late stage stiffness after chronic sympathetic damage. We propose that the increased bladder stiffness seen in congenital sacral lesions may be analogous to the stiffness during late stages of filling reported here. Our results also imply that the presence of this increased stiffness is closely associated with chronic sympathetic damage. Whether the increased stiffness in congenital and traumatic neural lesions in humans arises from sympathetic damage remains to be determined.

Animals↗
PubMed1990

Reduction in human bladder wall compliance following decentralization.

The urodynamic records of patients who presented with voiding symptoms and/or incontinence, and who had areflexia after conal-cauda equina injury (33) or a radical pelvic operation (31) were examined. In contrast to reported experimental and clinical evidence, we found a higher prevalence of decreased compliance in the patients who had undergone a radical pelvic operation than in those who had sustained conal-cauda equina injury.

Adolescent↗
PubMed2003

Maximum permissible lateral decentration in aberration-sensing and wavefront-guided corneal ablation.

PURPOSE: To investigate the lateral alignment accuracy needed in wavefront-guided refractive surgery to improve the ocular optics to a desired level in a percentage of normally aberrated eyes. SETTING: Department of Ophthalmology, University of Zurich, Zurich, Switzerland. METHODS: The effect of laterally misaligned ablations on the optical outcome was simulated using measured wavefront aberration patterns from 130 normal eyes. The calculations were done for 3.0 mm, 5.0 mm, and 7.0 mm pupils. The optical quality of the simulated correction was rated by means of the root-mean-square residual wavefront error. RESULTS: To achieve the diffraction limit in 95% of the normal eyes with a 7.0 mm pupil, a lateral alignment accuracy of 0.07 mm or better was required. An accuracy of 0.2 mm was sufficient to reach the same goal with a 3.0 mm pupil. CONCLUSION: Procedures must be developed to ensure that the ablation is within a tolerance range based on each eye's original optical error. Rough centration based on the surgeon's judgment might not be accurate enough to achieve significantly improved optical quality in a high percentage of treated eyes.

Adolescent↗
PubMed2000

[Central and decentralized aspects of the development and implementation of a concept of quality].

This article presents component parts of quality concepts of the nursing administration in the Swiss Paraplegic Centre Nottwil. These concepts are based on centralised and decentralised methods of quality assurance and improvement. Both methods were modified so as to compensate for their disadvantages. Thereby the demand for systematic scientific control, which is set out in the Swiss health insurance laws, can be achieved. For this purpose a general framework of quality requirements specific to the institution for rehabilitative nursing was developed along with nursing quality standards for specific topics. By both methods, the emphasis is on the inclusion of staff in the development as well as in scrutiny of quality criteria/requirements. In this way a high level of acceptance of quality criteria will be reached among the staff. The quality concept presented here reflects the vision that quality should not be seen as a heavy burden but as an every-day necessity.

Humans↗
PubMed1996

Drug treatment in Switzerland: harm reduction, decentralization and community response.

This paper first outlines the history of illicit drug issues in Switzerland, and then describes drug treatment services and shifts in treatment concepts. In the last 15 years the drug treatment system in Switzerland has expanded considerably. In particular there has been an unprecedented growth of the non-residential sector and of low-threshold programmes, including methadone treatment, the establishment of injection rooms and controlled drug-prescription pilot projects. In the second part, the paper considers some selected factors that promote or impede changes in drug treatment systems, such as treatment policy and the public response to treatment measures. This is manifested in the influence of community action groups on local programme development.

Community Networks↗