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PubMed1999

Evidence-based surgery: A passing fad?

Recent years have witnessed the development of a new movement within health care: the promotion of "evidence-based medicine" (EBM). EBM is about integrating individual clinical expertise and the best external evidence derived from scientific research. Advocates claim that much medical practice is based too much on opinion and experience and insufficiently on research evidence. Their approach would increase the quality of care and its efficiency. This paper describes the principal steps in the evidence-based approach-systematic reviews of the literature and meta-analyses-and its shortcomings in surgery. These include the reliance of EBM on randomized trials, the lack of generalizability of scientific evidence to individual patients, the lack of attention to third party interests, the threat to the "art" of medicine, and the dangers of an oversimplistic approach. Although EBM clearly has a place, it does not have all the answers.

Endoscopy↗
PubMed1998

[Minimally invasive heart surgery--a fad or a clinically recognized therapy method?].

Within the last 5 years new less invasive surgical techniques have been developed in the field of cardiac surgery. This new field named "minimally invasive cardiac surgery" can be subdivided into techniques which do not require cardiopulmonary bypass and are used mainly for coronary artery surgery (called minimally invasive direct coronary artery surgery, MIDCAB technique). This MIDCAB procedure can be done through a small left anterior thoracotomy or a sternotomy. In addition there are other methods which allow the performance of complex cardiac surgery through small accesses in combination with the use of an endovascular CPB system and internal aortic clamping to achieve cardioplegic arrest (so-called Port-Access method). Also for valvular surgery, new surgical techniques were developed allowing access to mitral and aortic valves through limited incisions. In addition, new less invasive techniques were developed for congenital heart surgery. This article will describe the various surgical techniques and define the indications for minimally invasive cardiac surgery.

Endoscopes↗
PubMed1988

Immunochemical studies on the FAD-dependent NADPH-cytochrome c reductase from Trypanosoma cruzi.

The cytosolic flavin enzyme from Trypanosoma cruzi was isolated by a modification of the previously reported method (T. Kuwahara, R. A. White, Jr., and M. Agosin (1985) Arch. Biochem. Biophys. 239, 18-28). In the present study, rabbits were inoculated with the purified enzyme and antibodies were purified from the sera. Ouchterlony double-diffusion analysis indicated that the antibodies reacted specifically with the flavoenzyme and not with other T. cruzi proteins. At the equivalence point, 1 ml of antibody neutralized about 4 nmol of enzyme. The IgG fraction had a small inhibitory effect on the catalytic activity of the enzyme as measured by cytochrome c reduction but only at IgG concentrations well above the equivalence point. Immunotitration of the enzyme in T. cruzi cultures showed that the enzyme corresponds to about 1% of the total protein during the logarithmic phase of growth, but this value decreases to about 0.6% during the stationary phase. Among various trypanosomatids tested, T. cruzi had the highest enzyme concentration; whereas, in other species it ranged from 0.25 to 2.4 micrograms/mg protein. These marked differences suggest that the antibody may be suitable for taxonomic purposes. The presence of the enzyme in amastigotes maintained in tissue culture cells was demonstrated by indirect immunofluorescence. The enzyme was found localized in the periphery of the cell, just beneath the subpellicular microtubules. However, distribution of the enzyme in epimastigotes was more diffuse. As immunofluorescence could be detected only in amastigotes and not in the tissue culture cells, it is suggested that the antibody may be suitable for histopathological diagnosis of Chagas' disease.

Animals↗