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PubMed2001

Look before you leap.

Learning to critically evaluate therapeutic claims is vital to the success of the practicing veterinarian and the veterinary profession as a whole. Until such time as good scientific data in support of therapies are obtained, veterinarians should be careful in their advocacy and employment of new and unproved practices. They should also be aware of the many reasons why therapeutic "success" may be the result of a variety of factors unrelated to the treatment modality itself. Only by relying on rigorous standards of evidence can equine veterinarians prevent a return to the sincere but misguided ways of yesteryear.

Animals↗

PubMed1998

[Heat and moisture exchanging filters for conditioning of inspired gases in adult anesthesia and resuscitation].

OBJECTIVES: Heat and moisture-exchanging filters (HMEFs) are increasingly used in clinical practice. At the same time, new scientific data are available which clarify the benefits of these devices. DATA SOURCES: We searched in the Medline database for all papers written in English or French, without limiting date of publication, using the following key-words separately or in combination: humidity, temperature, mechanical ventilation, equipment. STUDY SELECTION: From the 200 articles provided by Medline, we selected those directly concerning HMEFs. Some older studies and those on HMEFs no longer available were excluded. DATA EXTRACTION: Principle data available from the literature were analysed. DATA SYNTHESIS: Humidification and warming of the inspired gas mixture is mandatory during mechanical ventilation. There is a direct link between HMEF performance and the characteristics of tracheal secretions. This justified the recommendation for the use of HMEFs with a humidity output above 30 mg of water per litre of gas mixture. In this case, HMEFs are as efficient as conventional heated humidifiers. HMEFs seem to decrease the rate of nosocomial pneumonia in comparison with heated humidifiers. HMEFs induce a slight increase of dead space which should be taken into consideration during weaning from mechanical ventilation. There are demonstrable data in the literature suggesting the possibility of cross viral infection via the anaesthetic machine when an HMEF is not used. There are no data which suggest a specific type of HMEF regarding viral filtration. CONCLUSION: According to the literature data, using an HMEF is essential in anaesthesia and is highly recommended in intensive care.

Adult↗

PubMed1997

Timing for effective application of anteriorly directed orthopedic force to the maxilla.

Class III malocclusion with retrusive maxilla can be orthopedically corrected in the deciduous and mixed dentition, with reverse-pull headgear in combination with rapid palatal expansion. The literature recommends this procedure be carried out before the patient is 8 years old to obtain the optimal orthopedic result. This statement, however, has not been supported by scientific data. The current study examined the treatment effects of patients younger than 8 years old (5 to 8 years) and patients older than 8 years old (9 to 12 years). Thirty patients treated with maxillary protraction and expansion in the Department of Children's Dentistry and Orthodontics, University of Hong Kong were included in this study. Cephalometric radiographs were taken 6 months before the initiation of treatment (T(0)), at the initiation of treatment (T1), and after 6 months of treatment (T2). In this way, (T(2)-T1) represented cephalometric changes during the treatment period and (T1-T0) represented 6 months of growth changes without treatment. Experimental subjects served as their own control in this study. A grid system consisting of maxillary occlusal plane (OL) and a line perpendicular to OL through sella (OLp) was used for linear measurements. A total of 15 linear and 3 angular cephalometric measurements were made. A multivariate analysis of variance (MANOVA), which used age and treatment time as its factors, was used to determine effect of age and/or treatment on each cephalometric parameter. Results indicated strikingly similar therapeutic response between the younger and older age groups. These data suggest that similar skeletal response can be obtained when maxillary protraction was started either before age 8 (5 to 8 years) or after age 8 years (8 to 12 years).

Aging↗

PubMed2002

Pharmacologic management of childhood hypertension: current status, future challenges.

The treatment of childhood hypertension has been hampered by several factors, including a lack of extensive scientific data regarding drug efficacy and pharmacokinetics in children, a lack of manufacturer's recommendations for the use of antihypertensive agents in children, and a lack of age-appropriate drug formulations. These problems have forced clinicians either to rely on limited data from older studies of agents empirically no longer considered first-line choices for use in children, or to adapt agents studied in adults for pediatric use. Recent developments, including publication of single-center studies of newer agents and the proliferation of industry-sponsored trials spurred by the Food and Drug Administration Modernization Act, have increased the amount of data available. Investigators involved in such studies must ensure that the unique aspects of using antihypertensive drugs in children are adequately addressed.

Antihypertensive Agents↗

PubMed1988

Antacids: the past, the present, and the future.

Antacids have served us well for over a century. The attitude in the late 1950s to 1970s that antacids should be taken only on demand was unjustified and was based on what can be seen nowadays as misinterpretation of scientific data. Twelve recent endoscopic controlled studies have confirmed the efficacy of antacids in the healing of duodenal ulcer, achieving about 75% healing in 4 weeks. Like H2-receptor antagonists, the efficacy of antacids in the healing of gastric ulcers is controversial, most probably related to the even greater pathogenetic heterogeneity of this condition. Antacids should be given at least four times a day and at least 1 hour after meals, since their therapeutic success most likely depends on neutralization of postprandial acid secretion. In vivo, the newer tablet forms are indistinguishable from the liquid forms in terms of neutralizing efficiency and healing efficacy. The ideal dose is one that neutralizes 400 mmol of acid. Combination with an anticholinergic drug is effective and a recent report suggests that this may lead to longer remission than with H2-receptor antagonists. As a long-term therapy, antacids appear to work but need to be taken in multiple daily doses, a regimen which is unlikely to meet with long-term patient compliance. The success of antacids in duodenal ulcer healing should alert us to the importance of controlling the meal-stimulated acid secretion in ulcer therapy, and to the hard fact that acid is a non-permissive factor in ulcer healing.

Antacids↗

PubMed1995

Anti-cytokine therapy in rheumatoid arthritis.

The past few years have seen an explosion of knowledge concerning the role of cytokines and their naturally occurring inhibitors in the promotion and modulation of inflammatory disease. In RA, this knowledge has been translated into the clinic, with ongoing evaluation of specific cytokine inhibitors, including those targeting tumour necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1) and interleukin-6 (IL-6). In this review, we outline the scientific data supporting anti-cytokine therapies in RA and describe the results of published and unpublished clinical trials with biological agents. At least for anti-TNF therapy, short-term clinical efficacy and good tolerability have been confirmed in randomized, placebo controlled trials. The results of IL-1 blockade in vivo also appear encouraging, although detailed descriptions of trail outcomes are awaited. Problems associated with long-term administration of biological agents are discussed, including the development of antiglobulin responses to injected monoclonal antibodies and poor pharmacokinetics of low-molecular-weight inhibitors. Ways of facilitating the long-term use of current biological agents and alternative means for inhibiting cytokine function in future studies in RA are presented.

Animals↗

PubMed2000

Gene transfer from genetically modified food.

The current debate about the safety of genetically modified food includes some important scientific issues where more scientific data would aid the robustness of safety evaluation. One example is the possibility of gene transfer, especially from genetically modified plant material.

Bacteria↗

PubMed2002

A method for determination of upper extremity kinematics.

Kinematic analysis of the upper extremity has been conducted using a wide variety of techniques, philosophies, and analytic methods. We describe a simple, marker-based three-dimensional video analytic technique that borrows concepts from lower extremity kinematic analysis. A sequential rotation order about orthogonal axes is described, although alternate methods are examined as well. The method has been verified by application to a mechanical model. In certain positions, gimbal lock may occur, and a different sequence of rotational decomposition may be required. Agreement on standardization of technique would assist in the dissemination of upper extremity scientific data.

Algorithms↗

PubMed1998

Should claudicants receive angioplasty or just exercise training?

Robust clinical and scientific data to support the use of angioplasty or exercise for intermittent claudication are scanty. The purpose of this article is to explore the evidence for each of these treatments. A computer search of relevant published material. Very few randomised controlled trials are available on which to base a sound treatment policy. Currently, the evidence in favour of exercise therapy for short term improvement in symptoms is more compelling than that for angioplasty. The mechanisms of action, the magnitude of effects on walking, the relative efficacy and the hazards of the treatments are discussed. The only way to seriously address the question of which treatment is best for claudicants is by means of the randomised trial and until this has been done angioplasty will remain an expensive treatment of unproven benefit for claudication.

Angioplasty, Balloon, Coronary↗

PubMed2003

Percutaneous vertebroplasty: rationale, clinical outcomes, and future directions.

Percutaneous transpediculate vertebroplasty is an innovative and successful treatment of painful osteoporotic and pathologic compression fractures that are refractory to medical therapy. Large-scale clinical series have shown that vertebroplasty can provide significant pain relief with very low complication rates. Expectations of positive results of the ongoing randomized trials are high. With the accumulation of scientific data, technological advancements, and acceptance by the general community, vertebroplasty may be become the standard of care for treatment of painful vertebral body compression fractures.

Fracture Fixation↗

PubMedDate not supplied

Manual lymph drainage (MLD).

Treatment review is intended to inform and update nurses about treatments relevant to HIV/AIDS. Information presented in this column does not imply endorsement by ANAC. Additionally, the reader is advised that there is a paucity of scientific data to validate the effectiveness of manual lymph drainage.

Drainage↗

PubMed1997

The effects, limitations, and long-term dentofacial adaptations to treatment with the Herbst appliance.

The purpose of this article is to summarize the existing scientific data with respect to the short- and long-term effects of the Herbst appliance on the occlusion and on the maxillo/mandibular complex. The article also discusses the treatment indications and possible treatment limitations. The Herbst method is most effective in the treatment of Class II malocclusions. Long-term stability seems to be dependent on a stable cuspal interdigitation. Marked mandibular morphological changes occur during therapy and sagittal condylar growth is increased. Posttreatment, most of the mandibular morphological changes revert and no long-term influence of Herbst treatment on mandibular growth can be verified. The appliance effect on the maxillary complex can be compared with that of a high-pull headgear. Without proper retention, however, this effect is of a temporary nature. Herbst treatment is especially indicated in the permanent dentition at or just after the pubertal peak of growth. Mixed dentition treatment is not recommended, as a stable cuspal interdigitation after therapy is difficult to achieve and relapses are prone to occur. In the nongrowing patient, the appliance should be used with great caution.

Adaptation, Physiological↗

PubMed1997

Psychosomatic pain in children: a psychomuscular tension reaction?

Although recurrent psychosomatic pain is a common paediatric condition, our understanding of it is still limited. In this article, the clinical picture is presented and the concept of psychosomatic pain is discussed. Some recent scientific data are presented including a controlled blind study of pain pressure thresholds showing significantly reduced mean values over common pain areas in a group of children with psychosomatic pain. According to another study, these children also have significantly reduced concentrations of the hypothalamic hormone oxytocin and cortisol. With these data as a point of departure, a model for psychosomatic pain reaction is outlined in which stress is assumed to induce muscular tension, in turn triggering the nociceptive process. In this psychosomatic reaction, the hypothalamus is believed to have a central regulatory function.

Journal Article↗

PubMedDate not supplied

Identification of the epidural space: is loss of resistance to air a safe technique? A review of the complications related to the use of air.

BACKGROUND AND OBJECTIVES: The major determinant of successful epidural anesthesia is the localization of the epidural space. The manual loss of resistance technique is widely used by anesthesiologists in identifying the epidural space. Should air or saline be used in detecting the point of loss of resistance? No consensus exists as to which technique is superior, and individual providers currently use the technique with which they are most comfortable. The incidence of adverse effects associated with the use of epidural air is unknown and may be underreported as the effects may be unrecognized or considered trivial. The authors comprehensively review the complications of epidural air from published reports. METHODS: Using the appropriate key words, the authors searched the Medline (National Library of Congress) scientific data bank from 1966 to 1995, for case reports of epidural complications. RESULTS: There are few prospective, controlled, double-blinded studies comparing the relative merits of using air versus saline for the loss of resistance technique of epidural placement. There are, however, numerous case reports. Complications associated with the use of air for the loss of resistance technique included pneumocephalus, spinal cord and nerve root compression, retroperitoneal air, subcutaneous emphysema, and venous air embolism. Additionally, inadequate analgesia and paresthesia have been associated with the loss of resistance technique using air. Transient and permanent neurologic sequelae have been attributed to some of the complications. The simultaneous administration of nitrous oxide and positive. Pressure ventilation has also been reported to expand localized collections of air, resulting in heightened symptoms. CONCLUSIONS: The potential complications associated with the use of air for identifying the epidural space with the loss of resistance technique may outweigh the benefits. The use of saline to identify the epidural space may help to reduce the incidence of these complications.

Adult↗

PubMedDate not supplied

Can wine tasting be used as a defence to a charge of excess alcohol?

Wine-tasting has been used as a defence in the UK to charges of driving with excess alcohol on the breath. There is little scientific data to support this explanation. The authors carried out an experimental wine-tasting using twelve volunteer subjects. Breath alcohol samples were taken at the start of the experiment and fifteen minutes after the end. All subjects after wine-tasting had breath alcohol levels below the instrumental limit of detection. The authors conclude that the wine-tasting defence is not credible.

Adult↗

PubMedDate not supplied

A multitask scientific investigation resolved an unusual road crash case.

Crime or accident scenes are sometimes almost unbelievable. Elements of the scene can be so strange that a reconstruction of the event is almost impossible. What can the investigator do in such a case? The only solution is to collect all the evidence and samples, even if they appear useless, and send them to specialised laboratories. Scientific data are held in high esteem by the law and court proceedings consequent on crashes will almost certainly require analytical results of one sort or another to be presented as evidence. The case presented is one of those strange and almost unbelievable cases with little physical evidence, no eyewitnesses and the almost fortuitous collection of one unique, incredibly small, sample. The prosecutor's decision to instruct unusual but appropriate experts turned out to be successful.

Journal Article↗

PubMed1997

A survey of contact lens wear among diabetic patients in the United Kingdom.

A survey of attitudes to the fitting of contact lenses to diabetic patients was sent to 1122 optometric, ophthalmological and dispensing members of the British Contact Lens Association; 418 completed questionnaires were analysed. Sixty-two per cent of practitioners considered rigid lenses to be the safest form of lens wear. Most preferred daily lens wear and advised frequent aftercare visits, regular soft lens replacement, special attention to hygiene and restricted wearing time. A survey of 218 diabetic patients attending three diabetic clinics revealed that 3% wore contact lenses, which is a similar percentage to the non-diabetic population. Eight patients had been advised that they could not wear contact lenses because of their diabetes. It is concluded that controlled clinical trials of contact lens wear by diabetic patients are required to supplant anecdotal opinions (such as those reported here) with sound scientific data in order to form a proper rationale for the safe fitting of contact lenses to this group of patients.

Journal Article↗

PubMed2002

Hybrid Capture II HPV Test detects at least 15 human papillomavirus genotypes not included in its current high-risk probe cocktail.

BACKGROUND: Hybrid Capture II HPV Test (HCII) (Digene Corporation, Gaithersburg, MD) is a signal amplified hybridization microplate-based assay designated to detect 18 human papillomavirus (HPV) genotypes using two probe cocktails, for high-risk HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 and low-risk HPV genotypes 6, 11, 42, 43 and 44. At present, HCII is the only commercially available HPV assay with sufficient scientific data to support its performance in the clinical setting. OBJECTIVES: To determine the specificity and accuracy of HCII high-risk probe cocktail for detection of 13 HPV genotypes included in the high-risk probe cocktail. STUDY DESIGN: Cervical samples obtained from 325 women recognized as HPV positive using the HCII high-risk probe cocktail were included in the study. HPV genotypes were determined by restriction fragment analysis of PGMY09/PGMY11 polymerase chain reaction (PCR) products using seven restriction endonucleases. RESULTS: A 450 bp fragment of HPV L1 gene was successfully amplified from 312 out of 325 samples. Of the 312 PCR-positive samples, 280 samples were associated with the expected high-risk HPV genotypes and 32 samples with the HPV genotypes not included in the HCII high-risk probe cocktail. Thus, HPV53 was detected in 8 samples, HPV66 in 4 samples, HPV54 in 3 samples, HPV6, HPV26, HPV70 each in 2 samples, and HPV11, HPV40, HPV42, HPV61, HPV73, HPV81, MM4, IS39, CP6108 each in 1 sample. In 2 samples, we were not able to determine the HPV genotype. CONCLUSIONS: Our study shows that HCII high-risk probe cocktail detects at least 15 HPV genotypes not included in the current HCII high-risk probe cocktail. The potential impact of HCII high-risk probe cocktail cross-reactivity with phylogenetically related and unrelated HPV genotypes, including genotypes currently considered to be low-risk HPVs, remains to be determined.

Cross Reactions↗