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At least 667 records · Page 37Linked to original sources
PubMed1996

Reflections on renal replacement therapy (particularly on dialysis).

Organ replacement therapy is one of the three new forms of life (molecular biology, computer science, organ replacement) that modern techno-medicine affords. Of all the organs, the kidney is pre-eminent in quality and quantity of results. The kidney experience, indeed, acts as a teacher to the other organs in terms of organization and clinical practice. Among the various programs used in the treatment of chronic renal failure, transplantation stands first. It is the only non-illusory form of therapy (in clinical, social and economic terms), but it is only possible in 30% of cases, due to the shortage of valid donors. Artificial replacement (hemodialysis or its alternatives), predominates today and will predominate tomorrow, provided the political and economic structures of various countries are able to afford it. Without dialysis, transplantation itself would not be possible in over 95% of cases, and the graft would have failed in 50% after surgery. Thus, without the backup af artificial replacement therapy, transplantation may be an individual solution for individual cases, but not the solution to the problem as a whole in social terms. Although progressive improvements in technology have resulted in improved survival both in dialysis and in transplantation, all the other expectations of high-tech replacement have tended to be disappointing. As a multidisciplinary reality, renal replacement therapy still requires the integration of various sciences. Results so far achieved have shown the discrepancy between expectations and results, and indicated the way to follow to make the treatment biologically closer to man and physiologically closer to the organ.

Animals↗
PubMed2000

HAART and medical management: the realities of clinical care. Interview with Keith Henry, M.D. Interview by John S. James.

In many outpatient HIV clinics the medical staff is so poorly funded that over 95% of the cost of patient care goes to drugs and laboratory tests--and less than 5% to physicians, nurses, other staff, clinic overhead, medical records, patient education, adherence monitoring, and other costs of care. This misdirection of resources results in patients not receiving the professional time and attention they need, and drug being taken incorrectly, leading to unnecessary drug failure and other medical problems. Keith Henry, M.D., who recently called for more cautious use of antiretroviral therapy, describes the realities of inadequate funding for medical care, and some needed steps for improvement. Also, we asked him to explain how his clinic has consistently performed leading-edge research without the major funding usually available at research institutions.

Antiretroviral Therapy, Highly Active↗
PubMedDate not supplied

Early dialysis in heart insufficiency of patients with chronic renal failure.

In patients with severe heart failure life expectancy is short, the quality of life is affected, and the service costs are very high. Drug therapies remain restricted despite continuous clinical research. Therefore new therapeutic approaches have been attempted to improve the signs and symptoms of the disorder. In our study we followed patients suffering from class-IV cardiac failure concomitant with chronic renal failure. The patients were initially treated by means of hemofiltration, and subsequently they underwent a personalized dialysis program. The survival rate after 2 years was 62.5%. In 7 of the 8 patients the results revealed a drop to a class-III condition. The hospitalization period was limited to a few days. Early dialytic therapy represents a reality for such patients.

Aged↗
PubMed1994

Issues of social policy and ethics in gene technology.

Technical developments in the last ten years have made possible mapping and sequencing of the entire human genome, along with the possibility of treating genetic disorders by manipulating DNA. A variety of issues regarding potential uses and abuses of these technologies have become apparent. They relate to both genetic screening and gene therapy. Problems facing individuals and their families mostly revolve around rights of self-determination and of confidentiality. Health care professionals will need to design optimal systems to provide genetic counseling and to protect confidentiality of DNA data bases. Society and social institutions will need to develop policies and laws that protect the privacy of individuals whose DNA is stored in data banks. Patenting of the results of gene research remains controversial internationally. Moreover, there is concern in many quarters about society's potential abuse of gene technology for eugenic purposes. Gene therapy is now a reality. There is little disagreement on the use of gene therapy to treat genetic diseases in individuals by somatic cell therapy. There is much controversy, however, over the use of germ-line cell therapy. Gene technology has contributed to the growth among a small group of influential people of the Post-Modern Movement, which is strongly antiscience and antitechnology. This movement may pose a long-term threat to future technological advances and should not be ignored. There is much outside of the laboratory that scientists, particularly molecular biologists, can do to assure a secure place for science and technology in our culture.

Ethics, Medical↗
PubMed2006

[Regenerative therapy in cardiology: how distant is it from reality?].

During acute myocardial infarction, ischemia causes progressive loss of contractile tissue. Subsequently, structural changes lead to left ventricular remodeling finally resulting in the development of heart failure. In addition to an optimal reperfusion and pharmacologinal post-infarction therapy, increased neovascularization and regeneration of cardiomyocytes could reduce or even abolish the ongoing left ventricular remodeling processes within the infarct area. Experimental studies have demonstrated that transplantation of adult progenitor cells leads to increased neovascularization, reduced fibrosis and, therefore, increased left ventricular function after acute myocardial infarction. In contrast to current treatment strategies, progenitor cell therapy offers a new regenerative approach for myocardial tissue. Initial clinical studies have demonstrated, apart from safety and feasibility of intracoronary infusion of adult autologous progenitor cells, a significant improvement of left ventricular function, geometry and vascularization in patients with acute myocardial infarction receiving intracoronary infusion of progenitor cells. However, in patients with chronic ischemic cardiomyopathy, the improvement in contractility is less pronounced. Finally, whether intracoronary infusion of adult progenitor cells can also reduce morbidity and mortality due to heart failure, remains to be investigated.

Adult Stem Cells↗
PubMed2000

Future developments in the treatment of end-stage renal disease: a North American perspective.

New technology for the treatment of end-stage renal disease will need to be pharmacoeconomically persuasive in reducing the life-cost of treatment to obtain entry into the market. Increased automation, with closed-loop sensing technology, will occur in the near term. Clearance-based terminology for quantifying performance of equipment will give way to direct quantification of toxin removal. Experiments on the frequency and duration of treatment will redefine what is considered to be adequate therapy in terms other than simple urea removal. Near-term changes in current vascular access technology will be driven by the current cost of access failure. Automated peritoneal dialysis will displace continuous ambulatory peritoneal dialysis, and online compounding of solution for use is likely for both hemodialysis and peritoneal dialysis. In a longer time frame these technologies will merge. Xenografting from the pig will be a reality, and gene therapy of the mesothelium will provide a more user-friendly therapy for end-stage renal disease.

Cost Control↗
PubMed1985

Day Center experience in rehabilitation of craniocerebral injured patients.

The Day Center for head-injured patients specialises in treating patients at later stages following brain trauma. The goal of therapy is social reintegration as measured by the quality of family and social life and by actual occupational status. At this later stage, a year or more since injury, the cognitive and behavioral aspects of brain damage determine the outcome of rehabilitation. The therapy aims at preserving as well as improving patients' overall performance including family life and therefore their families are treated as well. As the patients are not hospitalised at this stage, the asset of this model is that it constitutes an arresting factor in preventing regressive attitudes acquired during hospitalisation which is a sheltered framework. The Day Center System encourages the patients to cope "in vivo" with reality, while the therapy given strives at providing them with the instruments needed for coping in actual life situations. We present here our experience in 38 patients admitted consecutively during the course of a year. The results show that the therapeutic milieu was of great help in preserving as well as improvement patients' performance; furthermore, it is evident that some improvement was achieved even after several years post trauma.

Adolescent↗
PubMed1999

The use of PC based VR in clinical medicine: the VREPAR projects.

Virtual reality (VR) is an emerging technology that alters the way individuals interact with computers: a 3D computer-generated environment in which a person can move about and interact as if he actually was inside it. Given to the high computational power required to create virtual environments, these are usually developed on expensive high-end workstations. However, the significant advances in PC hardware that have been made over the last three years, are making PC-based VR a possible solution for clinical assessment and therapy. VREPAR - Virtual Reality Environments for Psychoneurophysiological Assessment and Rehabilitation - are two European Community funded projects (Telematics for health - HC 1053/HC 1055 - http://www.psicologia.net) that are trying to develop a modular PC-based virtual reality system for the medical market. The paper describes the rationale of the developed modules and the preliminary results obtained.

Cerebrovascular Disorders↗
PubMed2003

A virtual reality environment for evaluation of a daily living skill in brain injury rehabilitation: reliability and validity.

OBJECTIVE: To establish the stability and validity of information collected in a virtual reality environment from persons with traumatic brain injury (TBI). DESIGN: Prospective correlation design to examine 3-week test-retest results for equivalence reliability between computer-simulated and natural environments. SETTING: A residential rehabilitation center for brain injury. PARTICIPANTS: Fifty-four consecutive patients with TBI who received comprehensive rehabilitation services and who were at different stages of recovery. INTERVENTION: An immersive virtual kitchen was developed in which a meal preparation task involving multiple steps was performed. The subjects completed meal preparation both in a virtual reality kitchen and an actual kitchen twice over a 3-week period. MAIN OUTCOME MEASURES: Time and errors on task completion using virtual reality assessment, actual kitchen performance (analogous to the virtual reality environment), occupational therapy (OT) evaluation, and neuropsychologic tests. RESULTS: The stability of performance using the simulated virtual environment was estimated with intraclass correlation coefficients (ICCs). The ICC value for total performance, based on all steps involved in the meal preparation task, was.76 (P<.01). The construct validity of the simulated environment was examined by correlating performance in the virtual environment with that in the actual kitchen (r=.63, P<.01), the OT evaluation (r=.30, P=.05 for meal preparation; r=.40, P=.01 for cognitive subskills), and neuropsychologic tests (r=.56, P<.01 for the full-scale intelligence quotient [IQ]; r=.40, P<.01 for the verbal IQ; r=.56, P<.01 for the performance IQ). Finally, a multiple regression analysis revealed that the virtual reality environment test was a good predictor for the actual assessment kitchen (beta=.35, P=.01). CONCLUSION: The virtual reality system showed adequate reliability and validity as a method of assessment in persons with brain injury.

Adolescent↗
PubMed1998

Experiential cognitive therapy: a VR based approach for the assessment and treatment of eating disorders.

Even if there has been significant progress in research on eating disorders, little empirical work has been done yet to specify the content of clinical guidelines and to validate their efficacy in treatment. In particular there are at least three themes that are somehow neglected by current guidelines: body experience disturbances, motivation for change and the integration between the different approaches used. This chapter details the characteristics of the Experiential Cognitive Therapy (ECT), an integrated approach ranging from cognitive-behavioral therapy to virtual reality (VR) sessions. In particular, using VR, ECT is able to address both body experience disturbances and motivation for change. In the chapter a description of all the phases of this approach are offered by using an actual clinical case: a 22-year old female anorectic patient.

Adult↗
PubMed2006

Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games.

Buying or creating a virtual reality (VR) software is very costly. A less expensive alternative could be to modify already existing 3D computer games. The goal of this study is to assess the effectiveness of in virtuo exposure in the treatment of arachnophobia using modified 3D games. Participants were 10 women and 1 man. Virtual worlds were created using the game editor of a 3D computer game (Half-Life), modified to offer graduals hierarchies of fearful stimuli (spiders). Analyses revealed significant improvement between pre and post results on the behavioral avoidance test, the Spider Beliefs Questionnaire, and perceived self-efficacy. These promising results suggest that therapy using virtual reality exposure via a modified computer game is useful in the treatment of arachnophobia.

Adult↗
PubMed1994

Systemic targeting of liposome-encapsulated immunomodulators to macrophages for treatment of cancer metastasis.

The therapy of cancer is, in reality, the design of therapeutic strategies for therapy of metastatic disease. Metastases consist of unique subpopulations of tumor cells that are derived from the primary tumor, colonize distant target organs, and are able to subvert host immune responses, establish necessary angiogenesis, and obtain a sufficient nutrient supply while evolving to become autonomous from homeostatic mechanisms that function within normal, differentiated tissues. Attempts at eradication of metastases by conventional therapies have generally been unsuccessful due to genetic instability and heterogeneity of metastatic tumors; these properties lead to the emergence of tumor cells that are resistant to most conventional treatments. It may be possible to circumvent this heterogeneity by the activation of tissue macrophages to the tumoricidal state. Activated macrophages are able to kill tumor cells while sparing normal tissues, and efficient activation can be achieved by encapsulation of synthetic muramyl tripeptide analogues into multilamellar vesicles composed of phospholipids. Systemic administration of these liposome-encapsulated compounds leads to tumoricidal activation of alveolar and peritoneal macrophages and eradication of established tumor metastasis in numerous animal tumor models, and this form of therapy is enhanced by combination with parenteral administration of cytokines. Phase III clinical trials of recurrent osteosarcoma are currently in progress. Modulation of the tumor microenvironment by activated macrophages may prove to be an additional modality in treatment strategies that combine the use of biological response modifiers with conventional therapies.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed2006

Motor learning: its relevance to stroke recovery and neurorehabilitation.

PURPOSE OF REVIEW: Much of neurorehabilitation rests on the assumption that patients can improve with practice. This review will focus on arm movements and address the following questions: (i) What is motor learning? (ii) Do patients with hemiparesis have a learning deficit? (iii) Is recovery after injury a form of motor learning? (iv) Are approaches based on motor learning principles useful for rehabilitation? RECENT FINDINGS: Motor learning can be broken into kinematic and dynamic components. Studies in healthy subjects suggest that retention of motor learning is best accomplished with variable training schedules. Animal models and functional imaging in humans show that the mature brain can undergo plastic changes during both learning and recovery. Quantitative motor control approaches allow differentiation between compensation and true recovery, although both improve with practice. Several promising new rehabilitation approaches are based on theories of motor learning. These include impairment oriented-training (IOT), constraint-induced movement therapy (CIMT), electromyogram (EMG)-triggered neuromuscular stimulation, robotic interactive therapy and virtual reality (VR). SUMMARY: Motor learning mechanisms are operative during spontaneous stroke recovery and interact with rehabilitative training. For optimal results, rehabilitation techniques should be geared towards patients' specific motor deficits and possibly combined, for example, CIMT with VR. Two critical questions that should always be asked of a rehabilitation technique are whether gains persist for a significant period after training and whether they generalize to untrained tasks.

Electric Stimulation Therapy↗
PubMed2002

The importance of drug interactions in epilepsy therapy.

Long-term antiepileptic drug (AED) therapy is the reality for the majority of patients diagnosed with epilepsy. One AED will usually be sufficient to control seizures effectively, but a significant proportion of patients will need to receive a multiple AED regimen. Furthermore, polytherapy may be necessary for the treatment of concomitant disease. The fact that over-the-counter drugs and nutritional supplements are increasingly being self-administered by patients also must be considered. Therefore the probability of patients with epilepsy experiencing drug interactions is high, particularly with the traditional AEDs, which are highly prone to drug interactions. Physicians prescribing AEDs to patients with epilepsy must, therefore, be aware of the potential for drug interactions and the effects (pharmacokinetic and pharmacodynamic) that can occur both during combination therapy and on drug discontinuation. Although pharmacokinetic interactions are numerous and well described, pharmacodynamic interactions are few and usually concluded by default. Perhaps the most clinically significant pharmacodynamic interaction is that of lamotrigine (LTG) and valproic acid (VPA); these drugs exhibit synergistic efficacy when coadministered in patients with refractory partial and generalised seizures. Hepatic metabolism is often the target for pharmacokinetic drug interactions, and enzyme-inducing drugs such as phenytoin (PHT), phenobarbitone (PB), and carbamazepine (CBZ) will readily enhance the metabolism of other AEDs [e.g., LTG, topiramate (TPM), and tiagabine (TGB)]. The enzyme-inducing AEDs also enhance the metabolism of many other drugs (e.g., oral contraceptives, antidepressants, and warfarin) so that therapeutic efficacy of coadministered drugs is lost unless the dosage is increased. VPA inhibits the metabolism of PB and LTG, resulting in an elevation in the plasma concentrations of the inhibited drugs and consequently an increased risk of toxicity. The inhibition of the metabolism of CBZ by VPA results in an elevation of the metabolite CBZ-epoxide, which also increases the risk of toxicity. Other examples include the inhibition of PHT and CBZ metabolism by cimetidine and CBZ metabolism by erythromycin. In recent years, a more rational approach has been taken with regard to metabolic drug interactions because of our enhanced understanding of the cytochrome P450 system that is responsible for the metabolism of many drugs, including AEDs. The review briefly discusses the mechanisms of drug interactions and then proceeds to highlight some of the more clinically relevant drug interactions between AEDs and between AEDs and non-AEDs. Understanding the fundamental principles that contribute to a drug interaction may help the physician to better anticipate a drug interaction and allow a graded and planned therapeutic response and, therefore, help to enhance the management of patients with epilepsy who may require treatment with polytherapy regimens.

Anticonvulsants↗
PubMed1992

Multiple modality treatment of carcinoma cells with Pt(Rh-123)2 plus x-ray plus light.

A complex of platinum tetrachloride with two molecules of rhodamine-123 (Rh-123), Pt(Rh-123)2, has been reported to act as hypoxic cell radiosensitizer of carcinoma cells in vitro and in vivo. In the present paper we report that Pt(Rh-123)2 photosensitizes human mammary carcinoma (MCF-7) cells and cis-platinum resistant human mammary carcinoma (MCF-7/CP) cells to 400-800 nm light in vitro. The efficiency of photosensitization by Pt(Rh-123)2 was 10 times greater than for Rh-123. Combination therapy using Pt(Rh-123)2 plus x-ray plus light was also much more effective compared to the combination therapy using Rh-123 plus x-ray plus light. After 15 microM of Rh-123 plus x-ray (0-8 Gy) plus light (5 J/cm2) treatment, cell survival curve was parallel to the x-ray cell survival curve with an initial decrease in the surviving fraction corresponding to the drug plus light mediated killing. Cell killing caused by Rh-123 (15 microM) plus x-ray (0-8 Gy) plus light (5 J/cm2) was additive as determined by the product of the surviving fraction after Rh-123 plus light and x-ray. In contrast, for 15 microM of Pt(Rh-123)2 plus x-ray (8 Gy) plus light (5 J/cm2) treatment, whereas additive killing predicts a survival fraction of approximately 0.024, in reality, the combination therapy caused the survival fraction to decrease to 0.0012, implying that the cell killing was enhanced by a factor of 20. Using Pt(Rh-123)2 plus x-ray plus light, supra-additive cell killing was also observed under hypoxic conditions, although compared to normally oxygenated conditions the degree of cytotoxicity was significantly reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed2002

Recipient selection in cardiac transplantation: contraindications and risk factors for mortality.

Currently the only acknowledged, definitive treatment for refractory heart failure is heart transplantation (HTx). During the past 10 years, selection criteria for heart transplant recipients have been developed that use an analysis of risk factors associated with mortality, which were identified by consensus opinion and by single-center and multi-center database review. A number of other studies also have been designed to evaluate specific risk factors for transplant such as advanced age, diabetes, and sex. This review identifies variables that continue to provoke controversy during the candidate selection process or variables that have changed from absolute to relative contraindications for HTx. Clinicians may use the data summarized in this review as a guide to making decisions about patient candidacy for HTx. One could conclude from this analysis that a more formalized and objective scale to select patients and to assess risk of death after HTx is necessary. Moreover, as alternative therapies to HTx become reality, a better instrument for triaging patients to one form of therapy or another may be necessary.

Age Factors↗
PubMed2004

What is a cure and how do we get there?

The absence of adequate treatment for most of the world's 400 000 individuals with haemophilia makes the development of a cure compelling. Advances in the basic molecular sciences over the past 20 years have resulted in the feasibility of curing haemophilia through the application of gene therapy. However, the reality of this therapeutic strategy is highly complex. In addition, challenges to achieving a cure exist beyond the basic scientific hurdles. Thoughtful attention must also be given to a number of interrelated issues, including ethical considerations in patient recruitment, informed consent and geographical variables of global clinical trials. The global inequalities in healthcare mean that the ethics of international medical research, especially when it includes countries where people usually do not receive quality care, become much more complicated. The majority of haemophiliacs lives in developing countries and is a valuable resource of human subjects who could be enrolled in clinical trials. When recruiting subjects globally, investigators must be ever mindful that the patient population is a precious resource, which must be treated with respect and care. This presents a major challenge for investigators engaged in trials of haemophilia gene therapy to ensure that the informed consent process is current and comprehensive, that therapeutic misconceptions are appropriately managed, and that the roles of the researcher and physician are clear. Global clinical gene-therapy trials are an important and appropriate component in the quest to achieve a cure for haemophilia. When trials follow identical internationally accepted standards, a successful outcome can be achieved for trials including developing countries, if country specific cultural and economic aspects are considered.

Clinical Trials as Topic↗