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PubMedDate not supplied

Cytology screening program in an urban and rural community in India. Review of a ten-year experience.

An approach to the detection and management of early cervical cancer and its precursors utilizing basic and inexpensive equipment and a team of workers comprising physicians, cytotechnicians and social workers in an urban and rural community in India is described. In the ten-year period from 1970 to 1979, a total of 26,217 patients had Papanicolaou smears taken; 104 patients had histologically proven carcinoma in situ or microinvasive cancer of the cervix in which the clinical findings at the time of cell study did not indicate malignancy. The policy of management based on judicial conservatism and essential radicalism gave good survival rates and minimum morbidity.

Carcinoma in Situ↗
PubMedDate not supplied

[Comparative x-ray diffraction study of the crystalline lens in a number of vertebrates including man].

X-ray diffraction method has been applied for comparative investigation of native structure of eye lens proteins (crystallins). X-ray diffraction patterns of the whole lenses and/or their nuclear parts were obtained for man and vertebrate animals. Crystalline lenses of the fishes Acerina cernua and Pelmatochromis kribensis, frog Rana temporaria, bull and man contain crystallins with a very similar secondary and tertiary structure, whereas lenses of chicks and the tortoise Testudo horsfieldi contain mainly crystallins with other structure. The results obtained reveal evolutionary conservatism of crystallin structure in fishes, amphibians and mammals. It was also concluded that there is no correlation between crystallin structure of the lens, elasticity of the latter and accommodation mechanism.

Accommodation, Ocular↗
PubMed1983

Surgery in the aged.

The ageing process has changed little since the days of the psalmist. The number of elderly patients, however, is increasing. Old people seem more reluctant to undergo surgery than younger patients and more concerned with quality of life. The authors conducted a survey in a small community in British Columbia to determine the attitudes of old people towards surgery. The survey confirmed that they are reluctant to undergo surgery if there is an appreciable risk that they will be physically or mentally impaired afterwards. A substantial number also do not wish to undergo complicated procedures to prolong their lives. Quality of life and conservatism should be important considerations in the surgical management of elderly patients.

Aged↗
PubMedDate not supplied

[Action of dioxidine on the membrane apparatus of the bacterial cell].

A study of dioxydine effect on the membrane apparatus of Staphylococcus aureus 209 P and Micrococcus lysodeikticus revealed a decrease in the dehydrogenase activity of membrane preparations and in the specific concentration of cytochromes, if cells had been cultivated in a medium with subbacteriostatic concentrations of dioxydine. The total activity of the respiratory chain was slightly decreased. Conservatism of the membrane apparatus of the bacteria studied was demonstrated.

Anti-Bacterial Agents↗
PubMed1983

Symptomatic hemifacial spasm: case report and review of literature.

The purpose of this article is to discuss a case of hemifacial spasm due to a fusiform basilar aneurysm. The hemifacial spasm was successfully treated by decompression of the facial nerve in the facial canal 14 months before death due to aneurysmal rupture. The literature on symptomatic hemifacial spasm is reviewed, the pathophysiology discussed and the therapeutic options presented. Since the pathophysiology is poorly understood, conservatism is recommended.

Basilar Artery↗
PubMed1978

Skeletal metastases of melanoma.

Sixteen hundred and seventy-seven melanoma patients were treated at Duke University Medical Center from 1956 to 1976. Osseous metastases were more common than previously reported and occurred in 116 patients (6.9 per cent), most often in the axial skeleton. Diagnosis was made by roentgenogram, bone scan, or both in the symptomatic patient. Seventy-five patients sustained pathological fractures, most of which were successfully treated conservatively. Nine of the ten patients with neurological symptoms were improved by laminectomy. The grave prognosis for melanoma patients with osseous metastases (mean survival, 3.6 months) led to conservatism even for an impending pathological fracture. Unstable pathological fractures of long bones were treated by internal fixation and irradiation.

Adult↗
PubMed1983

General principles of antimicrobial therapy.

The initial treatment of suspected life-threatening bacterial infection should be sufficiently broad to cover the likely causative agents. Definitive therapy depends on microbial isolation, identification, and, when indicated, in vitro susceptibility tests. Parenteral therapy should be used, at least initially, and optimal doses are necessary. The dose is particularly important when aminoglycosides are administered; a concern for potential side effects with use of these agents had engendered a tendency to administer inadequate doses. The problems leading to recurrence or persistence of fever during antimicrobial therapy include failure to diagnose and drain abscesses, superinfection, drug fever, and clinical or microbiologic errors. Combinations of antibiotics are indicated in severe infections due to Pseudomonas aeruginosa, enterococcal group D streptococci, and Cryptococcus neoformans. Laboratory assistance for the selection of antimicrobial therapy can be valuable but is not always necessary because certain microorganisms--for example, Streptococcus pneumoniae and S. pyogenes--have stable, predictable susceptibilities. Cautious conservatism is advocated with regard to the use of new antimicrobial agents.

Anti-Bacterial Agents↗
PubMed1981

[The aorto-coronary by-pass. Personal clinical experience (author's transl)].

The surgical treatment of coronary artery disease still remains controversial, despite the fact that the surgical indications are widely recognized and so the efficacy of the aortocoronary bypass in relieving angina and in improving the prognosis of the patients with left mainstem lesions. However, one gets the impression that the criteria for surgery not always are correctly applied, with the consequence that the bypass is often performed on patients that could still benefit from proper medical treatment. At Groote Schuur Hospital, during the period 1976-78, we have bypassed a total of 395 coronary arteries in 204 patients. All the patients were in NYHA class III and IV. The peculiarity of this rather small series is based on the conservatism of the selection criteria, the operation being offered only to candidates with a very long history of angina uncontrolled by adequate medical treatment. The early mortality rate has been 1.47%, the late mortality rate 3.5% and the perioperative infarction rate 10.8%. All the patients have been followed up for 12-48 months (mean follow up 30.3 months). 80% of the patients returned in class I and 13.5% in class II. 80 out of 112 patients operated during 1976-77 have had routine coronary angiography one year post-surgery: the graft patency rate in this group has been 71%. The majority of the obstructed grafts were related to small vessels of 1 mm in diameter. On the basis of these clinical results we conclude that no controversy is justified once and adequate trial with proper medical treatment has already failed.

Angina Pectoris↗
PubMed1982

[Control of sex cycle functions in sheep using cloprostenol, an analog of prostaglandin F2a].

Studied was the synchronizing effect of the prostaglandin F2a analague - estrumate (ICI, England). with the Tsigai sheep. The investigations included observations on the clinical characteristics of the estrus, determination of the hormonal profile in naturally manifested estrus and in estrus induced with prostaglandin, and the conception rate with the first two successive estrus cycles along with the total conception. Estrumate was used twice ar a 9-day interval in a single dose of 125 mg, with a following programmed artificial insemination at the 48 h and the 72d hour after the second treatment. The conception rate with the first estrus of the ewes of the control and the test group was comparatively low - 41.3 and 30.4 per cent, and with the two successive cycles - 68.5 and 76.8 per cent, respectively. The total conception of the test group was 96.4 per cent as against 87.5 per cent of the control group. The studies on the content and dynamics of the basic hormones taking part in the endocrine regulation of the cycle functions in sheep with naturally manifested estrus and those with prostaglandine-unduced estrus did not show reliable differences in the hormonal profile. It was found that estrumate could successfully be used to synchronized the estrus cycle with the Tsigai sheep - a breed with pronounced conservatism' in the manifestation of cyclic functions.

Animals↗
PubMed1978

Some clinical aspects of geriatric surgery.

The relative frequency of surgical problems in the aged is discussed and some statistics based on experience are given. General rules in the management of the aged are suggested and the situation is analysed with stress on biological age and past influences. The increased importance in surgery of fluid loss as well as shock is discussed. A regimen for fluid replacement therapy is suggested. Problems in history-taking and the investigation of the elderly surgical patient are debated, and the value of ice as an anaesthetic agent for geriatric patients is discussed. Points about postoperative care are made. The problem of emergency surgery in the elderly, with emphasis on conservatism, is set out. The importance of avoiding complications, of reassurance and of optimism is stressed.

Aged↗
PubMed1981

[Therapy of polycystic kidney from the viewpoint of our changed perspective].

Even today the majority of authors stress the need for maximum conservatism in the treatment of polycystic kidneys. Since 1979 the therapeutic principles have been modified in agreement with the suggestions of Pytel. It is claimed that the polycystic lesion of kidneys causes--according to the Goldblatt-effect--hypertension due to the compression of the renal arteries by the cysts. Extirpation of the cysts reduces the compression of the vessels, thus reduction of the high blood pressure and of the pressure atrophy of the parenchyma can be expected. The first results (12 patients) have been promising. The operational method described is believed to be one of the possibilities of treating polycystic kidneys.

Adult↗
PubMed1977

Marsupial immunoglobulins: the distribution and evolution of macropod IgG2, IgG1, IgM and light chain antigenic markers within the sub-class Metatheria.

The distribution within Australian and American marsupials of the heavy and light chain antigenic markers identified by antisera to purified quokka (Setonix brachyurus) immunoglobulins is described. Markers for IgM and IgG2 constant region determinants as well as for light chains were widely distributed in Australian species and were also detected in Didelphis, the American opossum, thus indicating a long-term structural conservatism of some immunoglobulins within the marsupials. More detailed analysis of the distribution of quokka IgG2 determinants by quantitative precipitation and sequential absorption procedures suggested that there had been a gradual and cumulative acquisition of these markers with time. The presence of IgG2 markers in species separated for 130 million years (quokka and opossum) suggested that IgG2 was the ancestral IgG present before the divergence of these separate lines. The origin of IgG1 remains obscure as it appears to be limited to a small group of closely related diprotodont marsupials suggesting a recent origin.

Animals↗
PubMedDate not supplied

[Divergence of repetitive DNA sequences in Echinodermata. I. Comparison of sequences with a high degree of intragenomic divergence].

The molecular DNA-DNA hybridization method was used for comparison of repetitive sequences with a high degree of intragenomic divergence in seven species of echinodermata, representatives of three classes of this type, and also for a representative of the type Annelida. The value of intragenomic divergence was estimated with respect to a thermolabile fraction of repetitive [3H]DNA of Strongylocentrotus intermedius isolated by thermoelution at 70 degrees after reassociation up to C0t=140. The data obtained indicate a significant conservatism of the given fraction: its homologues are present in DNA of all the species studied. Hybridization of the thermolabile fraction of [3H]DNA S. intermedius at C0t=10 and 1000 allowed one to estimate the divergence of sequences in DNA of all the species studied. Hybridization of the thermolabile fraction of [3H]DNA highly repetitive sequences of the given DNA fraction is more appreciable than that of moderately repetitive ones. Intragenomic divergence of moderately repetitive thermolabile sequences is higher than that of highly repetitive sequences both in phylogenetically close and distant species of sea urchins.

Animals↗
PubMed1978

Cryosurgery for cancer.

Cryosurgery has a wide range of uses for the destruction of tumours. Acceptability among dermatologists for the treatment of skin cancer appears high. In the treatment of oral cancer, cryosurgery is not yet widely accepted, but it should be more commonly used for early cancer and in the management of selected problems in therapy. It has established a reasonably firm place in the treatment of prostatic cancer, perhaps because of continued interest in the immunologic benefits, while its use in gynecologic organs is limited to carcinoma in situ or to selected patients with advanced cancer. In all these areas, it has been used with surprisingly good results in selected patients who were high risks under conventional methods of therapy. The trial of cryosurgery in the treatment of bone tumors should prove its efficacy. Today's interest in cryosurgery is consistent with the current trend to conservatism in cancer surgery.

Bone Neoplasms↗
PubMedDate not supplied

Diagnosis of syncytial (lacunar cell-predominant) nodular sclerosing Hodgkin's disease by fine needle aspiration. A case report.

We report a case of syncytial nodular sclerosing Hodgkin's disease diagnosed by fine needle aspiration biopsy. To our knowledge, the cytologic findings of this unusual histologic variant have not been reported previously. We believe this entity represents a serious potential pitfall to the aspiration cytologist who targets lymph nodes. This report describes the cytologic features of syncytial nodular sclerosing Hodgkin's disease and emphasizes the need in general for moderate conservatism in fine needle aspiration biopsy interpretation in patients without a previously documented malignancy. It also demonstrates the superiority of tissue sampling with fine needle aspiration biopsy when compared to incisional biopsy.

Adult↗
PubMed1994

A commentary on the NRC report "Science and judgment in risk assessment".

This article provides a brief overview of the report "Science and Judgment in Risk Assessment," prepared by a Committee of the National Research Council/National Academy of Science in response to a U.S. Environmental Protection Agency request mandated by the Clean Air Act Amendments of 1990 (CAAA-1990). The report critiques EPA's current approaches for characterizing human cancer risks from exposure to chemicals and offers recommendations for the conduct of future cancer risk assessments, especially those required in implementing the CAAA-1990 provisions which are concerned with hazardous air pollutants. The report offers specific recommendations that address the role of default options, data needs, methods and models, uncertainty, variability, and the aggregation of data. A cross-cutting theme of the report is the use of an iterative approach in which screening assessments with limited data and, of necessity, default options used in the absence of specific scientific data may be performed initially followed by subsequent assessments, as needed, in which increasing amounts of data are developed and incorporated. In some instances, the specific data on a given chemical or pollutant source will replace conservative default options used in earlier assignments. The report includes two authored appendices that address issues related to the use of default options and their replacement by specific scientific information. One appendix by Finkel advocates a principle of "plausible conservatism" for choosing and altering default options and in making cancer risk estimates. A second appendix by McClellan and North advocates the full use of scientific information in the risk assessment process. This article gives major attention to the key aspects of the NRC/NAS report, especially those dealing with the use and replacement of default options. The default options and the extent to which the options are replaced with specific science have major impact on the final quantitation of cancer risk for exposure to chemicals.

Air Pollution↗
PubMed1994

Managing the U.S. health care workforce: creating policy amidst uncertainty.

Managing the health care workforce will have important implications for costs, quality, and access. Factors influencing supply include the production of new professionals, their relative effort, and rates of retirement. Demand will depend upon the development of new diseases, new drugs, and technologies, as well as the growth of managed care, which uses fewer physicians, fewer specialists, and more midlevel practitioners. There is a general consensus that there are too many physicians, especially specialists. Reducing the number of residency positions would reduce supply, predominantly by slowing importation of international physicians. Obstacles to workforce reform include a distrust of supply projections, skepticism about governmental planning, conservatism of established institutions, and the reality that some hospitals would lose positions and resources.

Adult↗
PubMed1993

Endoscopic therapy of pancreatic disease.

Endoscopic management of a variety of benign and malignant biliary tract diseases is now a well-established alternative to surgery. Similar techniques are beginning to be applied to the pancreas. Endoscopic therapy is now being utilized in the setting of acute pancreatitis, chronic pancreatitis, complications of pancreatitis, and pancreas divisum. In this review, we will analyze the current state of the art of these exciting new applications of endoscopy. Selection of appropriate candidates for the various treatment modalities appears important for optimal results of therapy. However, definite recommendations are difficult to make because there are few controlled studies, follow-up in most series is brief, and there are no comparison studies of endoscopic versus surgical therapy. At present, conservatism is the appropriate general rule in these therapeutic endeavors.

Acute Disease↗