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At least 793 records · Page 44Linked to original sources
PubMed1991

Simple bone cysts. The effects of methylprednisolone on synovial cells in culture.

Ten years ago, a protocol using Depo-Medrol injections was developed for the treatment of unicameral bone cysts. This concept, designed by tumor surgeons and based on theory, has been cautiously approached. However, reproducible results have gradually increased clinical acceptance. Understanding the healing process has been restricted because of the lack of an experimental model. In an attempt to elucidate this mechanism of healing, a cell culture model was used to investigate the effects of methylprednisolone on synovial cells. Initially, three doses of the drug were tested and maximal changes were noted with the concentration of 40 mg/ml. Changes were then quantified by morphology, DNA assay, cell protein analysis, and electron microscopy. Results suggest that methylprednisolone may have a direct effect on the cellular component of unicameral bone cysts.

Bone Cysts↗
PubMed1990

Soluble products of Staphylococcus aureus-stimulated blood mononuclear cells in enhancing polymorphonuclear leukocyte degradation of bone.

Rapid, extensive loss of infected bone implies abnormal localized inflammatory cell activity. We have demonstrated, using a live bone Ca-45 release model, that polymorphonuclear leukocytes degrade bone in a dose dependent manner. Staphylococcus aureus-stimulated blood mononuclear leukocytes release soluble products in vitro that enhance that process. Despite the usually accepted roles of osteoclasts and their blood-borne monocytic precursors in normal bone remodelling, these results indicate that considerable early pathological infected bone loss may be attributable to inflammatory polymorphonuclear leukocytes.

Animals↗
PubMed1990

Carbon-based immunocytochemistry. A new approach to the immunostaining of epoxy-resin-embedded material.

A carbon-based immunocytochemistry (CarBIC) method, whereby the epoxy resin is completely removed from a section prior to immunocytochemistry (IC), is described. The resulting absence of embedding medium allows for an optimal access of both primary antibodies and marker systems to structures at various levels throughout the depth of the section. A carbon film evaporated onto the surface of the section before extraction of the resin forms a base to which the section adheres and maintains structural integrity during subsequent processing. The conventional and accepted electron microscopical (EM) appearance for epoxy-resin-embedded material is regained by re-embedding in Epon before contrasting in the normal manner. The technique is demonstrated using human cytomegalovirus (HCMV)-infected human fibroblasts. HCMV+ serum is the source of primary antibodies and 10-nm protein A-gold (pA-G10) together with rabbit anti-human IgG + IgM is the marker for IC.

Carbon↗
PubMed1990

[Peculiarities of pharmacokinetics in young animals].

In young animals, especially in newborns, absorption, distribution, metabolism and elimination of drugs differ markedly from adults. Respective differences and the cause of these differences are described, including some examples of drug pharmacokinetics in young and adult animals of different species. However, the estimation of pharmacokinetic differences and their pharmacological consequences in young animals is not generally possible, because published data on characteristics of pharmacokinetics in young animals are available only for relatively few drugs. Furthermore, such estimation is complicated by an interaction of different pharmacokinetic processes. Thus, a generally accepted adaptation of dosage schedules for drugs in young animals cannot be offered as yet. In any event, veterinarians should consider the age-dependency of drug pharmacokinetics when drugs, dosages and dosage intervals for treatment of young animals are chosen.

Age Factors↗
PubMed1986

[Comments on the diagnostic criteria of mitral valve prolapse].

Two-dimensional echocardiography has been the reference standard for establishing the clinical diagnosis of mitral valve prolapse. Superior systolic displacement of the mitral leaflets, however, is not necessary abnormal. Whether and at what point leaflet displacement uniquely describes a pathologic process should not be accepted without defining the pattern of normal mitral leaflet motion. One should combine informations from phonocardiograms, Doppler color flow mapping and two-dimensional echocardiograms in an effort to avoid the artifice of using two-dimensional echocardiography as a categoric reference standard and to establish new clinical guidline or criteria that distinguish pathologic mitral valve prolapse from normal superior systolic displacement of the mitral leaflets. Mitral valve prolapse is a dynamic disease that results in varying clinical and morphologic presentations depending upon the degree of structural abnormality. Therefore, clinical and morphologic studies are required in not only severely symptomatic patients but also perfectly asymptomatic patients.

Echocardiography↗
PubMed1984

Protocols and dollars.

A protocol is part of the process which translates a research question into a feasible project. It must be specific and include all relevant circumstances under which the research will be conducted (for example, the patient's age, sex, time of presentation, pre existing conditions) with an appropriate decision about each. As the examples show, preparation of a protocol (Table 2) can be a painstaking process and, even after acceptance by a funding organisation, it might require modification.

Australia↗
PubMed1993

[Evaluation of smoking prevention programs].

To be generalized, preventive or curative health actions must be efficient. Unfortunately, at this moment in France few promoters of anti-smoking actions have tried to demonstrate the efficiency of the programmes they had proposed. Any evaluation aimed at demonstrating the efficacy of a programme (experimental situation) or its routine applicability requires, like all scientific works, formulation of the objectives, choice of the adequate methodology and list of the tools needed for the analysis. Two levels must be evaluated: the process which includes feasibility, acceptability and efficiency, and the results expressed in terms of changes in behaviour and incidence of target diseases. A few actions which have been evaluated include sensitization by the media, therapeutic assistance in withdrawal, education in schools and legal actions; they are commented in this article.

Adolescent↗
PubMed1996

Relaxation and hypnosis in pediatric dental patients.

Relaxation and hypnosis are methods which, may solve the problem of extreme dental anxiety, when all other methods, behavioral or pharmacological may not be used. A simple definition of hypnosis is suggestion and repetition. Suggestion is the process whereby an individual accepts a proposition put to him by another, without having the slightest logical reason for doing so. Relaxation is one method of inducing hypnosis. A case of using hypnosis on an 11-year-old boy is described.

Child↗
PubMedDate not supplied

Cellular and molecular bases of B-cell clonal expansions.

The concept that lymphomagenesis is a multistep process is now widely accepted. Various factors are involved in the development and malignant progression of B-cell lymphoproliferative disorders. The most frequently recognized alterations in these disorders are chromosomal translocations which lead to the activation of proto-oncogenes (c-myc) or genes encoding for proteins involved in the control of the cell cycle (cyclin D1), differentiation (bcl-6) and apoptosis (bcl-2). In addition, genetic changes that inactivate tumor suppressor genes (p53, Rb, p16) have recently been identified. Infectious agents may also play a role in lymphomagenesis either by directly driving B-cell proliferation (EBV) or by inducing a chronic antigenic stimulation (EBV, HCV, HBV, helicobacter pylori). Finally, several data indicate that local cytokine networks and, in particular, autocrine (IL-6, IL-10) and/or paracrine (IL-2, IL-4, IL-6) loops probably play a contributory role in the development and evolution of B-cell lymphoproliferation. In the last few years, the advent of molecular biology techniques has allowed important advances in the definition of the events involved i the earlier phases of lymphoma development. This has been made possible, in particular, by the study of a series of oligoclonal or monoclonal lymphoproliferative disorders characterized by an indolent or "smoldering" clinical course, such as follicular lymphoma and the lymphoproliferation associated with autoimmune diseases, which are at high risk of evolution to a highly malignant lymphoma. In nearly all of these conditions, the clonal B-cells responsible for the early stages of the disease are probably not fully transformed and retain various degrees of responsiveness to a wide variety of microenvironmental stimuli (antigen or autoantigen stimulation, interactions with "reactive" T lymphocytes, local cytokine networks). These latter in turn may induce the regression of pathological lesions, maintain the disease in an active state or contribute to the evolution towards an overtly malignant lymphoma. These findings open new avenues for the design of unconventional strategies of intervention aimed at preventing the malignant evolution of pre-lymphomatous lesions and controlling the clinical course of certain low-grade B-cell lymphomas.

Animals↗
PubMed1996

Writing a surgical paper.

A personal view is presented of the steps required to take a surgical paper from the drawing board to a finished manuscript that will be accepted for publication. The process starts with an appropriate choice of material, followed by selection by the most suitable journal and then slavish attention to its Instruction for Authors. The following order is suggested for writing the manuscript: Methods, Results (including tables and figures), Discussion, Introduction, Summary, References and Title Page. The final stage of correcting, improving and shortening the finished manuscript is probably the most important, and additional contributions by co-authors or other colleagues are especially valuable.

General Surgery↗
PubMed1977

A rationale and method for the sexual history in family practice.

The taking of a sexual history produces a therapeutic effect for the patient by giving the patient permission to be sexual, filling patient knowledge gaps, providing a reality check, and beginning the process of self-acceptance by the patient. The physician's own empathy may seem to interfere with his feeling comfortable while eliciting a sexual history; at the same time the patient may struggle with feelings of shame and embarrassment. The physician can alleviate patient discomfort by being accepting and empathetic, and by assuming the patient has thought, felt, and done everything in the sexual area. He can also help by beginning with general questions, avoiding "why" questions and jargon, and gently reporting inconsistencies.

Attitude of Health Personnel↗
PubMed1996

Relevance and reliability of Ludwig's scientific conceptions of the physiology of the microcirculation.

Modern research into the physiology of the blood circulation has been influenced decisively by Carl Ludwig. His contributions to the special field of microcirculation are typical examples of his scientific mode of thinking, being characterised by exactness and richness of ideas. His demand for a useful division of the complete circulatory system into two parts, namely the intra- and extravascular circulation, has remarkable heuristic value. His ideas concerning the functions of the extravascular space have maintained their validity up to the present day. His conception of the existence of open connections between the interstitial compartments and the inside of the lymphatic vessels was far ahead of contemporary knowledge: the relevant findings and ideas of Ludwig look, in part, like "confirmations" or anticipations of modern investigation results. This is illustrated by corresponding examples. As far as his scientific conceptions are concerned Ludwig was very particular to abstain from admission of any hypothetic throughts into them. The high reliability of his conceptions resulting from this custom is exemplified by comparing his interpretation of fluid and substance exchange in the terminal vessel area with "Starling's law" as the currently accepted explanation of these processes.

Blood Circulation↗
PubMed1997

Selective supplementation of calcaneal ultrasound densitometry with dual-energy x-ray absorptiometry of the spine and femur for population screening.

OBJECTIVE: To determine the limitations on the improvements in the efficacy of screening with ultrasound densitometry of the calcaneus that can be achieved by adding direct-site mineral measurements of the lumbar spine and the femur when the ultrasound t-score is low. SUBJECTS AND METHODS: The author retrospectively analysed data from 2500 women for whom the results of both dual-energy x-ray absorptiometry of the lumbar spine and femur and ultrasonometry of the calcaneus were available. Various ultrasound t-score cut-off values (from 0 to -4.5) were tested to determine changes in sensitivity, specificity, false negatives, false positives and accuracy with and without adding direct-site measurements of the lumbar spine and the femur neck. RESULTS: For this analysis, the addition of direct-site measurement data increases the specificity to 100% for all t-score cut-off values without affecting the sensitivity, thereby improving the accuracy; however, the number of false negatives remains unknown. The number of false negatives decreases as the cut-off value is increased, but with higher cut-off values, greater numbers of subjects would have to be recalled for direct-site measurements of the lumbar spine and the femoral neck, which would entail extra costs. CONCLUSIONS: The accuracy of screening for low mineral content by calcaneal ultrasonometry is improved by recalling subjects for direct-site measurements if their ultrasound t-score falls below some arbitrary value. The cut-off value must be chosen to achieve a balance between the number of missed false negatives that are acceptable in the screening process and the number of subjects recalled for the direct-site study at additional cost. In remote areas, where dual-energy x-ray absorptiometry devices for performing the supplemental measurement are not usually available, the cost of transportation would be another factor.

Adult↗
PubMed1994

Comparative review of bitemark cases from Pretoria, South Africa.

Bitemark evidence has become more scientifically based and is currently widely accepted in the legal process. Bitemarks can be inflicted by humans or animals on humans, animals and a variety of inanimate objects and can be found on any part of the body, with their quality and appearance being influenced by a variety of factors. The purpose of this study was to record the experiences with bitemark cases presented to forensic odontologists at the University of Pretoria from 1983-1993 and to compare them with trends and findings elsewhere. Sixteen cases are presented, of which 14 were bitemarks inflicted by humans and two by dogs. Thirteen cases occurred in human tissues, three in inanimate objects. Of the bitemarks in human skin, most were present on the arms, followed by the face, thorax and back. Bitemarks over the entire body were seen in the two victims bitten by dogs. The male:female ratio was 4:1 and in 46% of cases single marks were present while the rest were multiple. Eight of the victims had been assaulted. Two cases were associated with sexual behaviour (rape), two were inflicted by dogs, and the circumstances surrounding one case were unknown. A variety of factors complicated the investigations. The major factors responsible for disqualifying bitemarks as evidence included mutilation, removal of tissues, inexperience of officials involved and multiple bitemarks. The results of the study confirm the importance of bitemarks as forensic evidence. Humans are the primary victims with the arm being the anatomical site most often involved. Inexperience on the part of the investigating officers and other officials in the handling of these cases strongly emphasises the need for proper training and education of these personnel.

Animals↗
PubMed1996

Ethnicity and morality in a multicultural world.

The choice of moral acts is governed by the unique ethnic and/or cultural meaning and values ascribed to by the individual. In pursuing an "acceptable" moral choice, the process of analysis is further directed by the ethical theories which are molded by time and tempered by the current context to which the action is undertaken. An OPTIMIN MODEL OF ETHICAL-DECISION MAKING PARADIGM is proposed, and health care policy on cultural diversity is adduced.

Adolescent↗
PubMed1998

General practitioner experience of clinical self audit.

OBJECTIVE: To record the experience of 87 general practitioners who undertook a two phase clinical self-audit of their recording of risk factors for cancer and cardiovascular disease and the acceptability of the audit process to them. METHOD: Participants were members of two Victorian Divisions of General Practice, one rural and one metropolitan. Each practitioner completed a clinical self-audit with a pre and post audit questionnaire. The post audit questionnaire was a repeat of the pre audit questionnaire with the addition of specific questions to measure their experience of the audit process. OUTCOME MEASURES: Likert scale and qualitative response. RESULTS: The results indicate that general practitioners thought the process was sound and taught them something about their actual rather than perceived practice, but were wary of sampling techniques and whether the audit reflected the recording of risk factors rather than preventive practice. CONCLUSION: The potential of clinical self audit in Australian general practice is highlighted particularly in the light of Practice Assessment as a compulsory component of vocational registration.

Adult↗
PubMed1994

A method of developing and weighting explicit process of care criteria for quality assessment.

The use of explicit criteria to evaluate how well processes of care conform to accepted standards is a key method of quality assessment. Synthesizing four decades of literature, we devised an inexpensive, 6-step method of developing reliable, content-valid, explicit process criteria. This paper describes the method using a set of congestive heart failure criteria. In step 1 of the Criteria Development Method, criteria are derived from state-of-the-art clinical literature. In step 2, criteria are refined by expert panels. In this study, panelists refined the items by mail in a three-round Delphi process. In step 3, decisions about unit-or differential item weighting are made; we derived differential item weights from the panelists' third-round ratings. Step 4 consists of flagging items which may yield little information, i.e., consensus items of low import, and nonconsensus items. Numeric flags were computed using third-round median ratings and their interquartile ranges. Selection of a scoring method to summarize scores and communicate results is done in step 5. In step 6, chart reviewers are trained, inter-rater reliability is measured, and items with poor reliability are culled. This straightforward developmental method can be used to devise explicit process criteria for use in ambulatory or hospital settings and to evaluate care delivered by different types of providers. The method yields reliable criteria representing accepted standards of current clinical practice. This high content validity is a sine qua non for convergent and predictive validity, both of which must be demonstrated in empirical studies in which the criteria are compared against external yardsticks.

Delphi Technique↗
PubMed1994

Chimerism after whole organ transplantation: its relationship to graft rejection and tolerance induction.

Bone marrow-derived "passenger" leukocytes that normally reside in the interstitial tissues of whole organs migrate into the recipient after transplantation and establish microchimerism. An equally important phenomenon is the reciprocal migration of circulating recipient leukocytes, which repopulate the interstitium of whole organ allografts. This bidirectional exchange and interaction of bone marrow-derived cells after organ transplantation is considered a seminal event in the acceptance of allografts and in the induction of donor-specific tolerance. The apparent dichotomous role of donor cell chimerism in the processes of organ rejection and acceptance is discussed.

Bone Marrow Cells↗