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PubMed2000

Immunotherapy in bronchial asthma.

The incidence and prevalence of allergic diseases are constantly increasing in our times. The only etiologic treatments currently available are allergen avoidance and immunotherapy. Many scientific data demonstrate that immunotherapy with allergens is an effective and safe treatment for allergic rhinitis and asthma in adequately selected patients and that it reduces treatment costs for the patients in the long run. Other promising aspects of immunotherapy are its capacity to produce prolonged clinical remissions over time, that it is the only treatment capable of stopping the natural development of the respiratory allergic disease, and the possibility that immunotherapy could avoid evolution to asthma in a significant percent of patients with rhinitis.

Allergens↗

PubMed2001

Differences in body-composition assumptions across ethnic groups: practical consequences.

Body-composition methodologies rely on assumptions that are not constant across ethnic groups. The consequence is that the methods used need to be population specific to guarantee unbiased conclusions. Alternatively, assumption-free methods such as chemical multiple-compartment models or scanning techniques should be used. Adequate and unbiased scientific data on body fat among ethnic population groups are necessary for a better understanding of the aetiology of obesity and its co-morbidities. The World Health Organization cut-off points for underweight, overweight, obesity and fat distribution, now universally defined, may need revision because the relationship between body mass index and body composition, and between indices of fat distribution and the actual amount of visceral fat, differ across ethnic groups. The need for ethnically specific cut-off points for obesity and fat distribution is substantiated, for example, by elevated disease risks at low levels of body mass index in several populations. Properly designed and conducted studies are needed to obtain unbiased information on these topics.

Adipose Tissue↗

PubMedDate not supplied

Early nutritional screening of older adults: review of nutritional support.

Protein-energy malnutrition and its consequences can have considerable impact on the quality of life of the elderly. Healthcare providers working with older adults are challenged to recognize individuals at risk for undernutrition and to initiate early nutritional assessment and intervention strategies to prevent malnutrition. In so doing, they can assist in improving the quality of life for the older adult and decrease healthcare costs associated with serious outcomes of malnutrition. Current knowledge about the nutritional needs of the elderly, definition of malnutrition, age-related risk factors, and causes of malnutrition in the elderly are presented in this article. A practical approach to preventing the occurrence of malnutrition is suggested through the use of a quick and easy nutritional screening assessment tool, the Mini Nutritional Assessment (MNA). Recommendations for specialized nutritional support, as well as its role in wound healing and immune enhancement, are discussed. Where available, scientific data supporting its use are included.

Aged↗

PubMed2002

Patient and family support organization services should be included as part of treatment for the severely mentally ill.

Patient and family support organizations for Axis I disorders have grown exponentially and expanded their services over the past two decades. However, psychiatrists generally have not referred patients and families to these organizations. The goal of this paper is to change clinicians' behavior so that they more commonly include support organization services in treatment plans for patients and families. We performed a literature review focusing on the changing needs of patients and their families as they relate to mental health teams, changes in the family therapy field, and concerns of both healthcare providers and related organizations about referral. Abundant anecdotal evidence and some scientific data suggest that patients and families are satisfied with these support organizations and the services they provide. However, support organizations need clinician referrals in order for their services to be integrated into a multi-modal quality treatment plan to achieve full treatment efficacy.

Journal Article↗

PubMed2005

Podium versus poster publication rates at the Orthopaedic Trauma Association.

Original studies at orthopaedic meetings are presented on the podium and in poster format. Publication of those studies in peer-reviewed journals is the standard of communicating scientific data to colleagues. Investigators of previous studies have reported publication rates, but never differentiated between the modes of presentation. We evaluated the annual meeting of the Orthopaedic Trauma Association from 1994-1998 and found that studies presented on the podium were 1.3 times more likely to be published than those presented in a poster format (67% versus 52%). The mean time to publication was similar, 21.6 months for poster presentations and 24.8 months for podium presentations. Podium presentations were more likely to be published in the Journal of Orthopaedic Trauma, Clinical Orthopaedics and Related Research, and the Journal of Bone and Joint Surgery (American and British editions). Our findings suggest different rates and distribution of publication between podium and poster presentations at an international trauma meeting. These findings should be considered when evaluating studies of interest at the Orthopaedic Trauma Association meeting.

Humans↗

PubMed2006

Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group.

OBJECTIVES: The optimal surgical approach and treatment of unstable thoracolumbar spine injuries are poorly defined owing to a lack of widely accepted level I clinical literature. This lack of evidence-based standards has led to varied practice patterns based on individual surgeon preferences. The purpose of this study was to survey the leaders in the field of spine trauma to define the major characteristics of thoracolumbar injuries that influence their surgical decision making. In the absence of good scientific data, expert consensus opinions may provide surgeons with a practical framework to guide therapy and to conduct future research. METHODS: A panel of 22 leading spinal surgeons from 20 level I trauma centers in seven countries met to discuss the indications for surgical approach selection in unstable thoracolumbar injuries. Injuries were presented to the surgeons in a case scenario survey format. Preferred surgical approaches to the clinical scenarios were tabulated and comments weighed. RESULTS: All members of the panel agreed that three independent characteristics of thoracolumbar injuries carry primary importance in surgical decision making: the injury morphology, the neurologic status of the patient, and the integrity of the posterior ligaments. Six clinical scenarios based on the neurologic status of the patient (intact, incomplete, or complete) and on the status of the posterior ligamentous complex (intact or disrupted) were created, and consensus treatment approaches were described. Additional circumstances capable of altering the treatments were acknowledged. CONCLUSIONS: Decision making for the surgical treatment of thoracolumbar injuries is largely dependent on three patient characteristics: injury morphology, neurologic status, and posterior ligament integrity. A logical and practical decision-making process based on these characteristics may guide treatment even for the most complicated fracture patterns.

Algorithms↗

PubMed2005

Dietary risk factors for rheumatic diseases.

PURPOSE OF REVIEW: Recent scientific data illuminate the dietary link to rheumatic disorders. This review summarizes recently published articles on the dietary link to rheumatoid arthritis, gout, and osteoarthritis. RECENT FINDINGS: A prospective study suggests that higher intakes of meat and total protein as well as lower intakes of fruit, vegetables, and vitamin C are associated with an increased risk of inflammatory polyarthritis or rheumatoid arthritis. Several studies suggest that the Mediterranean-type diet or its main components may have protective effects on the development or severity of rheumatoid arthritis. A recent prospective study investigated several purported dietary factors for gout and confirmed some of the long-standing suspicions (red meats, seafood, beer, and liquor), exonerated others (total protein, wine, and purine-rich vegetables), and also identified potentially new protective factors (dairy products). Recent double-blind, randomized, placebo-controlled studies suggest that antioxidant vitamins (vitamin E, vitamin C, beta-carotene, and retinol) do not halt the progression of symptomatic knee osteoarthritis, as was previously suggested. SUMMARY: Because diet is an unavoidable universal exposure for people, even a small effect that can be achieved by dietary manipulation may produce a large impact on the population's health. As the evidence on the role of dietary factors in rheumatic disorders grows it becomes increasingly important for clinicians and investigators in the field of rheumatology to familiarize themselves with the relevant data and appropriately apply them to clinical and public health practice.

Arthritis↗

PubMed2005

Nutritional care of the obese intensive care unit patient.

PURPOSE OF REVIEW: This review discusses the unique metabolic changes in critically ill obese patients and the challenges in estimating and providing them with nutritional support while in the intensive care unit. It provides some of the scientific data in support of and against hypocaloric, high-protein nutritional support in critically ill obese patients. RECENT FINDINGS: The growing prevalence of obesity worldwide and particularly in the developed countries has resulted in concerns regarding the implementation of effective and specialized nutritional support for critically ill obese patients. The concerns arise from the limited data regarding the obese individual's response to various metabolic stresses, especially trauma and burns. There is continuous debate about the most appropriate method of calculating the critically ill obese patient's basic energy and calorie needs. SUMMARY: Nutritional support of the critically ill obese represents a unique challenge but early administration of protein followed by carbohydrates and finally lipids can result in net protein anabolism and better glycemic control.

Critical Care↗

PubMed2006

Ginseng: is it in the root?

In athletics today, there is no shortage of participants looking for an extra edge in competition. In addition, there is no shortage of nutritional supplements for athletes to use with hopes of reaping ergogenic benefits. Ginseng is and will continue to be one of these supplements consumed by athletes despite little or no scientific data to support its ergogenicity. Multiple different types of ginseng can be consumed; the most studied and most common types are Siberian, Chinese, and American. Although related, each has different active compounds, and likely, different effects on the body. There do not appear to be significant adverse effects when used for short periods, but further studies are needed to confirm this. Similarly, more studies are needed to address the ergogenic potential of ginseng. At this time, ginsengs cannot be recommended to improve athletic performance, but there may be some utility for athletes by preventing viral upper respiratory infection and improving cognition. This review evaluates recently published literature on ginseng use in athletes.

Cognition↗

PubMed2005

Soft tissue management in endodontic surgery.

Modern endodontic surgery involves both root-end preparation and proper sealing of all apical portals of exit. Both components are requirements for mechanical and biological success, but the management of soft tissues becomes increasingly important for an esthetically successful treatment. A healthy appearance of soft tissues plays an important role in the esthetic outcome of periradicular surgery. This is true considering maintenance of attachment levels and regarding the amount of possible recession after surgical procedures. Complete, recession-free and predictable healing of gingival tissue is one important goal of endodontic surgical treatment. A critical review of currently used techniques based on clinical and scientific data reveals great potential for improvements. Possible reasons for scar formation and recession specifically in healthy periodontal conditions requiring surgical endodontic intervention are highlighted. Based on anatomical considerations various incision types are evaluated and recommendations made. Clear understanding of wound closure and tissue-healing patterns call for the use of atraumatic procedures, nonirritating suture materials and adequate suturing techniques. This article gives an overview and guidance for integrating current and new successful flap designs and wound closure methods. The methods described have the intention of maintaining the attachment level and avoiding postoperative recession after surgical endodontic therapy.

Apicoectomy↗

PubMedDate not supplied

Genetics and genomics in practice: the continuum from genetic disease to genetic information in health and disease.

This article reviews how the continuum and gradual shift from genetics (study of genes) to genomics (study of the whole genome) in medicine and public health will require reassessment of the traditional approach to delivery of genetic information, namely genetic services. A more general approach is needed to assess the value-added of genetic information for promoting health and for diagnosing, treating, predicting, and preventing all diseases, not only "genetic diseases." The article also discusses how family history can serve as a bridge from genetics to genomics in practice because it reflects the presence, not only of single-gene disorders, but also of shared genes, shared environments, and complex gene-environment interactions. Because of the expected volume of new genetic information, evidence-based practice should increasingly rely on scientific data on analytic performance of such information, its validity in predicting health outcomes, and its utility in improving health and preventing disease beyond approaches that do not use genetic information.

Environment↗

PubMed2003

A review of the physiology and pharmacology of peripheral (vaginal and clitoral) female genital arousal in the animal model.

PURPOSE: We review contemporary scientific data concerning the physiology and pharmacology of peripheral female genital arousal responses in the animal (rabbit and rat) model. MATERIALS AND METHODS: We reviewed the contemporary literature and our research studies concerning physiology and pharmacology of peripheral genital arousal from 3 experimental animal models, including genital smooth muscle cell culture, genital strip organ bath and in vivo animal model studies. RESULTS: Nitric oxide (NO) appears to be a key pathway mediating clitoral smooth muscle relaxation. In the vagina NO appeared to have a more controversial role in mediating vaginal muscularis smooth muscle relaxation. Vasoactive intestinal polypeptide induced vaginal smooth muscle relaxation. Functional alpha-adrenergic receptors were expressed in the clitoris and vagina, and mediated norepinephrine induced genital smooth muscle contraction. Androgens and estrogens modulated distinct physiological responses in vagina, and androgens facilitated vaginal smooth muscle relaxation. Papaverine hydrochloride, a smooth muscle relaxant, and phentolamine mesylate, an alpha-blocker, administered into the vaginal spongy muscularis layer increased vaginal wall pressure and vaginal blood flow. Sildenafil caused significant increases in genital (clitoral and vaginal) blood flow and vaginal lubrication in intact and ovariectomized animals. This response was more pronounced in animals treated with estradiol, suggesting that the NO cyclic guanosine monophosphate pathway is involved in the physiological mechanism of female genital arousal and that sildenafil facilitates this response in an in vivo animal model. CONCLUSIONS: To achieve improved understanding of the biological aspects of female sexual function, further research is needed in the physiology and pharmacology of peripheral (clitoral and vaginal) genital arousal in the animal model.

Animals↗

PubMed2006

Diagnosis and management of acute diverticulitis.

Although the diagnosis of acute diverticulitis is somewhat standardized, the scientific evidence and basis for treatment has been questioned. For years, medical and surgical management of acute diverticulitis has been based on the theory that more than 2 significant attacks of diverticulitis would lead to the recommendations of surgical resection. This should be questioned and further investigated with prospective randomized trials. Only a small number of well-published articles support the surgical management with good scientific data. Although our ability to take a history and skill of physical examination has not changed, the use of improved technology such as high-speed computerized axial tomography has afforded us the ability to make earlier and more accurate diagnoses. This may further allow us to standardize treatment and study outcomes. The time has come to further investigate and justify this management. It is possible that only the most critical situations may necessitate an operation. Clearly, the age group less than 40 years, as well as the immunocompromised, steroid-dependent, diabetic, and transplant patients, seem to be at greater risk with increased morbidity if not treated early and aggressively. And those individuals who present with perforation or compromised obstruction most likely will continue to need emergent intervention. We should try to set the rules by evidence-based medicine, while remaining within the confines of excellent and cost-effective care.

Acute Disease↗

PubMed2006

Gastrointestinal endoscopy in pregnant and lactating women: emerging standard of care to guide decision-making.

Endoscopic procedures generally are considered to be low-risk modalities, being performed on an on-demand basis in many ambulatory endoscopy centers and hospitals. However, the safety and efficacy of gastrointestinal endoscopy in pregnancy has not been well studied. In pregnancy, the risks to the fetus and mother are numerous and the magnitude of this risk will differ depending on trimester, the disease process being addressed, the underlying health and status of the maternofetal unit, and the nature of the endoscopic intervention being contemplated. Given the difficulties in performing prospective studies in the pregnant patient, these risks have not been well-quantified. Decision-making in practice is at times highly individualized. The obstetrician and endoscopist may therefore need to rely on prudent practice based on personal experience in conjunction with recognized underlying basic principles and consensus guidelines, rather than hard scientific data, to guide decision-making and advising patients. The purpose of this review is to make those caring for pregnant patients aware of the clinical considerations necessary to ensure a successful outcome and to provide guidance with respect to what is now considered to be the standard of care when managing pregnant and lactating patients in whom an endoscopic procedure is being contemplated.

Anti-Bacterial Agents↗

PubMed2006

Perfusion zones of the DIEP flap revisited: a clinical study.

BACKGROUND: The Hartrampf perfusion zones of the lower abdominal flap are generally accepted. They were empirically based on the clinical impression of the perfusion in the first 16 unipedicled transverse rectus abdominis musculocutaneous flaps and have been uncritically adopted for the free transverse rectus abdominis musculocutaneous and the free deep inferior epigastric perforator (DIEP) flap. Scientific data proving the validity of these perfusion zones do not exist. The objective of this study was to evaluate and quantitatively assess the perfusion zones of the DIEP flap. METHODS: In a clinical, prospective study of 15 patients undergoing DIEP flap breast reconstruction, tissue perfusion was intraoperatively assessed using the method of laser-induced fluorescence of indocyanine green. RESULTS: Perfusion of zones I, II, and III was seen 25, 41, and 32 seconds, respectively, after injection, and the perfusion index constituted 76, 25, and 47 percent (median) of normal tissue. Perfusion of zone IV was completely absent in five patients (33 percent); in the remaining patients, it was dramatically decreased (5 percent) and occurred with a delay of 67 seconds. CONCLUSIONS: On the basis of the results of this study, the Hartrampf concept of a centrally perfused skin ellipse with declining perfusion of its peripheral ends is wrong and should be revised. Instead, one should think of the lower abdominal flap as two halves separated by the midline. The ipsilateral half has an axial pattern of perfusion; the contralateral half shows a random-pattern, individually variable blood supply. Therefore, the classic Hartrampf zones should be rearranged, switching zones II and III.

Abdominal Wall↗

PubMed2003

Significant increase in breast conservation in 16 years of trials conducted by the Austrian Breast & Colorectal Cancer Study Group.

OBJECTIVE: To confirm evidence that breast-conserving treatment (BCT) does not impair the prognosis in breast cancer patients as compared to mastectomy and to argue that it be regarded as the treatment of choice in stage I and II disease. SUMMARY BACKGROUND DATA: Scientifically, survival rates in breast cancer have been shown to be stage-dependent, but independent of the extent of surgical breast tissue removal, as long as the resection margins are free of tumor infiltration. METHODS: Between 1984 and 1997, six different trials conducted by the Austrian Breast & Colorectal Cancer Study Group accrued a total of 4,259 women with hormone-responsive disease. The authors selected and compared three patient groups (n = 3,316) according to pathologic stage, age, and the surgical procedure applied. RESULTS: Over this interval, the BCT rate in the premenopausal node-positive subgroup experienced a highly significant increase from 27.2% to 73.2% overall. In the group of postmenopausal node-negative patients, the BCT rate grew significantly by 37.3% to 77.3% in total. With an overall BCT rate growing from 22.5% to 56.8% in postmenopausal node-positive women, those presenting with T1 tumors saw a significant increase from 35.1% to 65.9%. Mortality and local recurrence rates proved stable or even decreased considerably over time and in all subgroups. CONCLUSIONS: The presented outcome of BCT rates, significantly improved over this 16-year period and in no way counterbalanced by higher local recurrence or death rates, reflects an excellent example of surgical quality control. BCT can safely be regarded as the standard of therapy for T1 and increasingly for T2 disease. Especially in multi-institutional adjuvant breast cancer trials, the highest priority should be given to breast-conserving procedures.

Aged↗

PubMed2005

Approach to communicating with patients about the use of nutritional supplements in cancer care.

In recent years, complementary and alternative medicine has become popular among the general population in the Western world. Cancer patients have joined this global trend, often seeking supplements to conventional oncologic care, usually without their physicians' knowledge. Among the most common forms of complementary and alternative medicine used by cancer patients are natural products such as herbs and megavitamins. The extensive use of nutritional supplements by cancer patients raises multiple questions and challenges for the physician. Since there are limited scientific data on the efficacy and safety of many nutritional supplements, advising patients about when to use them during the course of illness is difficult. This is true for each stage of cancer care: prevention, acute active care (radiation, chemotherapy, surgery), and post-acute care (follow-up visits and prevention of recurrence). The authors describe a patient-centered approach to the use of nutritional supplements in cancer care.

Combined Modality Therapy↗

PubMed2002

The role of high density lipoproteins in thrombosis.

Lipids and lipoproteins, as well as factors involved in hemostasis and thrombosis, play a central role in the pathogenesis of cardio- and cerebrovascular disease. In recent years it has become clear that a strong association exists between coagulation factors and plasma lipoproteins. Anionic phospholipids are necessary for the optimal activity of both pro- and anticoagulant enzymatic complexes. Cell membranes have traditionally been considered to provide the essential lipid-containing surfaces. However, in light of recent studies, plasma lipoproteins are also believed to provide appropriate surfaces to support coagulation. While triglyceride-rich lipoproteins and oxidized low-density lipoproteins are associated with a procoagulant profile, high-density lipoproteins (HDL) may have an anticoagulant effect. This paper reviews scientific data on the potential role of HDL as modulator of thrombotic processes.

Humans↗