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PubMed2001

NASPE Plenary Lecture 2001. Catheter ablation: a personal perspective.

Catheter ablation for control of cardiac arrhythmias was introduced 20 years ago. Since then, this technique has been applied successfully to virtually all cardiac rhythm disturbances. In this essay, some of the newer applications of ablative techniques for patients with AV nodal reentrant tachycardia, atrial flutter, and atrial fibrillation are emphasized. "AV nodal reentrant tachycardia" may involve a nodofascicular tract. A new classification of atrial flutter is proposed and various causes of atrial fibrillation are discussed.

Animals↗
PubMed2004

Psychiatric epidemiology of old age: the H70 study--the NAPE lecture 2003.

OBJECTIVE: To describe methodological issues and possibilities in the epidemiology of old age psychiatry using data from the H70 study in Göteborg, Sweden. METHOD: A representative sample born during 1901-02 was examined at 70, 75, 79, 81, 83, 85, 87, 90, 92, 95, 97, 99 and 100 years of age, another during 1906-07 was examined at 70 and 79 years of age, and samples born between 1922 and 1930 were examined at 70 years of age. The study includes psychiatric examinations and key informant interviews performed by psychiatrists, physical examinations performed by geriatricians, psychometric testings, blood sampling, computerized tomographies of the brain, cerebrospinal fluid analyses, anthropometric measurements, and psychosocial background factors. RESULTS: Mental disorders are found in approximately 30% of the elderly, but is seldom detected or properly treated. Incidence of depression and dementia increases with age. The relationship between blood pressure and Alzheimer's disease is an example of how cross-sectional and longitudinal studies yield completely different results. Brain imaging is an important tool in epidemiologic studies of the elderly to detect silent cerebrovascular disease and other structural brain changes. The high prevalence of psychotic symptoms is an example of the importance to use several sources of information to detect these symptoms. Dementia should be diagnosed in all types of studies in the elderly, as it influences several outcomes such as mortality, blood pressure, and rates of depression. Suicidal feelings are rare in the elderly and are strongly related to mental disorders. CONCLUSION: Modern epidemiologic studies in population samples should be longitudinal and include assessments of psychosocial risk factors as well as comprehensive sets of biologic markers, such as brain imaging, neurochemical analyses, and genetic information to maximize the contribution that epidemiology can provide to increase our knowledge about the etiology of mental disorders.

Aged↗
PubMed2001

The John Stanley Coulter lecture. The power of compassion and caring in rehabilitation healing.

Rehabilitation of persons with catastrophic illnesses or injuries is a complex, labor-intensive interaction between patients and caregivers. Experiences of overwhelming loss and suffering evoke strong emotions that shape the behavior of both patients and staff during the rehabilitation process. In response to each patient's unique experience, compassion, caring, and other humanistic qualities of the effective caregiver help create a healing environment. Although these qualities are universally accepted as important, they have not been widely studied or critically examined. In recent years, however, there has been a growing interest in use of scientific methods to investigate the impact of "humanistic elements" (ie, complementary and alternative medicine) as therapeutic agents. A review of 7 articles from this literature provides examples of research-based interventions with potential for enhancing outcomes in traditional rehabilitation populations. In today's high-tech impersonal health care system, the use of scientific methods to show that humanistic treatments are effective may represent an important new frontier and opportunity for rehabilitation research.

Complementary Therapies↗
PubMed1999

The Denolin Lecture 1998. Towards measurement of coronary blood flow in patients and its alteration by interventions.

AIM: Several methods of measuring coronary blood flow in intact conscious man are reviewed, on the basis of personal contributions or the experiences of our teams. METHODS AND RESULTS: It is important to distinguish between global, regional and transmural blood flow measurements. The advantages and limitations of the following methods are discussed: diffusible inert and radioactive tracers, dye dilution, roentgendensitometry, magnetic resonance imaging and contrast echocardiography. In interventional cardiology it is most important to be able to measure flow through single coronary vessels. Information on coronary artery Doppler velocity during vasodilation and at rest is less useful than the concept of fractional flow reserve. This is based on pressure measurements under maximal vasodilation to ascertain the presence of borderline flow-limiting lesions. This information is necessary in order to decide whether to proceed with angioplasty or not. CONCLUSIONS: The historical design of percutaneous coronary angioplasty and beta-irradiation of coronary restenosis, established under the author's guidance, are put into perspective. The author pays tribute to many excellent colleagues who worked with him at the Zurich and Geneva University Hospitals.

Angioplasty, Balloon, Coronary↗
PubMed2002

Historical perspective of finger joint motion: the hand-me-downs of our predecessors. The Richard J. Smith Memorial Lecture.

Understanding the mechanics of human dexterity requires an appreciation of the kinetic chains that comprise the hand and the intricate interplay of muscles and ligaments that control its movements. Some of the salient contributions to this field are described from a personal point of view in the hope that this perspective will stimulate further understanding of this unique human tool.

Finger Injuries↗
PubMed2002

Stephen L. Gans overseas lecture. Mass screening for neuroblastoma in Japan: lessons learned and future directions.

BACKGROUND/PURPOSE: Since 1985, a nationwide mass screening program (MS) for neuroblastoma has been conducted for 6-month-old infants throughout Japan, resulting in the detection of more than 1,900 cases of neuroblastoma. The outcome of these patients has been excellent: more than 97% of them are alive. Yet, several reports suggest that the number of advanced-stage neuroblastoma patients over 1 year of age has not changed substantially. The current report focuses on the 15-year experience with MS of the Kyushu Pediatric Oncology Study Group. METHODS: The clinical and biological features of neuroblastoms detected (n = 320) and not detected by MS (n = 245) were compared. Regional and national statistics for neuroblastoma before and after 1985 were analyzed using standard epidemiologic measures for the occurrence of disease. RESULTS: The majority of the MS-positive cases were biologically favorable and had an excellent outcome. In contrast, the majority of non-MS patients in whom neuroblastoma later developed had advanced-stage, unfavorable-prognosis tumors. The overall mortality rate of neuroblastoma in the Kyushu area was not improved by MS. CONCLUSIONS: The optimal time for screening is the point at which neuroblastomas regressing spontaneously can no longer be detected, but more aggressive disease can be found. A birth cohort study could determine the optimal timing for a second screening. Identification of other new prognostic factors may be required.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Adriana and Luisa Castellucci award lecture 1999: role of oxygen in the regulation of trophoblast gene expression and invasion.

Changes in oxygen levels characterize normal and pathological human placentation. For example, relatively low Po(2)values are present around the blastocyst during implantation and in the placenta of the first trimester of pregnancy, a time of maximal trophoblast invasion. Our studies have revealed that low oxygen levels stimulate the in vitro invasiveness of cultured first trimester trophoblasts. This increased invasive ability is linked to elevated expression of some components of the plasminogen activator system and requires the participation of a putative haem protein. As gestation proceeds beyond the first trimester, and the extent of trophoblast invasion decreases, placental oxygen levels rise with a corresponding increase in blood flow. However, during certain pathological conditions, such as pre-eclampsia/intrauterine growth restriction, impaired remodelling of the uterine spiral arterioles leads to vessels with reduced diameters and localized regions of placental ischaemia/hypoxia. Placental hypoxia in the second half of gestation, as a consequence of reduced uteroplacental blood flow, may result in aberrant expression of genes that contribute to the pathophysiology of pre-eclampsia. Some of these genes encode certain cytokines and vasoactive molecules. We have also identified other genes whose expression is regulated by oxygen. Expression of one of them is induced in trophoblast and other cell types cultured under low oxygen levels and the product of the gene is a 43-kDa protein which we have termed PROXY-1. Compared to placental tissues and membranes isolated from uncomplicated pregnancies, PROXY-1 expression is elevated in tissues from pre-eclamptic pregnancies such as chorionic villi of peri-infarct regions, basal plate and membrane decidua, as well as chorion. Overall, these observations suggest that oxygen levels play an important role in placentation and in the pathophysiology of certain complications of pregnancy.

Adult↗