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PubMed2001

Diazotrophy in Modern Marine Bahamian Stromatolites.

N2 fixation (nitrogenase activity), primary production, and diazotrophic community composition of stromatolite mats from Highborne Cay, Exuma, Bahamas, were examined over a 2-year period (1997-1998). The purpose of the study was to characterize the ecophysiology of N2 fixation in modern marine stromatolites. Microbial mats are an integral surface component of these stromatolites and are hypothesized to have a major role in stromatolite formation and growth. The stromatolite mats contained active photosynthetic and diazotrophic assemblages that exhibited temporal separation of nitrogenase activity (NA) and photosynthesis. Maximal NA was detected at night. Seasonal differences in NA and net O2 production were observed. Photosynthetic activity and the availability of reduced organic carbon appear to be the key determinants of NA. Additions of the de novo protein synthesis inhibitor chloramphenicol did not inhibit NA in March 1998, but greatly inhibited NA in August 1998. Partial sequence analysis of the nifH gene indicates that a broad diversity of diazotrophs may be responsible for NA in the stromatolites.

Journal Article↗
PubMed2004

Modern aspects of mushroom culture technology.

The production and culture of new species of mushrooms is increasing. The breeding of new strains has significantly improved, allowing the use of strains with high yield and resistance to diseases, increasing productivity and diminishing the use of chemicals for pest control. The improvement and development of modern technologies, such as computerized control, automated mushroom harvesting, preparation of compost, production of mushrooms in a non-composted substrate, and new methods of substrate sterilization and spawn preparation, will increase the productivity of mushroom culture. All these aspects are crucial for the production of mushrooms with better flavor, appearance, texture, nutritional qualities, and medicinal properties at low cost. Mushroom culture is a biotechnological process that recycles ligninocellulosic wastes, since mushrooms are food for human consumption and the spent substrate can be used in different ways.

Agaricales↗
PubMed2005

Intestinal anastomoses prior to 1882; a legacy of ingenuity, persistence, and research form a foundation for modern gastrointestinal surgery.

This review describes some of the main intestinal suture and anastomosis techniques up to 1882. The disparity between the great variety of proposed techniques and the paucity of actual clinical application is highlighted. Additionally, the statistical reviews of Rydygier (1881) and Madelung (1882), sources originally written in German and only rarely cited, are compared and analyzed. Historical terminology regarding anastomoses is clarified, and the contribution made by experimental surgery toward the establishment of modern suture technique is discussed. The technique of Philipp Ramdohr (1727) is presented in greater detail.

Anastomosis, Surgical↗
PubMed2006

Education of the modern surgical resident: novel approaches to learning in the era of the 80-hour workweek.

INTRODUCTION: Implementation of the 80-hour work week has resulted in limitations on the hours available for resident education, creating a need for innovative approaches to teach surgical residents successfully. Herein we report the methods and results of an innovative didactic learning program at a large academic surgical residency program. METHODS: Between 2004 and 2005, based on known principles of adult education and innovative learning techniques, a didactic learning program was instituted in a major academic surgery program. The course work consisted of a structured reading program using Schwartz's Textbook of Surgery, with weekly testing and problem-based learning (PBL) groups led by surgical faculty. The residents' progress was assessed by American Board of Surgery In-Training Examination (ABSITE) training scores before and after program implementation. A resident survey was also conducted to assess residents' attitudes toward the new program. Results were reported as a mean, and categoric variables were compared using a paired Student's t-test. RESULTS: During the academic year of the structured reading program, the mean ABSITE score improved by 10% (P=0.02) from the previous year. The postgraduate year 4 class had the largest change, with a score increase of 17% over the previous year's performance (P=0.02). Survey results demonstrated that 64% of the responders agreed that the small-group PBL was preferable for achieving educational goals. Furthermore, 89% of residents responded that the PBL groups improved interaction between residents and faculty members. CONCLUSIONS: An innovative formal learning program based on a major surgical textbook with weekly testing and small group sessions can significantly improve surgical training in the modern era of work-hour restrictions. Furthermore, surgical trainees find this format to be innovative and useful for improving didactic teaching.

General Surgery↗
PubMed2006

Modern laparoscopy and the archery episode in the greatest epic of India: Mahabarata.

The laparoscopic surgeon is trained to acquire advanced skills to perform the complicated laparoscopic surgery of the target tissue in a three-dimensional (3D) space by viewing its two-dimensional (2D) video image. This technique finds its parallel in a very ancient archery episode portrayed in the longest and the greatest Indian epic, Mahabarata. In this epic, Arjuna, the master archer, is required to employ the strategy of aiming at the eye of a target fish rotating above his head by viewing its reflected image below in water; of course, all this to win the hand of a beautiful princess! Arjuna is so trained that he cannot but excel in focusing his attention on his target. A comparative study of the laparoscopic surgeon and the ancient master archer is done in this paper with a view to throwing light on the interesting similarities between the archer and the modern laparoscopic surgeon with respect to training methods, skills, and techniques.

Clinical Competence↗
PubMed2001

Modern anesthetic techniques for thoracic operations.

Continuing advances in anesthesiology enable surgeons to perform more and more complex operations. Nowhere is this relation more important than for the patient undergoing thoracic surgery. Specialized anesthetic techniques including safe lung separation, the maintenance of oxygenation during selective one-lung ventilation, and effective postoperative analgesia allow procedures such as lung volume reduction surgery and lung transplantation to be performed routinely. This paper reviews modern clinical practices in the field of thoracic anesthesia.

Anesthesia↗
PubMed1998

Looking back to the advent of modern endoscopy: 150th birthday of Maximilian Nitze.

This year, 1998, marks the 150th anniversary of the birthday of Maximilian Nitze (1848-1906), a German scientist responsible for the initiation of modern endoscopy: He integrated two of his ideas in the construction of the first functional cystoscope. Nitze realized that the field of view during endoscopy could be enlarged by the use of an optical system, and that the light source should be placed on the tip of the instrument. He presented this cystoscope on October 2, 1877 for the first time, at age 28 years.

Cystoscopes↗
PubMed2004

Modern diagnostics in chronic myeloproliferative diseases (CMPDs).

According to the new WHO classification a group of chronic myeloproliferative diseases (CMPDs) were defined: chronic myeloid leukemia (CML), chronic neutrophilic leukemia (CNL), chronic eosinophilic leukemia and hypereosinophilic syndrome (CEL/HES), polycythemia vera (PV), chronic idiopathic myelofibrosis (with extramedullary hematopoiesis, CIMF), essential thrombocythemia (ET), and so called CMPD/unclassifiable. As clinical features and laboratory findings differ widely between these diseases several diagnostic approaches are mandatory at diagnosis for classification and are needed also for follow up studies, especially for the measurement of minimal residual disease (MRD). We here outline the laboratory set up at diagnosis and during follow up in CMPDs with specific focus on the respective therapeutical consequences. Only by using a comprehensive diagnostic panel including cytomorphology, cytogenetics, and molecular genetic methods establishing the correct diagnosis, optimizing treatment as well as evaluating treatment response is possible in CMPDs today.

Blood Cell Count↗
PubMed2005

Comparison of modern marker proteins in serum and synovial fluid in patients with advanced osteoarthrosis and rheumatoid arthritis.

Numerous studies have focused on the significance of modern marker proteins in the synovial fluid of the knee joint and in the serum both, for osteoarthritis (OA) and rheumatoid arthritis (RA). The relationship between the serum concentrations and the concentrations in the synovial fluid is still unclear. Synovial fluid and serum samples were obtained from 13 patients with advanced OA and from 8 patients with severe RA and concentrations of MMP-1, MMP-3, MMP-13, TIMP-1, COMP and MIA/CD-RAP were determined. All values were normalized against the total protein concentrations. Serum concentrations of MMP-13 in the RA-group were statistically higher than the synovial values (P<0.05). MMP-13 was the only marker protein that revealed distinct higher levels in the serum than in the synovial fluid. The study design allows only conclusions about advanced stages of RA and OA. Longitudinal investigations may provide further information about the value of MMP-13 as a potential marker to monitor the course of RA and OA.

Aged↗
PubMed2002

[Corneal dystrophies in the light of modern molecular genetic research].

Modern methods of molecular genetics have resulted in new insights into the pathogenesis of corneal dystrophies which now require a new classification. Clinical evidence, the results of histopathological and electron-microscopical examinations, especially in cases of recurrence which reflect early disease, and the immunohistochemical analysis of the deposits have already aroused the suspicion that the "old" classification dividing the dystrophies into those of the epithelium, of the so-called anterior membrane, of the stroma and of the endothelium may no longer be adequate. The detection of the BIGH 3 gene which is mainly expressed in the corneal epithelium, and its gene product keratoepithelin, have led to the insight that the so-called anterior membrane dystrophies (Reis-Bücklers, Thiel-Behnke) as well as the more common "classical" stromal dystrophies (granular dystrophies Types I and II, lattice dystrophies Types I and IIIA) are caused by different mutations of the above mentioned BIGH3 gene and are thus to be regarded as epithelial in origin. Lattice dystrophy Type II is part of the Meretoja syndrome, a systemic amyloidosis, and is caused by a mutation of the gelsoline gene on chromosome 9 (9q34). Gelsoline is also predominantly expressed in the corneal epithelium. In addition, the responsible genes, their gene-products and the mutations are known for Meesmann's epithelial dystrophy and for the so-called gelatinous drop-like dystrophy, while in other dystrophies only the location on a certain chromosome can be given, namely: 16q22 for the macular dystrophy, 1p36 for the central crystalline dystrophy of Schnyder and 20p11.2-q11.2 for the congenital hereditary endothelial and for Schlichting's posterior polymorphous dystrophies. As the production rate of new results in molecular genetics is very fast, the proposed new classification can only be of preliminary character.

Chromosome Mapping↗
PubMed2004

Separation of craniopagus twins in the era of modern neuroimaging, interventional neuroradiology, and frameless stereotaxy.

INTRODUCTION: Craniopagus twinning is a rare embryological event occurring in 1 in 2.5 million births. CASE REPORT: We present our recent experience with the separation of total vertical craniopagus twins in the modern era of neuroimaging and interventional neuroradiology. Three-dimensional CT images revealed the twins' heads were axially rotated 30 degrees. MRI showed deficient dura between the brains of the twins, and some sharing of parietal brain tissue. Cerebral angiography showed a dominant arterial circulation of one twin with unilateral middle cerebral artery (MCA) branches feeding the other twin. The twins shared a common superior sagittal sinus in its middle segment where a circular sinus was formed. Prior to surgery, endovascular separation of the twins' arterial and venous circulations was achieved in part using tantalum coils for the MCA feeders in one twin, and balloon occlusion of the anterior superior sagittal sinus of the other. Using the ISG wand intraoperatively, surgery proceeded stepwise and included the circumferential removal of bone and opening of the dura, separation of the twins' brains along leptomeningeal planes, and identification of the major draining veins from the superficial cerebral cortex. DISCUSSION: The separation of craniopagus twins demands a multidisciplinary team approach. Utilizing preoperative neuroendovascular techniques to occlude shared vascular anastomotic channels, complex total vertical craniopagus twins can now be successfully separated in a one-stage procedure.

Child, Preschool↗
PubMedDate not supplied

Modern treatment strategies in medulloblastoma.

Chemotherapy has an important role in the modern treatment of children with medulloblastoma (MB). In patients at high risk, intense chemotherapy should improve the survival rate. In low-risk patients chemotherapy should allow the dose of craniospinal irradiation to be reduced, which in turn should improve the quality of life. In infants under 3 years of age radiotherapy should be delayed, or even replaced by postoperative chemotherapy. Chemotherapy is also necessary to prevent or treat systemic dissemination. The optimal timing of chemotherapy is a focus of contemporary research.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Antenatally diagnosed duplication cyst of the tongue: modern imaging modalities assist perinatal management.

When a foetal abnormality is detected during routine antenatal screening, further information is required in order to plan the remainder of the pregnancy and perinatal management. If a lesion is detected in the foetal mouth or neck, there may be compromise of the foetal airway. The ex-utero intrapartum (EXIT) procedure has recently been developed to allow lifesaving foetal surgery to be performed during delivery of such cases whilst relying on placental support. Detailed antenatal assessment is essential when planning the EXIT procedure, and modern imaging modalities may be implemented. We illustrate this by reporting a rare case of enteric duplication cyst arising from the base of the tongue, which was detected on routine antenatal ultrasound scan. Subsequent imaging using foetal MRI and colour Doppler ultrasound reassured us that the foetal airway was patent, and an EXIT procedure was avoided.

Cysts↗
PubMed2002

Modern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial.

BACKGROUND AND AIMS: Postoperative pain is the most distressing sequela of conventional hemorrhoidectomy. A modern alternative of circumferential mucosectomy has been proposed to reduce the pain in this procedure. PATIENTS AND METHODS: This controlled trial included 80 patients with second to fourth degree hemorrhoidal disease operated on over a 2-year period. The patients were randomly allocated to undergo either the stapled Longo procedure (group 1) or Milligan-Morgan hemorrhoidectomy (group 2) under epidural anesthesia. The operating time, postoperative pain scores at 3, 6, 12, and 24 h, analgesic consumption, hospital stay, and complication rate were recorded. At follow-up the outcome and patient satisfaction were evaluated. RESULTS: The mean operating time in group 1 was shorter than in group 2, postoperative pain scores at all time points and the mean epidural morphine requirement was lower, and mean hospital stay was shorter. The complication rate did not differ (three cases of postoperative bleeding in group 1 and two cases in group. At follow-up no recurrence or complains were recorded except three cases of mild incontinence (one in group 1 and two in group 2). The patients in group 1 (95%) were more satisfied than in group 2 (89%). CONCLUSION: The Longo procedure is thus a simple, safe, and effective method that entails less postoperative pain, more satisfaction, and shorter hospital stay than the standard Milligan-Morgan hemorrhoidectomy.

Anesthesia, Epidural↗
PubMed2006

Leadership characteristics and business management in modern academic surgery.

BACKGROUND: Management skills are necessary to successfully lead a surgical department in future. OBJECTIVE: This article focuses on practical aspects of surgical management, leadership and training. It demonstrates how the implementation of business management concepts changes workflow management and surgical training. METHODS: A systematic Medline search was performed and business management publications were analysed. RESULTS: Neither management nor leadership skills are inborn but acquired. Management is about planning, controlling and putting appropriate structures in place. Leadership is anticipating and coping with change and people, and adopting a visionary stance. More change requires more leadership. Changes in surgery occur with unprecedented speed because of a growing demand for surgical procedures with limited financial resources. Modern leadership and management theories have to be tailored to surgery. It is clear that not all of them are applicable but some of them are essential for surgeons. In business management, common traits of successful leaders include team orientation and communication skills. As the most important character, however, appears to be the emotional intelligence. Novel training concepts for surgeons include on-the-job training and introduction of improved workflow management systems, e.g. the central case management. CONCLUSION: The need for surgeons with advanced skills in business, finance and organisational management is evident and will require systematic and tailored training.

Entrepreneurship↗
PubMed1997

Microsatellite variation and the differentiation of modern humans.

This study presents an analysis of 20 tetranucleotide microsatellites in 16 worldwide human populations representing the major geographic groups. Global Fst values for the 20 microsatellites are indicators of their relative validity as tools in human population genetics. Four different measures of genetic distance (Fst, DSW, delta mu 2 and Rst) have been tested and compared with each other. Neighbor-joining trees have been constructed for all the measures of genetic distance and populations. Measures of genetic distance such as Fst, which does not consider different mutational relationships among alleles and has a known relationship to differentiation by drift, and to some extent DSW, reflect what is known of human evolution, while mutation-based distances such as Rst and delta mu 2 give very different results from those recognized from other sources (genetic or archaeological). When the genetic relationship between human populations is analyzed through allelic frequencies for microsatellites, the choice of distance may be a key issue in the picture obtained of genetic relationships between human populations. The results of the present study suggest that genetic drift played the main role in generating the present distributions of microsatellite alleles and their variation among human populations; the role of mutation must have been less important owing to the time constraint imposed by the small timescale in which most human differentiation has occurred. Moreover, the results support the theory of a recent origin of modern humans, although the existence of strong bottlenecks in the origin of the various human groups seems unlikely.

Analysis of Variance↗
PubMed2005

Potential applications of breath isoprene as a biomarker in modern medicine: a concise overview.

Human breath contains hundreds of trace volatile organic compounds. These volatile substances may be generated in the body or may be absorbed as contaminants from the environment. Some of the endogenous substances are characteristic markers of pathophysiological processes and clinicians are already using breath testing of such substances as an additional non-invasive diagnostic tool for certain diseases. Isoprene, another volatile compound, is formed endogenously in humans, and while the biochemical pathways of biosynthesis and exact origins of isoprene found in human breath have not been elucidated in sufficient depth, its measurement in exhaled breath has been suggested as a non-invasive indicator with diagnostic potential. This test has not yet reached the level of routine clinical methods and is still under development. Breath isoprene levels have been reported to be altered in a number of clinical conditions; however, the physiological meaning of these changes has not been established. Various lines of supportive evidence suggest that isoprene is related to cholesterol biosynthesis. Therefore, breath isoprene measurements could potentially be used for mass screening for lipid disorders and could, at minimum, serve as an additional parameter to complement invasive tests for monitoring the efficacy of lipid-lowering therapy, pharmacological and dietary or lifestyle. As a potentially useful biomarker of mevalonate synthesis in humans, it may have non-invasive applications, not only in metabolic disorders, but possibly also in cancer screening. In the present work, we aim to give a concise overview of breath isoprene, its measurement techniques, problems concerning its physiological meaning, and potential applications as a non-invasive biomarker in modern medicine.

Biomarkers↗
PubMed1997

Genetic detection: the need for psychosocial support in modern cancer prevention.

During recent years the gap between the rapid implementation of new technologies in cancer prevention and the slow development of a complementary psychological framework to conceptualize the transmission of genetic informations to patients has been deplored. Such a framework should include all psychological aspects surrounding the genetic consultation, reaching from the information and education of the general public to the impact of prophylactic surgery. While some of the psychological consequences of modern cancer prevention can not be fully foreseen and have first to be documented and analysed, others can easily be anticipated. The authors will try to outline a psychological framework that could help in facing potential negative effects of these beneficial preventive possibilities.

Adaptation, Psychological↗