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PubMed2001

Prevention: a psychoanalytic viewpoint.

Psychoanalysis teaches that a symptom should not be regarded as an accident occurring during the development of one individual or another, but basically the effect of his or her "predisposition" to a disorder before any interaction with the environment takes place. Prevention seems to assume the form of a scientific and technical expedient aimed at the optimisation of life and the repression of pain. If it is not possible to prevent dreams, slips of the tongue and other parapraxes, in the same way we cannot prevent the other inventions of the unconscious from which a psychic illness, such as anorexia, bulimia, distortion of or obsession with the body image etc., emerges. The ethics of the unconscious subject does not surrender to the perverse mirages of illness, nor, however, to the normalising appearances of health. It simply claims the right not to be distorted, to be understood, but not made uniform. What could be the form of prevention that those who have chosen to work with the psyche are destined for?

Adolescent↗
PubMed1997

Inclusion bodies and purification of proteins in biologically active forms.

Even though recombinant DNA technology has made possible the production of valuable therapeutic proteins, its accumulation in the host cell as inclusion body poses serious problems in the recovery of functionally active proteins. In the last twenty years, alternative techniques have been evolved to purify biologically active proteins from inclusion bodies. Most of these remain only as inventions and very few are commercially exploited. This review summarizes the developments in isolation, refolding and purification of proteins from inclusion bodies that could be used for vaccine and non-vaccine applications. The second section involves a discussion on inclusion bodies, how they are formed, and their physicochemical properties. In vivo protein folding in Escherichia coli and kinetics of in vitro protein folding are the subjects of the third and fourth sections respectively. The next section covers the recovery of bioactive protein from inclusion bodies: it includes isolation of inclusion body from host cell debris, purification in denatured state alternate refolding techniques, and final purification of active molecules. Since purity and safety are two important issues in therapeutic grade proteins, the following three sections are devoted to immunological and biological characterization of biomolecules, nature, and type of impurities normally encountered, and their detection. Lastly, two case studies are discussed to demonstrate the sequence of process steps involved.

Animals↗
PubMed1998

[Free toe transplantation in reconstructive hand surgery].

Since the invention of microsurgical techniques the free toe-to-hand transplantation is an established method for reconstruction of hand function. The indication for this method following thumb and finger amputations as well as congenital defects with aplasia of the fingers and the thumb is discussed in comparison to alternative operations. The operative technique as well as the functional and aesthetic results that can be expected are described by presentation of clinical cases. Since 1992 we performed 18 free toe-to-hand transplantations for the above mentioned indications. Depending on the primary situation the elementary hand function with grip and pinch could be restored in all our patients using this method. Restoring sensibility next to length, mobility and strength in one operation has to be considered as an advantage compared to alternative methods.

Female↗
PubMed1998

Evolution of substrate specificities in the P-type ATPase superfamily.

P-type ATPases make up a large superfamily of ATP-driven pumps involved in the transmembrane transport of charged substrates. We have performed an analysis of conserved core sequences in 159 P-type ATPases. The various ATPases group together in five major branches according to substrate specificity, and not according to the evolutionary relationship of the parental species, indicating that invention of new substrate specificities is accompanied by abrupt changes in the rate of sequence evolution. A hitherto-unrecognized family of P-type ATPases has been identified that is expected to be represented in all the major phyla of eukarya.

Adenosine Triphosphatases↗
PubMed2000

The historical development of endophotography.

The history of photography starts with the camera of Leonardo da Vinci at around 1500 and the photographic plates by Niepce and Daguerre at the beginning of the nineteenth century. At the same time as those first experiments were being made with photographic plates, the development and study of endoscopy began with the invention of an instrument designed by Phillip Bozzini. Later in that century, Czermak had advanced the technique sufficiently to produce the first endophotograph: his own larynx pictured with a normal camera. Stein then constructed his endocamera with a picture-developing system like the modern Polaroid Land Camera. The definitive step from pioneering experiment to routine application was made by Max Nitze at the end of the nineteenth century with his Photographierkystoskop. Only 50 years later, the quality of color film, and the use of telescopes and light intensity enabled the routine taking of endoscopic pictures. Here the endocorporeal flash and fiberglass light conduction were the decisivecontributions. Hand-colored drawings for scientific use became superfluous and the first photographic atlases were in print from 1960 onwards, thus establishing modern endophotography.

Endoscopes↗
PubMed2001

Treatment of supraventricular tachycardias in the new millennium--drugs or radiofrequency catheter ablation?

UNLABELLED: Supraventricular tachycardias are a cause of significant morbidity in children. Newer anti-arrhythmic drugs and the invention of radiofrequency catheter ablation have revolutionised anti-arrhythmic therapy in children. CONCLUSION: With the availability of these very effective therapeutic options, an improved knowledge of these methods and their indications is required.

Anti-Arrhythmia Agents↗
PubMed2001

Excimer laser coronary angioplasty (ELCA) for diffuse in-stent restenosis: beneficial long-term results after sufficient debulking with a lesion-specific approach using various laser catheters.

Although brachytherapy became frequently used technique for treating in-stent restenosis (ISR) in 2000 (stenosis recurrence: 14-25%), removing the tissue (i.e., debulking) is still under evaluation. Regarding XeCl Excimer laser no randomised trials have been completed so far. The entirely attainable and published data originate from five one-centre and one multicentre registries which showed a high procedural success-(98%) and a very low complication rate (<2%), but heterogeneous results based on (I) manifold laser- and lasing technology due to evolving catheter and lasing technology during the studies and (II) inhomogeneous patient-populations, which had been documented only occasionally, although we now know that ISR-recurrence rates are significantly higher in patients with (1) high grade stenosis (>70%), (2) long lesions (>15mm in length), (3) recurrent ISR. (4) ISR in saphenous vein grafts, (5) early-ISR (<3 months after stent implantation), (6) multi-vessel disease and (7) low ejection fraction. Because all athero-ablative procedures are typically finalised by adjunctive balloon PCI, diameter stenosis before adjunctive PTCA was between 23% and 64%, reflecting the different lasing (and therefor debulking) intensity between the studies. The mean lesion-length, vessel diameter, stent-type and coronary differed significantly between the studies (i.e. mean lesion length between 14 and 32 mm) and although of major influence, the speed of lasing (=ablation) was not recorded in the various studies. Concerning eccentric ELCA the invention of the area-ablation technique provide a significant greater ablation effect and the new OS-technology provide 60% more ablating area. In summary, the feasibility, effectiveness, procedural success and presumably long-term outcome of the Excimer laser for treating ISR depend on multiple outcome-influencing aspects. The lack of recording variables make analysis of various laser-for-ISR trials difficult or even impossible. ELCA seems to have advantageous procedural and long term results in lesions, where aggressive debulking effect using eccentric ELCA catheters can be achieved. The OS-catheter can provide a maximum debulking in distal lesions and tortuous vessels, where the debulking abilities of the eccentric catheter are limited. If laser debulking is inadequate (DS 30%), the incidence of recurrent restenosis appear to be higher and brachytherapy is probably more suitable. Sufficient laser debulking can only be achieved through use of precise technique respecting the laser-specific abilities of plaque dissolution, appropriate energy levels and quantities, and possibly recovery time.

Angioplasty, Laser↗
PubMed2000

Human genetics in health care.

UNLABELLED: The Human Genome Project, the mapping of our 100,000 genes and the sequencing of all of our DNA, will have major impact on biomedical research and the whole of therapeutic and preventive health care. The tracing of genetic diseases to their molecular causes is rapidly expanding diagnostic and preventive options, while the increased insights into molecular pathways open tremendous perspectives for pharmacological and genetic therapies. The design of animal model systems for the functional study of disease and development and the use of bioinformatics and biostatistics to improve our pattern recognition abilities are greatly accelerating progress. However, the optimal value from the current explosion of 'data mining' possibilities will only be gained when the basic data are made and kept publicly accessible, while at the same time safeguarding the protection of intellectual property arising from downstream inventions. This is one of the goals of the international Human Genome Organisation, established 10 years ago to assist coordinating data acquisition and exchange and societal implementation of the genome project. Additional points of major attention in this historic endeavour are the safeguarding of a worldwide balance in the contribution and benefits to countries and populations, the prevention of stigmatisation and discrimination of individuals and groups and the maintenance of respect for the diversity of our world's cultures and traditions. CONCLUSION: The acquisition and use of genomic information for health care benefit should be seen in the light of a worldwide improvement without prejudice.

Ethics, Medical↗
PubMed2002

Differential display technology: a general guide.

The 10 years since the invention of differential display technology (DD) has produced a massive amount of literature detailing problems and improvements to the technique, successful gene expression studies and studies done using genes found through the use of DD. In this review we summarise the results of 10 years of research that has focussed on improving DD and discuss how some of the problems associated with DD can be resolved or minimised. In addition to discussing DD, we address issues related to other differential gene expression analysis techniques and try to illustrate how these techniques can be used to complement one's use of DD. This review also serves as an introduction to the taxa-specific DD review articles that are found in this issue.

Adenosine↗
PubMed2006

[Reconstructive surgery of the aortic valve: the Ross, David, and Yacoub procedures].

The aortic valve consists of three cusps attached to the wall of the aortic root. During the cardiac cycle, the aortic root undergoes complex movements that precede and aid opening and closing of the aortic valve. The aortic valve cusps themselves form thin-walled pocket-like structures, made from specialized tissue with fibrous, elastic, nervous, and muscular properties. The complex interactions of this tissue with the aortic root and within the cardiac cycle are only incompletely understood yet. In summary, the aortic valve is a complex structure which shows a perfect function in systole and diastole and under a wide range of hemodynamic conditions. No valve prosthesis (so far) can keep up with the function of the native aortic valve. Therefore, surgical techniques have been invented that aim at sparing the aortic valve or replacing it with very similar autologous tissue. Besides the resulting (near) normal valve function, one appealing advantage of these techniques is that oral anticoagulation can be abandoned completely. If the valve cusps themselves are normal, but the aortic root is aneurysmatic or dissected (with or without resulting secondary aortic insufficiency), the aortic valve can be spared by resecting the aortic root tissue and replacing it by a vascular graft. The aortic valve can then be implanted into the vascular graft in a way described by David, or can be remodeled into it (Yacoub technique) - in this case, the graft first needs to be incised at its base so that the three commissures of the valve can be sewn into the three incisions. This way pseudosinuses within the vascular graft are created. The sinuses within the aortic root are considered important for aortic valve function and coronary perfusion. On the other hand, incisions at the base of the vascular graft harbor the potential for redilatation of the aortic root because of a missing circular fixation. Such a fixation is achieved by the David technique. Therefore, there is a great debate in the surgical community which valve-sparing technique is the best and numerous modifications of the original techniques exist. A clear clinical advantage of one technique over the other could not be demonstrated so far, but many authorities advise that the David technique is to be used preferentially in patients with Marfan's syndrome (or other connective tissue disorders) and those with a very wide basal aortic root. If the aortic valve cusps themselves are diseased and cannot be reconstructed, the autologous pulmonary valve is the most physiological substitute. Replacing the aortic valve with the autologous pulmonary valve is named Ross procedure. The defect in the right ventricular outflow tract that is created while harvesting the autograft must be reconstructed during the same procedure; usually, a pulmonary valve allograft is used for this purpose. With all reconstructive surgical techniques and with all autologous replacements there is a risk of reoperation, mainly (besides technical issues) because it is feared that leaving autologous tissue in place leads to recurrence of the original illness. The published results, however, with aortic valve-sparing surgery and with the Ross procedure show that the risk of reoperation appears to be very acceptable. This statement is especially true for the Ross procedure for which more and longer experience exists worldwide. Echocardiographic studies show that the aortic valve function after valve-sparing techniques and - especially - after the Ross procedure is indeed excellent. Therefore, patients with aortic root pathologies or aortic valve diseases should be informed about valve-sparing aortic root reconstructive techniques or the Ross procedure. The choice of technique should be made in close contact between patient, cardiologist, and cardiac surgeon. However, the described techniques require extensive experience within the surgical team.

Aortic Aneurysm↗
PubMed2004

[Molecular classification in leukemias using gene expression profiling].

A comprehensive approach to the diagnosis in leukemias relies on cytomorphology, cytochemistry, cytogenetics, fluorescence in situ hybridization, multiparameter flow cytometry, and molecular methods. Recently, gene expression profiling using microarrays was invented to measure the expression of thousands of genes in one step. A specific signature stands for the molecular fingerprint of a tumor sample. Therefore, gene expression profiling may lead to a better molecular classification of leukemias and insights into pathophysiology. Furthermore, gene expression profiling may lead to new targeted therapies and can detect genes to be used for minimal residual disease studies. Very recent studies point also to the possibility to use gene expression profiling for prognostication. In conclusion, microarrays may lead to a single platform approach in leukemia diagnosis with quick and very robust results. This new technique should be further validated in parallel to the standard work-flow and has to be proven before substituting other methods in the future.

Algorithms↗
PubMed2001

The rotameter and the waterwheel.

The publication imparts information about the personal life and professional sphere of activity of J.A. Segner, Karl Küppers, Maximilian Neu, Hans Bunte, and Felix Meyer, as far as they were involved with the invention of devices for measuring gas flow, especially their involvement in testing the introduction of Rotameters into the medical field. The knowledge that the threat of deportation in October 1940, due to his Jewish background and in view of the politics of the National Socialists at the time, led to Maximilian Neu's committing suicide, is of added historical interest. Together with biographical details, the role played by the Institute of Research in Karlsruhe and the establishment of the Rotameter site in Aachen is presented. The historical outline finishes with a short report of the author's first experience with Rotameters at the Nuffeld Department of Anaesthetics, Oxford University during the Second World War and with his subsequent efforts to introduce Rotameters into anesthesia equipment design in the United States.

Anesthesiology↗
PubMed2002

[In memory of the 160(th) birthday and the 80(th) anniversary of the death of Heinrich Irenäus Quincke, as well as of his description of angioedema 120 years ago].

In the year 2002 we celebrate the 160(th) birthday and the 80(th) anniversary of the death of Heinrich Irenäus Quincke, former head of the department of internal medicine at the University of Kiel from 1878 to 1908. Moreover we remember the description of the angioedema by Quincke in the "Monatsheften für Praktische Dermatologie" 120 years ago. Because his name is so tightly linked with angioedema, Quincke's other discoveries and achievements are scarcely recalled today. Some of his other accomplishments include the invention of the lumbar puncture, the initiation of the term siderosis, the study of the resorption of inorganic iron to treat iron-deficiency anemia and his early contributions to pulmonary surgery. Quincke was the first to describe the causative organism of animal favus, which today is known as Trichophyton quinckeanum. Quincke suspected a syphilitic infection as the cause of aortic aneurysms and recommended antisyphilitic therapy. In the beginning of his career in Kiel, Quincke gave lectures not only in internal medicine but also in dermatology and venerology, pediatrics, bacteriology and public health, until chairs were established for these disciplines. Quincke was for four terms Dean of the medical faculty and in 1900 Rector of the University of Kiel.

Angioedema↗
PubMed1999

[Surgical therapy of sleep-related respiratory disorders].

Before the invention of CPAP therapy, the only effective surgical treatment for obstructive sleep apnea syndrome was tracheotomy. Now, surgical approaches mainly focus on two anatomical sites. Each procedure influences either the retropalatal or retrolingual portion of the pharynx. They might be applied individually, synchronously with other procedures, or sequentially with other therapeutic devices. Common methods of velar surgery include uvulopalatopharyngoplasty (UPPP), Laser-assisted uvuloplasty (LAUP), radiofrequency or uvulaflap. These techniques are indicated mainly in patients with mild OSAS. Other procedures focus on the posterior airway space (PAS), including operations that reduce the volume of the tongue or base of tongue. In selected patients, an enlargement of the retrolingual airway is gained by osteosynthetic techniques. Improvement of the nasal airway passage is gained by performing a septoplasty and/or conchotomy. In this paper, the different methods and their indications for surgical therapy will be explained and the results are summarized.

Electrocoagulation↗
PubMed2007

[Prolonged vascular complications with subsequent finger necrosis after humeral head luxation fracture in the elderly].

Fractures of the proximal humerus represent a typical injury of the elderly. Additional lesions of nerves or arteries are rare and there is only little information in the literature on the co-occurrence of proximal humerus fractures and compromised peripheral circulation which could lead to the loss of the upper extremity. To prevent damage to the injured limb, it is necessary to invent and initiate a standardized algorithm involving trauma care matching the special needs of this combined injury.

Aged, 80 and over↗
PubMed2002

[Recall and pseudo-memory. On the yearning to be a trauma victim].

Memories are not called up from "storage" but instead are constructed anew in each case. Although many experiments have proven that memories are visual and inaccurate, many psychotherapists still assume that memories which surface during therapy are realistic representations of facts. They do not take into account that reminiscences (pseudomemories) of events can be planted in the memory by the imagination or through behavioral pressure. In light of this, the question arises as to why some patients during therapy tend to invent in particular memories of traumatic early childhood experiences. The authors assume that certain suggestive elements come to bear with victimization. The advantage gained is of great importance and has many facets. The case of Wilkomirski proves that mystification of the ego via identification with victims is not only provoked in psychotherapeutic treatment but also is a means of gaining public attention and support. As concerns the therapeutic handling of actual emotional traumatization (whose pathogenic significance and long-term effects used to be underestimated), suggestive and autosuggestive processes play a large role. In this respect, modern trauma research and psychotherapy are faced with special challenges.

Adult↗
PubMed1997

[Reflections on the psychobiology of depression].

Our present understanding of the disorder "depression" undergoes a changing process. Together with the appearance of empirical studies on epidemiology, genetics and therapy, the hypothesis of "endogenous" depression has vanished. The search for "markers" has been replaced by a growing interest for functional connections, thereby generating a variety of possible etiological factors instead of the "depressogenic" synapse. Therapy has been revolutionized by the invention and the empirical proof of new, short-term psychotherapies. However, the lack of a theoretical basis warrants its development as a major endeavor for future research.

Antidepressive Agents↗
PubMed2005

[Godfrey N. Hounsfield and his influence on radiology].

On August 12, 2004 Sir Godfrey N. Hounsfield died at the age of 84 years. Computed tomography, which he developed, has been the most important invention in radiology since the discovery of X-rays; it revolutionized the medical diagnostic undisputedly. The essay gives an insight into the personality and the achievments of G. N. Hounsfield as well as the evolution of computed tomography of the classical sequential scanning via single to the current multislice spiral technique. The perspectives of computed tomography are shown.

England↗