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PubMed2005

Pharmacology of modern volatile anaesthetics.

The volatile anaesthetics sevoflurane and desflurane feature new and promising properties. Their low blood and tissue solubility enables rapid onset of and emergence from anaesthesia, thus enhancing patient safety and comfort. This article is designed as an up-to-date review of the pharmacokinetic and pharmacodynamic properties of modern volatile anaesthetics. The first part focuses on pharmacokinetic issues such as substance properties, uptake and elimination. The second part covers the effects of inhaled anaesthetics on organ systems, with emphasis on the central nervous system, the cardiovascular system, the respiratory tract, liver and kidneys.

Anesthetics, Inhalation↗
PubMed2006

Modern preoperative fasting guidelines: a summary of the present recommendations and remaining questions.

This chapter is complementary to the others in this volume focusing on preoperative fasting routines. In it we discuss some of the issues in need of more research to define best practice. One of these is the role of fasting in emergency patients. Modern preoperative fasting recommendations almost exclusively deal with elective patients. In emergency patients preoperative fasting cannot secure gastric emptying to reduce the risk of pulmonary aspiration. Hence, surgery should be timed according to the urgency of the situation, and the patient should always be treated as if the stomach was full. More data are needed to better define what is going on in the gastrointestinal tract during the perioperative period in these patients. In certain patient groups--such as patients with diabetes, gastro-oesophageal reflux disease and/or obesity--the data are insufficient to give complete guidance to best practice. Preoperative fasting guidelines also affect fluid balance and perioperative fluid management, a topic of debate in recent years. In addition, carbohydrate-enriched fluids for oral use in the preoperative phase have been shown to have a positive effect on postoperative metabolism. Recent studies also suggest that the immune system would be less affected by surgery with such preparations. Last but not least, new scientific evidence alone is not enough to change daily practice. Active implementation of new evidence is also needed. To improve perioperative care, anaesthesiologists, surgeons and the nursing staff must work together.

Anesthesiology↗
PubMed2006

Access to modern contraception.

Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery.

Contraception↗
PubMedDate not supplied

The modern paradigm of phototherapy.

The recognition of medical benefits obtained with suberythemogenic doses of natural sunlight extends back centuries. Modern medical application of phototherapy has been in place for over 100 years. It is the nature of scientific discovery to depend upon the use of new investigational methods or new devices to gain a better understanding of the mechanisms involved with the observed effects. Advancements in the field of photobiology and in the development of delivery systems for light therapy, such as narrow band UVB and laser, has given us additional insight into why and how phototherapy works in regards to treatment of skin disease and conditions of the skin. This discussion will primarily focus on ultraviolet light, photochemotherapy and a brief mention of photodynamic therapy.

Humans↗
PubMed2004

The perils and promise of modern risk assessment: the example of trichloroethylene.

This article summarizes some of the major scientific shortcomings identified by reviewers of the draft "Trichloroethylene Health Risk Assessment: Synthesis and Characterization" (TCE HRA) in the context of current US Environmental Protection Agency risk assessment guidance and the Data Quality Act guidelines. Our purpose is not to further criticize the draft HRA but to highlight specific areas for improvement and suggest specific ameliorative actions that we believe would improve the scientific credibility (quality) of the final document. This exercise is expected to be applicable beyond the specific case of TCE, because the draft HRA surely exemplifies many of the new challenges being posed to risk assessment in general by the ever-increasing sophistication of modern science.

Animals↗
PubMed2004

How should public policy respond to the challenges of modern biotechnology?

Modern biotechnology has been a topic of public and political debate around the world for over 30 years; continuing scientific breakthroughs keep it high on the agenda. Policy responses have been diverse, fragmented and incoherent, at levels ranging from local regions to agencies of the United Nations, but particularly in national administrations and the European Union. Reactions have been ambivalent, combining fears about conjectural risks with concern to maintain competitiveness and exploit beneficial applications. Adverse public perceptions have become a significant influence on policy, in combination with more cynical and self-interested motives of some of the players in policy debates. Future options, in Europe and elsewhere, are constrained by past and continuing mistakes and over-reactions.

Biotechnology↗
PubMed2006

Treatment of children's nighttime fears: the need for a modern randomised controlled trial.

Children's nighttime fears are common and cause significant interference to the child's functioning as well as causing much distress for the child and family. Therefore, effective and cost-efficient interventions are urgently needed by mental health professionals and counsellors. The authors review 29 studies, which investigated the efficacy of psychosocial treatment for children's nighttime fears. Most studies employed multiple baseline across subject designs or between group designs and most employed cognitive-behavioral techniques (i.e., desensitisation, emotive imagery, cognitive self-instruction, and reinforcement procedures). Although multi-method, informant assessments were not always conducted, in most studies rapid reduction of nighttime fears was typically achieved after only a few sessions with maintenance of gains. On the basis of our review, we make recommendations about assessment and intervention issues for the effective treatment of children's nighttime fears. Finally, future research directions are discussed including the need for a modern randomised clinical trial to more fully investigate treatment efficacy and the role of non-specific treatment factors.

Adolescent↗
PubMed2005

Destructive and non-destructive microanalysis of biocarbonates applied to anomalous otoliths of archaeological and modern sciaenids (Teleostei) from Peru and Chile.

Anomalous otoliths were discovered among modern and archaeological (8th millennium BP) sciaenids. The two species concerned, Cilus gilberti and Sciaena deliciosa, are common on the Peruvian-Chilean coast and do not seem to be affected by this morphological anomaly that maintained in their populations for thousands of years. The carbonates of the anomalous forms, determined by X-ray diffraction, are different from that of the normal otoliths, i.e. calcite and vaterite instead of aragonite. A method of non-destructive analysis by cathodoluminescence is tested and assumptions on the origin of the anomaly and its possible implications on environmental studies are advanced.

Animals↗
PubMed2004

Long-term outcomes of valve replacement with modern prostheses in young adults.

OBJECTIVES: To examine the multiple impacts of valve replacement on the lives of young adults. METHODS: Patients (N=500) between age 18 and 50 who had aortic valve replacement (AVR) and/or mitral valve replacement (MVR) with contemporary prostheses were followed annually. Events, functional status, and quality of life were examined with regression models. RESULTS: Median follow-up was 7.1+/-5.3 years (maximum 26.7 years). Five, 10, and 15-year survival was 92.7+/-1.7, 88.3+/-2.4 and 80.1+/-4.7% after AVR, and 93.1+/-2.3, 79.5+/-4.3 and 71.5+/-5.4% after MVR, respectively. Survival decreased with concomitant coronary disease (hazard ratio (HR): 4.5) and preoperative LV grade (HR: 2.0/grade increase) in AVR patients, and with atrial fibrillation (HR: 5.5), coronary disease (HR: 5.7), preoperative left atrial diameter (HR: 3.0/cm increase) and NYHA class (HR: 2.1/class increase) in MVR patients. Despite reoperation, late survival was equivalent between bioprostheses and mechanical valves in both implant positions. The ten-year cumulative incidence of embolic stroke was 6.3+/-2.4% for mechanical AVR patients, 6.4+/-2.9% for bioprosthetic AVR patients, 12.7+/-3.9% for mechanical MVR patients, and 3.1+/-3.1% for bioprosthetic MVR patients. Atrial fibrillation (HR: 2.8) and smoking (HR: 4.0) were risk factors for stroke in MVR patients. In AVR patients, SF-12 physical scores, freedom from recurrent heart failure, and freedom from disability were significantly higher in bioprosthetic than mechanical valve patients. Career or income limitations were more often subjectively linked to a mechanical prosthesis in both implant positions. CONCLUSIONS: Late outcomes of modern prosthetic valves in young adults remain suboptimal. Bioprostheses deserve consideration in the aortic position, as mechanical valves are associated with lower physical capacity, a higher prevalence of disability, and poorer disease perception. Early surgical referral and atrial fibrillation surgery may improve survival after MVR.

Adolescent↗
PubMed2005

Reproduction concepts and practices in ancient Egypt mirrored by modern medicine.

The treasured ancient papyri provide a glimpse into understanding of common concepts and practices in ancient Egypt. The Kahun gynecological papyrus and other texts unveil the traditions of reproduction, conception and delivery. This article addresses the rationale of beliefs and practices of that era. Frequently, the reason for common traditions exercised at the time is based on medical knowledge of female anatomy and physiology during pregnancy. Surprisingly some of the remedies commonly used in ancient Egypt were recently explored and found intriguing. This paper was aimed to look at the reflection of archaic practices and concepts of ancient Egypt by the modern mirror of evidence-based medicine.

Contraception↗
PubMed2006

Making sense of modernity's maladies: health and disease in the Industrial Revolution.

The industrialization and urbanization of Britain during the 19th century gave the medical profession something to think about. In particular, were the radical changes taking place in society responsible for the sudden rise in endemic and epidemic disease? This article (part of the Science in the Industrial Revolution series) examines the reactions of two key figures in the history of British public health, James Philips Kay and Thomas Southwood Smith, to this question. Their outlooks typify the tendency of Victorian medical practitioners to construct economies of health that saw disease as a consequence of the violation of natural laws and cycles rather than as a product of industrial modernity.

Disease Outbreaks↗
PubMed2006

Testosterone and prostate cancer: an historical perspective on a modern myth.

OBJECTIVES: To review the historical origins and current evidence for the belief that testosterone (T) causes prostate cancer (pCA) growth. METHODS: Review of the historical literature regarding T administration and pCA, as well as more recent studies investigating the relationship of T and pCA. RESULTS: In 1941 Huggins and Hodges reported that marked reductions in T by castration or estrogen treatment caused metastatic pCA to regress, and administration of exogenous T caused pCA to grow. Remarkably, this latter conclusion was based on results from only one patient. Multiple subsequent reports revealed no pCA progression with T administration, and some men even experienced subjective improvement, such as resolution of bone pain. More recent data have shown no apparent increase in pCA rates in clinical trials of T supplementation in normal men or men at increased risk for pCA, no relationship of pCA risk with serum T levels in multiple longitudinal studies, and no reduced risk of pCA in men with low T. The apparent paradox in which castration causes pCA to regress yet higher T fails to cause pCA to grow is resolved by a saturation model, in which maximal stimulation of pCA is reached at relatively low levels of T. CONCLUSIONS: This historical perspective reveals that there is not now-nor has there ever been-a scientific basis for the belief that T causes pCA to grow. Discarding this modern myth will allow exploration of alternative hypotheses regarding the relationship of T and pCA that may be clinically and scientifically rewarding.

Humans↗
PubMed2005

High-resolution respirometry--a modern tool in aging research.

Alterations in mitochondrial function are believed to play a major role in aging processes in many species, including fungi and animals, and increased oxidative stress is considered a major consequence of altered mitochondrial function. In support of this theory, a lot of correlative evidence has been collected, suggesting that changes in mitochondrial DNA accumulate with age in certain tissues. Furthermore, genetic experiments from lower eukaryotic model organisms, indicate a strong correlative link between increased resistance to oxidative stress and an extended lifespan; in addition, limited experimental evidence suggests that the inhibition of mitochondrial function by selected pharmacologically active compounds can extend lifespan in certain species. However, changes in mitochondrial function may affect aging in a different way in various tissues, and a clear statement about the role of mitochondrial deterioration during physiological aging is missing for most if not all species. At this point, respirometric analyses of mitochondrial function provide a tool to study age-associated changes in mitochondrial respiratory chain function and mitochondrial ATP production within living cells and isolated mitochondria. In the recent years, new instruments have been developed, which allow for an unprecedented high-resolution respirometry, which enables us to determine many parameters of mitochondrial function in routine assays using small samples of biological material. It is conceivable that this technology will become an important tool for all those, who are interested in experimentally addressing the mitochondrial theory of aging. In this article, we provide a synopsis of traditional respirometry and the advances of modern high-resolution respirometry, and discuss how future applications of this technology to recently established experimental models in aging research may provide exciting new insights into the role of mitochondria in the aging process.

Aging↗
PubMed2004

Enological and genetic traits of Saccharomyces cerevisiae isolated from former and modern wineries.

Saccharomyces cerevisiae strains isolated from two different wineries in central Italy were subjected to enological and molecular characterization to investigate the influence of the winery environment. One of the selected wineries is a modern, working winery, whereas the second one was abandoned since 1914 and was located in an artificial cavern. The results obtained by our analysis of the fermentation traits underline the selectivity of the winery environment (winery effect), since strains isolated from the industrial winery showed higher values for characters typically subjected to selective pressure, such as maximum capability to produce ethanol, fermentation rate and SO(2) resistance. Pulsed-field gel electrophoresis (PFGE), random amplification of polymorphic DNA (RAPD)-PCR and SAU-PCR were carried out to assesss genetic differences between the two populations studied. Only RAPD-PCR could distinguish between the two populations based on their provenience, whereas PFGE and SAU-PCR gave profiles shared between strains isolated from the industrial and former winery. Moreover, analysis of the karyotypes suggested the presence of chromosomal-length polymorphism; differences in the size and number of chromosomes between the two groups of isolates, as well as within each group, were observed.

Chromosomes, Fungal↗
PubMed2005

Modern embryo transfer catheters and pregnancy outcome: a prospective randomized trial.

OBJECTIVE: Embryo transfer (ET) is the final crucial step in IVF treatment. The type of catheter used can affect the pregnancy rate (PR). In this prospective, randomized trial we compared the clinical PR between the Wallace and the Cook K-Jet embryo transfer catheters. DESIGN: Prospective, randomized clinical trial. SETTING: A National Health Service Assisted Reproduction Unit. PATIENT(S): One hundred fifty women undergoing a fresh ET. Age more than 40 years, a high basal FSH, a previous difficult ET, or more than six previous ETs were the exclusion criteria. INTERVENTION(S): Women undergoing a fresh ET were randomized at the time of ET to either the Cook K-Jet or Wallace embryo transfer catheter. The randomization was stratified according to age and the number of previous ETs. MAIN OUTCOME MEASURE(S): Clinical PR. RESULT(S): There was no significant difference in the clinical PR between the Wallace and the Cook catheters (22/75 [29.3%] and 23/75 [30.6%], relative risk [RR]: 0.96 [95% confidence interval 0.58-1.58]). CONCLUSION(S): There is no significant difference in the PRs achieved by modern, soft, double-lumen ET catheters.

Adult↗
PubMed2004

A structured ancestral population for the evolution of modern humans.

The view that modern humans evolved through a bottleneck from a single founding group of archaic Homo is being challenged by new analyses of contemporary genetic variation. A wide range of middle to late Pleistocene ages for gene genealogies and evidence for early population structures point to a diverse and scattered ancestry associated with a metapopulation history of local extinctions, re-colonization and admixture. A different balance of the same processes has shaped chimpanzee diversity.

Africa↗
PubMed2007

[Interest of modern imagery for conservative management of a placenta percreta].

The placenta percreta is a rare form of anomaly of placental insertion threatening the maternal and foetal lives. The incidence of abnormal placental adhesion is correlated to frequency of caesarean sections and advanced maternal age. Patients who are at high risk should be identified during pregnancy by ultrasound examination with Color Doppler looking for characteristic features. The practice of MRI in case of echographic suspicion may be useful, particularly in posterior placentas. A late diagnosis, in an emergency context, leads generally to hysterectomy and even to partial resection of neighbour organs. Thus, we report the case of a conservative management associating uterine embolisation following an elective caesarean delivery at 36 weeks gestation. In postpartum, the placental involution was followed clinically and by imagery. In our case, a total abdominal hysterectomy was performed on the fifth postoperative week because of a severe antibiotics resistant infection. No blood transfusion was required and the postoperative period was uneventful. This clinical case aims to show, through an analysis of the recent data of the literature, the interest of modern imagery to select patients with suspected placenta percreta that would be suitable candidates for conservative management.

Adult↗
PubMed2006

Evidence of the principle of similitude in modern fatal iatrogenic events.

Samuel Hahnemann attributed fundamental importance to the principle of similitude, promoting it to a 'natural law'. Observing that enantiopathic or allopathic treatment produced enduring aggravation of the disease symptoms after a brief and transitory initial relief, he systematised homeopathic treatment, prescribing substances that provoke similar symptoms in healthy individual. Based on clinical and experimental observations, he anticipated the concept of homeostasis, dividing the effects of substances into: primary action of the medicine followed by secondary action or reaction of the organism. This reaction, known as the rebound effect or paradoxical action by modern pharmacology, used to awake the curative response of the body when the principle of similitude is applied, is responsible for several iatrogenic diseases when used on the basis of the principle of contraries. This study discusses the role of this paradoxical reaction of the organism in the fatal side effects of four important drugs, used according to the model of enantiopathic treatment of the symptoms. I present evidence relating to acetylsalicylic acid, rofecoxib, antidepressants and long-acting bronchodilators. The consequences of the allopathic treatment could be decreased if health professionals valued homeostasis, minimising the rebound effect of the organism by gradual suspension of palliative drugs.

Antidepressive Agents↗