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PubMed1990

The necessity of contralateral surgical exploration in Wilms tumor with modern noninvasive imaging technique: a reassessment.

Surgical exploration of the contralateral kidney in unilateral Wilms tumor has been the standard of surgical practice. During the last decade advances in noninvasive imaging techniques (ultrasound, computerized tomography and magnetic resonance imaging) have led to more accurate definition of intrarenal pathological conditions. The intuitive question presently is whether contralateral exploration remains mandatory in Wilms tumor patients. We reviewed the records of 52 consecutive children at our institutions who underwent radiological and operative staging of the Wilms tumor from 1979 to 1988. All 48 evaluable patients underwent either preoperative computerized tomography, ultrasound and/or magnetic resonance imaging. Five bilateral Wilms tumors were diagnosed preoperatively and confirmed surgically, whereas extensive operative exploration of the contralateral kidney in the other 43 cases of radiologically diagnosed unilateral disease failed to reveal any contralateral abnormality. Thus, in all patients preoperative radiological investigation was accurate to stage the disease regarding bilaterality. With modern imaging techniques and effective chemotherapy, extensive contralateral renal exploration may no longer be mandatory to manage Wilms tumor.

Child, Preschool↗
PubMed1989

Modern assessment of tonsils and adenoids.

Modern assessment of the tonsils and adenoids is based on an appreciation of new concepts pertaining to the pathogenesis of tonsil and adenoid disease. Recognition of the emergence of beta-lactamase-producing and encapsulated anaerobic bacteria in the tonsils and adenoids should lead to a reconsideration of present therapeutic recommendations for antibiotic therapy in infectious tonsil and adenoid disease. The performance of a precise history, use of a standardized physical examination, and judicious use of laboratory evaluation are all necessary for appropriate patient management and improved communication between the pediatrician and otolaryngologist. Thus, appropriate recommendation for tonsillectomy and adenoidectomy will enhance their benefits, and the result will be happier and healthier children.

Adenoids↗
PubMed2000

Modern pollen rain from the Biligirirangan-Melagiri hills of southern Eastern Ghats, India.

A total of 39 soil surface samples collected between 11 degrees 30'N 76 degrees 45'E and 12 degrees 45'N 78 degrees 15'E from the mainly deciduous forests in the Biligirirangan-Melagiri hills of the southern Eastern Ghats were analysed for their pollen content. The samples are distributed among four different deciduous and evergreen vegetation types between 210 and 1700m altitudes and fall within three distinct rainfall regimes. The aims of this paper are to provide new data on the modern pollen rain from the Southern Eastern Ghats, a region characterized by a unique and complex climate and vegetation, and to interpret these data using multivariate statistics and the diagram of pollen percentages. We could distinguish first between the deciduous and the evergreen forests and then also between different types of deciduous forest. The distinction between the evergreen and deciduous forests was based on a humidity gradient and that among the deciduous forests on a physiognomic gradient identified through correspondence analysis. The above analysis also allowed us to identify a set of 14 pollen taxa markers and 11 associated pollen taxa that help differentiate the evergreen from deciduous forests. Similarly, a set of 12 pollen taxa markers and six associated pollen taxa was demarcated to help distinguish woodland formations from scrub and thicket formations, among the deciduous vegetation. We could also differentiate amongst the four distinct vegetation types sampled, on the basis of distinct associations of both tree and herb pollen taxa according to their relative abundance in the pollen diagram as well as on the proportion of total arboreal pollen. The ground cover of grasses and other herbaceous plants in the deciduous forests is effectively demonstrated by percentages of non-arboreal pollen varying between 40 and 70%. The 1000m altitude limit reflecting a gradient of humidity and the physiognomic gradient among deciduous forests seem to be important in this region.

Journal Article↗
PubMed1975

Modern approach to the diagnosis of anaerobic surgical sepsis.

Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina, and the colon are the areas of the human body where the obligate anaerobes are predominant and can be isolated in very high numbers. Sepsis following surgery of any of these organs is frequently due to the escape of these endogenous bacteria during the course of the operative procedure. To enable the isolation and successful identification of most of these anaerobic microorganisms from clinical exudate, special collection and bacteriologic techniques are necessary. The acceptable anaerobic collection techniques have been reviewed in this paper. All of these techniques minimize the exposure of the clinical specimen to atmospheric oxygen during collection and transfer. The modern equipment used in sophisticated anaerobic bacteriologic workup has been discussed. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis, or associated gas formation. The importance and value of the gram-stain in the early identification of surgical sepsis has been stressed.

Anaerobiosis↗
PubMedDate not supplied

Phacoemulsification and modern cataract surgery.

The techniques and results of cataract surgery have changed dramatically during the past three decades. In the USA, we have moved from intracapsular cataract extraction as the preferred technique to almost exclusively extracapsular techniques. Smaller incisions have become the standard, with phacoemulsification now being the method of choice for most surgeons. Along with these advances have come improved intraocular lens materials and designs, especially well suited for use with smaller incisions. Phacoemulsification as a method to remove the cataractous lens was first proposed more than 20 years ago. Advances in techniques and equipment have led to a dramatic increase in the popularity of phacoemulsification with increased safety and efficiency. Viscoelastic agents have been developed synchronously with modern phacoemulsification techniques, playing an integral role in the success of this new technology. Improved surgical techniques for removing the anterior lens capsule have decreased the incidence of both intraoperative and postoperative capsular complications. Nucleus removal, formerly performed primarily in the anterior chamber, is now performed in the posterior chamber, decreasing damage to the corneal endothelium. Improved wound construction allows many wounds to be left unsutured, and smaller wounds allow shorter recovery time and greater intraoperative control and safety. Intraocular lenses can have smaller optic sizes and still maintain accurate centration. Foldable intraocular lenses can take advantage of the smaller incision, even further shortening the time to visual recovery. Continual evolution of this technology promises to further improve patient outcomes after cataract surgery.

Anesthesia, Local↗
PubMedDate not supplied

From four-bed clinic to modern eye hospital: ophthalmology in Leipzig, 1820-1996.

The opening of the "Heilanstalt für arme Augenkranke" by Friedrich Philipp Ritterich (1782-1866) in 1820 was an important landmark for ophthalmology in Leipzig and in all of Germany. The first chair of ophthalmology in Germany was taken by Christian Georg Theodor Ruete in 1852. In 1883 the clinic moved to a new domicile, a modern building in the Leipzig "medical quarter." In the ensuing years, the hospital developed into a well-known university center of ophthalmology with the scientific, clinical, and organizational work of ophthalmologists such as Hubert Sattler and Ernst Hertel. The extension of the old building in 1908-1911 and the rebuilding after the destruction in World War II created better opportunities for research, teaching, and patient treatment. Comprehensive expansion and reconstruction of the Eye Hospital since 1994 has created excellent conditions for both clinical and experimental ophthalmology as well as the training of students.

Education, Medical, Continuing↗
PubMed2003

Receptor-binding properties of modern human influenza viruses primarily isolated in Vero and MDCK cells and chicken embryonated eggs.

To study the receptor specificity of modern human influenza H1N1 and H3N2 viruses, the analogs of natural receptors, namely sialyloligosaccharides conjugated with high molecular weight (about 1500 kDa) polyacrylamide as biotinylated and label-free probes, have been used. Viruses isolated from clinical specimens were grown in African green monkey kidney (Vero) or Madin-Darby canine kidney (MDCK) cells and chicken embryonated eggs. All Vero-derived viruses had hemagglutinin (HA) sequences indistinguishable from original viruses present in clinical samples, but HAs of three of seven tested MDCK-derived isolates had one or two amino acid substitutions. Despite these host-dependent mutations and differences in the structure of HA molecules of individual strains, all studied Vero- and MDCK-isolated viruses bound to Neu5Ac alpha2-6Galbeta1-4GlcNAc (6'SLN) essentially stronger than to Neu5Acalpha2-6Galbeta1-4Glc (6'SL). Such receptor-binding specificity has been typical for earlier isolated H1N1 human influenza viruses, but there is a new property of H3N2 viruses that has been circulating in the human population during recent years. Propagation of human viruses in chicken embryonated eggs resulted in a selection of variants with amino acid substitutions near the HA receptor-binding site, namely Gln226Arg or Asp225Gly for H1N1 viruses and Leu194Ile and Arg220Ser for H3N2 viruses. These HA mutations disturb the observed strict 6'SLN specificity of recent human influenza viruses.

Agglutination Tests↗
PubMed2002

Modern scientific methods and their potential in wastewater science and technology.

Application of novel analytical and investigative methods such as fluorescence in situ hybridization, confocal laser scanning microscopy (CLSM), microelectrodes and advanced numerical simulation has led to new insights into micro- and macroscopic processes in bioreactors. However, the question is still open whether or not these new findings and the subsequent gain of knowledge are of significant practical relevance and if so, where and how. To find suitable answers it is necessary for engineers to know what can be expected by applying these modern analytical tools. Similarly, scientists could benefit significantly from an intensive dialogue with engineers in order to find out about practical problems and conditions existing in wastewater treatment systems. In this paper, an attempt is made to help bridge the gap between science and engineering in biological wastewater treatment. We provide an overview of recently developed methods in microbiology and in mathematical modeling and numerical simulation. A questionnaire is presented which may help generate a platform from which further technical and scientific developments can be accomplished. Both the paper and the questionnaire are aimed at encouraging scientists and engineers to enter into an intensive, mutually beneficial dialogue.

Bioreactors↗
PubMed2002

The evolution and state of modern technology for prostate cryosurgery.

Cryosurgery is the in situ ablation of a target tissue by application of extreme cold temperature. The ability of cryosurgery to ablate tissue is unquestioned. It is the controlled application of a cryoinjury in a manner to minimize morbidity that is problematic. Prostate cryosurgery is complicated by the proximity of the prostate to adjacent structures that are sensitive to a freeze injury, namely the urethra, rectal wall, and neurovascular bundles. Several recent technological advances have led to the development of an effective treatment protocol with acceptable morbidity. These include the advent of real-time transrectal ultrasound, cryomachines with almost instant freeze-thaw control through the use of the Joule-Thompson effect, and warming catheters to effectively preserve the integrity of the urethra and external sphincter. Further, temperature monitoring at the posterior margin of the prostate sometimes combined with an injection of saline solution into Denonvilliers fascia has reduced the occurrence of urethrorectal fistula formation to 0% to 0.5% in modern series. We review the key innovations of prostate cryosurgery that differentiate this state-of-the-art procedure from that used by early investigators to even that of the early 1990s. Potential future innovations, specifically related to image guidance of the procedure, are also addressed.

Body Temperature↗
PubMed1998

The invention of the modern uroflowmeter by Willard M. Drake, Jr at Jefferson Medical College.

The uroflowmeter is perhaps the most important and certainly the most commonly used urodynamic instrument currently employed in urologic practice. The modern uroflowmeter was invented by Willard M. Drake, Jr., in 1946 at the Jefferson Medical College. The original manuscript, entitled "The uroflometer: an aid to the study of the lower urinary tract," appeared in Journal of Urology in 1948. Drake obtained a US patent for the device, entitled "Uroflometer," in 1953. The flowmeter, originally manufactured by van Beek Industries, was more recently manufactured and distributed by Grewe Plastics. Drake is now retired and living in Nacogdoches, Texas.

Equipment Design↗
PubMed1999

Post-treatment PSA < or = 0.2 ng/mL defines disease freedom after radiotherapy for prostate cancer using modern techniques.

OBJECTIVES: The prostate-specific antigen (PSA) definition of disease freedom after radiotherapy for prostate cancer is still in dispute. This report focuses on the PSA nadir achieved in men treated by modern radiotherapy techniques. METHODS: From 1984 to 1994, 489 consecutive men with clinical Stage T1 -T2 prostate cancer were treated by simultaneous radiation: prostate iodine-125 implant followed by external beam radiation. A transperineal implant was performed on 143 men with Stage T1-T2NX, the focus of this study; 346 men with Stage T1-T2N0 had a retropubic implant. The median pretreatment PSA was 8.3 ng/mL (range 0.3 to 188). A rising PSA was defined as one that rose on three consecutive occasions above whatever nadir was achieved. A minimum 5-year follow-up (range 5 to 15) was reached by 453 men. RESULTS: After a minimum 5-year follow-up, 336 men had a nonrising PSA, and of this group, 107 had undergone simultaneous radiation by the transperineal implant technique. A PSA nadir of 0.2 ng/mL or less was achieved by 97% of the transperineally implanted men, and 3% had a nadir of 0.3 to 1.0 ng/mL. Of the 489 men, those who had a nadir of 0.2 ng/mL or less had a 92% nonrising PSA rate (P = 0.001) 10 years after treatment compared with a 41% rate for men who had a nadir of 0.3 to 1.0 ng/mL. All men whose nadir was greater than 1.0 ng/mL had recurrence. The median time to achieve the PSA nadir of 0.2 ng/mL was 27 months (range 3 to 102). CONCLUSIONS: Primarily on the basis of the results from men treated with simultaneous radiation using the transperineal technique, the definition of disease freedom for radiotherapy should be men who achieve and maintain a PSA nadir of 0.2 ng/mL or less.

Aged↗
PubMed1997

How is quality of life in prostate cancer patients influenced by modern treatment? The Wallenberg Symposium.

OBJECTIVES: To identify complications of various forms of treatments for prostate cancer and their influence on patients' quality of life with the ultimate goal of suggesting a Quality of Life Questionnaire specific for prostate cancer for further validation. METHODS: The literature was screened for reports on the more common complications following various forms of therapy for prostate cancer. Frequencies were summarized. The scarce literature reporting on quality of life in prostate cancer was reviewed and conflicting data were discussed and reassessed. Suggested questionnaires used in other studies were critically scrutinized and the various questions recorded. RESULTS: Following radical surgery, impotence and incontinence were the most common complications reducing patients' quality of life. The literature was not uniform with regard to whether loss of sexual function was regarded as a worse complication than loss of urinary control. Following radiotherapy, intestinal problems and sexual dysfunction were the dominating side effects. Quality of life was best preserved in surveillance-only series. Following endocrine therapy, not only impotence and hot flushes were focused upon, but also mental dysfunction and intestinal dysfunction from nonsteroidal antiandrogens, additionally, the importance of effective palliation was highlighted. A Quality of Life Questionnaire should contain general domains relevant to cancer patients, cancer-specific questions, and prostate-cancer-specific questions. The latter group includes: worry for prostate cancer and its prognosis, bone/pelvic pain, lower urinary tract symptoms, urinary incontinence, urinary diversion, bowel function, sexual function, endocrine effects, and satisfaction with medical care for prostate cancer. CONCLUSIONS: A modern trial of prostate cancer treatment should be regarded as insufficient without including a validated Quality of Life Questionnaire.

Costs and Cost Analysis↗
PubMed2003

The beginning of human life and its modern scientific assessment.

One of the most controversial topics in modern bioethics, science, and philosophy is the beginning of individual human life. In the seemingly endless debate, strongly stimulated, by recent technologic advances in human reproduction, a synthesis between scientific data and hypothesis, philosophical thought, and issues of humanities has become a necessity to deal with ethical, juridical, and social problems. Furthermore, in this field there is a temptation to ask science to choose between opinions and beliefs, which neutralize one another. The question of when human life begins requires the essential aid of different forms of knowledge. Here we become involved in the juncture between science and religion, which needs to be carefully explored.

Beginning of Human Life↗
PubMed1984

Reduction of breast cancer mortality through mass screening with modern mammography. First results of the Nijmegen project, 1975-1981.

Since 1975 four rounds of screening with modern mammography for breast cancer have been carried out among 30 000 Nijmegen women born before 1940. The results up to the end of 1981 shows that the odds ratio of screened vs unscreened subjects among women who died from breast cancer compared with women who did not, was 0.48 (95% confidence interval 0.23-1.00) in all age groups.

Adult↗
PubMed2003

Modern Bedouin exposures to copper contamination: an imperial legacy?

The exposure of a modern Bedouin population living in the deserts and mountains of southwestern Jordan, to metal contamination was assessed via the analysis of sediments, plants, livestock, and foodstuffs. Exposure to copper is demonstrated to be a potential hazard. The Bedouin are shown to be vulnerable to contamination via several pathways, the most serious of which are familiar in the industrialized environments of the developed world.

Animals↗
PubMed2001

Consensus statement on the modern therapy of Paget's disease of bone from a Western Osteoporosis Alliance symposium. Biannual Foothills Meeting on Osteoporosis, Calgary, Alberta, Canada, September 9-10, 2000.

BACKGROUND: Bisphosphonate therapy remains the most effective way of controlling Paget's disease of bone (PD). Along with salmon calcitonin, etidronate has been the mainstay of therapy for approximately 20 years. However, the advent of newer bisphosphonates with different molecular actions on osteoclasts warrants a reevaluation of optimal treatment. OBJECTIVE: At a symposium of the Western Osteoporosis Alliance, physicians with experience in the management of PD met to review currently available information and generate this consensus statement as a guideline for clinicians and a source of information for health care payers. METHODS: All available randomized, double-blind, controlled studies that compared the efficacy of newer bisphosphonates with that of etidronate in the treatment of PD were identified through a search of MEDLINE using the terms Paget's disease, bisphosphonates, pamidronate, etidronate, alendronate, risedronate, tiludronate, clodronate, calcitonin, and salmon calcitonin. Because no such studies have been conducted for pamidronate, clodronate, or calcitonin, these drugs were not included in the analysis. CONCLUSIONS: The consensus of the symposium was that etidronate has little place in the modern management of PD. Newer bisphosphonates such as alendronate and risedronate provide significant therapeutic advantages over etidronate, both in the extent of reduction in bone-specific alkaline phosphatase (BSAP) and/or total serum alkaline phosphatase (SAP) and in the duration of remission, as measured by normalization of BSAP/SAP. In the absence of a direct comparison between alendronate and risedronate in the treatment of PD, physician choice is likely to be based on personal experience, relative cost, and differences in dosing.

Alendronate↗
PubMed1998

The US Food and Drug Administration Modernization Act of 1997: impact on consumers.

This paper provides a consumer's perspective on an important issue that has a profound impact on all of us: the US Food and Drug Administration (FDA) Modernization Act of 1997. In addition, it provides some background information on the National Consumers League, an organization that promotes consumer safety and protection with the FDA and its predecessors.

Consumer Product Safety↗