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At least 1,297 records · Page 72Linked to original sources
PubMed2005

Improvement of glucose tolerance in type 2 diabetic patients: traditional vs. modern insulin regimens (results from the Austrian Biaspart Study).

OBJECTIVE: Major advantages of modern insulin regimens containing premixed insulin analogues in comparison to traditional insulin regimens have not been evaluated yet. The aim of the present study was to investigate whether meal-related (breakfast, lunch, dinner) application of biphasic insulin aspart 30 (BIAsp 30) provides better glycaemic control than administration of biphasic human insulin 30 (BHI 30) twice per day. RESEARCH DESIGN AND METHODS: In a multi-centre, randomized, open-label parallel trial, a total of 177 patients with type 2 diabetes mellitus were exposed to the two different insulin regimens described above over a study period of 24 weeks. HbA1c and glycemic exposure parameters were measured at predefined intervals. RESULTS: The mean difference between treatment groups in HbA1c after 24 weeks of treatment was 0.08% (p = 0.6419). Analysing the 7-point blood-glucose (BG) profiles, significant differences in BG levels were observed after lunch (156 vs. 176 mg/dl, p = 0.0289), before dinner (142 vs. 166 mg/dl p = 0.006) and after dinner (154 vs. 182 mg/dl p = 0.002) in favour of BIAsp 30 insulin. Prandial BG increment was lower in the BIAsp 30 group at breakfast (p = 0.057) and lunch (p < 0.0005). No difference was found regarding safety parameters in the two treatment groups. CONCLUSIONS: This study demonstrates that meal-related BIAsp 30-insulin maintains postprandial BG control more effectively than traditional BHI 30 insulin twice per day in type 2 diabetic patients.

Adult↗
PubMed2005

[Gerocomy -- gerontology -- geriatrics. The naming of a modern medical discipline].

300 years ago, the lawyer Theodosius Schöpffer coined the notion gerontology. On this occasion, this paper offers terms and corresponding concepts of gerontology which arose in the western tradition: 1. From the Graeco-Roman antiquity until 1750, gerocomy (the care for the elderly) was defined as a branch of medicine, but in practice almost did not exist. Basically, it provided instructions for a way of life in conformity with the physiological circumstances of elderly people. Its implementation was left to the patient. Furthermore, in the early modern times medical treatises dealt more frequently with diseases of the elderly and their therapy. The gerokomia succeeded in evolving a specific technical literature. Yet it failed to get institutionalized. 2. At the beginning of the 20th century, Ignaz Nascher interpreted geriatrics as a counterpart to pediatrics and opposed it to a clinical-pathological consideration of old age before 1900. He aimed at the exploration and treatment of old age as an autonomous physiological entity. Under the influence of the demographic transformation the institutionalization of geriatrics as a interdisciplinary branch within medicine could be realized relatively soon. 3. Around 1930, we experience the recreation of the notion gerontology, initially restricted to medical gerontology. However, with the integration of the non-medical sciences of old age the spectrum and the objectives changed. Today gerontology signifies on a international level a generic term or independent scientific discipline beside medicine. This evolution corresponds with the intentions pursued 300 years ago.

Aged↗
PubMed2006

[Refractive aspects of modern cataract surgery].

OBJECTIVE: Modern cataract surgery is a refractive procedure whereby one basically can achieve the targeted postoperative refraction. METHODS: To achieve this goal, according to the patient's wishes, biometry, mathematical calculation of IOL power and astigmatism management are important factors. On the other hand, multifarious developments in intraocular lens technology also contribute to this target. RESULTS: The individual choice of incision (on axis surgery: incision in the steeper meridian, length, shape and location concerning cornea or sclera) reduces the preoperatively existing astigmatism. Biometry with personalised data and formulas of the third generation are important factors to achieve the targeted refraction. In addition to this, the development of manifold lens designs in the last years to improve intraocular lens quality has enabled progress within various domains, for example, the use of optimised intraocular lenses to compensate corneal aberration, the implantation of toric lenses for corrections of higher pre-existing corneal astigmatism or the use of phacic intraocular lenses to correct higher ametropia. CONCLUSION: Patient satisfaction postoperatively depends on the precise refractive result as desired. With our current operative and technical possibilities we are able to achieve this with high probability and safety.

Astigmatism↗
PubMed1987

[Differential diagnosis of spinal processes using modern diagnostic procedures].

Modern diagnostic management of diseases of the spinal cord is discussed, illustrated by some exemplary cases and reviewed by the literature. Special attention is directed to high resolution tomography, magnetic resonance imaging, analysis of the cerebrospinal fluid and electrophysiological methods. It seems conceivable that a shift from invasive methods to noninvasive procedures (e.g. magnetic resonance imaging) may occur.

Angiography↗
PubMed1995

[Modern aspects of tympanoplasty. An overview].

The cholesteatoma should be removed with a canal wall down-technique in small mastoids. In patients with well or highly pneumatized temporal bones the reconstruction of the posterior canal wall is recommended after complete removal of the matrix. Myringoplasty is mainly performed using perichondrium. In highly damaged middle ears the cartilage palisade technique is indicated. The reconstruction of the ossicular chain performed using modern artificial materials.

Cholesteatoma, Middle Ear↗
PubMed1993

[Legal aspects of modern transplantation surgery].

The legal and legislative aspects of transplant surgery in reunified Germany have been the subject of intense and even fierce discussions both recently and at the present time. Legally, the situation in Germany is not governed by specific laws and the reunification of Germany has posed new problems since the codification of transplantation that had been practised in the former German Democratic Republic is still valid in what are now the new Federal Laender. As a result, uniform legislation is more imperative than ever for the benefit of all the involved physicians, hospitals and patients. Independent of the models that have been proposed in the past for solving this legal tangle it has been overlooked that the so-called "extended consent" solution would not only fully take into account the self-determination of the individual but would also appeal to the civic responsibility of the citizen, i.e. his social duties within the community. Hence, the new German legislative body must face the challenge to have the courage to arrive at a clear and positively legal assessment of values and a uniform regulation governing this highly sensitive complex to do justice to the needs of modern transplant medicine. While doing so, whatever has been laid down in the Constitution must not suffer should there be any collision with fundamental rights; maximum agreement with these must therefore be aimed at.

Cadaver↗
PubMed1987

Cerebral palsy in very low birthweight infants surviving to 2 years with modern perinatal intensive care.

The rate of cerebral palsy and factors associated with its occurrence were determined in surviving 2-year-old very low birthweight (VLBW) infants born during an era of modern perinatal intensive care. Of the survivors, 12.5% (52/416) of those traced had spastic cerebral palsy. Motor handicaps were mild in 42%, moderate in 25%, and severe in 33% of children with cerebral palsy. The prevalence of cerebral palsy was similar in all birthweight groups up to the upper limit of 1500 gm, and was considerably higher than in survivors born in the same hospital a decade earlier. Although several perinatal variables were associated with the occurrence of cerebral palsy, either singly or in combination, little statistical or clinical confidence would be placed in these associations. Moreover, although 77% of children with cerebral palsy had one or more commonly recognized perinatal risk factors, almost identical rates of risk factors were present in normal children. The advent of cranial ultrasonography during the time of the study was associated with an increase in mortality but no effect on the prevalence of cerebral palsy. Cerebroventricular hemorrhage correlated poorly with the presence of cerebral palsy. The prevalence of cerebral palsy in surviving VLBW infants is unacceptably high; however, no obvious preventable factors in its etiology could be identified.

Australia↗
PubMed1984

Is there a role for fetal cephalocentesis in modern obstetrics?

Obstetricians have traditionally viewed fetal hydrocephalus with resultant macrocephaly as a dismal condition with little chance for a good outcome. Cephalocentesis with decompression of the fetal head in order to permit vaginal delivery has often been the management of choice. In view of the significant perinatal consequences of cephalocentesis and the changing outlook for optimally managed neonatal hydrocephalus, the authors reassess the role of cephalocentesis in modern obstetrics.

Drainage↗
PubMed1992

[Renal osteodystrophy: the spectrum of the x-ray symptoms in modern forms of kidney transplantation and long-term dialysis therapy].

Plain film radiography and microradioscopy represent standard imaging for diagnosis and grading of renal osteodystrophy. The aim of this retrospective study was to evaluate the effects of modern therapeutic regimens on skeletal abnormalities as diagnosed radiographically. 198 patients were investigated. X-ray findings of 38 patients from 1981-1983 (16-66 years, 40.1 +/- 13.4; 23 male, 15 female) were compared with those of 160 patients from 1991 (20-71 years, 48.4 +/- 12.5; 98 male, 62 female). We found significant differences in respect of the spectrum and the degree of skeletal abnormalities. The prevalence of phalangeal resorptions lowered from 87 to 50%, the prevalence of soft tissue calcification from 68 to 57%. Therefore, renal osteodystrophy is not as extensive as it was ten years ago, but it still continues to be an unavoidable complication of renal insufficiency.

Adolescent↗
PubMed1992

[Meningioma of the optic nerve sheath. Diagnostic problems despite use of modern imaging procedures].

In spite of modern optical examination techniques such as sonography, nuclear magnetic resonance tomography (NMR) and x-ray computer tomography up to now the meningioma of the optic nerve sheath still poses a problem in respect of differential diagnosis. This problem is illustrated by two case reports. In both patients a meningioma of the optic nerve sheath could be diagnosed only after various attempts using all the imaging techniques mentioned above. NMR in combination with Gadolinium injection gave most important information.

Cranial Nerve Neoplasms↗
PubMed1995

Frameless neuronavigation in modern neurosurgery.

A fundamental effort in neurosurgery is to reduce surgical trauma. Microneurosurgical technique combined with precise localization of lesions, can minimize the invasiveness of neurosurgical procedures. This report summarizes the utility of frameless neuronavigator systems and examines their value in reducing operative invasiveness. The basic principle of neuronavigation is the virtual linkage between digitized neuroradiological data and real anatomical structures, allowing an excellent three-dimensional orientation by real-time graphic-anatomic interaction. As frameless graphic interactive neuronavigation is developed further, these devices should become an important component of the modern microneurosurgical armamentarium and reduce surgical morbidity.

Humans↗
PubMed1986

[Neuroradiologic study using modern imaging procedures (CT:NMR) in venous, cerebral vascular malformations].

Clinical, neuroradiological and surgical findings were analysed in nine patients with venous cerebral malformations. Special emphasis has been placed on MR findings. Venous angiomas are characterised in MR tomography as low-signal areas whereas cavernous angiomas are characterised by a high incidence of signals due to the blood coagulates. In this manner MR tomography confirmed pathologico-anatomical findings to the effect that malformations are often made up of a venous and a cavernous component. Today it is also occasionally possible to clarify the aetiology of so-called "cryptogenic" epilepsies. Modern microsurgery enables the removal of a venous vascular malformation even in the parietal area without the risk of impairment or loss of nerve function.

Adult↗
PubMed1981

[Goniotrepanation using scleral flap in modern surgery of glaucoma].

In the introduction, the principles and limitations of modern glaucoma surgery are described. There then follow some personal observations on the history of goniotrepanation, from which it is evident that the scleral flap is not the invention of any single surgeon, but rather the result of experiments by several. The importance of the scleral flap was proved by the almost simultaneous appearance of trabeculectomy and goniotrepanation and, some time later, of Schleie's covered fistulizing operation. The technical details of goniotrepanation and the features peculiar to this procedure are then described. It follows from this description that goniotrepanation is a microsurgical procedure demanding skill and experience on the part of the surgeon. Comparative studies of goniotrepanation in the literature are then discussed in detail. These are concerned with postoperative findings, pressure regulation, morphological changes at the site of the operation and the effect on visual function. The advantages of goniotrepanation and the function of the parathalamus, which represents a new drainage path for the aqueous, are then described. The procedure creates a normal balance between the quantity of aqueous produced and its drainage to the exterior, resulting in a normalization of intraocular pressure. This drain does not lead directly to the subconjunctival space, but indirectly, via normal pathways, through the parathalamus formed by the flap. The creation of the parathalamus can be useful in glaucoma surgery; it offers advantages as regards both indication and surgical technique.

Glaucoma↗
PubMed2003

Comparative in vivo bioactivity of modern H1-antihistamines on AMP challenge in atopic asthma.

BACKGROUND: Modern H(1)-antihistamines differ in their in vitro binding affinity, but their comparative in vivo bioactivity in asthmatic airways is unknown. OBJECTIVES: We compared clinically recommended doses of 3 H(1)-antihistamines on airway hyperresponsiveness to AMP challenge (the primary outcome variable). METHODS: Sixteen atopic patients with mild-to-moderate asthma of whom 10 were receiving inhaled corticosteroid therapy (all had positive results to house dust mite on skin prick testing) were randomized in a double-blind, placebo-controlled, cross-over fashion to receive single doses of 5 mg of desloratadine, 180 mg of fexofenadine hydrochloride (FEX), 5 mg of levocetirizine dihydrochloride (LEV), or placebo, with AMP challenge performed 12 hours after dosing. RESULTS: All H(1)-antihistamines demonstrated significantly greater (P <.05) geometric mean +/- SEM AMP PC(20) values compared with that of placebo (86 +/- 29 mg/mL): desloratadine, 189 +/- 54 mg/mL; FEX, 176 +/- 57 mg/mL; and LEV, 163 +/- 48 mg/mL. Prechallenge forced expiratory flow at 25% to 75% of maximal lung volume (percent predicted) but not FEV(1) was significantly higher (P <.05) for all H(1)-antihistamines compared with that of placebo (53% +/- 4%): desloratadine, 62% +/- 4%; FEX, 62% +/- 4%; and LEV, 59% +/- 3%. There were no significant differences in either AMP PC(20) or lung function values among the H(1)-antihistamines. CONCLUSION: Single doses of H(1)-antihistamines improved airway hyperresponsiveness and small-airways caliber to a similar degree. Data for in vitro binding affinity do not therefore translate into commensurate differences in in vivo bioactivity at clinically recommended doses.

Acetates↗
PubMed2001

The role of cephalocentesis in modern obstetrics.

OBJECTIVE: Destructive procedures to permit vaginal delivery of the fetus with hydrocephalus are rarely performed. STUDY DESIGN: We performed intrapartum cephalocentesis in 3 cases in which alobar holoprosencephaly was diagnosed in the third trimester. RESULTS: All 3 fetuses were stillborn. Two delivered vaginally, and one delivered abdominally with a lower uterine incision. CONCLUSIONS: A reappraisal of the proper role of cephalocentesis in modern obstetrics is offered.

Adult↗
PubMed1994

A modern view of male infertility.

It is archaic to view male factor infertility today separately from in vitro fertilization (IVF) and treatment of the female partner. Oligoasthenozoospermia may be an inherited condition (most likely on the Y chromosome), and is refractory to any treatment of the male including hormones and varicocelectomy. IVF technology is the only justifiable approach for achieving a pregnancy in these couples. The reasons for this view and the suggested modern approach to couples with oligoasthenozoospermia are outlined in this review. However, obstructive azoospermia is different as it can be successfully corrected with microsurgery in over 90% of men. When it cannot be corrected, as in congenital absence of vas, microsurgical sperm retrieval combined with IVF can still be highly effective in producing pregnancy with sperm from the husband. The most important arena for research into male infertility in the next decade will be to map out the deletions on the Y chromosome that might result in defective spermatogenesis, and which probably cause most cases of non-obstructive male factor infertility.

Female↗
PubMed2005

Ernst Mayr and the modern concept of species.

Ernst Mayr played a central role in the establishment of the general concept of species as metapopulation lineages, and he is the author of one of the most popular of the numerous alternative definitions of the species category. Reconciliation of incompatible species definitions and the development of a unified species concept require rejecting the interpretation of various contingent properties of metapopulation lineages, including intrinsic reproductive isolation in Mayr's definition, as necessary properties of species. On the other hand, the general concept of species as metapopulation lineages advocated by Mayr forms the foundation of this reconciliation, which follows from a corollary of that concept also advocated by Mayr: the proposition that the species is a fundamental category of biological organization. Although the general metapopulation lineage species concept and Mayr's popular species definition are commonly confused under the name "the biological species concept," they are more or less clearly distinguished in Mayr's early writings on the subject. Virtually all modern concepts and definitions of the species category, not only those that require intrinsic reproductive isolation, are to be considered biological according to the criterion proposed by Mayr. Definitions of the species category that identify a particular contingent property of metapopulation lineages (including intrinsic reproductive isolation) as a necessary property of species reduce the number of metapopulation lineages that are to be recognized taxonomically as species, but they cause conflicts among alternative species definitions and compromise the status of the species as a basic category of biological organization.

Animals↗
PubMed2006

Adenine and 2-aminopurine: paradigms of modern theoretical photochemistry.

Distinct photophysical behavior of nucleobase adenine and its constitutional isomer, 2-aminopurine, has been studied by using quantum chemical methods, in particular an accurate ab initio multiconfigurational second-order perturbation theory. After light irradiation, the efficient, ultrafast energy dissipation observed for nonfluorescent 9H-adenine is explained here by the nonradiative internal conversion process taking place along a barrierless reaction path from the initially populated 1(pipi* La) excited state toward a low-lying conical intersection (CI) connected with the ground state. In contrast, the strong fluorescence recorded for 2-aminopurine at 4.0 eV with large decay lifetime is interpreted by the presence of a minimum in the 1(pipi* La) hypersurface lying below the lowest CI and the subsequent potential energy barrier required to reach the funnel to the ground state. Secondary deactivation channels were found in the two systems related to additional CIs involving the 1(pipi* Lb) and 1(npi*) states. Although in 9H-adenine a population switch between both states is proposed, in 7H-adenine this may be perturbed by a relatively larger barrier to access the 1(npi*) state, and, therefore, the 1(pipi* Lb) state becomes responsible for the weak fluorescence measured in aqueous adenine at approximately 4.5 eV. In contrast to previous models that explained fluorescence quenching in adenine, unlike in 2-aminopurine, on the basis of the vibronic coupling of the nearby 1(pipi*) and 1(npi*) states, the present results indicate that the 1(npi*) state does not contribute to the leading photophysical event and establish the prevalence of a model based on the CI concept in modern photochemistry.

2-Aminopurine↗