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At least 1,657 records · Page 92Linked to original sources
PubMed2003

Golden Jubilee Lecture. Randomised clinical trials of choroidal melanoma treatment.

PURPOSE: To illustrate an approach to evidence-based medical practice by reporting the Collaborative Ocular Melanoma Study (COMS) randomised clinical trials and cohort studies of choroidal melanoma. METHODS: COMS randomised clinical trials of Iodine-125 (I-125) brachytherapy, adjunctive cohort study of visual acuity in eyes treated with brachytherapy and adjunctive natural history study. COMS randomised clinical trial of pre-enucleation radiation. RESULTS: The COMS I-125 brachytherapy trial (N = 1,317 patients) of medium-sized choroidal melanoma showed 5-year all-cause mortality of 18% [95% Confidence Interval (CI), 16-20%] and no statistically significant difference in mortality following I-125 brachytherapy or enucleation. Adjunctive cohort natural history study (N-42 patients) of patients eligible for the I-125 brachytherapy trial who deferred treatment or had no melanoma treatment had a 5-year all-cause mortality of 30% (95% CI, 18-47%). The COMS pre-enucleation radiation trial (N = 1,003 patients) of large-sized choroidal melanoma showed 5-year all-cause mortality of 40% (95% CI, 37-44%). CONCLUSIONS: Evidence derived from randomised clinical trials and cohort studies shows the need for longterm (> or = 5 years) follow-up to determine the efficacy of treatment for choroidal melanoma by any modality. The rather similar 5-year mortality for treated and untreated medium melanoma patients suggests that metastatic dissemination may occur at an early stage of choroidal melanoma. To increase longterm survival, ocular treatment of choroidal melanoma must strive for diagnosis and treatment of melanoma at an early stage when metastasis is less likely and be combined with measures to detect and treat micrometastasis.

Brachytherapy↗
PubMedDate not supplied

Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future challenges.

Bonding to tooth tissue can be achieved through an "etch&rinse," "self-etch" or "glass-ionomer" approach. In this paper, the basic bonding mechanism to enamel and dentin of these three approaches is demonstrated by means of ultramorphological and chemical characterization of tooth-biomaterial interfacial interactions. Furthermore, bond-strength testing and measurement of marginal-sealing effectiveness (the two most commonly employed methodologies to determine "bonding effectiveness" in the laboratory) are evaluated upon their value and relevance in predicting clinical performance. A new dynamic methodology to test biomaterial-tooth bonds in a fatigue mode is introduced with a recently developed micro-rotary fatigue-testing device. Eventually, today's adhesives will be critically weighted upon their performance in diverse laboratory studies and clinical trials. Special attention has been given to the benefits/drawbacks of an etch&rinse versus a self-etch approach and the long-term performance of these adhesives. Correlating data gathered in the laboratory with clinical results clearly showed that laboratory research CAN predict clinical effectiveness. Although there is a tendency to simplify bonding procedures, the data presented confirm that conventional three-step etch&rinse adhesives still perform most favorably and are most reliable in the long-term. Nevertheless, a self-etch approach may have the best future perspective. Clinically, when adhesives no longer require an "etch&rinse" step, the application time, and probably more importantly, the technique-sensitivity are substantially reduced. Especially "mild," two-step self-etch adhesives that bond through a combined micromechanical and chemical interaction with tooth tissue closely approach conventional three-step systems in bonding performance.

Acid Etching, Dental↗
PubMed2003

26th Kellersberger Memorial Lecture. Lessons from leprosy rehabilitation for general rehabilitation.

Leprosy is primarily a disease of skin and peripheral nerves. Because of nerve function impairment, leprosy patients may develop primary nerve related impairments such as, loss of sensation and weakness or paralysis. These primary impairments may lead to secondary impairments such as ulceration and contractures. Many other diseases and disorders present with similar impairments as seen in leprosy e.g. diabetes and peripheral nerve injuries. Nerve function assessment and ulcer prevention and treatment are areas that have been researched in leprosy but these research findings are not yet commonly known and adopted in diseases and disorders that 'relate' to leprosy. Rehabilitation is a relatively new field in medicine and not (well) developed in many developing countries. Rehabilitation requires an integrated approach from different disciplines and professionals. As for other medical specialty fields, rehabilitation demands evidence based practice.

Activities of Daily Living↗
PubMedDate not supplied

[Keynote lecture: Work seen through the clinical viewpoint: history and ideology].

One of the problems harassing Italy during the period between the 19th and 20th centuries was the "health issue", that was typical of a country penalized by age-old backwardness and shaken by the initial shocks of the industrial revolution. Diseases of poverty like pellagra were combined with diseases of progress like those associated with new techniques and relationships in manufacturing. In this regard, Milan developed an ethical and political leadership first in promoting reforms and also in providing the matrix for advanced organization, assistance and scientific models: among them was "work clinicalization" as achieved at the Clinic for Occupational Diseases, founded and directed by Luigi Devoto.

Ambulatory Care Facilities↗
PubMed2003

Stuart Gan Memorial Lecture 2002. HIV/AIDS in children.

The incidence of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in children has risen steadily over the years and has become an increasing cause of morbidity and mortality during childhood. More than 90% of all children with HIV infection acquired their infection at birth from HIV-infected mothers. With increasing evidence of heterosexual HIV transmission, the number of infected women and consequently their children is increasing. The transmission rate of HIV from mother to infant varies from 20% to 40%. Children can be affected directly through HIV infection and AIDS, and indirectly by the effects of their parents' HIV infection, including being orphaned, discrimination, infant abandonment and negative impact on children's education. Another concern regards children who are most vulnerable to HIV infection and AIDS, such as child prostitutes and children in difficult circumstances. Recommended actions include prevention of parental HIV infection, prevention of mother-to-child HIV transmission, addressing child prostitution, prevention of child labour and improving work conditions, assistance to street children, addressing discrimination, solving the problem of children orphaned by AIDS, reducing HIV-related child abandonment and creating new roles for schools in reducing negative social impact. Although the largest number of HIV-infected persons are from sub-Saharan Africa, the annual incidence of HIV infection in Asia is escalating alarmingly. As reported by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization in December 2001, HIV infection has already killed more than 20 million people worldwide since the beginning of the epidemic and has infected more than 40 million people; almost half of them were women. There are at least 7 million people living with HIV/AIDS in the Asia-Pacific region. The numbers of HIV-infected women and children are increasing at an alarming rate. Over 1 million children are HIV-infected; in the year 2000 alone, 600,000 children acquired HIV infection.

Acquired Immunodeficiency Syndrome↗