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PubMed1994

Minimally invasive surgery. Future developments.

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures.

Forecasting↗

PubMed1998

Serum cholesterol, lifestyle, working capacity and quality of life in patients with coronary artery disease. Experiences from a hospital-based secondary prevention programme.

Coronary artery diseases (CAD) are main causes of morbidity and hospitalisation in western countries and CAD patients are at considerable risk of suffering further cardiac events. The development and evaluation of secondary prevention programmes therefore an important task. This thesis includes investigations on CAD patients admitted to a secondary prevention programme at Malmö University Hospital, Malmö, Sweden. Four weeks after discharge from the hospital, consecutive male and female patients aged 50-70 years with acute myocardial infarction (AMI) or treated with coronary artery bypass grafting (CABG) surgery were randomised to a hospital organised preventive intervention or to usual follow-up at their general practitioners. In the three studies using this randomised design, 87 (study II), 90 (study IV), and 106 (study V) intervention patients were available for evaluation. In addition, without randomisation, lipid levels at four weeks after the event was compared with levels estimated within 24 hours after onset of symptoms in 141 AMI patients (study I), and quality of life (QL) were estimated by questionnaire at one month and at one year after the event in 266 AMI, 94 CABG, and 16 percutaneous transluminal coronary angioplasty (PTCA) patients (study III). The prevention programme was effective in improving food habits but showed no impact on smoking habits or physical exercise in AMI patients (study II). The intervention also did not show any significant improvement in working capacity in AMI and CABG patients. However, working capacity improved in both intervention and reference CABG patients, most probably due to improved coronary circulation from the surgery (study IV). Cholesterol levels decreased significantly in AMI and CABG intervention patients as compared to the corresponding reference patients. This difference most likely was due to a higher frequency of lipid lowering drugs used in the intervention patients (study V). The prevention programme also decreased body mass index significantly in AMI but not in CABG patients (study V). In AMI patients receiving thrombolysis, cholesterol levels estimated within 24 hours after onset of symptoms and at four weeks after the event were virtually equal. In AMI patients not receiving thrombolysis, the lipid estimates from four weeks after the event were slightly, but significantly, above the within 24 hours from onset of symptoms estimates (study I). One month after the event, both somatic and psychological aspects of QL were negatively affected in AMI and CABG patients compared to population controls. One year after the event, patients differed from controls mainly in somatic symptoms (study III). Thus, the intervention programme was most successful in affecting lipid levels and food habits in AMI patients. QL was considerably affected in patients following an cardiac event, especially during the initial recovery phase. In addition, in patients receiving thrombolysis, cholesterol levels estimated four weeks after an AMI are reasonably valid estimates of baseline values and may be used to decide about lipid lowering interventions.

Aged↗

PubMed1986

Successful removal of a brainstem hemangioblastoma.

This is the report of the surgical removal of a solitary hemangioblastoma that had developed in the left nucleus cuneatus of the medulla oblongata. The surgical intervention was simple and no technical or anesthetic problems were encountered. In spite of the patient's extremely serious neurological state before the operation, his nervous functions reverted virtually to normal.

Brain Neoplasms↗

PubMedDate not supplied

Production of functional chimaeric mouse/human antibody.

The availability of monoclonal antibodies has revived interest in immunotherapy. The ability to influence an individual's immune state by administering immunoglobulin of the appropriate specificity may provide a powerful approach to disease control and prevention. Compared with immunoglobulin from other species, human immunoglobulin (Ig) might be best for such therapeutic intervention; it might function better with the recipient's effector cells and should itself be less immunogenic. The success of the mouse hybridoma system suggests that immunoglobulin of virtually any specificity can be obtained from a properly immunized animal. In the human system, however, immunization protocols are restricted by ethical considerations, and it is not yet clear whether human antibody-producing cell lines of the required specificity can be obtained from adventitiously immunized individuals or from in vitro immunized cells. A method which might circumvent these difficulties is to produce antibodies consisting of mouse variable regions joined to human constant regions. Therefore, we have constructed immunoglobulin genes in which the DNA segments encoding mouse variable regions specific for the hapten trinitrophenyl (TNP) are joined to segments encoding human mu and kappa constant regions. These 'chimaeric' genes are expressed as functional TNP-binding chimaeric IgM. We report here some of the properties of this novel IgM.

Animals↗

PubMed1981

The single-case design in family therapy evaluation research.

This paper discusses the need for the development of new research designs for family therapy evaluation, and a manner for meeting that need. The single-case research design has gained acceptance as bona fide experimental designs for evaluating the effectiveness of intervention techniques in drug and psychotherapy outcome research. Although the need for more outcome studies on the effectiveness of family therapy has been frequently noted, there has been virtually no use of the single-case design in family therapy outside of the behavior modification literature on families. This paper presents potential benefits of the application of single case-design for the practice of family therapy. Preliminary guidelines are suggested for the application of these designs.

Behavior Therapy↗

PubMed1987

Dietary treatments of obesity.

Dietary treatment of obesity is based on one or another of two premises: that the obese eat too much or that they eat the wrong things. The first is a tautology lacking explanatory power. The second is a meaningful and promising hypothesis but has yet to be effectively applied. At present, virtually all outpatient treatments of obesity, including behavior modification, are based on the first premise and consist of strategies for reducing the subject's caloric intake. Most such interventions produce short-term weight loss. Regain after the end of treatment remains the usual outcome. A survey of studies published in the period 1977-1986 and reporting on dietary or behavioral treatment of obesity reveals that the maximum percentage of body weight lost is, on average, 8.5 percent--no different from the value, 8.9%, in similar studies from 1966-1976, as reviewed by Wing and Jeffery. The principal determinant of success in such programs appears to be the intake weight of the subjects: the higher the intake weight, the more successful the intervention will appear to be. The goals and research methods of studies on dietary treatments for obesity are overdue for ethical as well as scientific reevaluation. The same may be said for the numerous programs providing such treatment outside the context of research.

Animals↗

PubMed2000

[3D virtual imaging of the upper airways].

The different three dimensional reconstructions of the upper airways that can be obtained with spiral computed tomograpy (CT) are presented here. The parameters indispensable to achieve as real as possible spiral CT images are recalled together with the advantages and disadvantages of the different techniues. Multislice reconstruction (MSR) produces slices in different planes of space with the high contrast of CT slices. They provide information similar to that obtained for the rare indications for thoracic MRI. Thick slice reconstructions with maximum intensity projection (MIP) or minimum intensity projection (minIP) give projection views where the contrast can be modified by selecting the more dense (MIP) or less dense (minIP) voxels. They find their application in the exploration of the upper airways. Surface and volume external 3D reconstructions can be obtained. They give an overall view of the upper airways, similar to a bronchogram. Virtual endoscopy reproduces real endoscopic images but cannot provide information on the aspect of the mucosa or biopsy specimens. It offers possible applications for preparing, guiding and controlling interventional fibroscopy procedures.

Bronchi↗

PubMed1996

[Open laparoscopy for prevention of puncture injuries].

Perforating lesions occurring during the establishment of the pneumoperitoneum using the Veres needle and blind introduction of the camera trocar are among the major complications of laparoscopic surgery. Even when all the necessary safety measures are observed and despite complete mastery of the technique, this complication cannot be completely avoided during the blind procedure. The technique of open laparoscopy, so-called, with the introduction of a blunt trocar under direct vision is the sole alternative available for the prevention of such injuries. The advantages of this procedure are that, with appropriate practice, it takes no longer, can be employed in all possible situations, including previous surgery, and, in particular, when assisting a surgeon who is in the process of gaining experience in laparoscopic surgery. Severe perforating injuries and their sequelae are often advanced as an argument against the use of laparoscopic surgical procedures. Through the use of open laparoscopy, injuries to blood vessels and viscera can be virtually completely eliminated, and patient safety considerably improved. On the basis of our own experience, we can unreservedly recommend open laparoscopy as the routine approach for all laparoscopic interventions.

Abdominal Injuries↗

PubMed2026

Comparative Evaluation of Virtual Reality versus Standard Nursing Care in Managing Pain and Fear during Lumbar Puncture Procedures: A Randomised Controlled Trial.

BACKGROUND: Meningitis is a serious infectious disease that can cause significant morbidity and long-term neurological problems. Although a lumbar puncture is a necessary diagnostic procedure, it is often accompanied by discomfort, anxiety, and fear, which can severely impact the patient's experience. Although there is few data on its application prior to lumbar puncture in adult patients with meningitis, immersive virtual reality (VR) has become a promising non-pharmacological technique for lowering procedural distress. Thus, among individuals undergoing lumbar punctures, this randomized controlled research assessed how well pre-procedural VR reduced pain, anxiety, and fear while enhancing patient satisfaction. OBJECTIVE: This study aims to evaluate the effectiveness of virtual reality (VR) in reducing pain and fear among adults undergoing lumbar puncture (LP) compared with standard care protocol. METHODS: A randomised clinical trial was conducted from May to October 2025, using a single-blind, true experimental design. A total of 85 patients were randomly assigned to either the VR intervention group ( n = 41) or the control group receiving standard care ( n = 44). Pain levels were assessed using a visual analogue scale. Fear was assessed using the Multidimensional Fear-of-Injection Scale. Data were analysed using SPSS version 26. RESULTS: According to the study, the findings revealed a significant reduction in pain levels among the study group following the VR intervention, with mean pain scores dropping from 7.54 ± 1.925 to 2.49 ± 0.675. In contrast, the control group showed increased pain intensity, with mean scores rising from 6.84 ± 1.842 to 8.36 ± 1.348. The VR group showed a significant reduction in fear scores across all domains, whereas no significant changes were observed in the control group. Direct fear decreased from 20.12 ± 1.71 to 9.44 ± 2.00, indirect fear from 17.24 ± 1.46 to 8.66 ± 2.24, physiological response improved from 0.34 ± 0.66 to 3.00 ± 1.00 and avoidance behaviour decreased from 16.71 ± 1.49 to 7.80 ± 1.85. CONCLUSIONS: The research shows that the use of VR prior to LP significantly reduces level of pain and fear compared to standard care. These results support VR as a non-pharmacological intervention for fear and pain to improve patient experience during invasive procedures. In contrast, the control group experienced no improvement.Trial Registration: The IRCT code for the trial was IRCT ID 20250803066743N1.

Humans↗

PubMed1998

[Changes in and acceptance of surgical and noninvasive therapy procedures in cholecystolithiasis].

BACKGROUND: The treatment of cholecystolithiasis has changed fundamentally in recent years due to the development of non-surgical techniques (extracorporeal shockwave lithotripsy [ESWL], oral litholysis) and the implementation of laparoscopic cholecystectomy. PATIENTS AND RESULTS: Retrospective analysis of 2270 patients (1649 women, 621 men; age: 47.2 +/- 14 years) presenting with gallstone disorders in a university medical outpatients department between 1988 and 1992 in order to be instructed as to the most suitable therapy method bear witness to the rapid change in therapeutic procedure. Laparoscopic removal of the gallbladder has virtually supplanted conventional cholecystectomy, and within 5 years the proportionate role of ESWL has declined from 21 to 12%. Over the years, the proportion of patients requiring no therapeutic intervention remained constant (at about 20%). The therapeutic recommendations of the "experts" were implemented in almost 80% of cases. The majority of patients were satisfied with the chosen therapeutic approach (surgery: 93.0%, ESWL: 77.6%), although 44% of ESWL-patients and 36% of surgically managed patients reported complaints which persisted even after completion of therapy. Despite unsuccessful ESWL (residual fragments or recurrent stones) 58/95 (61%) of interviewed patients would again give preference to this non-invasive modality in the event of a renewed therapeutic decision. CONCLUSION: Only a few years after its introduction, laparoscopic cholecystectomy has asserted itself as the predominant treatment option. But as far as acceptance and preference by the patient are concerned extracorporeal shockwave lithotripsy--as a non-invasive treatment modality--also enjoys high popularity and can be recommended as an alternative to surgery in suitable patients chosen according to the currently established stringent selection criteria.

Adolescent↗

PubMed2006

TIES that BIND: an introduction to domain mapping as a visualization tool for virtual rehabilitation.

The application of virtual reality (VR) to rehabilitation is a young, interdisciplinary field where clinical implementation very rapidly follows scientific discovery and technological advancement. Implementation is often so rapid that demonstration of intervention efficacy by investigators, and establishment of research and development priorities by funding bodies tend to be more reactive than proactive. An examination of the dynamic unfolding of the history of our young discipline may help us recognize the facilitators of current practice and identify the barriers that limit greater progress. This paper presents a first step towards the examination of the past and future growth of VR-based rehabilitation by presenting the use of concept maps to explore the publication history of application of VR to rehabilitation.

Bibliometrics↗

PubMed2006

Treating the acute stroke patient as an emergency: current practices and future opportunities.

Developments in acute stroke therapy have followed advances in the understanding of the evolving pathophysiology in both ischaemic stroke and intracerebral haemorrhage (ICH). In ischaemic stroke, rapid reperfusion of the ischaemic penumbra with thrombolysis within 3 h of symptom onset is of proven benefit, but few patients currently receive therapy, mainly due to the short-time window and lack of stroke expertise. In ICH, a recent study indicated that a haemostatic agent can limit ongoing bleeding and improve outcomes when administered within 4 h of stroke onset. These advances in acute stroke therapy underlie the concept that 'time is brain' and that urgent intervention can limit cerebral damage. Neuroprotective therapy could offer the prospect of a greater proportion of stroke patients receiving treatment, potentially before imaging and even in the ambulance setting. Virtually all stroke patients would benefit from receiving multidisciplinary care in acute stroke units.

Emergencies↗

PubMed2004

The moral lens of population control: condoms and controversies in southern Malawi.

The study presents an investigation of stories about condoms in southern Malawi. Malawians' concerns about coercive population control imposed by a national government or international cabal provide a moral lens through which condoms and other health promotions are viewed, with unknown but probably negative impact on the use of condoms. The focus of the study is on the long shadow cast by population control because it is underresearched and, in fact, virtually unmentioned in most studies of health promotion, yet appears to be common if not ubiquitous. Moreover, this long shadow poses a distinct challenge to HIV-prevention and intervention efforts. The data for the study were gathered by six Malawian research assistants in Balaka district, in southern Malawi, who kept journals over a period of three years in which they recorded conversations and everyday chats that they observed. These journals demonstrate that condoms do not arrive in communities as neutral, value-free objects; rather they enter a social setting permeated with ideas about health, self-protection, and danger. The lens of population control has proved to be both durable and flexible, providing a moral context in which both commodities and actors can be understood. Disentangling condoms from the symbolic nexus in which they are fused with disease, population control, and malevolence will be an ongoing challenge in the struggle to prevent the spread of HIV/AIDS in Malawi.

Adult↗

PubMed1997

Evaluation of abnormal vaginal bleeding in perimenopausal women with endovaginal ultrasound and saline infusion sonohysterography.

Saline infusion sonohysterography enhances endovaginal ultrasound examination of the uterine cavity in perimenopausal patients with abnormal uterine bleeding. It is easily and rapidly performed at minimal cost, is extremely well tolerated by patients, and is virtually devoid of complications. Its use can prevent invasive diagnostic procedures in some patients as well as optimize the preoperative triage process for those patients who will require therapeutic intervention.

Female↗

PubMed2001

Diabetes and endothelial dysfunction: a clinical perspective.

The main etiology for mortality and a great percent of morbidity in patients with diabetes mellitus is atherosclerosis. A hypothesis for the initial lesion of atherosclerosis is endothelial dysfunction, defined pragmatically as changes in the concentration of the chemical messengers produced by the endothelial cell and/or by blunting of the nitric oxide-dependent vasodilatory response to acetylcholine or hyperemia. Endothelial dysfunction has been documented in patients with diabetes and in individuals with insulin resistance or at high risk for developing type 2 diabetes. Factors associated with endothelial dysfunction in diabetes include activation of protein kinase C, overexpression of growth factors and/or cytokines, and oxidative stress. Several therapeutic interventions have been tested in clinical trials aimed at improving endothelial function in patients with diabetes. Insulin sensitizers may have a beneficial effect in the short term, but the virtual absence of trials with cardiovascular end-points preclude any definitive conclusion. Two trials offer optimism that treatment with ACE inhibitors may have a positive impact on the progression of atherosclerosis. Although widely used, the effect of hypolipidemic agents on endothelial function in diabetes is not clear. The role of antioxidant therapy is controversial. No data have been published regarding the effects of hormonal replacement therapy on endothelial dysfunction in postmenopausal women with type 2 diabetes.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1989

Metastatic disease of bone and treatment of pathological fractures.

The importance of early, secure, internal fixation in the management of pathologic fractures, especially if bone stock has been severely compromised, is clearly recognized by the orthopedic surgeon. There is virtually no place for denying surgical treatment to the majority of these cases, because it would most probably leave them in a painful, bedridden state. The risks of operative intervention and the use of methylmethacrylate along with fixation devices are justified when analyzing the end results of relief of pain, ambulatory activity, and restoration of function, as well as psychologic benefits. The use of radiotherapy and chemotherapy along with surgery has greatly enhanced the management of this disabled patient population. Fracture healing can take place in the presence of extensive destructive lesions. Survival rates are improving and earlier recognition of skeletal metastasis by newer technology, including bone scanning and computerized axial tomography, is helpful in the overall management of these patients. The goals of treatment can be achieved by proper planning and a multidisciplinary approach to the patient with metastatic skeletal disease.

Bone Neoplasms↗

PubMed1977

Reduction of stereotyped behavior in profoundly retarded individuals.

High-frequency, stereotyped behavior may interfere with the acquisition of appropriate behavior. Through the use of a procedure involving access to vibratory stimulation and its response-contingent withdrawal, stereotyped behavior of two profoundly retarded students was virtually eliminated. A reversal design, employed in Experiment 1, demonstrated that the nonoccurrence and the occurrence of stereotypic hyperventilation was a function of the presence or absence of the intervention procedure. In Experiment 2, a multiple-baseline design provided evidence that the procedure repeatedly produced suppression of stereotyped mouthing across three settings in which it was employed. The observed level of suppression was similar to that typically achieved by contingent application of aversive stimulus procedures. In addition, the procedures seemed to be learned quickly by teachers and administered effectively by public school personnel.

Adolescent↗

PubMed1998

Methods for providing probe position and temperature information on MR images during interventional procedures.

Interventional magnetic resonance imaging (MRI) can be defined as the use of MR images for guiding and monitoring interventional procedures (e.g., biopsy, drainage) or minimally invasive therapy (e.g., thermal ablation). This work describes the development of a prototype graphical user interface and the appropriate software methods to accurately overlay a representation of a rigid interventional device [e.g., biopsy needle, radio-frequency (RF) probe] onto an MR image given only the probe's spatial position and orientation as determined from a three-dimensional (3-D) localizer used for interactive scan plane definition. This permits 1) "virtual tip tracking," where the probe tip location is displayed on the image without the use of separate receiver coils or a "road map" image data set, and, 2) "extending" the probe to predict its path if it were directly moved forward toward the target tissue. Further, this paper describes the design and implementation of a method to facilitate the monitoring of thermal ablation procedures by displaying and overlaying temperature maps from temperature sensitive MR acquisitions. These methods provide rapid graphical updates of probe position and temperature changes to aid the physician during the actual interventional MRI procedures without altering the usual operation of the MR imager.

Animals↗