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PubMed1994

Comparison of cancer mortality trends in major European areas, 1960-89.

In the prospect of a political and economic 'harmonization' of the European Economic Community (EEC) and, possibly, all Europe, the identification of differences in cancer frequencies and trends in major European areas (ie EEC, non-EEC western countries, and eastern European countries) can help to set health priorities. From 1960-64 to 1985-89 all-age mortality rates of some common cancers (mouth or pharynx, pancreas, lung, kidney, prostate and skin) increased substantially especially in East Europe. Conversely, mortality rates from cancer of the stomach, uterus, testis and from Hodgkin's disease declined, but, again, trends in East Europe were less favourable. Some elevations in rare malignancies (non-Hodgkin's lymphomas, multiple myeloma and connective and soft-tissue sarcomas) emerged rather uniformly in Europe, especially in elderly people. Most favourable trends in total cancer mortality were apparent among females in the EEC (minus 7%) and non-EEC western countries (minus 14%). The picture becomes gradually less favourable with respect to non-EEC western European males and eastern European females (virtually no change) and EEC males (plus 13%). With a 25% increase in total cancer mortality rates in the past 30 years, males in East Europe emerge as the 'problem' group. The even wider gap between West and East Europe in cancer rates in young males leaves no hope for future improvements in the absence of effective interventions. Raising public awareness (especially with respect to smoking and alcohol consumption), and increasing motivation and quality controls among health professionals are badly needed in disadvantaged European areas.

Adult↗

PubMed1996

Thoracoscopic sympathicolysis for essential hyperhidrosis: effects on pulmonary function.

Bilateral interruption of the upper dorsal sympathetic chain at the D2 and D3 level represents the only permanent cure for essential hyperhidrosis. Following surgical sympathectomy, significant and symptomatic changes in pulmonary function have been observed. Since functional effects of the surgical intervention cannot be excluded, we wondered whether such alterations also occurred after thoracoscopic sympathicolysis; these should then be attributable to the surgical denervation itself. Pulmonary function tests (PFTs), including spirometry and body plethysmographic measurement of lung volumes and airway resistance and conductance, were compared before and 6 weeks after thoracoscopic sympathicolysis in 47 patients. In order to virtually exclude any effects of thoracoscopy on the test results PFTs were repeated 6 months after thoracoscopic sympathicolysis in 35 patients. Essential hyperhidrosis was completely relieved in all patients, thereby confirming the interruption of the D2-D3 sympathetic chain. None of the patients developed respiratory symptoms after thoracoscopic sympathicolysis. Forced expiratory volume in one second (FEV1) (-3%), forced expiratory flow after exhaling 75% of vital capacity (FEF75) (-8%) and total lung capacity (TLC) (-3%) were slightly but significantly reduced at six weeks after thoracoscopic sympathicolysis; whereas airway resistance (Raw) had increased (+12%). After correction for the small decrease in lung volume (FEV1/forced vital capacity (FVC), specific airway resistance (sRaw), specific airway conductance (sGaw))significant changes in "volume-dependent" PFT parameters were no longer observed. Smoking status had no influence on the reduction in FEF75. At 6 months after thoracoscopic sympathicolysis, TLC had returned to preoperative values, whereas FEF75 remained decreased (-8.6%). The decrease in airway calibre was confirmed by small but significant changes in FEV1/FVC (-2%) and Raw (+29%). We conclude that thoracoscopic sympathicolysis in patients with essential hyperhidrosis causes only minimal and subclinical changes in pulmonary function secondary to a temporary small decrease in lung volume, which in turn is probably inherent to the thoracoscopic procedure. D2-D3 sympathicolysis, in itself, is responsible only for a small and permanent decrease in forced expiratory flow, which suggests that, at least in essential hyperhidrosis patients, airway bronchomotor tone is influenced by sympathetic innervation.

Adolescent↗

PubMed1994

The signs and symptoms of poor nutritional status.

Many signs and symptoms suggest poor nutritional status, and some have been categorized by consensus of the Nutrition Screening Initiative as "major indicators"; this term implies that, if certain standards of change from the norm in that parameter have occurred, poor nutritional status as a cause must be considered and appropriate steps taken to correct such poor nutritional status if confirmed. Virtually all of the signs and symptoms of poor nutritional status are nonspecific and may be caused or exacerbated by other medical conditions. However, by categorizing them as major or minor indicators and summarizing them, the hope is that practicing health professionals will more frequently note these commonly observed changes, appreciate their nutritional significance, and implement nutritional interventions to correct the problems thus preventing the increased morbidity and mortality known to occur in the malnourished older individual.

Aged↗

PubMed2003

Gender and role-based perceptions of domestic abuse: does sexual orientation matter?

Although it is estimated that domestic abuse is as common in gay male and lesbian intimate relationships as in heterosexual relationships, the legal system often fails to recognize or respond to same-gender cases. Empirical research examining the impact of sexual orientation on perceptions of abuse is virtually nonexistent. Undergraduates (N = 252) read a summary of a domestic abuse incident in which victims and perpetrators varied by gender and, by implication, sexual orientation. Victim and respondent gender, rather than the couple's sexual orientation, primarily affected responses to domestic abuse. Domestic abuse perpetrated against women was perceived to be more serious and in need of intervention than abuse against men. Women were more likely than men to believe the victim and to recommend criminal justice system interventions. Because they are inconsistent with gender role stereotypes, domestic abuse cases involving male victims or female perpetrators may not receive equitable treatment within the criminal justice system.

Adolescent↗

PubMed2004

Radiation-induced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management.

BACKGROUND: Xerostomia is a common, debilitating complication of radiation therapy (RT) for head and neck cancer. This article reviews the pathogenesis of radiation-induced xerostomia, its impact on quality of life (QOL), and treatment options. METHODS: Virtually all patients undergoing RT for head and neck cancers have xerostomia, which causes oral discomfort and pain, increased dental caries and oral infection, and difficulty speaking and swallowing. This significantly impairs QOL and can compromise nutritional intake and continuity of cancer therapy. The literature describing pathogenesis, impact on QOL of radiation-induced xerostomia, and preventive and interventional therapies was reviewed. RESULTS: Current management strategies include stringent dental and oral hygiene; parotid-sparing radiation techniques to prevent or minimize xerostomia; and pharmacotherapies, such as salivary substitutes and sialogogues. Future strategies may include advanced three-dimensional intensity-modulated RT techniques, salivary gland transfer, newer sialogogues, and gene therapy. CONCLUSIONS: New treatment approaches to xerostomia from RT for head and neck cancer may result in significant improvement in patient QOL.

Head and Neck Neoplasms↗

PubMed2003

Management of peritoneal surface component of ovarian cancer.

Primary surgery followed by systemic platinum-based chemotherapy is the cornerstone of management for ovarian cancer. However, the majority of patients have an advanced disease (stage III/IV) at the time of diagnosis rendering the optimal primary cytoreduction feasible in only a small percentage of cases. A large tumor bulk limits the success of subsequent antiblastic therapy. There are two alternatives to overcome this unfavorable situation: (1) employment of ultra-radical interventions such as peritonectomy procedures, to increase the optimal cytoreduction rate; or (2) neoadjuvant chemotherapy. Whether such strategies would have an influence on the final outcome of patients is an issue to be defined in further prospective randomized studies. For second-line therapies no consensus regarding treatment has emerged. When previous effective drug combinations fail, there is virtually no chance of inducing a significant response with second-line treatment. The combination of secondary CRS and intraperitoneal hyperthermic perfusion constitutes a feasible and potential option for this subset of patients based on phase II studies. A randomized trial will be conducted to test the effectiveness of this strategy in patients with cisplatin-resistant disease. The indication for second-line treatment is macroscopic residual or relapse within 6 months after the completion of first line chemotherapy.

Adult↗

PubMed2000

Image-guided surgery: from X-rays to virtual reality.

Since the discovery of X-rays, medical imaging has played a major role in the guidance of surgical procedures. While medical imaging began with simple X-ray plates to indicate the presence of foreign objects within the human body, the advent of the computer has been a major factor in the recent development of this field. Imaging techniques have grown greatly in their sophistication and can now provide the surgeon with high quality three-dimensional images depicting not only the normal anatomy and pathology, but also vascularity and function. One key factor in the advances in Image-Guided Surgery (IGS) is the ability not only to register images derived from the various imaging modalities amongst themselves, but also to register them to the patient. The other crucial aspect of IGS is the ability to track instruments in real time during the procedure, and to portray them as part of a realistic model of the operative volume. Stereoscopic and virtual-reality techniques can usefully enhance the visualization process. IGS nevertheless relies heavily on the assumption that the images acquired prior to surgery, and upon which the surgical guidance is based, accurately represent the morphology of the tissue during the surgical procedure. In many instances this assumption is invalid, and intra-operative real-time imaging, using interventional MRI, Ultrasound, and electrophysiological recordings are often employed to overcome this limitation. Although now in extensive clinical use, IGS is often currently perceived as an intrusion into the operating room. It must evolve towards becoming a routine surgical tool, but this will only happen if natural and intuitive human interfaces are developed for these systems.

Brain↗

PubMed1997

Volumegraph (overlaid three-dimensional image-guided navigation). Clinical application of augmented reality in neurosurgery.

OBJECTIVE: We have developed an overlaid three-dimensional image (Volumegraph)-guided navigation system that allows navigation during operative procedures. The three-dimensional image is superimposed on the patient's head and body via a semi-transparent mirror. The Volumegraph can display three-dimensional images in the air by a light beam which is based on CT/MRI. METHOD: The system consists of a Volumegraph (thin plate of three-dimensional recorded medium), a Volumegraphscope and an original designed triangular-shaped marker system for registration. The three-dimensional data obtained from CT and MRI before the operation were processed by a computer. Such image data are applied for preoperative investigation to recognize the three-dimensional structure of organs and tumor. These reconstructed three-dimensional images were superimposed and registered at the patient's head according to a fiducial marker (registration). Then the operator can operate with this three-dimensional-image-guided navigation system. RESULTS: Based on clinical application in 7 cases, the system was found to be advantageous because the surgical procedures could be navigated easily by augmented reality in the surgical field. Invisible parts of the surgical field were supplemented with the overlaid three-dimensional images (Volumegraph) as if it were the virtual operative field. At another time, spatial positioning and overlaid visualization by the Volumegraph was useful for identifying anatomical structures and functional location in the image. CONCLUSION: This preliminary study of overlaid three-dimensional-image-guided navigation demonstrated its clinical usefulness. The application of augmented reality in the surgical field makes it possible to do a neurosurgical intervention easily and accurately.

Brain Neoplasms↗

PubMed1990

Induction and pathophysiology of remission of insulin-dependent diabetes mellitus during administration of ciclosporin. London Diabetes Study Group.

Ciclosporin-induced noninsulin-receiving remissions in insulin-dependent diabetes mellitus are associated with enhancement of beta-cell function. Patients in remission show virtually no insulin responses to parenteral glucose, contrasting with substantial responses to mixed meals, indicating effects of nonglucose nutrients and/or enteroinsular mechanisms. Remission is associated with normal insulin sensitivity; loss of insulin sensitivity can lead to relapse. The risks of the treatment call for studies with lower doses, and it is argued that a continuing search for immunomodulatory interventions that enhance and preserve the clinical remission-phase characteristics should be pursued.

Adolescent↗

PubMed1994

Effects of chronic beta-adrenergic blockade on the left ventricular and cardiocyte abnormalities of chronic canine mitral regurgitation.

The mechanism by which beta blockade improves left ventricular dysfunction in various cardiomyopathies has been ascribed to improved contractile function of the myocardium or to improved beta-adrenergic responsiveness. In this study we tested two hypotheses: (a) that chronic beta blockade would improve the left ventricular dysfunction which develops in mitral regurgitation, and (b) that an important mechanism of this effect would be improved innate contractile function of the myocardium. Two groups of six dogs with chronic severe mitral regurgitation were studied. After 3 mo both groups had developed similar and significant left ventricular dysfunction. One group was then gradually beta-blocked while the second group continued to be observed without further intervention. In the group that remained unblocked, contractile function remained depressed. However, in the group that received chronic beta blockade, contractile function improved substantially. The contractility of cardiocytes isolated from the unblocked hearts and then studied in the absence of beta receptor stimulation was extremely depressed. However, contractility of cardiocytes isolated from the beta-blocked ventricles was virtually normal. Consistent with these data, myofibrillar density was much higher, 55 +/- 4% in the beta-blocked group vs. 39 +/- 2% (P < 0.01) in the unblocked group; thus, there were more contractile elements to generate force in the beta-blocked group. We conclude that chronic beta blockade improves left ventricular function in chronic experimental mitral regurgitation. This improvement was associated with an improvement in the innate contractile function of isolated cardiocytes, which in turn is associated with an increase in the number of contractile elements.

Adrenergic beta-Antagonists↗

PubMed1999

Improving usage of pediatric information on the Internet: the Virtual Children's Hospital.

OBJECTIVE: Digital health sciences libraries (DHSLs) bring order to the chaos of the Internet by making authoritative medical information easily and conveniently available to patrons. The goal of this project was to perform a baseline usage analysis of the pediatric-related information in a general DHSL and to determine whether reorganization of the pediatric-related information into its own pediatric DHSL could increase the usage of the pediatric-related information. METHODS: From March through August 1997, a baseline analysis of a general DHSL (Virtual Hospital) was conducted using computer server log file analysis programs. The quantity of pediatric-related information in the general DHSL and its baseline usage were determined. In September 1997, the pediatric-related information was reorganized into its own pediatric DHSL (Virtual Children's Hospital), and server log file analyses were conducted of the pediatric DHSL from September 1997 to August 1998. Statistical analysis was performed by time series autoregression. RESULTS: During the baseline, the general DHSL and the pediatric-related information received a monthly average of 2 320 782 and 141 444 qualified hits, respectively. After the intervention, the general DHSL and the pediatric DHSL received a monthly average of 2 765 454 and 256 998 qualified hits, respectively. This is an increase of 19. 2% for the general DHSL and 81.7% for the pediatric DHSL. These changes were statistically significant at the P >.0001 level. The most requested pediatric-related content in the pediatric DHSL did not change substantively from preintervention to postintervention. DISCUSSION: On the Internet, as in real life, children's services must have their own distinct identity and must be differentiated from adult services. Therefore, pediatric-related information will receive increased usage if it is part of a pediatric DHSL rather than part of a general DHSL. Others can use this process and the lessons learned to develop and enhance their own pediatric-related information on the Internet. Internet, pediatrics, digital health sciences libraries, digital library, medical library.

Data Collection↗

PubMed2004

Rationale and design of the Rockford CHIP, a community-based coronary risk reduction program: results of a pilot phase.

PURPOSE: While residential lifestyle intervention programs have demonstrated coronary risk reduction through education, diet, and exercise, this pilot study was designed to assess the feasibility of a community-based lifestyle intervention program that is both affordable and effective in facilitating better lifestyle choices and health habits and thus effecting indicators of better clinical outcomes. MATERIALS AND METHODS: A 40-h educational curriculum, delivered over a 30-day period with clinical and nutritional assessments before and after, was offered through the SwedishAmerican Center for Complementary Medicine to the general public. The participants were instructed to exercise 30 min/day and to embrace a more optimal diet (ad libitum) of largely unrefined plant foods high in complex carbohydrates and fiber, yet quite low in fat (<15%), animal protein, sugar, and salt, and virtually free of cholesterol. RESULTS: Of the 250 enrollees, 242 "graduated" (78 men and 164 women; almost all Caucasian; mean age 54 +/- 12 years). They had coronary artery disease (CAD) (12%), diabetes (16%), hypertension (55%), most were overweight (88%), and the majority (79%) had low-density lipoprotein (LDL) levels >or=100 mg%. At 4 weeks, stratified analyses of total cholesterol (TC), LDL, triglycerides (TG), blood glucose, blood pressure, and weight showed that those at highest risk also had the greatest improvements. Depending on baseline levels, TC means dropped 10-23% in men and 6-13% in women. At the same time, LDL means declined 5-30% in men and 6-14% in women. In TG, the biggest drop (48%) was found in men who at baseline were in the highest risk category (in women, the biggest TG drop was 32%). CONCLUSION: Community-based intervention strategies can be successfully and affordably utilized to lower coronary risk factor levels in a self-selected, free-living population. The true test, however, will be to what extent social infrastructures can be modified and alumni activities sustained to facilitate long-term adherence and sustained benefits.

Adult↗

PubMed1997

Do children eat what they say? Validity of intended food choices among Native American school children.

OBJECTIVE: To examine the agreement between school children's intended food choices and observed food choices. DESIGN: Native American students in the second through fifth grade completed a questionnaire that asked them to select from 10 paired food choices for a given meal or snack. Three weeks later students chose among foods identical to those on the questionnaire as part of their usual school lunch or breakfast over three consecutive days; afternoon snacks were also offered. RESULTS: Agreement between students' intended food choices and observed food choices was examined across 10 food pairs. The composite kappa coefficient between intended and observed food choices was 0.09 (95% confidence interval 0.06, 0.012), including virtually no agreement above that expected by chance. There were no differences in agreement by sex or grade. CONCLUSIONS: Intended food choices were not significantly associated with observed food choices. It is unclear whether intended food choices reflect nutrition knowledge, socially desirable responses, food preferences, or some other dimension of eating behavior. Although responsive to school-based nutrition interventions, the interpretation of changes in intended food choices must be clarified in future research.

Child↗

PubMed1998

Spiral analysis: a new technique for measuring tremor with a digitizing tablet.

A new computational method for quantification of tremor and other aspects of motor dysfunction is described. By using a digitizing tablet connected to a microcomputer, this analysis is derived from the handwritten Archimedean spiral. This technique extends the standard clinical neurologic test of spiral drawing into an objective and accurate measure that can automatically detect, characterize, and quantify motor dysfunction in patients with movement disorders. Further, it is safe, inexpensive, fast, portable, noninvasive, and can be administered to a large cohort of patients without the need for wires or other attachments. Spiral data are collected in the X, Y, and pressure axes, providing virtual "triaxial" recordings. Spiral analysis is shown to be capable of assessing subtle motor abnormalities potentially indicative of clinical problems in their earliest stages, and thus allow the most rational forms of genetic testing, treatment, or prevention. Spiral analysis may be useful as an initial marker of clinical involvement or serve as an objective gauge of change after therapeutic intervention.

Diagnosis, Computer-Assisted↗

PubMed1997

Prevalence and risk factors for anabolic-androgenic steroid abuse in Australian high school students.

Abuse of anabolic-androgenic steroids (AAS) is reportedly increasing in prevalence and spreading from sportsmen to cosmetic and recreational use, though there are few accurate estimates of the extent of AAS use outside North America. In order to identify the prevalence of, and risk factors for, 'ever' (lifetime) or 'recent' (within last month) use of AAS among Australian high school students, 13,355 students (51.3% male, median age 13.8 years) in 203 schools constituting a stratified random sample of all high schools in New South Wales and Victoria completed a self-report questionnaire about drug use. Lifetime ('ever') use of AAS was reported by 213 boys (3.2%; 95% CI, 2.7-3.6%) and 74 girls (1.2%; 95% CI, 0.9-1.5%). Factors associated with 'ever' use were truancy [odds ratio (OR) 17.7 (95% CI, 9.4-31.6) for 7 or more truant days compared with no trauncy over the last fortnight], unsupervised recreation [OR 8.4 (5.9-11.9) for 6 or more compared with 2 or fewer nights per week], speaking only a non-English language at home [OR 7.75 (4.4-13.1)], Aboriginality [OR 3.4 (2.0-5.5)], male gender [OR 2.8 (2.1-3.7)], higher student income [OR 2.3 (1.7-3.0)], overseas born [OR 2.2 (1.6-3.0)] and low level of social support [OR 2.5 (1.7-3.5)]. Use of AAS within the last month ('recent') was reported by 113 boys (1.7%; 95% CI, 1.4-2.0%) and 28 girls (0.4%; 95% CI, 0.3-0.6%) and virtually identical risk factor patterns except ORs were uniformly higher. We conclude that AAS abuse is relatively uncommon among Australian high school students but has distinctive and strong socio-economic and cultural predictors. Further studies of the behavioural epidemiology of AAS abuse are required to clarify the origins and significance of our findings and to identify potentially effective interventions.

Absenteeism↗

PubMed2001

[Antiinfectious prophylaxis in asplenia].

Asplenia in childhood may be congenital (e.g. Ivemark-syndrome) or acquired (functional hyposplenism in sickle cell disease; after splenectomy or bone marrow transplantation). Hereditary spherocytosis is the most common indication for splenectomy in childhood. Virtually every patient without spleen has a significantly increased risk of severe postsplenectomy infection (mostly caused by Streptococcus pneumoniae). Therefore, vaccinations against pneumococci, haemophilus influenzae and, under certain circumstances, meningococci are recommended. In addition a continuous prophylaxis with antibiotics should be performed for at least three years (or even longer depending on the disease) after splenectomy followed by lifelong interventional application of broad spectrum antibiotics in case of any unclear infection or high fever. This prophylaxis must be started as early as four months of age in sickle cell disease. In future the use of penicillin may be hampered by the growing resistance of pneumococci. Due to this fact the indication for splenectomy in childhood should be restricted to patients with hematologic disease (spherocytosis and other hemolytic anemias, chronic ITP etc.) and moderate to severe symptoms. It is unclear whether partial splenectomy for spherocytosis (and other hemolytic anemias) is an alternative regarding both longlasting reduction of hemolysis and prevention of severe infection. After trauma every effort should be undertaken to preserve a splenic remnant.

Age Factors↗

PubMed1997

Virtual cutting in medical data.

In this paper we present a method for virtual 3D cutting operations in 3D tomographic data. When cutting interactively the user specifies a series of 3D cutting points and corresponding cut depths on the surface of the object. Each pair of succeeding cutting points then defines a freeform shape of the incision. A 3D meshing algorithm constructs a Finite Element mesh formed by tetrahedrons, representing the surgical intervention.

Computer Simulation↗

PubMedDate not supplied

Systolic dysfunction of the ventricle in congestive heart failure: pathophysiology, diagnosis, and therapy.

Investigations into the pathophysiology and treatment of the failing left ventricle have yielded impressive results over the past three decades. Patients with systolic dysfunction have abnormalities of the molecular machinery and signaling of contraction which may be in-born or acquired, and result in the characteristic mechanical abnormalities associated with this condition. Correlation of these ultrastructural contractile abnormalities with the mechanical dysfunction observed clinically is complicated by alterations of preload and afterload which accompany systolic failure. The systemic consequences of contractile failure result in a cascade of neuroendocrine and cytokine activation which perpetuates a cycle of further myocardial dysfunction and systemic humoral response. Based on this neuroendocrine paradigm, pharmacologic intervention trials have yielded promising gains in survival and symptom status in patients with systolic dysfunction, particularly with the ACE inhibitors and the beta-adrenergic blockers. For patients with acute systolic failure the inotropic agents continue to be useful in short term support but chronic administration with these agents should be avoided because of enhanced mortality observed in virtually all placebo controlled trials. Finally, long-term mortality rates remain high in patients with systolic dysfunction despite current therapy, thus offering an opportunity for the novel approaches currently under investigation to substantially impact on patient outcomes. (c)1999 by CHF, Inc.

Journal Article↗