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PubMed2000

Computer assisted surgery with 3D robot models and visualisation of the telesurgical action.

This paper deals with the support of virtual reality computer action in the procedures of surgical robotics. Computer support gives a direct representation of the surgical theatre. The modelization of the procedure in course and in development gives a psychological reaction towards safety and reliability. Robots similar to the ones used by the manufacturing industry can be used with little modification as very effective surgical tools. They have high precision, repeatability and are versatile in integrating with the medical instrumentation. Now integrated surgical rooms, with computer and robot-assisted intervention, are operating. The computer is the element for a decision taking aid, and the robot works as a very effective tool.

Computer Simulation↗

PubMed2000

Global health challenges: trends in public health training, research and advocacy.

As we begin the 21st century, public health is at the crossroads in trying to understand the relative importance of health determinants in risk exposures, and the collective susceptibility of our societies. Classically conditioned attitudes of investigation, instruction, and exposition in the management of acute disease breaks down, when disease surveillance becomes virtually useless as in the prevention of chronic conditions. Older populations, new lifestyle changes, environmental hazards and urbanization have converged to make social class and poverty predominant factors in the expression of morbidity and mortality. In the process, the comfort of specific disease eradication is replaced by continuous challenges in dealing with the dynamics of social change--behaviors in diet and exercise--as well as the globalization of poverty, addiction, injury and violence. The consequent dilemma to develop a base for public health intervention, a strategy for training and a platform for advocacy for health improvement shows an eclectic pattern. The traditional clinically oriented perspective has moved towards a comprehensive population-based disease management model. A second trend with a somewhat narrowed vision for public health is the one focused on cost containment limiting preventive care. As technological advances in genetics and medicine and health informatics brings more rational, evidence based management in health care, two major gaps in public health training continues to persist. One is the lack of adequate attention to social class and poverty as a major pervasive factor. The other relates to the inability to address effectively, injury, violence, and mini wars diluting the value perspectives and advocacy in public health.

Communicable Disease Control↗

PubMed1977

The medicolegal investigation of operating room associated deaths.

For those medicolegal investigative systems charged by statute with the responsibility of investigating and examining known or suspected iatrogenic deaths--whether in a perioperative or operative situation, or in some other relationship to medical intervention--there is usually little doubt that these types of investigations constitute the most difficult, often perplexing, and far-reaching investigation, examination, and reporting problems of any of the types of cases referred. Much of this difficulty derives from the changing attitude of the public at large, including the medical and the legal community. In the United States, as recently as 15 years ago, the loss of life or injury subsequent to a therapeutic or operative procedure, with rare exception, was accepted virtually as an act of God.

Anesthesia↗

PubMed2006

The Barents project in psychiatry: a systematic comparative mental health services study between Northern Norway and Archangelsk County.

BACKGROUND: There is virtually no readily accessible systematically recorded evidence on how the organization of mental health services in Europe's largest country, Russia, may differ from other national systems. This study systematically compares the mental health services in Archangelsk County and Northern Norway using instruments developed for trans-cultural use. METHODS: The European Service Mapping Schedule (ESMS) and The International Classification of Mental Health Care (ICMHC) were used to describe: (i) resources, organisation and utilisation of the services; (ii) their decentralisation and differentiation; (iii) some interventions delivered by the mental health service units (n = 132) in both regions. RESULTS: The Norwegian services are more decentralised and differentiated, while the Russian services are largely hospital-based. The GPs are of considerable importance to the Norwegian services, functioning as gatekeepers-both centrally and peripherally. In contrast, the GP model is still poorly established in Archangelsk County. There are more units for long term stay in the Russian services than in Norway. General health care and taking over daily living activities are more organised in Archangelsk County, while psychopharmacological treatment and psychosocial interventions are more developed in Norway. CONCLUSION: The study has revealed several differences in resources, organisation and utilisation of the mental health services between the two compared areas. The very large variations indicate that underlying local patterns of service delivering must be further investigated and taken into account in the planning of the services development.

Catchment Area, Health↗

PubMedDate not supplied

New developments in anti-HIV chemotherapy.

Virtually all the compounds that are currently used, or under advanced clinical trial, for the treatment of HIV infections, belong to one of the following classes: (i) nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): i.e. zidovudine, didanosine, zalcitabine, stavudine, lamivudine, abacavir, emtricitabine, tenofovir (PMPA) disoproxil fumarate; (ii) non-nucleoside reverse transcriptase inhibitors (NNRTIs): i.e. nevirapine, delavirdine, efavirenz, emivirine; and (iii) protease inhibitors (PIs): i.e. saquinavir, ritonavir, indinavir, nelfinavir and amprenavir. In addition, various other events in the HIV replicative cycle are potential targets for chemotherapeutic intervention: (i) viral adsorption, through binding to the viral envelope glycoprotein gp120; (ii) viral entry, through blockade of the viral coreceptors CXCR4 and CCR5; (iii) virus-cell fusion; (iv) viral assembly and disassembly; (v) proviral DNA integration; (vi) viral mRNA transcription. Also, new NRTIs, NNRTIs and PIs have been developed that possess respectively improved metabolic characteristics, or increased activity against NNRTI-resistant HIV strains or, as in the case of PIs, a different, non-peptidic scaffold. Given the multitude of molecular targets with which anti-HIV agents can interact, one should be cautious in extrapolating from cell-free enzymatic assays to the mode of action of these agents in intact cells.

Anti-HIV Agents↗

PubMed2001

In silico research in drug discovery.

Target and lead discovery constitute the main components of today's early pharmaceutical research. The aim of target discovery is the identification and validation of suitable drug targets for therapeutic intervention, whereas lead discovery identifies novel chemical molecules that act on those targets. With the near completion of the human genome sequencing, bioinformatics has established itself as an essential tool in target discovery and the in silico analysis of gene expression and gene function are now an integral part of it, facilitating the selection of the most relevant targets for a disease under study. In lead discovery, advances in chemoinformatics have led to the design of compound libraries in silico that can be screened virtually. Moreover, computational methods are being developed to predict the drug-likeness of compounds. Thus, drug discovery is already on the road towards electronic R&D.

Computational Biology↗

PubMed1983

Behavioral treatment of psychogenic vomiting in the context of social phobia.

A case of psychogenic vomiting in the context of social phobia was treated by a combination of exposure in vivo, social skills training, and cognitive modification. The intervention was not directly aimed at the vomiting, but at aspects of the patient's behavior hypothesized to be instrumental in maintaining it; deficits in prosocial behaviors and associated anxiety. Change was assessed on the basis of patient's records of daily frequency of: vomiting; performance of treated behaviors; and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact. Clinically, the vomiting was virtually eliminated after 7 weeks, and the anxiety was substantially reduced in most previously feared (and avoided) social situations; except for a 2-week depressive spell, this outcome has been maintained for an available 2-year follow-up. A general improvement in the patient's personal, social, and vocational life has also occurred.

Adult↗

PubMed2006

Real-timereflectance confocal microscopy, a noninvasive tool for in vivo quantitative evaluation of comedolysis in the rhino mouse model.

BACKGROUND: Near-infrared reflectance confocal microscopy (RCM) is a noninvasive tool that provides real-time images of thin virtual horizontal tissue sections. AIMS/METHODS: We have used a rhino mouse model in combination with topical application of all-trans-retinoic acid and all-trans-retinol to investigate the usefulness of RCM as a noninvasive imaging tool to evaluate comedolysis in vivo and over time. Optical images were correlated with routine histology. RESULTS: Our results demonstrate that RCM in vivo can visualize the process of transformation of utriculi (pseudocomedones) towards a normal-appearing follicular structure during retinoid treatment. The retinoic acid intervention group showed a dose-related response, while the vehicle-treated group did not show utricular changes. CONCLUSIONS: RCM represents a useful tool for in vivo morphological and quantitative evaluation of skin utriculi over time and could be used as an adjunct tool to histopathological techniques for comedolysis studies.

Acne Vulgaris↗

PubMed2006

Thrombosis of the pulmonary artery in a patient with mucinous adenocarcinoma.

BACKGROUND: The increased tendency to thromboembolism in cancer patient has been recognized for a long time. However, arterial thromboembolism and thrombosis of the pulinonary artery have rarely been reported. Pulmonary thromboembolism is usually a complication of peripheral venous thrombosis. CASE REPORT: Here we report on a 62-year-old female patient who presented with pulmonary artery thrombosis anti peritonitis carcinomatosa. Computed tomography of the thorax and digital subtraction angiography of both pulmonary arteries revealed multiple filling defects in virtually all the lobes of the right lung, in the mid-zone of the left lung, and a gross filling defect in the right main pulmoinary artery. These findings suggested that the thrombosis in the right pulmonary artery was primary rather than an embolus. No venotis thrombos is in the vena cava, pelvic veins, or any of the lower extremity veins was documented. CONCLUSIONS: Although thrombosis of the pulmonary artery is rarely seen in cancer patients, it is usually fatal and needs urgent intervention to save the patient's life.

Adenocarcinoma, Mucinous↗

PubMed1989

Down's syndrome individuals begin life with normal levels of brain cholinergic markers.

We measured the activities of the cholinergic marker enzymes choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in autopsied brains of seven infants (age range 3 months to 1 year) with Down's syndrome (DS), a disorder in which virtually all individuals will develop by middle age the neuropathological changes of Alzheimer's disease accompanied by a marked brain cholinergic reduction. When compared with age-matched controls cholinergic enzyme activity was normal in all brain regions of the individuals with infant DS with the exception of above-normal activity in the putamen (ChAT) and the occipital cortex (AChE). Our neurochemical observations suggest that DS individuals begin life with a normal complement of brain cholinergic neurons. This opens the possibility of early therapeutic intervention to prevent the development of brain cholinergic changes in patients with DS.

Acetylcholinesterase↗

PubMed1998

[Conservative surgery in renal carcinoma in case of contralateral kidney involvement]].

A serious problem faced in renal carcinoma treatment are patients presenting bilateral tumor, or those with virtually one kidney. Over a 2-year period, in the Department of Urology three patients are subjected to operation--one with bilateral renal carcinoma, one with dysfunction of the contralateral kidney, and one with a large cyst of the contralateral kidney. In the patient presenting bilateral tumor, nephrectomy on one side and partial resection on the other are performed, and in the remainder two--enucleation of the neoplasm. The patient with contralateral loss of renal function is subjected to ipsilateral operation for calculosis before the intervention with ensuing lithotripsy--three times. Within a year of the operation the same patient undergoes operation for ipsilateral pyonephrosis. At the time of study, all three patients are in a good general condition with values of the residual nitrogen bodies within normal limits.

Aged↗

PubMed2001

2001 ASPET Otto Krayer Award Lecture. Molecular targets for antiviral agents.

There are a number of virus-specific processes within the virus replicative cycle or virus-infected cell that have proven to be attractive targets for chemotherapeutic intervention, i.e., virus adsorption and entry into the cells, reverse (RNA --> DNA) transcription, viral DNA polymerization, and cellular enzymatic reactions that are associated with viral DNA and RNA synthesis and viral mRNA maturation (i.e., methylation). A variety of chemotherapeutic agents, both nucleoside (and nucleotide) and non-nucleoside entities, have been identified that specifically interact with these viral targets, that selectively inhibit virus replication, and that are either used or considered for clinical use in the treatment of virus infections in humans. Their indications encompass virtually all major human viral pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), human papilloma virus (HPV), orthomyxoviruses (influenza A and B), paramyxoviruses [e.g., respiratory syncytial virus (RSV)] and hemorrhagic fever viruses (such as Ebola virus).

Adenosylhomocysteinase↗

PubMedDate not supplied

Do family physicians 'prevent' cesarean sections? A Canadian exploration.

In Canada the rate of births attended by family physicians has declined in parallel with a rise in cesarean births. This reciprocal association has been most marked in those provinces with a relative abundance of obstetricians, a falling birth rate, and large metropolitan areas. Yet, the perinatal mortality rate, with one exception, is virtually the same in all provinces, both where the obstetricians provide most maternity care and where the family physicians play the dominant role. Thus, societal, environmental, and interprofessional issues have more to do with the rising number of cesarean sections and the decline of family physician-attended births than any objective measurement of quality of care. There is evidence that low-technology, high-continuity approaches for women at no anticipated risk are as safe or safer than the universal application of highly interventive care for all. This paper presents an attempt to determine if the decline in family physician-attended births in Canada is related to the rise in the cesarean section rate.

Adult↗

PubMed1995

The hinged mucosal flap. A contour-saving approach to submucosal lesions of the lip.

BACKGROUND: A variety of approaches have been described for the removal of lip lesions, but approaches to submucosal lesions are not generally explored as a separate category of problem. A new adaptation of hinged tissue elevation occurred when vermilion mucosa was elevated, a small mucous membrane flap created, and then reapplied over a submucosal lip mass defect. OBJECTIVE: Presentation of a new application of hinged flaps, using lip mucosa as the flap tissue to be raised and reapplied to the underlying muscularis. The purpose of the technique was to preserve all tissue above the mass, while successfully removing the submucosal lesion. RESULTS: Application of the hinged mucosal flap concept to the lower lip resulted in complete preservation of the lip contour without invasion of the infravermilion shelf or subjacent chin areas, and without any anterior vermilion invasion. METHOD: The surgical technique of evolving a hinged mucosal lip flap is described, with multiple photographs demonstrating the serial maneuvers carried out. Surgical intervention resulted in complete obliteration of the benign lesion with essentially no visible scarring and no change in lip contour. CONCLUSION: Utilization of a hinged mucosal flap on the lip for removal of smaller submucosal lesions results in complete preservation of the delicate lip contours without sacrifice of subjacent lip tissue or visible scar beyond the vermilion junction. Further extension of the hinged flap principle to subepidermal exploration and extirpation elsewhere logically follows. Applying the principles of hinged flaps to lip submucosal lesions results in virtually undetectable surgical sequellae.

Humans↗

PubMed1993

Comparison of the Bio Image Visage 2000 and the GELLAB-II two-dimensional electrophoresis image analysis systems.

To compare the Visage 2000 analysis system (Bio Image, Ann Arbor, MI, USA) with the GELLAB-II analysis system (National Cancer Institute, Frederick, MD, USA), we used each to perform image analysis of the same 29 silver-stained two-dimensional electrophoresis (2DE) gel image files from a study of urinary proteins in metal recovery plant workers who had confirmed body burdens of cadmium. Visage, aided by interactive analysis, detected an average of 890 +/- 177.6 spots per gel, or a total of 25,800 spots, whereas GELLAB-II detected 1971 +/- 198.5 spots per gel, or a total of 57,160 (a 222% increase over the Visage system), without operator intervention. Visage automatically quantified 52.5% (13,556) of the spots; 47.2% (12,173), consisting mostly of larger spots, had to be quantified interactively with an image editor, and 0.3% (71) were not quantified. GELLAB-II automatically quantified all detected spots. After we interactively assigned the maximum allowed number of landmarks (30 for Visage and 52 for GELLAB-II), we found that Visage matched 657 +/- 211.2 spots per gel, and GELLAB-II matched all detected spots and also extrapolated an average of 1269 virtual spots per gel. Plots of densities from the two systems on selected spots showed excellent agreement, and both systems showed high correlation between their measurements of the beta-2-microglobulin spot densities and an independent radioimmunoassay quantification of the original urine samples. By comparing the regression of the densities of all spots with urinary cadmium (UCD) levels, we found that several of the same detected spots from each system were highly correlated. The densities of four acidic proteins with relative molecular weights of approximately 112,000 Da (as quantified by GELLAB-II but not by Visage) were highly correlated with UCD concentrations. These proteins are new candidate biomarkers of cadmium toxicity. We compared the estimated labor costs of using each system to analyse a hypothetical 20-sample (60 gels) 2DE study and found that GELLAB-II was six times less expensive to use than Visage, primarily because of the operator time required to do interactive error correction with the Visage system.

Cadmium↗

PubMedDate not supplied

Hepatectomy using intraoperative ultrasound-guided radiofrequency ablation.

Radiofrequency (RF) ablation is emerging as a new therapeutic method for management of hepatic tumors. Here we report a new technique for hepatectomy using ultrasound-guided RF, which renders liver resection a less complex surgical procedure. Under intraoperative ultrasound (IOUS) guidance, a Cool-Tip RF probe is inserted into the liver parenchyma surrounding the tumor. A zone of coagulative desiccation is created around the tumor ensuring a 1-cm resection margin. Then, using a scalpel, the liver parenchyma is divided, and the tumor is removed with minimal blood loss. RF works by the conversion of RF waves into heat. Coagulative desiccation occurs and results in sealing of blood and biliary vessels. This is a new technique for liver resection that enables the surgeon to operate in a virtually bloodless field without the use of ischemia, sutures, or ties. It also spares the need for intraoperative blood transfusion and postoperative intensive care unit facilities, and it reduces the length of in patient stay.

Catheter Ablation↗

PubMed2005

C-mode real-time tomographic reflection for a matrix array ultrasound sonic flashlight.

RATIONALE AND OBJECTIVES: Real-time tomographic reflection (RTTR) permits in situ visualization of tomographic images so that natural hand-eye coordination can be used directly during invasive procedures. The method uses a half-silvered mirror to merge the visual outer surface of the patient with a simultaneous scan of the patient's interior without requiring a head-mounted display or tracking. A viewpoint-independent virtual image is reflected precisely into its actual location. When applied to ultrasound, we call the resulting RTTR device the sonic flashlight. We previously implemented the sonic flashlight using conventional two-dimensional ultrasound scanners that produce B-mode slices. Real-time three-dimensional (RT3D) ultrasound scanners recently have been developed that permit RTTR to be applied to slices with other orientations, including C-mode (parallel to the face of the transducer). Such slice orientation may offer advantages for image-guided intervention. MATERIALS AND METHODS: Using a prototype scanner developed at Duke University (Durham, NC) with a matrix array that electronically steers an ultrasound beam at high speed in 3D, we implemented a sonic flashlight capable of displaying C-mode images in situ in real time. RESULTS: We present the first images from the C-mode sonic flashlight, showing bones in the hand and the cardiac ventricles. CONCLUSION: The extension of RTTR to matrix array RT3D ultrasound offers the ability to visualize in situ slices other than the conventional B-mode slice, including C-mode slices parallel to the face of the transducer. This orientation may provide a broader target, facilitating certain interventional procedures. Future work is discussed, including display of slices with arbitrary orientation and use of a holographic optical element instead of a mirror.

Calibration↗

PubMed2005

Ecologically based family therapy outcome with substance abusing runaway adolescents.

Runaway youth report a broader range and higher severity of substance-related, mental health and family problems relative to non-runaway youth. Most studies to date have collected self-report data on the family and social history; virtually no research has examined treatment effectiveness with this population. This study is a treatment development project in which 124 runaway youth were randomly assigned to (1) ecologically based family therapy (EBFT) or (2) service as usual (SAU) through a shelter. Youth completed an intake, posttreatment, 6 and 12 months follow-up assessment. Youth assigned to EBFT reported greater reductions in overall substance abuse compared to youth assigned to SAU while other problem areas improved in both conditions. Findings suggest that EBFT is an efficacious intervention for this relatively severe population of youth.

Adolescent↗