Hyperthermia and AIDS: a critical review

Torsade de pointes in the congenital long QT syndrome (LQTS) is often pause dependent. Thus, the main goal of pacemaker treatment in the LQTS may be the prevention of pauses that facilitate the onset of torsade de pointes. A pause prevention pacing algorithm (rate smoothing) was used for arrhythmia prevention in a 14 year old girl with congenital LQTS. By temporarily increasing the pacing rate after spontaneous premature beats, rate smoothing down of 18% prevented postextrasystolic pauses, pause related T-U changes, and recurrence of pause induced torsade de pointes. Rate smoothing is a potentially useful tool that ought to be evaluated for the prevention of torsade de pointes in the LQTS.     

Cysticercosis and epilepsy: a critical review

Neurocysticercosis (NC) remains a major public health problem in developing and some developed countries. Currently, the best procedures for diagnosing NC are neuroimaging studies. Immunoserologic assays, such as enzyme-linked immunoelectrotransfer blot assay (EITB) or enzyme-linked immunosorbent assay (ELISA), detect antibodies against Taenia solium, or cysticercus. Consequently, they are useful in identifying a population at risk of contact with the parasite but do not necessarily indicate a systemic active infection. Most seropositive individuals are asymptomatic. No data from prospective studies concern the proportion of these individuals that will develop seizures or other neurologic symptoms. There is a discrepancy between the results of serologic assays and neuroimaging studies: >50% of those individuals with NC diagnosed by computed tomography (CT) scan test EITB negative. Pathophysiologic classification of NC into active, transitional, and inactive forms permits a good correlation between clinical manifestations and neuroimaging procedures and facilitates medical and surgical management and research. The most frequent clinical manifestations of NC are seizures. We assume that NC is the main cause of symptomatic epilepsy in developing countries; however, no case-control or cohort studies demonstrate this association. Most patients with NC with seizures have a good prognosis; nevertheless, further studies analyzing factors related to recurrence of seizures and possibilities of discontinuation of antiepileptic medications (AEDs) are needed. Regarding treatment of NC with antihelminthic drugs, no controlled clinical trials exist that establish specific indications, definitive doses, and duration of treatment. The most effective approach to taeniasis/cysticercosis infection is prevention. This should be a primary public health focus for developing countries. We critically review the available information regarding the epidemiology and diagnosis of human cysticercosis, the physiopathology and imaging correlation of the parasite in the central nervous system (CNS) of the host, the relation between seizures or epilepsy and NC, and the issues surrounding the treatment and prognosis of NC, including the use of antihelminthic therapy.     

Genetics of stuttering: a critical review

The fact that stuttering runs in families has been documented over a long period and has led to speculations and research about the role of a genetic component to this disorder. Although the genetic factor cannot be proved by familial aggregation and twin studies alone, such research has continued to provide support for a relationship between stuttering and genetics. The purposes of this article are to review and critique the research in this area. The article first assesses research methodologies that have been employed in familial studies of stuttering. It proceeds to review and critique incidence, twin, and aggregation studies. In addition, it includes sections on subgroups, genetic models of stuttering, and implications for future research as well as for clinical work. With a focus on improved methodology and recent findings, a current perspective on our knowledge of the genetic component to stuttering is provided. Among other conclusions, the article emphasizes that failure to consider epidemiologic factors has probably biased previous results regarding the genetics of stuttering. New preliminary data also appear to provide evidence that spontaneous recovery and chronicity are influenced by genetic factors. Generally, however, the review of incidence and twin studies, as well as of evidence for the various inheritance models, confirms previous conclusions about the interaction between genetic and environmental factors in stuttering.     

The vascular fellowship: a critical review

Spinocerebellar ataxia type 1 is due to a CAG repeat expansion in the gene encoding ataxin-1. In a case with an expansion of 56 repeats, intranuclear inclusions were found only in neurons, both in severely affected regions (such as the pons) and in areas where the lesions were inconspicuous (such as the cortex or the striatum). The inclusions were labelled by a monoclonal antibody directed against long polyglutamine stretches (1C2); they were also detected by the anti-ubiquitin antibody. They were faintly eosinophilic, Congo red negative and were not stained by thioflavin S or by ethidium bromide.     

The 4S study: a critical review

A 24 year old combat medic was admitted to the field hospital at Tomislavgrad in Bosnia, with a suspected forearm, fracture. Radiographs did not show any bony injury. Clinical examination showed marked swelling and tenderness over the extensor compartment. The pain became more severe over the following 12 hours with the pain becoming most intensely felt in the extensors on passive extension. Fasciotomy for suspected acute compartment syndrome was carried out. Acute compartment syndrome is a common complication of extremity injury, and is a clinical diagnosis which should be suspected in all injuries with marked swelling and severe pain.     

Oculomotor abnormalities in schizophrenia: a critical review

Oculomotor abnormalities, particularly in smooth pursuit tracking, are one of the most widely investigated biological markers of schizophrenia. However, despite the wealth of published data, important questions concerning the exact nature of these abnormalities remain unanswered. Many of the studies use unreliable methodology, and few attempts have been made to interpret the observed oculomotor dysfunction in terms of current understanding of eye movement physiology. Also, the potential effects of antipsychotic medication have been poorly addressed. Recent research, using more reliable measurement techniques and novel saccadic paradigms are producing important results and may provide a more productive framework for future studies of oculomotor abnormalities in schizophrenia.     

Achalasia: a critical review of epidemiological studies

Achalasia is one of the earliest recognized gastroenterological conditions. However, several centuries after it was first described, it remains also among the least understood. One of the main reasons for this is the relative rarity of the disease, which has resulted in limited opportunities to conduct investigative research. Few epidemiological studies have been conducted to date, and their data suggest a worldwide incidence estimated at between 0.03-1.1/10(5)/yr. This review of the literature on the epidemiology of achalasia lends support to the idea that pooling of resources and collaboration at an international level is required, if any significant progress in the cause, treatment, and prevention of the disease is to be made.     

Prognostic factors in osteosarcoma: a critical review

PURPOSE: The purpose of this critical appraisal was to determine the prognostic factors that influence survival in patients with nonmetastatic, high-grade osteosarcoma of the extremities. DESIGN: A computerized literature search of reports published from January 1973 to March 1992 was conducted to determine those eligible for inclusion in the review. Reports were reviewed blindly by two of the authors; inclusion and scoring were determined according to preestablished criteria. RESULTS: Eight reports were included in the appraisal. The prognostic variables evaluated were age, sex, anatomic tumor location, tumor size, and tumor necrosis. Tumor size and necrosis following preoperative chemotherapy were significant prognostic variables in relation to survival in univariate analysis. However, only tumor necrosis maintained its significance in multivariate modeling. CONCLUSION: The most important prognostic variable for patients with osteosarcoma of the extremity was tumor necrosis evident following preoperative chemotherapy. There is no consensus as to any prognostic variable that might be used to stratify patients before the onset of therapy.     

Capillary electrophoresis based immunoassays: a critical review

The purpose of this article is to review and evaluate the uses and potentials of capillary electrophoresis (CE) in immunoassay analysis (IA). This review will be divided into four sections. First, a brief summary of the fundamentals, applications and requirements of immunoassays in both research and clinical diagnostics will be given. This section will also cover the rationale behind the current research to combine CE and IA. Also, the specific needs to CE in this field will be addressed. Second, the modes of use of CE in IA will be discussed and typical applications for each will be given. Third, a separate section will be devoted to the investigation of performing immunoassays on micro fabricated devices, an interesting alternative to the conventional capillary-based approach. Finally, a critical assessment of the current status and merits of this technology will be presented.     

Depression scales in schizophrenia: a critical review

In Sweden, nurse-midwives in primary health care are responsible for taking Papanicolaou smears in population-based cervical cancer screening programs. This article discusses the manner in which a group of nurse-midwives, working with the cervical cancer screening program, view both opportunities and burdens inherent in their work. Semistructured interviews were conducted with 21 nurse-midwives engaged in screening at seven antenatal health care centers in demographically different parts of Stockholm, using a team approach to collect and inductively analyze the interviews. Results indicate discrepancies between ideals guiding the midwives and their practice. Positive aspects described by the midwives appear to be related to an ideology of care, whereas perceived burdens include the midwives' sense of powerlessness, lack of congruence between midwives' ideology and screening organization, and lack of professional familiarity with cancer. Several of these features can be related to issues that are challenges for many health care practitioners today, even in other settings. Our conclusion is that the screening program has latent potential for further development of the role of the nurse-midwife as an advocate for women throughout the lifespan and in a variety of situations.     

Post-traumatic middle cerebral artery occlusion: case report and review

Occlusion of extracranial carotid and vertebral arteries following closed craniocervical trauma is well known. However occlusion of intracranial arteries following closed head injuries is infrequently reported. In fact only 25 cases of post-traumatic middle cerebral artery occlusion have been adequately documented. This entity bears re-emphasis not only because of its rarity but also because of its clinical similarity to other intracranial mass lesions.     

Management of acute laryngeal injury: a critical review

The approach to management of 30 cases of laryngeal trauma coming to open exploration is outlined. Eighteen patients had blunt trauma and 12 had penetrating wounds. Four cases resulted in airway compromise and all were in the blunt trauma group. Although significant granulation tissue response occurred in only eight of 30 cases, it was present in three of the four concluding with stenosis. It is demonstrated that the use of a stent, with a tissue graft, when mucosal approximation cannot be accomplished, facilitates prevention of endolaryngeal distortion and webbing and maintenance of skeletal framework integrity; its use did not predispose to granulation tissue development. A principal etiologic factor in those patients who had good airway but only a fair voice was arytenoid fixation, this despite anatomic reduction when subluxation occurred. Recurrent nerve injury was identified in only one patient. Foremost in management is suspicion and recognition of laryngeal injury in the multiple trauma patient. Once the urgent problems of hemorrhage, shock, and airway are attended to, attention must be directed to a systematic evaluation of the neck and larynx.     

Headache and the cervical spine: a critical review

Headache related to the cervical spine is often misdiagnosed and treated inadequately because of confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as "cervicogenic" merely because of their occipital localization. Cervicogenic headache as described by Sjaastad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiates from occipital to frontal regions. Definition, pathophysiology; differential diagnoses and therapy of cervicogenic headache are demonstrated. Ipsilateral blockades of the C2 root and/or greater occipital nerve allow a differentiation between cervicogenic headache and primary headache syndromes such as migraine or tension-type headache. Neither pharmacological nor surgical or chiropractic procedures lead to a significant improvement or remission of cervicogenic headache. Pains of various anatomical regions possibly join into a common anatomical pathway, then present as cervicogenic headache, which should therefore be understood as a homogeneous but also unspecific pattern of reaction.     

Screening for gestational diabetes mellitus: a critical review

Bovine haptoglobin, which has been recognized as an acute phase protein following tissue injury and inflammation, was detected as a 33 k + 20 k Dalton fraction in the sera from calves transported by road for 2 days. The sera also possessed suppressive activity on lymphocyte proliferative response to concanavalin A. A significant correlation (r = 0.57, P < 0.05) was observed between haptoglobin concentrations and lymphocyte suppression in the sera. Furthermore, the haptoglobin fraction obtained from acute phase sera exerted dose-dependent suppression on lymphocyte blastogenesis. These circumstantial data suggest the possible involvement of bovine haptoglobin, at least in part, as an immunomodulator in serum suppression of lymphocyte blastogenesis in transported calves.     

Adrenaline dosage during cardiopulmonary resuscitation: a critical review

Since the end of the nineteenth century adrenaline has been used for the treatment of cardiac arrest. Since the 1960s a standard 1 mg dose administered intravenously every 5 min is common practice in cardiopulmonary resuscitation. Because of growing interest in the pharmacological aspects of cardiopulmonary resuscitation, experimental studies in animals conducted in the 1980s suggested the use of higher doses of adrenaline. Several case reports of successfully resuscitated patients who had been given high dose adrenaline were published, but large, prospective, randomized, controlled clinical trials in humans found no statistically significant improvement in survival rates between high dose and standard dose resuscitated patients. It seems that 1 mg adrenaline given intravenously every 3-5 min during resuscitation for cardiac arrest remains the standard.     

Effects of SSRIs on sexual function: a critical review

Sexual problems are highly prevalent in both men and women and are affected by, among other factors, mood state, interpersonal functioning, and psychotropic medications. The incidence of antidepressant-induced sexual dysfunction is difficult to estimate because of the potentially confounding effects of the illness itself, social and interpersonal comorbidities, medication effects, and design and assessment problems in most studies. Estimates of sexual dysfunction vary from a small percentage to more than 80%. This article reviews current evidence regarding sexual side effects of selective serotonin reuptake inhibitors (SSRIs). Among the sexual side effects most commonly associated with SSRIs are delayed ejaculation and absent or delayed orgasm. Sexual desire (libido) and arousal difficulties are also frequently reported, although the specific association of these disorders to SSRI use has not been consistently shown. The effects of SSRIs on sexual functioning seem strongly dose-related and may vary among the group according to serotonin and dopamine reuptake mechanisms, induction of prolactin release, anticholinergic effects, inhibition of nitric oxide synthetase, and propensity for accumulation over time. A variety of strategies have been reported in the management of SSRI-induced sexual dysfunction, including waiting for tolerance to develop, dosage reduction, drug holidays, substitution of another antidepressant drug, and various augmentation strategies with 5-hydroxytryptamine-2 (5-HT2), 5-HT3, and alpha2 adrenergic receptor antagonists, 5-HT1A and dopamine receptor agonists, and phosphodiesterase (PDE5) enzyme inhibitors. Sexual side effects of SSRIs should not be viewed as entirely negative; some studies have shown improved control of premature ejaculation in men. The impacts of sexual side effects of SSRIs on treatment compliance and on patients' quality of life are important clinical considerations.     

Acute stress disorder: a critical review of diagnostic issues

Acute stress disorder (ASD) is a recently developed diagnosis that describes posttraumatic stress reactions that occur in the first month following a trauma. Diagnostic criteria include dissociative, intrusive, avoidance, and arousal symptoms. ASD was driven by the proposal that trauma leads to dissociative reactions, and these are predictive of longer-term psychopathology. This paper reviews a series of anomalies in the diagnostic criteria, highlights discrepancies between criteria for ASD and posttraumatic stress disorder (PTSD), and illustrates the lack of empirical evidence for some assumptions inherent in the conceptualization of ASD. It is argued that future revisions of ASD criteria need to be based on empirical evidence of acutely traumatized individuals.     

Acupuncture in the treatment of asthma: a critical review

OBJECTIVES: This study was undertaken in the mid-1990s (1994) to describe the use of tobacco, alcohol, and non-institutionalized drugs among pre-adolescent and adolescent Spanish students. METHODS: Information was collected within the framework of a periodic transversal study of life styles among European students, with particular emphasis on health-related habits. In the current study we present the results of the last survey carried out in Spain within the context of this study (1994), which involved a representative sample of Spanish students 11, 13, 15, 17 and 18 years-old (n = 6,711). An anonymous questionnaire was completed by the students in class. The survey sampling uses proportionate stratification and multistage sampling. RESULTS: In 1994, 49% of the Spanish students in this age group had tried tobacco. Twenty-four percent were sporadic or regular smokers. There was a large proportion of female smokers than male smokers (27% vs 20%). The overall proportion of smokers increased from 3% at 11 years to 47% at 18 years. One third (33%) of the 18-year-old students smoked daily. Eighty-four percent of the students of this age indicated that they had tried one or more types of alcoholic beverage. Twenty-one percent consumed alcohol regularly (at least once a week). Regular alcohol use was somewhat more common among males (24%) than among females (19%). Forty-six percent of the 18-year-old students consumed alcoholic beverages regularly and 66% had been intoxicated one or more times. Almost one fifth (18%) of the 13-to-18 year-old students indicated that they had tried some type of non-institutionalized drug, although the current rate of consumption was 8%. Cannabis was the drug most frequently tried (18%) and the drug most often consumed at present (8%), followed by cocaine and heroin. More males than females had tried non-institutionalized drugs. DISCUSSION: Analysis of the data revealed that adolescent tobacco use is increasingly frequent among females. Alcohol use continues to be widespread among Spanish pre-adolescents and adolescents. Alcohol use begins in childhood and becomes consolidated in adolescence. The results suggest, in relation to gender differences in the use of tobacco, alcohol, and non-institutionalized drugs, that there is a strong tendency toward the homogenization of these habits between genders. It is necessary to emphasize the preventive measures of drug dependence among Spanish pre-adolescents and adolescents.