Implantable hormonal contraceptives: emerging controversy

There is an emerging policy debate over the inclusion of Norplant incentives in welfare reform. Even if women were guaranteed access to the implant and payment for its removal were assured, the possibility of increased human immunodeficiency virus infection would remain a strong argument against its use. Although this article focuses on Norplant, many of the arguments apply to other long-acting contraceptives that may become available in the future.     

Erythropoietin treatment: concept and controversy

We assessed two new rapid urease tests, the Helicobacter Urease Test (HUT, Astra, Sweden) and the Polish test, for accuracy, reaction time, and the effect of biopsy site and bacterial density on test characteristics and time to positivity. A prospective study was conducted in two groups of patients: 64 consecutive patients undergoing upper endoscopy for dyspepsia and 61 consecutive patients with duodenal ulcer on upper endoscopy. In the first group, test accuracy, time to positivity, and possible associations with biopsy site and bacterial density were assessed between the tests. In the second group, the two new tests were compared with the CLOtest for time to positivity and effect of bacterial density on test outcome. The Polish and HUT test had similar specificities (97%), but the Polish test was more sensitive (90.3% vs. 80.7%). The Polish test was positive within 10 minutes in 55% of the positive patients compared with 10% for the HUT test. There was no association between bacterial density (by histologic count) and reaction time in either test or in the CLOtest in the second group. The Polish test was more accurate and had a quicker time interval to positivity than the HUT. There was no significant association between bacterial density and reaction time in any of the urease tests assessed, and the biopsy site did not affect test accuracy in the HUT test.     

Role of splenectomy in human liver transplantation under modern-day immunosuppression

Between January 1987 and October 1991, 1466 patients underwent consecutive Orthotopic Liver Transplantation (OLTx) at the University of Pittsburgh. Forty of these patient's had concomitant splenectomy with OLTx. These patients were compared to 147 randomly selected OLTx patients without splenectomy within the same time period. One-year patient and graft survival (PS and GS) were lower in splenectomized (Splx) patients compared to nonsplenectomized (non-Splx) patients (59% vs 86% PS, 55% vs 80% GS, respectively). One-month and one-year patient mortality in the Splx group was higher than in the non-splx patients (20% vs 3.4%, P < 0.001 for one month; 40% vs 14.3%, P = 0.003 for one year, respectively). One-month and one-year sepsis-related mortality was also high in Splx patients (17.5% vs 2.7%, P = 0.0022, for one month, and 30% vs 11.5%, P = 0.0043, for one year, respectively). We conclude that concomitant splenectomy with OLTx has a significantly higher patient mortality mainly due to its septic complications and, at present, unless there is a specific indication for a splenectomy, the routine addition of this procedure to liver allograft surgery would not be recommended.     

Cholesterol & atherosclerosis: a controversy resolved

We should regard the so-called cholesterol "controversy" as resolved. Elevated cholesterol levels cause coronary disease and probably are an essential ingredient for the development of atherosclerosis. Elevated cholesterol levels should be a cause for concern. From a public health point of view, the ultimate treatment of atherosclerosis will depend on major changes in the lifestyles of populations in developed countries, including a shift to diets that are largely vegetarian, as well as the elimination of tobacco use, an increase in regular exercise, and a reduction in the propensity of to increase weight, particularly with age. For patients at high risk for coronary events, including those with other coronary risk factors and with clinically established coronary disease, cholesterol lowering is absolutely essential. In the majority of cases, it will require not only dietary change but also cholesterol-lowering medication. Taken together, these public health and medical measures can massively reduce, if not eliminate, the burden of atherosclerosis that currently plaques developed countries and now threatens the developing world.     

The controlled-drinking controversy: A commentary.

A study by M. B. Sobell and L. C. Sobell (see PA, Vols 50:3611 and 56:8425) showed that alcoholic inpatients who received individualized behavior therapy to control their drinking showed significant improvement in "days functioning well" (including days of controlled drinking) compared to patients who received treatment with a goal of abstinence. These results were challenged by M. L. Pendery et al (see record 1983-04261-001) in an independent follow-up of patients originally treated in the Sobells's study. Pendery et al claimed that most patients trained to do controlled drinking failed from the onset to drink safely, and charges were leveled against the Sobells stating that their earlier research was fraudulent. A brief review of the ongoing debate is presented, along with the conclusions of an investigative committee of independent scientists that exonerated the Sobells. The controversy is discussed with an emphasis on the following topics: the historical evolution and current status of controlled-drinking research and treatment, methodological issues in the assessment of posttreatment drinking behavior, questions for future research arising from the controversy, and an emerging paradigm shift in the alcoholism field. (66 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PSA screening--current controversy

OBJECTIVE: To evaluate treatment with noninvasive ventilation (NIV) by nasal mask as an alternative to endotracheal intubation and conventional mechanical ventilation in patients with hematologic malignancies complicated by acute respiratory failure to decrease the risk of hemorrhagic complications and increase clinical tolerance. DESIGN: Prospective clinical study. SETTING: Hematologic and general intensive care unit (ICU), University of Rome "La Sapienza". PATIENTS: 16 consecutive patients with acute respiratory failure complicating hematologic malignancies. INTERVENTIONS: NIV was delivered via nasal mask by means of a BiPAP ventilator (Respironics, USA); we evaluated the effects on blood gases, respiratory rate, and hemodynamics along with tolerance, complications, and outcome. MEASUREMENTS AND RESULTS: 15 of the 16 patients showed a significant improvement in blood gases and respiratory rate within the first 24 h of treatment. Arterial oxygen tension (PaO2), PaO2/FIO2 (fractional inspired oxygen) ratio, and arterial oxygen saturation significantly improved after 1 h of treatment (43+/-10 vs 88+/-37 mmHg; 87+/-22 vs 175+/-64; 81+/-9 vs 95+/-4%, respectively) and continued to improve in the following 24 h (p < 0.01). Five patients died in the ICU following complications independent of the respiratory failure, while 11 were discharged from the ICU in stable condition after a mean stay of 4.3+/-2.4 days and were discharged in good condition from the hospital. CONCLUSIONS: NIV by nasal mask proved to be feasible and appropriate for the treatment of respiratory failure in hematologic patients who were at high risk of intubation-related complications.     

The unnecessary controversy

Preservation-reperfusion injury of hepatic allografts is thought to be associated with Kupffer cell activation and TNF release from the transplanted organ. Confirmation that the allograft is the source of this TNF in an in vivo model is difficult because of rapid equilibration of this cytokine into all compartments. A novel experimental design was devised to aid in accurate localization of the site of TNF release following a orthotopic liver transplant (OLT). In the first group (anhepatic), livers were removed from rats and splanchnic and systemic venous returns were then reestablished using a conduit of donor IVC and portal vein with a portasystemic shunt. In the second group (asplanchnic), the liver, stomach, pancreas, and intestine of the recipient were removed and a donor liver was reimplanted using the recipient IVC as the source of portal blood. The third (OLT-16) and fourth (OLT 8) groups underwent standard OLT with preservation times of 16 and 8 hr in 4 degrees C Euro-Collins solution, respectively. TNF levels were significantly increased in the OLT-16 group compared with the OLT-8 group. There were modest elevations of TNF in the anhepatic model, but the TNF in the asplanchnic model approached baseline. Absence of TNF in the asplanchnic group and a rise in TNF levels in the anhepatic group to that not significantly different from OLT-16 or OLT-8 suggest that a major source of TNF following preservation reperfusion may be the intestine.     

Effectiveness of psychotherapy: The perennial controversy.

Reviews a number of important reviews of research on outcome in psychotherapy and evaluates the various critiques of these reviews and the issues involved. Although a number of important limitations in both existing research and the reviews of research are indicated, it is claimed that the different evaluations of the effectiveness of psychotherapy are influenced in part by the personal views of the individuals involved. It is argued that what is needed to help resolve past and current controversies is research that leads to a better understanding of the variables that produce change. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pulsatile and nonpulsatile perfusion: the continuing controversy

This report discusses pulsatile and nonpulsatile perfusion with regard to hemodynamics, cell metabolism, and the visceral consequences of these forms of cardiopulmonary bypass. It argues that differences between the two modes and a benefit for pulsatile perfusion, are most clearly manifested in identifiable high-risk patient groups.