Percutaneous vertebroplasty: state of the art

Vertebroplasty is an effective new radiologic procedure consisting of the percutaneous injection of a biomaterial, usually methyl methacrylate, into a lesion of a vertebral body. This technique allows marked or complete pain relief and bone strengthening in most cases. The principal indications for vertebroplasty are osteolytic metastasis and myeloma, painful or aggressive hemangioma, and osteoporotic vertebral collapse with debilitating pain that persists despite correct medical treatment. Radiography and computed tomography must be performed in the days preceding vertebroplasty to assess the extent of vertebral collapse, the location and extent of the lytic process, the visibility and degree of involvement of the pedicles, the presence of cortical destruction or fracture, and the presence of epidural or foraminal stenosis caused by tumor extension or bone fragment retropulsion. Leakage of methyl methacrylate during vertebroplasty may cause compression of adjacent structures and necessitate emergency decompressive surgery; thus, the procedure should be performed only in a surgical center. The decision to perform vertebroplasty should be made by a multidisciplinary team because the choice between vertebroplasty, surgery, radiation therapy, medical treatment, or a combination thereof depends on a number of factors. Radiologists need to be aware of the various indications for vertebroplasty and of potential future developments and applications of the procedure.     

Obstetric analgesia-anesthesia: state of the art

Based on our results and experiences, we consider the laryngeal mask anaesthesia a recommendable alternative to endotracheal intubation anaesthesia for adenotomies in children. Prerequisites with regard to the highest possible safety for the patient are specialist's knowledge, close anaesthesiological-otolaryngological cooperation and continuous clinical and apparative monitoring in order to detect possible accidental dislocations of the laryngeal mask without any delay. Using the laryngeal mask, disadvantages of endotracheal intubation, such as lesions of the vocal cords and damages to the tracheal mucous membrane can be avoided and the total time of narcosis can be reduced on average by about five minutes, particularly by shortening the recovery time of anaesthesia.     

Orthognathic surgery: the state of the art

Accelerated coronary artery disease in the transplanted heart remains the leading cause of death in heart transplant recipients. Traditional treatment modalities have generally yielded sub-optimal results. Coronary artery stents are used frequently in the non-transplanted heart to treat coronary artery disease. Only a few cases using this approach in the cardiac transplant recipient have been reported. This report details the use of this modality in a transplant recipient with significant two-vessel coronary artery disease 11 years after orthotopic cardiac transplantation.     

Angioscopy in vascular surgery: the state of the art

Incubation of a human fibrosarcoma cell line HT-1080 in increasing concentration of Ca2+ was found to enhance endocytic internalization of a fluid phase marker, horseradish peroxidase. At 16.8 mM Ca2+, generation of the effect required incubation for more than 45 min. The effect was reversed by removal of the excess ion for 30 min. Monitoring the intracellular concentration showed that the incubation induced a transient large Ca2+ influx followed by a recovery to 230 +/- 50 nM instead of the normal level of 83 +/- 5 nM. The activation was not inhibited by inhibitors of protein kinases nor a cAMP antagonist. In contrast, the effect was prevented by okadaic acid (OKA) at 100 nM without detectable effect on the basal activity. Fluid phase uptake by HT-1080 cells was also enhanced by phorbol 12-myristate 13-acetate (PMA). In contrast to the case with Ca2+, OKA at 100 nM did not prevent the PMA effect but further enhanced the endocytosis. The effect of OKA was concentration-dependent, as the reagent at 1 microM inhibited not only both the activation but also the basal activity. In Ca(2+)- or PMA-stimulated cells, FITC-dextran was delivered to endosomes that had been labeled with TRITC-transferrin. In contrast, following treatment with a combination of PMA and 100 mM OKA, fluid phase was internalized in vesicular compartments devoid of transferrin labeling. These results suggest that, through differential modifications of protein phosphorylation, endocytosis can be enhanced distinctively either by employing conventional receptor-bearing compartments or generating a new endosomal population.     

Crenotherapy in sports medicine: the state of the art

The existing relationship linking thermal and sport medicine has developed with time. This is shown by the established beneficial effects of thermal treatments (mineral waters, mud baths, balneotherapy, aerosol applications) in a wide range of sport and non-sport related injuries. The muscle fatigue syndrome is a condition particularly worrisome for sports practising individuals. This condition impairs the cardiovascular system, as well as hematologic, renal and gastrointestinal functions, acting via biochemical and metabolic modifications of the organism, which have effects also on the psyche of the subject. The treatment of this syndrome includes the use of specific mineral waters, which underscores that the correct hydration of the organisms is a precondition to achieve high performance levels. Traumas involving muscles and skeletal segments, and precocious arthrosis occur with higher frequency in sportsmen after continuous and intense stresses. Within the scope of rheumatology, mud-baths and balneotherapy have curative and rehabilitative potentials leading to a reduction, and often a disappearance, of pain with a faster recovery of the locomotory system. The gastrointestinal system is a target of psychic as well as physical stresses displaying symptoms or diseases which may be favourably addressed with the aid of mineral waters. This treatment has proved effective in secretory and motility dysfunctions of the biliary tree allowing a rapid functional recovery. Mineral water treatments are successfully employed in the treatment of urologic disturbance and ORL and dermatological pathologies, where local applications such as mud baths, balneotherapy, showers and aerosols, play a critical role.     

Posts and cores: state of the art

The primary way of preventing HIV infections is to change behaviors that enable transmission of the virus, specifically those behaviors relating to sex and drug injection. Realistic public health workers have focused on encouraging adoption of safer sexual practices, primarily condom use. The fundamental way to persuade people to engage in preventive practices is through targeted education aimed at particularly at-risk communities. Other effective behavioral interventions against HIV infections are: testing and follow-up counseling; comprehensive sex education; peer influence and community action; advertising and marketing; easing access to condoms; physician-patient dialogue; drug treatment; access to clean needles; and direct outreach. On the contrary, interventions that do not work are the following: one-time exposure to information; delivering a single message; abstinence-only programs; and coercive measures to identify people with HIV or their sexual partners.     

Microsurgery and varicocele: state of the art

Many surgical procedures have been proposed in the treatment of varicocele; however, the rate of recurrence and of postoperative complications, together with important correlation of this disease with male sterility, has played an important role in determining the success of microsurgery. In the present brief review, the indications for microsurgery and microsurgical dissection and/or anastomosis are described in comparison to traditional surgery.     

Liver assist systems: state of the art

Attempts to develop liver support systems for the treatment of patients with liver failure have ranged from use of plasma exchange to utilization of charcoal columns and extracorporeal devices loaded with liver tissue. However, no system has achieved wide clinical use and - in the absence of liver transplantation - severe hepatic failure continues to be associated with significant morbidity and mortality. In this paper, the authors review the current status of liver assist systems and summarize their clinical experience with a xenogeneic cell based-bioartificial liver.     

MRI of the breast: state of the art

Contrast-enhanced MRI of the breast is probably the most sensitive method to detect breast pathology. It is best used to improve the sensitivity of mammography and sonography in selected patient groups with high breast cancer prevalence, where conventional methods are known to be less sensitive. Despite the high sensitivity of MRI, 5-12 % of invasive carcinomas are not recognized during MRI, because of lack of the typical criteria of carcinoma. MRI is probably inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas (< 3 mm), because the neo-angiogenesis induced by these small carcinomas is too faint to be detected by contrast-enhanced MRI. These tumours cannot be excluded by a normal MRI examination. MRI is non-specific as the distinction of benign and malignant breast lesions is unreliable. Only in selected cases (fat- or blood-containing lesions) may it improve the specificity of mammography and sonography. Mostly image-guided core biopsy is by far the most specific and least expensive method to establish a definitive diagnosis. For lesions exclusively detected by contrast-enhanced MRI, simple and reliable localisation devices are urgently needed. Presently accepted indications for MRI of the breast are: patients with silicone implants after mastectomy or augmentation mammoplasty (detection of recurrence/prosthesis rupture/silicon leakage); patients whose breasts are difficult to evaluate by combined mammography and sonography, who have had breast conservation therapy (local recurrence), or who have proven carcinoma in one breast (multifocality/-centricity or contralateral breast carcinoma) or proven axillary lymph node metastases from an unknown primary tumor, especially when these are hormone receptor positive; patients with extensive postoperative scarring. In the future, genetically defined high breast cancer risk may become an indication.     

Evidence-based nursing practice: the state of the art

Numerous nursing leaders stress the need for stronger links between research and practice. These leaders suggest that links must be strengthened in two distinct yet complementary ways. First, practitioners and researchers must collaborate on research priorities; nurses providing direct care are perhaps best placed to know what questions need to be answered. Second, practitioners need to make better use of nursing research to establish a more evidence-based practice. Evidence-based practice enables nursing to provide and justify high-quality, cost-effective care.     

Hemodilution in clinical surgery: state of the art 1996

Acute normovolemic hemodilution entails removal of blood from a patient either immediately before or shortly after induction of anesthesia and simultaneous replacement with cell-free fluid. Nowadays, because of their predictable volume effects, the synthetic colloids (6% dextran 60/70, 6% hydroxyethyl starch 200,000) are preferred as volume substitutes; albumin should be avoided because of its high cost. Hemodilution has experienced a renaissance in recent years, mainly due to the evolving discussion of legal aspects, immunologic changes, viral infections, and a potentially higher cancer recurrence rate associated with the transfusion of homologous blood. Hemodilution should be considered for elective surgical patients free of contraindications and presenting with an initial hemoglobin concentration >/= 12 g/dl and an anticipated blood loss of >/= 1500 ml. The efficacy of this method (judged by the need to give homologous blood transfusion) depends on the preoperative (initial) hematocrit, the target hematocrit (to which hemodilution is performed), and the preset intra- and postoperative transfusion trigger. In the past, data from clinical trials showed that in healthy subjects a target hematocrit of 20% to 25% (hemoglobin 7.0-8. 0 g/dl) is feasible and safe for the patient. The lower the target hematocrit accepted, the more extensive is the monitoring required: Intraoperative target hemoglobin concentrations of 5.0 g/dl and less have been tolerated by surgical patients without adverse effects. The safety and efficacy of acute normovolemic hemodilution in terms of reducing homologous blood transfusion requirements has been demonstrated in various clinical studies. Hemodilution therefore is regarded an integral part of programs aimed at reducing the need for homologous blood and can thus be successfully combined with preoperative autologous blood deposition, intraoperative blood salvage, and carefully adjusted surgical techniques. Hemodilution is feasible and relatively cost-effective, and it minimizes adverse effects associated with transfusion of homologous blood, particularly transmission of viral diseases, immunosuppression, and infectious complications.     

American monitoring: standard and state of the art

Monitoring of the anesthetized patient, the anesthesia machine, and the patient-machine interface is an essential component of anesthetic practice in order to prevent anesthetic-related injuries resulting from equipment failure or human error. While the optimal monitor to detect anesthetic problems (hypoxia, esophageal intubation, hemodynamic compromise, for example) is unclear at present, American standards require continuous presence of qualified personnel who evaluate patient oxygenation, ventilation, circulation, and temperature. A common monitoring array includes electrocardiogram, autosphygmomanometer, pulse plethysmography/oximetry, stethoscope, anesthetic gas analyzer, thermistor, and nerve stimulator. The role of emerging technologies, including transesophageal echocardiography, automated electrocardiographic analysis of ST segments, transcranial Doppler, and transcranial near infrared spectroscopy are discussed.     

Oxygen toxicity and antioxidants: state of the art

Although the use of oxygen as metabolic fuel allows an attractive harvest of energy rich phosphates per molecule of glucose, a significant fraction of oxygen utilized by the body incompletely reduced and is known to be toxic. Such partially reduced forms of oxygen and some of their derivatives are highly reactive pro-oxidants that are collectively referred to as reactive oxygen species (ROS). A multitude of factors are known to modulate the amount of ROS formation in the body. To escape ROS dependent toxicity biological structures have their protective machinery in the form of physiological antioxidants. It appears that the physiological antioxidants are not independently capable of completely detoxifying the ROS constantly produced by the body. The supply of exogenous antioxidants is thus crucial. Endo- and exogenous antioxidants act in concert to minimize ROS dependent damage. ROS are involved in the pathogenesis of a large number of clinical disorders. The sensitive balance between the pro- and anti- oxidant forces in the body appears to be very crucial in determining the state of health, well being and longevity. This article presents an introductory overview covering the current concepts related to oxidants and antioxidants with special reference to human health.     

Bioreactors with immobilized lipases: state of the art

This review attempts to provide an updated compilation of studies reported in the literature pertaining to reactors containing lipases in immobilized forms, in a way that helps the reader direct a bibliographic search and develop an integrated perspective of the subject. Highlights are given to industrial applications of lipases (including control and economic considerations), as well as to methods of immobilization and configurations of reactors in which lipases are used. Features associated with immobilized lipase kinetics such as enzyme activities, adsorption properties, optimum operating conditions, and estimates of the lumped parameters in classical kinetic formulations (Michaelis-Menten model for enzyme action and first-order model for enzyme decay) are presented in the text in a systematic tabular form.     

The state of the art in psychotherapy.

Discusses challenges and unsolved issues that face the field of psychotherapy, including the roles of insight, affect, and the kinds of information brought by the patient to behavior therapy; the communication of therapist values; problems related to the selection and training of therapists; the relation between the conscious and the unconscious; and the possible influence on personality of intrauterine and birth experiences. It is argued that only when these challenges have been met can one speak of the state of the art in psychotherapy in the sense of its being a perfected discipline. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Celiac disease and autoimmunity: state of the art]

Coeliac disease is probably an immunologic disease of the small intestine which is caused by a gluten intake as promoting agent in genetically predisposed persons. Many authors described this autoimmune assumption: most of coeliac patients carry the HLA type, HLA-DQ (alpha 1 x 0501, beta 1 x 0201) etherodimer; it was found a correlation between disease specific antibodies antigliadin (AGA), antireticulin (ARA) and antiendomysium (AEA). Therefore an increase of autoantibodies and lymphocytes in the blood of coeliacs suggest the autoimmune nature of coeliac disease.     

Ultrafast contrast-enhanced three-dimensional MR angiography: state of the art

Selective uptake of high-density lipoprotein- (HDL-) associated cholesteryl esters (CE), i.e. lipid uptake independent from particle uptake, delivers CE to the liver and steroidogenic tissues in vivo. In vitro, besides hepatocytes and steroidogenic cells many other cell types selectively take up HDL CE. Hepatic lipase (HL) stimulates the internalisation of apoprotein (apo) B-containing lipoproteins by hepatocytes independent from lipolysis. In this study the role of HL in the hepatic metabolism of apo A-I-containing lipoproteins, i.e. HDL, was investigated. HDL3 (d = 1.125-1.21 g/ml) was radiolabeled in its protein (125I) and in its CE moiety ([3H]cholesteryl oleyl ether, ([3H]CEt)). HL originated from tissue culture media of hepatoma cells and from post-heparin plasma. Human Hep 3B hepatoma cells incubated in medium containing radiolabeled HDL3. In the absence of HL, the rate of apparent HDL3 particle uptake according to the lipid tracer ([3H]CEt) was in most cases in approximately 10-fold excess on that due to the protein label (125I), indicating selective CE uptake from HDL3. Addition of HL to these incubations increased the cellular uptake of [3H]CEt and of 125I from HDL3 and quantitatively the most prominent effect was an up to approximately 2.5-fold stimulation of apparent selective CE uptake ([3H]CEt-125I). This increase in selective CE uptake was observed in the presence of tetrahydrolipstatin, an inhibitor of the catalytically active site of HL, suggesting that this HL effect is independent from lipolysis. HL binds to cell surface heparan sulfate proteoglycans. To explore the role of these molecules for the HL effect on selective CE uptake, hepatoma cells were depleted of proteoglycans or Chinese hamster ovary (CHO) cells deficient in proteoglycan synthesis were used. Proteoglycan-deficiency reduced the HL-mediated increase in selective uptake by more than 80%. To investigate if low-density lipoprotein (LDL) receptors or the LDL receptor-related protein (LRP) are involved in the HL effect on selective CE uptake, murine embryonic fibroblasts (MEF) were used which are deficient in these receptors; alternatively, monensin, an inhibitor of endocytosis was present in the medium of Hep 3B cells during the uptake assay for labeled HDL3. These experiments yielded no evidence for a role of LDL receptors or LRP in the HL-mediated increase in selective CE uptake. In summary, HL mediates an increase in HDL3 selective CE uptake by human Hep 3B hepatoma cells. This HL effect is independent from lipolysis and independent from LRP and LDL receptors. However this HL effect is susceptible to cell surface proteoglycan deficiency. The potential physiologic implication is that HL modifies HDL selective CE uptake by the liver in vivo and such an effect could play a role in reverse cholesterol transport.