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Terms modified by Mainstay Selected AbstractsFS05.1 Treatment of hand eczemaCONTACT DERMATITIS, Issue 3 2004Niels K Veien Hand eczema is a common skin disease that often becomes chronic, and treatment of the disease is often challenging. Skin protection is of great importance for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Emollients have been shown to be successful in the primary prevention of hand eczema as well as in reducing eczema activity. Topical corticosteroids are still the mainstay of treatment, but randomised controlled trials of their efficacy are needed. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects. UV-therapy and Grenz rays can also suppress hand eczema. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. Treatment possibilities for hand eczema, indications and side effects will be discussed. [source] 68Ga-PET: a powerful generator-based alternative to cyclotron-based PET radiopharmaceuticalsCONTRAST MEDIA & MOLECULAR IMAGING, Issue 2 2008Melpomeni Fani Abstract PET (positron emission tomography) is a powerful diagnostic and imaging technique which requires short-lived positron emitting isotopes. The most commonly used are accelerator-produced 11C and 18F. An alternative is the use of metallic positron emitters. Among them 68Ga deserves special attention because of its availability from long-lived 68Ge/68Ga generator systems which render 68Ga radiopharmacy independent of an onsite cyclotron. The coordination chemistry of Ga3+ is dominated by its hard acid character. A variety of mono- and bifunctional chelators have been developed which allow the formation of stable 68Ga3+complexes and convenient coupling to biomolecules. 68Ga coupling to small biomolecules is potentially an alternative to 18F- and 11C-based radiopharmacy. In particular, peptides targeting G-protein coupled receptors overexpressed on human tumour cells have shown preclinically and clinically high and specific tumour uptake. Kit-formulated precursors along with the generator may be provided, similar to the 99Mo/99mTc-based radiopharmacy, still the mainstay of nuclear medicine. Copyright © 2008 John Wiley & Sons, Ltd. [source] Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma: Split-Face DesignDERMATOLOGIC SURGERY, Issue 1 2003Suhattaya Angsuwarangsee MD Background. Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety. Objective. To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma. Methods. Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score. Results. The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side. Conclusions. Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma. [source] Topical tacrolimus in the management of atopic dermatitis in JapanDERMATOLOGIC THERAPY, Issue 2 2006Masutaka Furue ABSTRACT:, Atopic dermatitis (AD) is a common, chronic, relapsing, severely pruritic, eczematous skin disease. Topical steroids are the mainstay of treatment. However, the adverse effects of steroids on hormonal function are the major obstacle for their use as long-term topical therapy. Topical calcineurin inhibitors, such as tacrolimus, not only complement existing treatment options but also overcome some of the drawbacks of topical steroid therapy and fulfill the long-term needs of patients in preventing disease progression. Short- and long-term efficacy and safety of topical tacrolimus has been widely recognized and it is also accepted as a first-line treatment for the inflammation of AD. In order to reduce the possible long-term adverse effects, it is important to monitor the clinical dose in daily clinics. [source] Why insulin sensitizers but not secretagogues should be retained when initiating insulin in type 2 diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2008Philip Raskin Abstract The stringent targets set for HbA1c levels in type 2 diabetes are currently achieved by fewer than half the patients in the United States. Failure to manage hyperglycaemia in the early stages of disease results in progressive loss of ,-cell function, which ultimately necessitates the initiation of insulin therapy. At this point, choices have to be made on whether to continue oral anti-diabetic drug therapy and, if so, with which agent(s). Historically, sulfonylureas have been the mainstay of oral anti-diabetic drug therapy; however, their long-term efficacy in patients with depleted ,-cell capacity is doubtful, and other classes of oral anti-diabetic drugs, notably the insulin sensitizers, may prove more reliable. These agents (metformin and thiazolidinediones) appear to provide various benefits over and above sustained glycaemic control, which may variably include reduced loss of ,-cell function as well as improvements to cardiovascular risk factors, morbidity, and mortality. Metformin also limits weight gain associated with insulin therapy. This manuscript presents the case that when insulin therapy is initiated it should be tailored to individual needs through combination with one or more insulin sensitizers rather than a secretagogue. Copyright © 2007 John Wiley & Sons, Ltd. [source] Conjunctival impression cytology in trachomaDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2009Anshu M.D., D.N.B. Abstract Trachoma is one of the leading causes of blindness and clinical examination remains the mainstay of diagnosis. However there is need to evaluate simple, inexpensive techniques which can be used for screening of trachoma in endemic regions. We report two cases where conjunctival impression cytology played a part in confirming the diagnosis of trachoma. We used a modified technique of obtaining conjunctival impressions, which not only met with better patient compliance and minimal ocular distress, but also provided better cellularity and morphology of cells for evaluation. The impression smears showed squamous metaplasia and loss of goblet cells. The cytoplasm of these cells had a hazy, moth eaten appearance and showed presence of intracytoplasmic inclusions. These basophilic inclusions were present singly and in clusters and were around 5 ,m in diameter. A large number of these inclusions were present extracellularly as well. Conjunctival impression cytology is a simple procedure which needs to be evaluated for its potential to be used for screening trachoma in endemic areas. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Barrett's esophagus: current and future role of endosonography and optical coherence tomographyDISEASES OF THE ESOPHAGUS, Issue 2 2004S. A. Faruqi SUMMARY., This paper reviews the role of endosonography and optical coherence tomography (OCT) for imaging of Barrett's esophagus (BE). The routine use of endoscopic ultrasound (EUS) to screen patients with BE is neither justified nor cost effective. EUS does appear to have a role in patients who have BE and high-grade dysplasia or intramucosal carcinoma, in whom a non-operative therapy is being contemplated. For patients with a diagnosis of esophageal cancer with or without BE, EUS is superior to computed tomography or magnetic resonance imaging for assessing esophageal wall penetration and for detecting regional lymph node involvement. In its current state, OCT is not yet ready for application in clinical practice. However, given its superior resolution compared with other modalities such as EUS, OCT has great potential as a powerful adjunct to standard endoscopy in surveillance of BE and may enhance the ability of endoscopists to detect high-grade dysplasia at an early stage. With further technical refinement, this technique may become a mainstay in the surveillance of BE and other premalignant conditions of the gastrointestinal tract. [source] Three Options Are Optimal for Multiple-Choice Items: A Meta-Analysis of 80 Years of ResearchEDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 2 2005Michael C. Rodriguez Multiple-choice items are a mainstay of achievement testing. The need to adequately cover the content domain to certify achievement proficiency by producing meaningful precise scores requires many high-quality items. More 3-option items can be administered than 4- or 5-option items per testing time while improving content coverage, without detrimental effects on psychometric quality of test scores. Researchers have endorsed 3-option items for over 80 years with empirical evidence,the results of which have been synthesized in an effort to unify this endorsement and encourage its adoption. [source] Interictal EEG spikes identify the region of electrographic seizure onset in some, but not all, pediatric epilepsy patientsEPILEPSIA, Issue 4 2010Eric D. Marsh Summary Purpose:, The role of sharps and spikes, interictal epileptiform discharges (IEDs), in guiding epilepsy surgery in children remains controversial, particularly with intracranial electroencephalography (IEEG). Although ictal recording is the mainstay of localizing epileptic networks for surgical resection, current practice dictates removing regions generating frequent IEDs if they are near the ictal onset zone. Indeed, past studies suggest an inconsistent relationship between IED and seizure-onset location, although these studies were based upon relatively short EEG epochs. Methods:, We employ a previously validated, computerized spike detector to measure and localize IED activity over prolonged, representative segments of IEEG recorded from 19 children with intractable, mostly extratemporal lobe epilepsy. Approximately 8 h of IEEG, randomly selected 30-min segments of continuous interictal IEEG per patient, were analyzed over all intracranial electrode contacts. Results:, When spike frequency was averaged over the 16-time segments, electrodes with the highest mean spike frequency were found to be within the seizure-onset region in 11 of 19 patients. There was significant variability between individual 30-min segments in these patients, indicating that large statistical samples of interictal activity were required for improved localization. Low-voltage fast EEG at seizure onset was the only clinical factor predicting IED localization to the seizure-onset region. Conclusions:, Our data suggest that automated IED detection over multiple representative samples of IEEG may be of utility in planning epilepsy surgery for children with intractable epilepsy. Further research is required to better determine which patients may benefit from this technique a priori. [source] Clinical picture of EPM1-Unverricht-Lundborg diseaseEPILEPSIA, Issue 4 2008Reetta Kälviäinen Summary Unverricht-Lundborg disease (ULD), progressive myoclonic epilepsy type 1 (EPM1, OMIM254800), is an autosomal recessively inherited neurodegenerative disorder characterized by age of onset from 6 to 16 years, stimulus-sensitive myoclonus, and tonic,clonic epileptic seizures. Some years after the onset ataxia, incoordination, intentional tremor, and dysarthria develop. Individuals with EPM1 are mentally alert but show emotional lability, depression, and mild decline in intellectual performance over time. The diagnosis of EPM1 can be confirmed by identifying disease-causing mutations in a cysteine protease inhibitor cystatin B (CSTB) gene. Symptomatic pharmacologic and rehabilitative management, including psychosocial support, are the mainstay of EPM1 patients' care. Valproic acid, the first drug of choice, diminishes myoclonus and the frequency of generalized seizures. Clonazepam and high-dose piracetam are used to treat myoclonus, whereas levetiracetam seems to be effective for both myoclonus and generalized seizures. There are a number of agents that aggravate clinical course of EPM1 such as phenytoin aggravating the associated neurologic symptoms or even accelerating cerebellar degeneration. Sodium channel blockers (carbamazepine, oxcarbazepine) and GABAergic drugs (tiagabine, vigabatrin) as well as gabapentin and pregabalin may aggravate myoclonus and myoclonic seizures. EPM1 patients need lifelong clinical follow-up, including evaluation of the drug-treatment and comprehensive rehabilitation. [source] Multiple Subpial Transections: The Yale ExperienceEPILEPSIA, Issue 2 2001Lisa P. Mulligan Summary: ,Purpose: Although resection of an epileptogenic region is the mainstay of epilepsy surgery, epileptogenic areas in functionally critical cortex cannot be approached in that manner. Multiple subpial transection (MST) was developed to treat those refractory seizures without causing unacceptable neurologic deficit. We review our experience with this technique. Methods: Twelve patients who underwent MST with or without resection between 1990 and 1998 were retrospectively reviewed with regard to seizure and neurologic outcome, and predictive factors. Results: Five (42%) of 12 patients obtained a significant improvement in seizure frequency, and two other patients had a marked decrease in the severity of their seizures. Resection with MST reduced seizure frequency more, but this was not a significant difference. No predictive factors for outcome were identified. Only one patient sustained any persistent neurologic deficit. Conclusions: In selected patients, MST may be a viable alternative when the epileptogenic focus lies in unresectable cortex. A multicenter study with appreciable patient numbers will be necessary to define predictive factors for success. [source] Atorvastatin therapy improves exercise oxygen uptake kinetics in post-myocardial infarction patientsEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 6 2007M. Guazzi Abstract Background Statins represent a modern mainstay of the drug treatment of coronary artery disease and acute coronary syndromes. Reduced aerobic work performance and slowed VO2 kinetics are established features of the clinical picture of post-myocardial infarction (MI) patients. We tested the hypothesis that statin therapy improves VO2 exercise performance in normocholesterolaemic post-MI patients. Materials and methods, According to a double-blinded, randomized, crossover and placebo-controlled study design, in 18 patients with uncomplicated recent (3 days) MI we investigated the effects of atorvastatin (20 mg day,1) on gas exchange kinetics by calculating VO2 effective time constant (tau) during a 50-watt constant workload exercise, brachial artery flow-mediated dilatation (FMD) as an index of endothelial function, left ventricular function (echocardiography) and C-reactive protein (CRP, as an index of inflammation). Atorvastatin or placebo was given for 3 months each. Results, Atorvastatin therapy significantly improved exercise VO2 tau and FMD, and reduced CRP levels. We did not observe changes in cardiac contractile function and relaxation properties during all study periods in either group. Conclusions, In post-MI patients exercise performance is a potential additional target of benefits related to statin therapy. Endothelial function improvement is very likely implicated in this newly described therapeutic property. [source] Basal TSH levels compared with TRH-stimulated TSH levels to diagnose different degrees of TSH suppression: diagnostic and therapeutic impact of assay performanceEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2002M. Christ-Crain Abstract Background The estimated prevalence of endogenous subclinical hyperthyroidism varies from 4% to 6% and a basal thyroid stimulating hormone (TSH) level < 0·5 mU L,1 may be associated with increased mortality in subjects over 60 years of age who are not on thyroid medication. Exogenous TSH suppression is a mainstay in the treatment of thyroid cancer. Because of recent concerns about potential adverse effects, especially of endogenous TSH suppression on bone, the cardiovascular system and cognitive functions, subclinical hyperthyroidism obtained new clinical importance. We therefore re-evaluated the diagnostic value of basal and thyrotrop in TRH-stimulated serum TSH measurements using TSH assays with different sensitivities. Materials and methods A total of 805 oral and nasal TRH stimulation tests were performed on 409 ambulatory subjects with low basal serum TSH concentrations of less than 0·1 mIU L,1. Basal serum TSH was measured either using a second generation assay (functional sensitivity > 0·03 mIU L,1) or two third generation assays (functional sensitivity 0·01 mIU L,1 and 0·007 mU L,1, respectively). Serum TSH concentration was determined before and 3 h after oral administration of 40 mg of TRH and before and 30 min after nasal administration of 2 mg of TRH. Results In the oral testing group, the basal TSH levels measured by the different TSH assays were 0·06 ± 0·03, 0·04 ± 0·02 and 0·03 ± 0·02, respectively, whereas the peak TSH levels were 0·4 ± 0·6, 0·4 ± 0·6 and 0·3 ± 0·5 in the patients with subclinical hyperthyroidism. In overt hyperthyroidism, the basal TSH levels were 0·06 ± 0·02, 0·03 ± 0·02 and 0·03 ± 0·02, whereas the peak TSH levels were 0·19 ± 0·3, 0·16 ± 0·3 and 0·15 ± 0·2, respectively. Basal TSH values could discriminate between different degrees of TSH suppression if measured with a third generation assay (P < 0·001), but not with a second generation assay. There was only a weak correlation between basal TSH and peak TSH when measured by a second generation assay (n = 126; r = 0·3; P < 0·001) in contrast to the strong correlation found using the third generation assays (n = 128; r = 0·7; P < 0·001 and n = 69; r = 0·8; P < 0·001, respectively). Conclusions In view of the recent concerns about potential adverse effects in TSH suppression and based on our data, it is mandatory to select a TSH assay with a functional sensitivity of , 0·01 mIU L,1 for optimal titration of L-T4 suppressive therapy, especially in patients with thyroid cancer. If, however, only a second generation TSH assay is available, additional TRH testing allows a more careful titration of suppressive thyroxine therapy. [source] Building Intercultural Citizenship through Education: a human rights approachEUROPEAN JOURNAL OF EDUCATION, Issue 2 2008RODOLFO STAVENHAGEN This article analyses the challenges posed by traditional ethnic and linguistic minorities in multicultural states and more specifically the problems faced by indigenous peoples and communities. Their educational and cultural needs and demands are increasingly being framed in the language of human rights, based on the expanding international legal and institutional human rights system. The United Nations World Conference on Human Rights, held in Vienna in 1993, endorsed a rights-based approach to development, human rights education is a growing field in educational practice, respect for cultural diversity is now enshrined in international and domestic laws, and the right of every person to education and to culture has become a mainstay of international human rights principles to which a majority of the world's states has subscribed. [source] Synthesis of "Trioxaquantel"® Derivatives as Potential New Antischistosomal DrugsEUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 5 2008Sophie A.-L. Abstract Over the past 20 years, praziquantel, a pyrazinoisoquinoline derivative, has become the mainstay for morbidity control of human and animal schistosomiasis. From early in their lives in vertebrate hosts, schistosomes ingest hemoglobin and aggregate the released heme as a dark pigment very similar to the hemozoin produced by Plasmodium in malaria infection. The antimalarial artemisinin derivatives have real, though low, schistosomicide activity. Because of the complementarity of the two drug classes , praziquantel and artemisinin derivatives , we designed new molecules, named trioxaquantels®, that combine the 1,2,4-trioxane unit responsible for the activity of artemisinin, and the pyrazinoisoquinoline moiety of praziquantel within a single drug. The synthesis of these new drugs and their preliminary evaluation in mice infected with Schistosoma mansoni is reported here.(© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2008) [source] Integrating remote sensing in fisheries controlFISHERIES MANAGEMENT & ECOLOGY, Issue 5 2005N. KOURTI Abstract, To complement existing fishery control measures, in particular the Vessel Monitoring System (VMS), a pilot operational system to find fishing vessels in satellite images was set up. Radar is the mainstay of the system, which furthermore includes fully automated image processing and communication protocols with the authorities. Different image types are used to match different fisheries , oceanic, shelf and coastal. Vessel detection rates were 75,100% depending on image type and vessel size. Output of the system, in the form of an overview of vessel positions in the area highlighting any discrepancies with otherwise reported positions, can be at the authorities within 30 min of the satellite image being taken , fast enough to task airborne inspection for follow up. [source] Hard X-ray micro(spectro)scopy: A powerful tool for the geomicrobiologistsGEOBIOLOGY, Issue 3 2008K. M. KEMNER ABSTRACT During the past few decades, the use of electron microscopy approaches , many developed by Terry Beveridge , to probe the physiology of microorganisms has become a mainstay in fields including microbiology, human health, and geomicrobiology. Recent developments of third-generation synchrotron X-ray sources and X-ray-based microscopy approaches for studying microbial systems have proved their utility as complements to the very powerful approaches regularly employed by electron microscopists. In addition, in recent geomicrobiological studies, researchers have begun to take advantage of the strengths of each technique by using the superior spatial resolution of the electron microscope (relative to the X-ray microscope) and the superior elemental sensitivity of the X-ray microscope (relative to the electron microscope), along with the ability of the X-ray microscope to spatially probe the chemical speciation of elements. The benefits of integrating these two nanoprobes for investigating the same microenvironments within a geomicrobial system are far superior to those of independent studies separately employing each probe. [source] Factor V deficiency: a concise reviewHAEMOPHILIA, Issue 6 2008J. N. HUANG Summary., Factor V (FV; proaccelerin or labile factor) is the plasma cofactor for the prothrombinase complex that activates prothrombin to thrombin. FV deficiency can be caused by mutations in the FV gene or in genes encoding components of a putative cargo receptor that transports FV (and factor VIII) from the endoplasmic reticulum to the Golgi. Because FV is present in platelet ,-granules as well as in plasma, low FV levels are also seen in disorders of platelet granules. Additionally, acquired FV deficiencies can occur in the setting of rheumatologic disorders, malignancies, and antibiotic use and, most frequently, with the use of topical bovine thrombin. FV levels have limited correlation with the risk of bleeding, but overall, FV-deficient patients appear to have a less severe phenotype than patients with haemophilia A or B. The most commonly reported symptoms are bleeding from mucosal surfaces and postoperative haemorrhage. However, haemarthroses and intramuscular and intracranial haemorrhages can also occur. Because no FV-specific concentrate is available, fresh frozen plasma remains the mainstay of treatment. Antifibrinolytics can also provide benefit, especially for mucosal bleeding. In refractory cases, or for patients with inhibitors, prothrombin complex concentrates, recombinant activated FVIIa, and platelet transfusions have been successfully used. Some patients with inhibitors may also require immunosuppression. [source] Malignant peripheral nerve sheath tumors of the head and neck: Management of 10 cases and literature review,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007Amir Minovi MD Abstract Background. This study analyzes the management and outcomes of a series of 10 malignant peripheral nerve sheath tumors (MPNST) of the head and neck. Methods. From 1984 to 2004, 10 patients underwent surgical treatment of a MPNST. We retrospectively reviewed presenting symptoms, radiological findings, surgical management, and follow-up status and performed a literature review. Results. Eight tumors were located at the lateral skull base; 2 involved the vagus nerve in isolation. Two lesions were growing within the sinonasal tract. The most common presenting symptom was a rapidly enlarging cervical mass. Seventy percent of the tumors could be resected completely. Long-term follow-up showed a 2-year disease-specific survival rate of 50% and 5-year survival rate of 20%. Negative prognostic indicators were advanced tumor stage, early recurrence, and presumably also the presence of von Recklinghausen's disease. Postoperative adjuvant radiotherapy was found to make no difference in outcome. Conclusions. Although rare, MPNST is one of the most aggressive tumors in the head and neck area. Complete tumor removal is the mainstay of treatment and most important prognostic factor of MPNST. Adjuvant radiotherapy should be used to assist surgical excision in local control. The role of adjuvant chemotherapy remains controversial. © 2006 Wiley Periodicals, Inc. Head Neck, 2007. [source] Remission induction, consolidation and novel agents in development for adults with acute myeloid leukaemiaHEMATOLOGICAL ONCOLOGY, Issue 1 2010Mehdi Hamadani Abstract Chemotherapy regimens used for remission induction in AML have not changed significantly over the last several decades. However the recognition of the prognostic value of cytogenetics and genomics has been a major advance which is helping clarify the most optimal post-remission consolidation strategy among various risk groups. We are not only beginning to realize the pitfalls of a ,one-fits-all' approach with intensive, cytarabine-based chemotherapy as the mainstay, but we are finally beginning to reap the rewards of decades of basic, translational, and clinical research. Developing individualized, ,targeted' therapy for each AML patient based on unique molecular features of disease remains a daunting goal yet one that we can now begin to envision. Hypothesis-based study designs,from pre-clinical/laboratory experiments to phase-I and subsequent efficacy trials,provide the foundation for advances in the diagnosis, risk stratification, and treatment for patients with AML. Here we critically review the literature for the management of AML, try to give recommendations regarding the appropriate induction and remission strategy, clarify the role of stem cell transplantation and discuss novel agents on the horizon. Copyright © 2009 John Wiley & Sons, Ltd. [source] Encapsulating peritoneal sclerosis: Importance to the hemodialysis practitionerHEMODIALYSIS INTERNATIONAL, Issue 4 2009Jeffrey PERL Abstract Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD) therapy. Encapsulating peritoneal sclerosis is characterized by peritoneal membrane inflammation, followed by progressive peritoneal membrane fibrosis and intestinal encapsulation. Clinical manifestations include ascites as well as intermittent and recurrent small bowel obstruction. The prognosis of EPS is poor. The exact cause of EPS remains unknown. While the risk factors for EPS are not well elucidated, EPS is seen with increased frequency after an increased duration of PD therapy. In more than half the patients who develop EPS, the diagnosis is made after transfer to hemodialysis (HD). It is important for the HD practitioner to initiate surveillance in any patient at risk for EPS while maintaining a heightened index of suspicion for EPS in an HD patient with gastrointestinal symptoms and a history of previous PD therapy. Early diagnosis and prompt initiation of treatment is essential. Early in the course of EPS, immunosuppressive therapy remains the mainstay of treatment. Ultimately, parenteral nutritional support may be required along with surgical therapy to relieve intestinal obstruction. We report a case of EPS in an HD patient at our center highlighting the incidence, risk factors, and treatment strategies in the context of available evidence. [source] Biliary physiology and disease: Reflections of a physician-scientist,HEPATOLOGY, Issue 4 2010Gustav Paumgartner A review is presented of Gustav Paumgartner's five decades of research and practice in hepatology focusing on biliary physiology and disease. It begins with studies of the excretory function of the liver including hepatic uptake of indocyanine green, bilirubin, and bile acids. The implications of these studies for diagnosis and understanding of liver diseases are pointed out. From there, the path of scientific research leads to investigations of hepatobiliary bile acid transport and the major mechanisms of bile formation. The therapeutic effects of the hydrophilic bile acid, ursodeoxycholic acid, have greatly stimulated these studies. Although ursodeoxycholic acid therapy for dissolution of cholesterol gallstones and some other nonsurgical treatments of gallstones were largely superseded by surgical techniques, ursodeoxycholic acid is currently considered the mainstay of therapy of some chronic cholestatic liver diseases, such as primary biliary cirrhosis. The major mechanisms of action of ursodeoxycholic acid therapy in cholestatic liver diseases are discussed. An attempt is made to illustrate how scientific research can lead to advances in medical practice that help patients. (HEPATOLOGY 2010:51:1095,1106.) [source] Bone disorders in chronic liver disease,HEPATOLOGY, Issue 4 2007Jane Collier Osteomalacia rarely occurs in adult patients with chronic liver disease despite a low serum vitamin D level being reported in up to two-thirds of patients with cirrhosis. In contrast, osteoporosis, which increases the risk of vertebral fractures, occurs in 12%-55% of patients with cirrhosis. Although the prevalence is probably falling, as shown by a fall from 57%-26% in patients with biliary disease requiring liver transplantation over the last 2 decades, it still accounts for significant patient morbidity. Bone density also falls in the first 3 months after liver transplantation, and pretransplant fractures are predictive of posttransplant fractures. Many of the known risk factors for postmenopausal osteoporosis exist in the cirrhotic population, such as excess alcohol intake, steroid use, poor nutrition, and hypogonadism. There is also an increased risk of osteoporosis in patients without cirrhosis, particularly those with hemochromatosis and biliary disease. The diagnosis is made with bone density measurements. The effective treatment is largely based on evidence from postmenopausal osteoporosis as there have been only a few small clinical trials of patients with chronic liver disease. Bisphosphonates are the mainstay of treatment; they have been shown to be effective in biliary disease and are well tolerated. (HEPATOLOGY 2007.) [source] Contrasting roles of neural firing rate and local field potentials in human memoryHIPPOCAMPUS, Issue 8 2007Arne Ekstrom Abstract Recording the activity of neurons is a mainstay of animal memory research, while human recordings are generally limited to the activity of large ensembles of cells. The relationship between ensemble activity and neural firing rate during declarative memory processes, however, remains unclear. We recorded neurons and local field potentials (LFPs) simultaneously from the same sites in the human hippocampus and entorhinal cortex (ERC) in patients with implanted intracranial electrodes during a virtual taxi-driver task that also included a memory retrieval component. Neurons increased their firing rate in response to specific passengers or landmarks both during navigation and retrieval. Although we did not find item specificity in the broadband LFP, both ,- and ,-band LFPs increased power to specific items on a small but significant percent of channels. These responses, however, did not correlate with item-specific neural responses. To contrast item-specific responses with process-specific responses during memory, we compared neural and LFP responses during encoding (navigation) and retrieval (associative and item-specific recognition). A subset of neurons also altered firing rates nonspecifically while subjects viewed items during encoding. Interestingly, LFPs in the hippocampus and ERC increased in power nonspecifically while subjects viewed items during retrieval, more often during associative than item-recognition. Furthermore, we found no correlation between neural firing rate and broadband, ,-band, and ,-band LFPs during process-specific responses. Our findings suggest that neuronal firing and ensemble activity can be dissociated during encoding, item-maintenance, and retrieval in the human hippocampal area, likely relating to functional properties unique to this region. © 2007 Wiley-Liss, Inc. [source] Robert Southey, Lord Macaulay and the Standard of Living ControversyHISTORY, Issue 284 2001W. A. Speck The early nineteenth century witnessed gladiatorial contests in print between the contributors to the conservative Quarterly Review and the radical Edinburgh Review. Among the chief protagonists of the two papers were Robert Southey, leading contributor to the Quarterly from its launch in 1809 until 1839, and Thomas Babington Macaulay, whose first contribution to the Edinburgh, on ,Milton', appeared in August 1825, after which he became a mainstay of the periodical. Their ,reviews' were long essays of 10,000 or more words, in which the works purportedly being reviewed were mere pegs on which to hang their own observations. They were generally scathing about publications which took an ideological stance opposite to their own, and sympathetic to those which adopted a similar position to that which they held. Though they frequently made barbed references to each other in their reviews, Southey never reviewed a work by Macaulay, who only once criticized one by his rival. Nevertheless, that particular occasion, in January 1830, was a classic clash of Titans. It demonstrated their fundamental disagreement over the prospects facing society from the initial impact of the industrial revolution. [source] Dementia: an update to refresh your memoryINTERNAL MEDICINE JOURNAL, Issue 11 2002D. Logiudice Abstract The number of people with dementia and cognitive impairment is predicted to rise exponentially in the future. The increasing awareness of dementia in the community has led to a better understanding of the impact of this condition on individuals, their families and their carers. There is burgeoning research in the pathogenesis of dementia, and advances have been made in pharmacological treatments for the management of symptoms, including behavioural and psychological disturbances. However, the mainstay of management rests in comprehensive clinical assessment, education, counselling and provision of support for those affected and their families. The present paper provides a clinical update on recent advances in diagnosis and management of the most common forms of dementia. (Intern Med J 2002; 32: 535,540) [source] Does early medical intervention have a role in the management of intracerebral haemorrhage?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2008A. Bhalla Summary Introduction:, An increasing amount of research is now being directed towards the medical treatment of patients who have suffered an intracerebral haemorrhage (ICH). Despite this, no routine drug treatment to date has been shown to be unequivocally effective in unselected patients. Treatments/Discussion:, Approaches to treatment are based upon our understanding of the pathophysiological sequelae following ICH. Strategies to reduce haematoma growth, subsequent oedema formation and perihaematoma ischaemia are key targets for further research. Whether these therapies become valuable tools for the future is as yet unclear. Until then, the mainstay of the medical management of ICH remains individualised care. Conclusions:, There is now a pressing need for large prospective randomised controlled trials to determine the effectiveness of pharmacological therapies for this condition. [source] Domestic tourism destination choices,,,a choice modelling analysisINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 6 2003Twan Huybers Abstract Tourism destinations compete with each other to attract visitors. Although international tourism has received a lot of attention, domestic tourism remains the mainstay for many destinations. To inform the basis on which destinations compete, an understanding of the determinants of destination choices is required. In this paper, the discrete choice modelling method is applied to investigate the determining factors underlying the short-break holiday destination choices of prospective tourists from Melbourne, Australia. The results from an estimated nested logit model indicate the relative importance of a number of destination and trip attributes and respondent characteristics. The model results are used to simulate the effects on destinations' market shares resulting from various changes in attributes and tourist characteristics. Copyright © 2003 John Wiley & Sons, Ltd. [source] Current concepts in hypospadias surgeryINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008Yutaro Hayashi Abstract: Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications. [source] Neuromodulation for the treatment of urinary incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008Tomonori Yamanishi Abstract: Neuromodulation has been reported to be effective for the treatment of stress and urgency urinary incontinence. The cure and improvement rates of pelvic floor neuromodulation in urinary incontinence are 30,50% and 60,90%, respectively. In clinical practice, vaginal, anal and surface electrodes are used for external, short-term stimulation, and sacral nerve stimulation for internal, chronic (long-term) stimulation. The effectiveness of neuromodulation has been verified in a randomized, placebo-controlled study. However, the superiority to other conservative treatments, such as pelvic floor muscle training has not been confirmed. A long-term effect has also been reported. In conclusion, pelvic floor exercise with adjunctive neuromodulation is the mainstay of conservative management for the treatment of stress incontinence. For urgency and mixed stress plus urgency incontinence, neuromodulation may therefore be the treatment of choice as an alternative to drug therapy. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||