Ensuring palliative medicine availability: the development of the IAHPC list of essential medicines for palliative care.

In response to a request from the World Health Organization (WHO), the International Association for Hospice and Palliative Care (IAHPC) developed a List of Essential Medicines for Palliative Care based on the consensus of palliative care workers from around the world. IAHPC designed a process of five steps, which included developing a set of ethical guidelines; identifying the most common symptoms in palliative care; identifying a list of medications to treat those symptoms; carrying out a survey using a modified Delphi process with participants from developed and developing countries; and convening a meeting of representatives from regional, international, and scientific organizations to develop the final list. Twenty-one symptoms were identified as the most common in palliative care, and an initial list of 120 medications resulted from the initial survey.

Riedel's thyroiditis: impact and strategy of a challenging surgery.

Background: No surgical standard for Riedel's thyroiditis (RT) is established. Salvage surgery follows severe cervical and compressive airway symptoms or strong suspicion of malignancy. Obscured planes and multi-infiltrative extension prevent sufficient surgery with considerate complications.

Modeling shear damage to suspended CHO cells during cross-flow filtration.

A mathematical model is presented for predicting the shear-induced decrease in live cells occurring over time during tangential flow filtration. The model uses a cell death rate constant (K) and considers the effects of flow rate, solution viability, and filtration system volumes and dimensions. Single pass and recycle capillary experiments with solutions of high (93%), medium (87%), and low (70%) viability were run, where the maximum laminar shear stress ranged from 10- 300 Pa, to validate the model and determine cell death rate constants.

Long-term results and functional outcome after cervical evisceration in patients with thyroid cancer.

Background: Surgical strategy in patients with thyroid cancer (TC) infiltrating the aerodigestive system is controversial. This study was undertaken to examine the long-term results of cervical evisceration (CE).

Patients And Methods: Since 1995, 14 consecutive patients with advanced TC underwent total laryngectomy (LE, n = 6) or esophagolaryngectomy (ELR, n = 8).

[Epidemiology, diagnosis, and treatment of giant pleomorphic adenomas of the parotid gland].

Pleomorphic adenomas of the parotid gland can be slowly growing over the course of many years and may reach an enormous and disfiguring size associated with significant morbidity of the patients. To our knowledge, over the last 80 years 20 cases of giant pleomorphic adenomas (weight 1.2-26.

Natural antiinflammatory agents for pain relief in athletes.

Most athletes experience musculoskeletal injuries during their sports activity that require rest at a minimum, and occasionally injuries are severe enough to necessitate surgical repair. Neurosurgeons are often consulted for athletically sustained injuries and prescribe medications for the associated pain. The use of both over-the-counter and prescription nonsteroidal medications is frequently recommended, but recent safety concerns must now be considered.

Quality measures for symptoms and advance care planning in cancer: a systematic review.

Purpose: Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps.

Methods: English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO (1995 to 2005); Internet-based searches; and contact with measure developers.

Hands-free speech after surgical voice rehabilitation with a Provox voice prosthesis: experience with the Provox FreeHands HME tracheostoma valve system.

Excellent results have been reported with the use of voice prostheses for the rehabilitation of laryngectomees. Patients, however, consider it a disadvantage that the tracheostoma must be closed manually for speech production. This limits their ability to simultaneously communicate by gesture or to work with both hands.

Anomalous ion channeling in AlInN/GaN bilayers: determination of the strain state.

Monte Carlo simulations of anomalous ion channeling in near-lattice-matched AlInN/GaN bilayers allow an accurate determination of the strain state of AlInN by Rutherford backscattering or channeling. Although these strain estimates agree well with x-ray diffraction (XRD) results, XRD composition estimates are shown to have limited accuracy, due to a possible deviation from Vegard's law, which we quantify for this alloy. As the InN fraction increases from 13% to 19%, the strain in AlInN films changes from tensile to compressive with lattice matching predicted to occur at [InN] = 17.

Effects of hypoxia on the onset of muscle deoxygenation and the lactate threshold.

Six subjects performed two trials of incremental cycling to exhaustion under normoxic and hypoxic conditions. The lactate threshold and onset of muscle deoxygenation were highly correlated under both conditions, and during the hypoxic condition both variables shifted leftward.

Intraoperative haemodynamic stability in patients with phaeochromocytoma--minimally invasive vs conventional open surgery.

Objective: There is conflicting evidence, whether or not minimally invasive adrenalectomy (MA) is associated with an increased perioperative cardiovascular instability in phaeochromocytomas compared to conventional open adrenalectomy (CA).

Design And Patients: In a retrospective analysis of 49 patients with phaeochromocytoma we compared 27 cases of MA to 22 cases of CA by assessing intraoperative haemodynamic parameters and perioperative complications. Patients undergoing MA for adrenocortical adenomas (aldosteronomas n = 15, inactive adenomas n = 13) served as controls.

Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV.

Patient-centered measures of functioning and well-being are needed to monitor and improve health for HIV-infected persons. We estimated the associations between HRQOL and symptoms over time in HIV-infected persons, adjusting for demographic and clinical characteristics using a longitudinal study of a nationally representative cohort of 2267 patients in care for HIV infection surveyed in 1996 and again in 1998. We used two global measures of HRQOL (overall health and overall quality of life) scored to have a mean of 50 and standard deviation of 10 in the sample.

Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study.

Objective: The aim of this experimental gingivitis study was to assess the efficacy and safety of two new chlorhexidine (CHX) mouthrinses.

Material And Methods: Ninety volunteers participated in this investigator-blind, randomized, clinical-controlled trial in parallel groups. During the treatment period, no oral hygiene measures except rinsing with non-alcoholic 0.

Total parathyroidectomy without autotransplantation for renal hyperparathyroidism: experience with a qPTH-controlled protocol.

Background: Controversy regarding the optimal surgical treatment for secondary hyperparathyroidism (sHPT) continues. Subtotal parathyroidectomy (PTX) with a small remnant and total parathyroidectomy with autotransplantation prevail, although impaired by considerable recurrence rates. Concerns about postoperative management and long-term supplementation prevent broader acceptance of total parathyroidectomy without autotransplantation.

A quality evaluation strategy for multi-sourced active pharmaceutical ingredient (API) starting materials.

Establishing appropriate impurity specifications for active pharmaceutical ingredient (API) starting materials is an important component of the commercialization and registration of an API. Multiple sources and routes of manufacture of starting materials and the capability of the API synthetic process for tolerating impurities introduced with starting materials must be understood. A strategy for purity method development and use test evaluation of starting materials to aid in establishing quality requirements is described.

[The use of the BrainLAB Kolibri navigation system in endoscopic paranasal sinus surgery under local anaesthesia. An analysis of 35 cases].

Background: As a result of technological advances, 3D-navigation systems are playing an increasingly important role in paranasal sinus and anterior skull base surgery.

Patients And Methods: The BrainLAB Kolibri navigation system (BrainLAB, Heimstetten, Germany) was used in the surgical management of chronic sinusitis and nasal polyposis in 35 patients. Surgery was performed under local anaesthesia.

Methodological approaches for a systematic review of end-of-life care.

As background for a National Institutes of Health State of the Science Conference on End-of-Life-Care, we performed a systematic review of end-of-life care and outcomes. The systematic review was intended to evaluate the evidence in the field from the perspective of concerns important to patients, caregivers, and the health care system. This article relates the challenges in performing a systematic review of end-of-life care and outcomes, and describes the methods that we used to define the scope, search the literature, develop exclusion and inclusion criteria, incorporate various types of articles, and synthesize the results.

[Prophylactic parathyroidectomy for familial parathyroid carcinoma].

In contrast to primary hyperparathyroidism, parathyroid carcinoma is a rare disease. In patients with hyperparathyroidism jaw tumor (HPT-JT) syndrome, caused by germline mutations in HRPT2, the development of parathyroid carcinoma is estimated to be 10-15%. This review summarizes the clinical and molecular genetic data of about 100 patients in the literature and three of our own cases.

Measurement of erythrocyte inosine triphosphate pyrophosphohydrolase (ITPA) activity by HPLC and correlation of ITPA genotype-phenotype in a Caucasian population.

Background: Inosine triphosphate (ITP) pyrophosphohydrolase (ITPA) catalyzes the pyrophosphohydrolysis of ITP/dITP and xanthosine triphosphate to prevent incorporation of unusual nucleotides into RNA and DNA. Important mutations leading to enzyme deficiency are 94C>A and IVS2 + 21A>C. An association between ITPA 94C>A and adverse reactions during azathioprine treatment has been shown.

Selective arterial chemoembolization for hepatic metastases from medullary thyroid carcinoma.

Background: Hepatic metastases from medullary thyroid carcinoma (MTC) may impair quality of life by hypercalcitonemia-associated diarrhea and pain. In this prospective study, the effect of selective arterial chemoembolization (SACE) was evaluated.

Methods: Eleven patients with hepatic metastases from MTC received 1 to 9 courses of SACE using epirubicine.

TAp73/Delta Np73 influences apoptotic response, chemosensitivity and prognosis in hepatocellular carcinoma.

We investigated the mechanisms by which TAp73 beta and dominant-negative p73 (Delta Np73) regulate apoptosis. TAp73 beta transactivated the CD95 gene via the p53-binding site in the first intron. In addition, TAp73 beta induced expression of proapoptotic Bcl-2 family members and led to apoptosis via the mitochondrial pathway.

Religiousness and spirituality among HIV-infected Americans.

Purpose: To describe the demographic and clinical factors associated with the importance of religiousness and spirituality among patients with human immunodeficiency virus (HIV) infection in the United States.

Methods: Longitudinal study of a nationally representative cohort of 2266 patients receiving care for HIV infection surveyed in 1996 and again in 1998. Measures included 12 items assessing religious affiliation and attendance, the importance of religion and spirituality in life, and religious and spiritual practices.

The transcriptional repressor Nab1 is a specific regulator of pathological cardiac hypertrophy.

Hypertrophy represents the major physiological response of the heart to adapt to chronically enhanced workload, but is also crucial in the development of heart failure. Although we know of numerous inducers of cardiac hypertrophy, little is known about mechanisms that limit cardiac hypertrophy. Here, we describe the transcriptional repressor NAB1 as an endogenous regulator of cardiac growth.