Cystic fibrosis: present and future

Cystic fibrosis (CF) is an inherited disorder of epithelial chloride transport affecting primarily pancreas, lungs, gut, liver and exocrine glands. The defect is caused by defects of the cystic fibrosis transmembrane regulation gene on chromosome 7. Genotyping has proved useful in identifying gene carriers, a definitive diagnosis, and in antenetal diagnosis. Genotype/phenotype relationships have shown that the commonest cause of pancreatic insufficiency is the D F508 mutation. Clinical trials are exploring the use of somatic gene therapy but this is not yet a viable treatment option. Liver, lung and intestinal disease result in malnutrition which causes further dysfunction of these organs. Aggressive nutritional and pancreatic enzyme therapy results in improved disease, normal growth and increased survival. However, high-dose enzyme therapy may in some individuals cause a fibrosing colonopathy. For those with end-stage liver and lung disease, transplantation holds out some hope.     

Occupational pathology: present and future

Formed 75 years ago, occupational pathology has defined structure of occupational morbidity, determined principles of occupational diseases' pathogenesis and pathomorphosis, demonstrated dependence of occupational entities on acting occupational hazards, described clinical manifestations of occupational diseases, emphasized informative diagnostic complexes. Diagnosis in occupational pathology now is established on basis of etiology. Manifold activities helped to form a system preventing health disorders caused by occupational hazards. Topical problem is to elaborate and put into practice some criteria for compensation of occupational damage with differential expert assessment of functional disorders caused either by occupational disease or by general one. Prospective trend could be to create a system organizing and managing workers' health on workplace and to put "protection by time" principle into practice with forecasting risk of occupational diseases and dose-effect dependence. Another prospect is to elaborate and put into practice a training in social and psychologic adaptation for occupational managers and industrial workers.     

Asbestos: past, present and future

Owing to its particular properties asbestos has been widely used for the production of insulating material, for fire proofing, and for strengthening to other materials such as cements and plastics, and thus the story of this mineral was one of progressive commercial success until the middle of this century. However, serious health hazards were realized early: around the turn of the century a progressive form of diffuse fibrosis (asbestosis) in asbestos workers was observed and in 1950 an excess risk of lung cancer, while in 1960 the causal relationship between asbestos and mesothelioma were confirmed. In view of the known potential risks of asbestos and its widespread use in the building industry, more recently asbestos has caused considerable public concern and anxiety. Based on numerous experimental and epidemiological observations, present knowledge of the pathogenic effects of asbestos is sufficient for a number of broad conclusions to be drawn. (1) The amphibole types of asbestos are too dangerous for use as industrial material, and should be banned. (2) Chrysotile can probably be used safely if there is strict control of the workers' dust exposure. (3) It is very unlikely that the general public is at any measurable risk from asbestos in buildings. Exceptions are people working regularly on maintenance tasks involving removing or cutting of asbestos in buildings; such people are properly classified as asbestos workers and should be protected accordingly.(ABSTRACT TRUNCATED AT 250 WORDS)     

Counterflow centrifugal elutriation: present and future

Only single cases with rheumatoid arthritis of the thoracic spine with vertebral subluxation have been reported to date. In a review of 100 patients with severe rheumatoid arthritis who had undergone occipitocervical fusion, arthritis of the upper thoracic spine with subluxation was discovered on conventional radiographs in four patients. Two additional patients were found elsewhere. Magnetic resonance imaging (MRI) was performed in three of the patients, confirming the diagnosis of subluxation of the upper thoracic vertebrae. In addition, MRI revealed encroachment on the anterior subarachnoid space and compression of the spinal cord.     

Pubovaginal slings: past, present and future

Renewed interest in the pubovaginal sling procedure for stress urinary incontinence has occurred in response to recent reports of poor durability and inconsistent efficacy associated with simple cystourethropexy. Many of the failures are felt to represent patients with an unrecognized component of intrinsic sphincteric deficiency. Historically slings have a favourable cure rate, but have been perceived as having unacceptably high rates of prolonged urinary retention and secondary detrusor instability. This article reviews the preoperative evaluation and indications for pubovaginal slings, describes the evolution of the current techniques, and discusses choice of sling material, surgical approach, results and complications. It is hoped that this review will stimulate interest in this versatile but technically challenging procedure.     

Pain: Past, present and future.

The gate control theory of pain proposes that a mechanism in the dorsal horns of the spinal cord acts like a gate that inhibits or facilitates transmission from the body to the brain on the basis of the diameters of the active peripheral fibers as well as the dynamic action of brain processes. As a result, psychological variables such as past experience, attention, and other cognitive activities have been integrated into current research and theory on pain processes. The gate control theory, however, is not able to explain some chronic pain problems which require a greater understanding of brain mechanisms. A new theory of brain function that proposes a new conceptual nervous system is described. One of the system's components is a body-self neuromatrix whose portions (or neuromodules) subserve major psychological dimensions (or qualities) of experience. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ischaemic preconditioning: present position and future directions

Antibodies generated against a synthetic growth hormone (GH) peptide in a number of animal species were shown to enhance the efficacy of GH. However, the ability to produce the effective antibodies diminished over the time and repeated boosters failed to overcome the hurdle. Therefore, this study was designed to address the issue on the fallen antibody responses by employing different GH peptide antigen preparations in cattle. Holstein steers were repeatedly immunized with a synthetic peptide corresponding to an amino acid sequence 54-95 of porcine GH (pGH). The peptide was conjugated to ovalbumin (OVA) as a carrier. Animals initially responded to the antigen well and elicited antibodies specific to the peptide. However, the 4th challenge with the same OVA-peptide antigen rendered animals unresponsive, resulting in a decline in antibody production. This unresponsiveness was overcome by switching the antigen at the 5th immunization from OVA-peptide to a recombinant peptide preparation which was composed of maltose binding protein (MBP) as a carrier. Antibodies generated in cattle after the 5th immunization recognized not only the pGH(54-95) peptide, but also bovine GH (bGH) and pGH. These antibodies were not immunoreactive with an unrelated control peptide. Hypophysectomized (hypox) rats were used for functional analysis and bGH was active in promoting the growth of these GH-deficient rats. The growth-promoting effect of bGH was significantly enhanced by mixing with bovine anti-peptide antibodies prior to administration. Therefore, the present findings suggest that peptide 54-95 induces cattle to elicit antibodies capable of not only recognizing bGH but also augmenting the somatogenic effectiveness of bGH in hypox rats.     

Psoriasis: a review of present and future management

Psoriasis is a chronic skin condition prevalent in a significant minority of the population. Its cause is unknown and effective treatments are elusive. In this article, the authors examine the impact of the disease on patients' lives and describe how unproven treatments make skilled nursing essential for people with such a challenging and disabling disease.     

Hydroxychloroquine: past, present, future

OBJECTIVE: To examine the trends in motor vehicle exhaust gas suicides since 1970 and to investigate the impact of catalytic converters. DESIGN: Australia-wide database analyses and a retrospective stratified series of 100 Victorian cases. DATA SOURCES: Australian Bureau of Statistics, 1970-1995; Australian Institute of Health and Welfare, National Injury Surveillance Unit, 1991/92-1995/96; Victorian Coroner's files, 1994-1996. RESULTS: There were 509 motor vehicle exhaust gas suicides in Australia in 1995, representing 22% of total suicides. Since the 1986 requirements for reduced carbon monoxide emissions from new vehicles (and thus the use of catalytic converters), the absolute numbers and rates of such suicides have increased, and they have come to represent a larger percentage of total suicides. Of 75 Victorian victims' vehicles traced, 36% were manufactured during or after 1986, showing that exhaust gas suicides have occurred in vehicles with catalytic converters. Blood carboxyhaemoglobin levels did not differ between victims using vehicles with or without catalytic converters. Between 1976 and 1991 exhaust gas suicides increased at a faster rate than motor vehicle registrations. Australian hospital admissions for exhaust gas suicide attempts have increased substantially since 1991-1992. CONCLUSION: Catalytic converters and the associated lower CO emission limits of 9.3 g/km had not, by 1995, resulted in a reduction in numbers, rates or percentages of exhaust gas suicides in Australia.     

Psychoneuroimmunology: Past, present, and future.

Provides a brief overview of the history and current status of behavioral immunology research as well as speculation on the likely future directions. It is suggested that field may have broad implications for basic biological sciences and medicine. The field of psychoneuroimmunology has clear relevance for health psychology; its relevance to actual health outcomes, however, is not yet known. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing clinical guidelines: present and future legal aspects

This article provides a legal update by discussing Department of Health advice on the legal aspects of clinical guidelines and a recent House of Lords' clinical negligence case. These have important implications for developers of clinical guidelines particularly when discussed in the context of recent government initiatives in legal aid and civil justice reform which will result in the development of increasingly specialist clinical negligence lawyers.     

Ecology and health in Chile: present and future development

In response to the progressive environmental deterioration, the Ecological Society of America has made a proposal, called "Sustainable Biosphere Initiative", to do research, teaching and decision making processes on biodiversity, global change and the effects of human activities on environment. The goal of appropriate environmental protection and welfare for mankind includes health and quality of life. Presently, Chile faces a number of environmental problems such as pollution, excessive urban growth, loss of agricultural areas, disposal of solid waste and species extinction. The lack of education and information in Chile, on these problems, is worrisome. The role of universities to overcome this deficit should be crucial in the future sustainable development of Chile.     

Cancer prevention: past, present, future

There are many examples of different types of cancers that have been prevented by appropriate measures in the past. Most of them were related to occupational, iatrogenic or accidental factors, often as the outcome of heavy exposure of humans to specific carcinogenic agents. Cancer is a disease of DNA, and is generally associated with multiple genetic alterations, these being produced in the typical case by exposure to various carcinogens, each of which exists at minute concentrations. Thus, the impact of carcinogenic factors, xenobiotics and autobiotics, is due to their actions in concert. However, a single mutation yielding genomic instability exerts a disproportionately large influence by resulting in a large number of secondary mutational events. Epigenetic changes can also not be disregarded especially from the view point of prevention of neoplasia. The occurrence of multiple primary cancers among survivors of initial primaries, and the presence of hereditary groups with a high risk of cancer development provide a strong stimulus for establishment of effective approach for cancer prevention, which should be, in principle, multi-faceted. Therefore, a holistic approach is essential with improvement in life style including choosing a balanced diet and avoidance of cigarette smoking and other sources of carcinogens, as integral elements.