Surgical management of reflux disease--laparoscopy: renaissance of fundoplication?

The importance of the surgical treatment of the gastroesophageal reflux disease have been increased in recent years. After the medical treatment has spread, the minimally invasive procedures were developed. Testing these procedures clinically and applying them on several numbers of patients, the surgical solution has become conspicuous again and the good results proved reason for the existence of the surgical methods that are effective, safe, cost-effective and load to limited complications. The goal of this article is to sum up the advance of the antireflux-surgery, to give a summary about the tendencies of surgical therapies and representating the new results on this topic.     

Nutritional quality of organic food: shades of grey or shades of green?

Consumer concern regarding possible adverse health effects of foods produced using intensive farming methods has led to considerable interest in the health benefits of organically-produced crops and animal products. There appears to be widespread perception amongst consumers that such methods result in foods of higher nutritional quality. The present review concludes that evidence that can support or refute such perception is not available in the scientific literature. A limited number of studies have compared the nutrient compositions of organically- and conventionally-produced crops, with a very small number of studies that have compared animal products (meat, milk and dairy products) produced under the two agricultural systems. Very few compositional differences have been reported, although there are reasonably consistent findings for higher nitrate and lower vitamin C contents of conventionally-produced vegetables, particularly leafy vegetables. Data concerning possible impacts on animal and human health of diets comprising organic or conventional produce are extremely sparse. Data from controlled studies in animal models, particularly within single species, are limited or poorly designed, and findings from these studies provide conflicting conclusions. There are no reports in the literature of controlled intervention studies in human subjects. Comparison of health outcomes in populations that habitually consume organically- or conventionally-produced foods are flawed by the large number of confounding factors that might contribute to any differences reported. If consumer perceptions regarding potential health benefits of organic foods are to be supported, more research of better quality is needed than that which is currently available.     

Childhood tuberculosis: out of sight,out of mind?

Despite significant improvements in tuberculosis (TB) management under the WHO directly observed treatment, short course (DOTS) strategy, childhood TB has been relatively neglected. Children are at high risk of severe disease, and reactivation of latent infection in adulthood perpetuates the epidemic. Almost a million cases of childhood TB are estimated to occur annually, but good-quality epidemiological data are scarce due to inherent difficulties diagnosing paediatric TB. There remains an urgent need both for better diagnostic tests and for robust regional data on the true burden of disease, otherwise childhood TB will remain an essentially 'invisible' and therefore neglected disease.     

The madness of Nietzsche: a misdiagnosis of the millennium?

This article represents a personal discussion about Nietzsche's mental illness, which formed part of a larger paper 'The masks of Nietzsche and eternal return of the repressed'. This was presented at the 6th Annual Conference of The Friedrich Nietzsche Society, September 1996, Manchester UK, as reported by Nussbaumer-Benz (1998).     

Flavonoids: modulators of brain function?

Emerging evidence suggests that dietary phytochemicals, in particular flavonoids, may exert beneficial effects on the central nervous system by protecting neurons against stress-induced injury, by suppressing neuroinflammation and by improving cognitive function. It is likely that flavonoids exert such effects, through selective actions on different components of a number of protein kinase and lipid kinase signalling cascades, such as the phosphatidylinositol-3 kinase (PI3K)/Akt, protein kinase C and mitogen-activated protein kinase (MAPK) pathways. This review explores the potential inhibitory or stimulatory actions of flavonoids within these pathways, and describes how such interactions are likely to underlie neurological effects through their ability to affect the activation state of target molecules and/or by modulating gene expression. Future research directions are outlined in relation to the precise site(s) of action of flavonoids within signalling pathways and the sequence of events that allow them to regulate neuronal function.     

Hypothesis: Vitamin A supplementation and childhood mortality: amplification of the non-specific effects of vaccines?

Most areas of health research will have accepted data and a dominating interpretation. If the interpretation is not correct, contradictions will accumulate, and it will eventually become clear that the current interpretation is untenable. In this situation, the best hypothesis is the one that accounts for all of the known data as well as the apparent contradictions. The area of vitamin A supplementation and childhood mortality in developing countries is afflicted with many contradictions and there is a need for a new hypothesis. We propose that the effect of vitamin A supplementation may depend on the amplification of non-specific effects of vaccines on childhood mortality.     

Loss of chance: what loss?

A recent New South Wales judgment, Rufo v Hosking, explored the concept of 'loss of a chance' in medical negligence claims. 'Loss of a chance' claims involve an allegation that the patient lost the chance of a better outcome as a result of the negligence of the medical practitioner. This article outlines the case and discusses the implications of the judgment for medical practitioners.     

Postoperative wound infections: a useful indicator of quality of care?

An indicator can be defined as a measurable element of care that gives an impression of the quality of care. It can be used for screening on potential quality problems, for monitoring of well-defined processes and for a check after the introduction of quality improvement activities. Although the notion of an indicator appears to be an attractive concept in quality management, some questions have to be answered before a specific indicator can be used. The first question regards the validity of the indicator: to what extent does the indicator reflect the quality of the care? Next is the question of registration: can the indicator be measured in a valid and reliable way? The third question is whether appropriate activities will be initiated after the indicator has given a signal. Postoperative wound infections appears to be a valid outcome indicator because of the relationship between process of care (infection prevention policy) and outcome of care (the number of infections). The weak point lies in the reliability of the registration of wound infections.     

The economics of blood: gift of life or a commodity?

OBJECTIVES: To calculate the costs of blood collection, testing, storage, and transfusion in Greece. METHODS: Costing information was collected from two large public hospitals, in Athens and Crete, that also act as blood banks. Given that private health care accounts for 40 percent of total health spending, the same costs were also considered in a private setting by collecting key reagent cost data from a leading private hospital in Athens. Mainly direct costs were considered (advertising campaigns, personnel, storage and maintenance, reagent costs, transportation costs from blood bank to end-use hospitals, and cross-matching and transfusion costs in receiving hospitals) and some indirect costs (opportunity cost of blood donorship). RESULTS: Captive donorship accounts for over 50 percent of the national blood supply. A unit of blood transfused would cost between Euro 294.83 and Euro 339.83 in public hospitals and could reach Euro 413.93 in a private facility. This figure may be an underestimate, as it excludes opportunity costs of blood transfusion for patients and the healthcare system. CONCLUSIONS: Blood has a significant cost to the health system. Policy makers and practitioners should encourage its rational use, build on current policies to further improve collection and distribution, encourage further volunteer donorship in Greece, and also consider alternatives to blood where the possibility exists.