Ureteral or vesical involvement in Henoch–Schönlein syndrome: a systematic review of the literature

Background

Little information is available on ureteral or vesical involvement in Henoch–Schönlein syndrome. To determine the features of this condition we performed a formal analysis of peer-reviewed scientific literature on this topic.

Methods

The US National Library of Medicine database was used as the data source. All articles published as full-length articles or letters were collected. Reports published in languages other than English, French, German, Italian or Spanish were not considered.

Results

We analyzed 32 reports describing 35 cases (24 male and 11 female subjects aged between 3.5 and 63, median 7.0 years) with ureteral (n?=?30), vesical (n?=?4), or both ureteral and vesical involvement (n?=?1). The presentation included colicky abdominal pain, macroscopic hematuria (sometimes containing blood clots), urinary tract infection or urinary retention. The diagnosis of ureteral involvement was often fortuitous. Patients with vesical involvement were managed conservatively. However, the majority of those with ureteral involvement were managed surgically.

Conclusions

Ureteral or vesical involvement is unusual and likely underappreciated in Henoch–Schönlein syndrome. Improved recognition and wider appreciation of this involvement can help to avoid associated morbidity. Management must be individualized for each patient. A multidisciplinary approach may be of value in planning medical treatment, surgical intervention, and follow-up.     

The circumcision of Jesus Christ

PURPOSE: We study the controversies manifested in religious writings, art, sculpture and music as well as the theological disputes surrounding the circumcision of Jesus Christ. MATERIALS AND METHODS: Data are derived from relevant historical and theological articles. RESULTS: Jesus Christ was circumcised as a Jew on the 8th day after his birth. Until 1960 the Catholic church celebrated the day as Circumcision Day. In medieval times the holy foreskin was worshipped in many European churches. CONCLUSIONS: Christianity never condoned the ritual of circumcision and established the sacrament of baptism in its place.     

Natural orifice translumenal endoscopic surgery (NOTES): safe implementation through technological innovation

BACKGROUND: NOTES is advancing at a rapid pace with large registries of human applications and increasing evidence to support safety and efficacy. We have however arrived at a stage in the development of the technique where many conceptual applications are not supported by available technology to ensure safe implementation. METHODS: The data presented in this editorial are based on the views of the authors and reviews of the literature which have been conducted using PubMed, a search tool of the National Library of Medicine and the national institute of Health, including the MEDLINE database and the Cochrane library until the 1st of February 2011. RESULTS: This editorial reviews the technological challenges that must be overcome and novel solutions are discussed. CONCLUSIONS: For NOTES to realise its full potential, surgeons have to wait for technology to catch up with ideological innovation before embarking on more complex procedures than the hybrid transvaginal feasibility studies currently taking place.     

Indications of vasopressin in the management of septic shock

OBJECTIVE: Vasopressin (antidiuretic hormone) is emerging as a potentially major advancement in the treatment of septic shock. Vasopressin is both a vasopressor and an antidiuretic hormone. It also has haemostatic, gastrointestinal, and thermoregulatory effects. This article reviews the physiology of vasopressin and all the relevant clinical literature on its use in the treatment of septic shock. DATA SOURCES AND EXTRACTION: Extraction from Pubmed database of French and English articles on the physiology and clinical use of vasopressin. The following key words were selected: vasodilatory shock, vasopressin, septic shock, catecholamines, norepinephrine, renal function, diuresis, mesenteric haemodynamic. The collected articles were reviewed and selected according to their quality and originality. DATA SYNTHESIS: Vasopressin mediates vasoconstriction via V1-receptor activation on vascular smooth muscle. Septic shock causes first a transient early increase in blood vasopressin concentrations that decreases later to very low concentrations compared to other causes of hypotension. Vasopressin infusion of 0.01-0.04 U min(-1) in septic shock patients increases plasma vasopressin concentrations. This increase is associated with a lesser need for other vasopressors. Vasopressin has been shown to produce greater blood flow diversion from non-vital to vital organ beds than does adrenaline. A large randomized clinical trial should be performed to assess its place as a therapeutic agent of septic shock patient.     

美国MEDLINE概述及向MEDLINE源期刊投稿应注意的问题

美国国立医学图书馆(NLM)建立的医学文献分析和联机检索系统(MEDLINE)是全球最具影响力的生物医学数据库。本文通过介绍MEDLINE数据库概况及其2006年收录的中国期刊情况,并分析向MEDLINE收录期刊投稿时应注意的问题,目的在于引导科技人员向MEDLINE收录期刊投稿,提高医学科技论文、医学科技工作者以及所在医院的国际影响力。     

Pierre Dionis and the Franco-British dialogue in surgery

Pierre Dionis (1643??1718), though not himself a very innovative surgeon, has been acclaimed as the author of a surgical textbook that opened a new era in which French surgical teaching dominated Europe. This dominance is reflected in the Gordon Craig Library, which contains four copies of the book by Dionis in English translation, as well as a number of other books by influential French 18th century surgical writers, notably Henri François Le Dran and François Quesnay. It is significant that many of these writers benefited from government patronage in various forms. Dionis himself began his career as demonstrator in anatomy and surgery at the Jardin du Roi, in his time the premier teaching institution in those sciences. He later became a court surgeon. During the course of the 18th century, French surgery gained ascendancy over French academic medicine and also on the inter­national stage. English surgery, likewise, made great progress. There was a very productive dialogue between medical scientists and teachers in both countries, assisted by textbooks in translation. The French Revolution demolished the medical and surgical institutions established under the old regime, but French surgery emerged from the rubble to play a great part in the birth of modern clinical medicine     

Laparoscopic colorectal cancer surgery

BACKGROUND: A number of controversies exist in the laparoscopic treatment of colorectal cancer, and thus the technique has so far failed to gain widespread acceptance throughout the United Kingdom. This review aims to discuss these issues in the context of ongoing published trials, assessing both purported advantages and disadvantages. METHODS: The United States National Library of Medicine Medline database, and the Bath Information Data Service (BIDS) were searched using keywords related to laparoscopic colorectal cancer surgery. Recent surgical journals were also reviewed for relevant publications. Attempts have been made to quote only the most recent work from institutions with multiple publications using the same group of patients, in order to present the most coherent picture. The data are presented as randomized controlled trials, nonrandomized controlled studies, and series comprising more than 10 patients. CONCLUSIONS: This review confirms that laparoscopic colorectal cancer surgery is technically feasible. In addition patients lose less blood, have less immunosuppression, and have shorter postoperative ileus, in-patient stay, and require less analgesia. However, concerns still remain as to the development of port-site metastases, the longer operating times, and the overall cost of the equipment. In view of these concerns, the place of laparoscopically assisted colorectal cancer surgery is likely to remain controversial for some years yet. Randomized, controlled trials are as yet too few to provide definitive answers to all these issues.     

The scientific contributions of United States plastic surgeons to the Revue de Chirurgie Plastique and the Revue de Chirurgie Structive Brussels (1931–1938)

The author emphasizes the close cooperation between United States plastic surgeons and the first international journal devoted entirely to plastic surgery, the Revue de Chirurgie Plastique (from 1931 to 1934) later to become the Revue de Chirurgie Structive (from 1935 to 1938) published under the editorship of Maurice Coelst, M.D., from Brussels. By the accurate recording of original articles, book reviews, proceedings of their annual meetings, and summaries in three different languages (English, French, German), the author stressed the intense scientific dynamism and the achievements made by the U.S. pioneers of this new specialty which really started during World War I. Received: 24 July 1998 / Accepted: 27 October 1998     

Presidential address: Knowledge,know-how,and vascular surgeons

Vascular surgeons know vascular disease and its treatment, yet uncertainties about the future of their specialty require an examination of its two basic components: knowledge and know-how. Knowledge, or understanding, flows from research efforts, and expands the scientific basis of our medical knowledge. It is imperative that new knowledge through funded research continues so that vascular surgical science progresses. Know-how, or skill, is a crucial component of the vascular surgeon's armamentarium and has been recognized through our history as a criterion of a surgeon's proficiency. The vascular fellowship program provides the vascular surgical trainee with the knowledge and know-how necessary to become accomplished and qualified for certification in this specialty. Future progress in vascular surgery depends on new knowledge and know-how and their innovative application to human vascular disease. This may involve a formal cooperative relationship between the two national vascular societies and our colleagues in interventional radiology to develop a comprehensive vascular health care program. The societies together must continually evaluate the forces for change that are prevalent in the health care environment to expand this program. This will ensure a healthy forecast for our dynamic specialty in the twenty-first century. (J VASC SURG 1995;21:169-73)     

Have the media influenced the use of hip resurfacing arthroplasty? A review of UK print media

INTRODUCTION

The aim of this study was to look at the different claims made about hip resurfacing arthroplasty in the popular UK print media and how this relates to findings in the scientific literature.

METHODS

A review of UK popular print media from January 1992 to June 2011 was performed using the Lexis® Library online news database. Only articles discussing the clinical results of hip resurfacing arthroplasty were included. After excluding duplicates, 49 newspaper articles were found suitable for this study. The main outcome measure was the claims made in popular UK print media about hip resurfacing. These were compared with the scientific publication. We reviewed the trend of use of hip resurfacing prostheses during the same period as reported in the National Joint Registry.

RESULTS

A disparity was found between the claims in the newspapers and published scientific literature. The initial newspaper articles highlighted only the positive aspects of hip resurfacing arthroplasty, without definitive contemporary evidence backing the claims. Most of these claims were refuted by future scientific publications. The initial positive media reports coincided with an increase in the use of hip resurfacing but the decline coincided with negative reports in the scientific literature.

CONCLUSIONS

The trend of the newspaper articles and that of the number of hip resurfacing prostheses implanted suggests that the media may have been partly responsible for the increased use of this prosthesis. The subsequent decrease was initiated by the scientific literature.     

Blood vessel structure and function: a brief update on recent advances

This article briefly reviews recent advances in knowledge of the histology and function of blood vessels. It focuses upon the multifunctional roles of endothelium and smooth muscle cells. Particular reference is made to the synthesis of a number of factors now known to be involved in maintenance of the integrity of the vessel wall and the initiation of arterial disease. The cells of the vascular wall are much more versatile and dynamic than previously thought.     

Two novel mutations at exon 8 of the Sequestosome 1 (SQSTM1) gene in an Italian series of patients affected by Paget's disease of bone (PDB).

PDB is genetically heterogeneous. Mutations of the sequestosome1 gene have been reported in sporadic and familial forms of Paget's in patients of French Canadian and British descent. Mutational analyses in different ethnic groups are needed to accurately investigate hereditary diseases. We describe two novel mutations of sequestosome1 in 62 Italian sporadic patients, confirming the role of the encoded protein in this disorder. INTRODUCTION: Paget's disease of bone (PDB) is a relatively common disease of bone metabolism reported to affect up to 3% of whites over 55 years of age. The disorder is genetically heterogeneous, and at present, there is scientific evidence that at least eight different human chromosomal loci are correlated with its pathogenesis. Mutations of the sequestosome1 (SQSTM1) gene were identified as responsible for most of the sporadic and familial forms of Paget in patients of French Canadian and British descent. Such mutations were located at exon 7 and 8 levels, encoding for the ubiquitin protein-binding domain (UBA) and representing a mutational hot spot area. MATERIALS AND METHODS: To verify the involvement of this gene in Italian subjects affected by PDB, we performed mutational analysis in 62 sporadic PDB cases. RESULTS: We described three different mutations at exon 8 level: P392L, already described in the French Canadian population and families predominantly of British descendent, and two novel mutations consisting of the amino acid substitutions M404V and G425R. No significant differences in the clinical history of PDB have been observed in patients with SQSTM1 mutations in respect to those without. CONCLUSIONS: Even though our findings suggest a minor involvement of the SQSTM1 gene in the pathogenesis of sporadic Italian Paget's cases, the identification of different significant mutations within the SQSTM1 gene in unrelated, but clinically similar individuals, offers extremely convincing evidence for a causal relationship between this gene and PDB. Longitudinal studies are needed to assess the penetrance of genotype/phenotype correlations. Our findings confirm the evidence of a clustered mutation area at this level in this disorder.     

Orthotopic liver transplant. Analysis of costs related to anesthesiologic and intensive care phases

BACKGROUND: To evaluate anesthesia and Intensive Care Unit (ICU) costs for Orthotopic Liver Transplantation (OLT) through a point by point analysis of the entire process from anesthesia induction to ICU discharge. DESIGN: Retrospective analysis. SETTING: Regional Transplantation Centre participating to the Italian National Health Care System. METHODS: Anesthesia and ICU costs for each OLT performed during 1997 were estimated through the analysis of costs of the following categories: drugs, medical and nurse staff, blood bank, radiology, laboratory, haemoderivates. RESULTS: Forty OLTs were performed in 38 recipients during the study period. The total charges for the anesthesia and ICU management of these patients calculated in US dollars were 583.433,23 (considering the exchange rates valid in January 1998). ICU costs resulted approximately 2.5 times higher than those for anesthesia. Blood bank and drugs were the categories that had the greatest impact on the final expense whereas laboratory had the lowest. The charges referred to medical and nurse staff resulted higher in the ICU than for anesthesia. CONCLUSIONS: The Italian National Health Care System has to deal with limited resources; costs analysis of high-tech procedures as OLT is of basic importance to optimise resources allocation and to enforce money-saving actions.     

Il Fasciculo di Medicina of 1493: medical culture through the eyes of the artist

THE FASCICULUS MEDICINA, printed in 1491, is considered the first illustrated medical book. The Latin essays and illustrations in this volume provide insight into the medical knowledge of Western Europe and, in the Italian edition published in 1493, glimpses into the medical culture of the late 15th century. We outline the scientific and social environments into which the Fasciculus Medicinae of 1491 was introduced and the transition that occurred with the publication of the 1493 Italian edition. The artist of the 1493 Fasciculo witnessed a paradigm shift occurring. In four woodcuts, the artist captured four themes: the relevance of knowledge-based medicine, the emergence of laboratory medicine, the Hippocratic lessons of patient observation, and the emerging revolution in anatomy.     

Nipple sparing mastectomy: Surgical and oncological outcomes from a national multicentric registry with 913 patients (1006 cases) over a six year period

BackgroundNipple sparing mastectomy is deemed surgically and oncologically safe based on a long lasting literature data from reviews of single institution series. This study aims at evaluating surgical and oncological outcomes of NSM on a large multi-institutional scale, by means of the Italian National registry.MethodsIn July 2011 a panel of Italian specialists agreed upon and designed a National database of NSM. Centers with at least 150 cancers per year and following the National follow-up schedule guidelines could participate inserting any NSM case performed, retrospectively and prospectively from that moment on. In March 2015 analysis of data was accomplished. Dataset for this study consists of cases performed in the period between January 1st 2009 and December 31st 2014.Results913 Women were included in the analysis, for a total of 1006 procedures. Prophylactic mastectomies were 124 (12.3%). MRI utilization increased over time. NSM failure rate, with NAC removal for any reason was 11.5%. NAC necrosis rate was 4.8%. Larger skin-flap necrosis rate was 2.3%. Major surgical complications rate was 4.4%. Oncological outcomes were calculated among primitive EBC cases only: locoregional recurrences rate was 2.9%, NAC recurrence 0.7%. Systemic recurrence rate was 1.0%. Five deaths (0.7%) were registered.ConclusionsMore than 10% of NSM procedures are prophylactic mastectomies. MRI is gaining more importance over time. Surgical and oncological results show that NSM is effective. This National multicentric analysis enables a comparison of results with no geographical differences and a “safe” state of the art of NSM in Italy.     

Cochrane Anaesthesia Review Group and the Cochrane Library. Useful resources for anaesthetists

The Cochrane Collaboration is an international non-profit organisation that aims to help clinicians in making well-informed decisions about health care issues.This is done through preparing, maintaining and disseminating systematic reviews on the effects of health care interventions.To facilitate this task, review groups have been established. These groups cover specific health care areas and form the organisational basis of the collaboration. They provide methodological and logistic help to the authors of the systematic reviews.The Cochrane Anaesthesia Review Group (CARG) covers anaesthesia, perioperative medicine, intensive care,pre-hospital medicine, resuscitation, and emergency medicine.Protocols and completed Cochrane reviews are published in a structured format in the electronic Cochrane Library.Beside this Cochrane database of systematic reviews, the Cochrane library contains a database with summaries of non-Cochrane systematic reviews (database of abstracts of reviews of effectiveness), and a comprehensive database with controlled clinical trials (Cochrane central register of controlled trials). Thus the Cochrane library is a useful source of information on health care interventions for anaesthetists.     

Congenital dislocation of the hip: current concepts as a preliminary for diagnosis and treatment

Congenital hip dislocation has been regularly reviewed, in the wake of important progress made over the last thirty years, and more precisely in the field of clinical and ultrasonographic screening, as well as in early treatment. The search of a consensus on the best screening methods (who? how?) should start from one initial point: a thorough knowledge of anatomical, clinical, pathological and therapeutic definitions and concepts underlying this far-reaching question. This is the purpose of the present review of current ideas (from a historical perspective). The two authors, members of French Society for Paediatric Orthopaedics (SOFOP), have extensively researched this subject and contributed to the implementation of national “good practice”.     

Do orthopaedic journals provide high-quality evidence for clinical practice?

BACKGROUND: In the hierarchy of research designs, randomized controlled trials and meta-analyses are considered to be evidence of the highest grade, and scientific journals are the main source of scientific information. METHODS: Using the National Library of Medicine Medline database, all randomized controlled trials and meta-analyses from 1966 to 1999 were retrieved from the journals indexed in the core list of the Science Citation Index in 1999, dedicated primarily to orthopaedics. The abstracts of the articles were reviewed independently by each author and classified by the year, journal name and subject. RESULTS: The total number of articles was 36,293, of which only 671 were randomized controlled trials (1.85%) and 12 were meta-analyses (0.03%). Although there was a progressively increasing trend for randomized controlled trials, more than half of them (81.9%) were published in four journals. Of the randomized controlled trials, 66% was about arthroplasty, and hip and knee arthroplasties covered 90.7%. CONCLUSION: Although the number of randomized controlled trials and meta-analyses is tending to increase, the conclusion of this study is that the high-quality evidence provided by the major orthopaedic journals is quite low, and more randomized controlled trials and meta-analyses are needed for evidence-based orthopaedic practice.