Professional autonomy and the dentist-patient relationship

This article discusses the concept of professional autonomy from an ethical viewpoint. First it is explained how the professional autonomy of the dentist relates to the autonomy of the patient. Subsequently the influence of the health care system is discussed.     

Early responses to Salmonella typhimurium infection in mice occur at focal lesions in infected organs

Salmonella typhimurium causes an invasive disease in mice that has similarities to human typhoid, with key roles for cytokines and possibly also inducible nitric oxide synthase (iNOS), in mediating host responses to infection. In this paper we demonstrate that iNOS mRNA, protein and enzyme activity is induced within spleens and livers of infected mice as early as 5 h post-infection. Immunohistochemistry and in situ hybridization indicated that iNOS expression occurs predominantly in macrophages in localized, discrete foci in the infected organs. iNOS activity in spleen and liver was not detectable in uninfected control mice. The presence of mRNA encoding pro-inflammatory cytokines (TNFalpha, IL-1beta and IFNgamma) in infected organs was measured using RT-PCR, all three being present from 2 h post-infection onwards, but not before. These data show that there is a very early host response to S. typhimurium infection in mice, limited to foci within the infected organs.     

Effects of pan- and subtype-selective N-methyl-D-aspartate receptor antagonists on cortical spreading depression in the rat: therapeutic potential for migraine

Spreading depression (SD) has long been associated with the underlying pathophysiology of migraine. Evidence that the N-methyl-D-aspartate (NMDA) glutamate receptor (NMDA-R) is implicated in the generation and propagation of SD has itself been available for more than 15 years. However, to date, there are no reports of NMDA-R antagonists being developed for migraine therapy. In this study, an uncompetitive, pan-NMDA-R blocker, memantine, approved for clinical use, and two antagonists with selectivity for NMDA-R containing the NR2B subunit, (1S,2S)-1-(4-hydroxyphenyl)-2-(4-hydroxy-4-phenylpiperidino)-1-propanol (CP-101,606) and (+/-)-(R*,S*)-alpha-(4-hydroxyphenyl)-beta-methyl-4-(phenylmethyl)-1-piperidine propanol (Ro 25-6981), were investigated to assess their protective effects against SD in the rat. Under isoflurane anesthesia, d.c. potential and the related cortical blood flow and partial pressure of O2 (pO2) were recorded simultaneously at separate cortical sites. Drugs (1, 3, and 10 mg/kg i.p.) were given 1 h or 30 min before KCl application to the brain surface. Core temperature and arterial pCO2,pO2, and pH measurements confirmed physiological stability. KCl induced 7.7+/-1.8 (mean+/-S.D.) SD events with d.c. amplitude of 14.9+/-2.8 mV. Memantine and CP-101,606 dose-dependently decreased SD event number (to 2.0+/-1.8 and 2.3+/-2.9, respectively) and SD amplitude at doses relevant for therapeutic use. Ro 25-6981 also decreased SD events significantly, but less effectively (to 4.5+/-1.6), without affecting amplitude. These results indicate that NR2B-containing NMDA receptors are key mediators of SD, and as such, memantine- and NR2B-selective antagonists may be useful new therapeutic agents for the treatment of migraine and other SD-related disorders (e.g., stroke and brain injury). Whether chronic, rather than acute, treatment may improve their efficacy remains to be determined.     

Health status in routine clinical practice: validity of the clinical COPD questionnaire at the individual patient level

Background  

There is a growing interest to use health status or disease control questionnaires in routine clinical practice. However, the validity of most questionnaires is established using techniques developed for group level validation. This study examines a new method, using patient interviews, to validate a short health status questionnaire, the Clinical COPD Questionnaire (CCQ), at the individual patient level.     

Psychometric functions for efficient and effective psychophysical testing of sensory function

An efficient test for sensory function has been reported using random order pairs of real and sham stimuli. The constant magnitude of the real stimulus is chosen such that the first error in a patient's forced-choice report on the order of real and sham stimulation, immediately indicates abnormal sensory function. This magnitude just exceeds a critical large percentile of the psychometric function (i.e. the relationship between percentage of detection and stimulus magnitude in healthy subjects). The aim was to determine psychometric functions for one tongue site and six facial sites for adjusting three variants of the real/sham stimulus method (i.e. for light touch, cold sensation and for two-point discrimination). All 150 healthy subjects participated in testing for light touch sensation, 100 subjects additionally participated in testing two-point discrimination and 50 subjects participated additionally in testing cold sensation. The stimulus magnitude was varied using a staircase-limits procedure. Following curve fitting with a Boltzmann function, 90th, 95th or 99th percentiles of the psychometric functions were determined. A set of at least two real/sham tests, one testing the function of large nerve fibres and one for small fibres, allows quick assessment of a patient's disturbed sensory function including its fibre pathology.     

Supraglottic laryngectomy: short- and long-term functional results

A supraglottic laryngectomy offers the possibility of resection of a large portion of the larynx leaving the true vocal cords. From 57 supraglottic laryngectomies performed between 1971 and 1984 in the Department of Otolaryngology and Head and Neck Surgery of the University of Nijmegen, the 5- and 10-year actuarial survival rates were 80% and 59%, respectively. The deaths after 5 years were not directly related to the original tumour. The functional results with respect to the voice were excellent. In this study particular attention has been paid to the postoperative results with regard to swallowing and aspiration. More than half of the patients (56%) had occasional complaints of aspiration, especially when taking liquids. It is concluded that supraglottic laryngectomy is an excellent alternative, especially for the treatment of extensive supraglottic tumours without involvement of the true vocal cords.     

Patient care and ethics. The dentist in love with his patient

A young dentist, who just started his practice, falls in love with a 24-year old woman, during an expensive treatment of several crowns and bridges. He gets confused if it is wise for him to continue this treatment. This question is discussed by a philosophical analysis of what is called the 'I-am-in-love-situation'.     

Patient care and dental ethics. III. The advice of an acupuncturist for the removal of dental amalgam

On the advice of an acupuncturist a patient requests her dentist to remove her amalgam fillings which are of a good quality. The question is discussed whether there is a moral justification to gratify the wishes of the patient.     

Patient care and dental ethics. The request of a patient for total extraction

On the basis of a case report in which a patient requests total extraction while, from the view of dental care, there are possibilities to preserve the teeth, the question is discussed if there is a moral justification to gratify the wishes of the patient.     

First-line gemcitabine with cisplatin or epirubicin in advanced non-small-cell lung cancer: a phase III trial

The purpose of our study was to compare progression-free survival and quality of life (QOL) after cisplatin-gemcitabine (CG) or epirubicin-gemcitabine (EG) in chemotherapy-naive patients with unresectable non-small-cell lung cancer. Patients (n=240) were randomised to receive gemcitabine 1125 mg x m(-2) (days 1 and 8) plus either cisplatin 80 mg x m(-2) (day 2) or epirubicin 100 mg x m(-2) (day 1) every 3 weeks for a maximum of five cycles. Eligible patients had normal organ functions and Eastern Cooperative Oncology Group performance status 相似文献