RESUMEN
Listerian antisepsis opened the way to surgical treatment of brain abscesses, at a time when advances in neurology made it possible to localize many of these lethal infections. William Macewen, a pupil of Joseph Lister, published in 1893 a remarkable monograph on pyogenic diseases of the brain and spinal cord. He recognized that these were caused by bacterial infection, and reported a series of 20 cerebral and cerebellar abscesses, treated by surgical drainage with antiseptic precautions. His mortality was amazingly low, but later surgeons were less successful. The causes of failure included inability to control microbial infection of the brain. Various chemical antiseptics and also serotherapy were tried, but mortality remained very high.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Absceso Encefálico/historia , Infecciones del Sistema Nervioso Central/historia , Drenaje , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Infecciones del Sistema Nervioso Central/tratamiento farmacológico , Infecciones del Sistema Nervioso Central/cirugía , Historia del Siglo XIX , HumanosRESUMEN
The discovery of the sulphonamides in 1935 was followed by the dramatic introduction of penicillin, first used in the management of a brain abscess in 1942 by J.B. Pennybacker of Oxford. He integrated antimicrobial drugs in a system of diagnosis, local and systemic antibiotics, and operative treatment, which was widely accepted. However, the mortality from brain abscess remained high until the advent of computerized tomography in 1973 made diagnosis safe and easy. During the next two decades, Pennybacker's system of management was modified, and applied with better results to all forms of brain abscess, including opportunistic infections associated with impaired immunity. These modifications have been studied historically in the management of 140 patients with brain abscesses treated in South Australia in the years 1955-95.
Asunto(s)
Antibacterianos/uso terapéutico , Absceso Encefálico/historia , Infecciones del Sistema Nervioso Central/historia , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/tratamiento farmacológico , Infecciones del Sistema Nervioso Central/diagnóstico por imagen , Infecciones del Sistema Nervioso Central/tratamiento farmacológico , Drenaje , Historia del Siglo XX , Humanos , Tomografía Computarizada por Rayos XRESUMEN
A novel class of mitogen-activated protein kinase-activated protein kinase 2 (MAPKAP-K2) inhibitors was discovered through screening a kinase-focused library. A homology model of MAPKAP-K2 was generated and used to guide the initial SAR studies and to rationalize the observed selectivity over CDK2. An X-ray crystal structure of a compound from the active series bound to crystalline MAPKAP-K2 confirmed the predicted binding mode. This has enabled the discovery of a series of pyrazolo[1,5-a]pyrimidine derivatives showing good in vitro cellular potency as anti-TNF-α agents and in vivo efficacy in a mouse model of endotoxin shock.
Asunto(s)
Antiinflamatorios no Esteroideos/síntesis química , Péptidos y Proteínas de Señalización Intracelular/antagonistas & inhibidores , Proteínas Serina-Treonina Quinasas/antagonistas & inhibidores , Pirazoles/síntesis química , Pirimidinas/síntesis química , Animales , Antiinflamatorios no Esteroideos/farmacocinética , Antiinflamatorios no Esteroideos/farmacología , Línea Celular , Cristalografía por Rayos X , Proteínas de Choque Térmico HSP27/metabolismo , Humanos , Péptidos y Proteínas de Señalización Intracelular/química , Lipopolisacáridos/farmacología , Masculino , Ratones , Ratones Endogámicos C57BL , Modelos Moleculares , Fosforilación , Conformación Proteica , Proteínas Serina-Treonina Quinasas/química , Pirazoles/farmacocinética , Pirazoles/farmacología , Pirimidinas/farmacocinética , Pirimidinas/farmacología , Choque Séptico/metabolismo , Bibliotecas de Moléculas Pequeñas , Estereoisomerismo , Relación Estructura-Actividad , Factor de Necrosis Tumoral alfa/biosíntesisRESUMEN
Leonard Lindon was the first neurosurgeon on the staff of the Royal Adelaide Hospital, and headed this hospital's neurosurgical service from 1931 to 1951, with an interruption from war service. Like other early neurosurgeons, Lindon began as a general surgeon. In 1929, when he was well established in his surgical practice, he took unpaid leave from his hospital duties to undertake a study tour of neurosurgical centres in Europe and North America. Lindon visited the London Hospital, where Hugh Cairns, like him, an Adelaide medical graduate and veteran of Gallipoli, was establishing a modern neurosurgical service. Lindon also visited Harvey Cushing in Boston, USA. Cushing was then at the zenith of his reputation as the master of a safe neurosurgical operative technique; he was also famous for his contributions in the neurosciences. Lindon was deeply impressed by Cushing's philosophy and his operative methods. When Lindon returned to Adelaide in 1930, he prepared a plan for a neurosurgical unit in Adelaide, and over the next 20 years, he achieved some of his aims. In this plan, Lindon gave priority to the management of head injuries as a role for neurosurgeons.
Asunto(s)
Neoplasias Encefálicas/historia , Traumatismos Craneocerebrales/historia , Neurocirugia/historia , Procedimientos Neuroquirúrgicos/historia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Traumatismos Craneocerebrales/cirugía , Historia del Siglo XX , Humanos , Australia del SurRESUMEN
OBJECTIVE: To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. METHODS: The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. RESULTS: Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment. CONCLUSIONS: An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Cese del Hábito de Fumar/métodos , Tabaquismo/psicología , Adulto , Estudios de Factibilidad , Femenino , Humanos , Masculino , Proyectos Piloto , Derivación y Consulta , Telefacsímil , Tabaquismo/terapiaRESUMEN
Bartholomeo Eustachi, usually latinized as Eustachius, was an important anatomist in the 16th century, arguably second only to his contemporary and rival Andreas Vesalius. He was the first to identify several important anatomical structures, including the suprarenal glands, though he was probably not the first to describe the Eustachian tube. However, it has been hard to evaluate his achievements, because during his lifetime he published only some short monographs, and his career as a teacher in Rome is not well documented. He and his assistant P.M. Pini were the first to use copper plate engravings to illustrate human and animal anatomy, but most of their engravings were not published in their time, and the original plates were lost for some 140 years after the death of Eustachius. Early in the 18th century, these plates were rediscovered by the anatomist and papal physician G.M. Lancisi; he published the engravings in a book which aroused much interest and many reprintings. In 1744, Bernhard Siegfried Albinus of Leiden University published a version of these engravings, with commentaries by himself. The engraved illustrations prepared by Eustachius and Pini are clear and largely accurate. They idealize the findings of actual dissections, and have a diagrammatic quality that facilitates understanding and memory. They are the ancestors of later anatomical atlases, which have helped generations of surgeons in teaching and in planning operations.
Asunto(s)
Anatomía/historia , Ilustración Médica/historia , Grabado y Grabaciones/historia , Historia del Siglo XVI , Ciudad de RomaAsunto(s)
Kuru/historia , Investigación/historia , Historia del Siglo XX , Humanos , Papúa Nueva GuineaRESUMEN
In the seventeenth century, Holland and the allied provinces of the northern Netherlands won final independence from their Spanish overlords and formed a worldwide economic empire. Dutch ships dominated the seas from the Caribbean to Japan and reconnoitred the coasts of Australia and New Zealand. Dutch society was cosmopolitan and supported great painters, philosophers and scientists. In these astonishing years, the physician Nicolaes Tulp [1593-1674] practised medicine in Amsterdam and, in 1641, published a book of his medical observations. This book ran into many editions; the Cowlishaw collection contains one of the last, dated 1716. Tulp is best known as the chief figure in a famous painting by Rembrandt, but his book has been studied by medical historians as a source of early descriptions of cranial surgery, spina bifida, vesical calculi, beriberi and many other conditions. The book is also a mirror of Dutch society in a great period in European history.
Asunto(s)
Cirugía General/historia , Historia del Siglo XVI , Historia del Siglo XVII , Humanos , Países BajosRESUMEN
The pseudoscience of phrenology arose from the observations and intuitions of Franz Joseph Gall (1758-1828) and his disciple Johann Gaspar Spurzheim (1776-1832). Gall believed that mental functions are localized in discrete parts of the brain, which he called organs. He located the organs subserving intellectual functions chiefly in the cerebral cortex. To support this doctrine, Gall and Spurzheim carried out extensive neuro-anatomical studies, and made some important discoveries. The Gordon Craig Library contains a book by Spurzheim on the anatomy of the brain, published in London in 1826, which summarizes these discoveries. Gall also believed that the functional strength of the cerebral and cerebellar organs was expressed by their bulk: a well-developed organ caused a bulge in the overlying cranial bone. Hence, feeling the bumps of the skull was a means of assessing the individual's personality. This very fallacious component of Gall's doctrine had great influence in the nineteenth century, affecting psychiatry, criminology and educational theory. Further research demolished Gall's doctrine, and phrenology sank into disrepute. Nevertheless, phrenological thinking played an important part in the growth of clinical neurology in the second half of the nineteenth century.
Asunto(s)
Neurociencias/historia , Frenología/historia , Austria , Francia , Historia del Siglo XVIII , Historia del Siglo XIX , Humanos , Ilustración Médica/historiaRESUMEN
OBJECTIVES: To determine whether the risk attitudes of pediatric emergency physicians are related to the likelihood that otherwise healthy infants with bronchiolitis will be admitted for inpatient care. METHODS: Risk aversion and discomfort with diagnostic uncertainty were assessed among 46 pediatric emergency physicians from three hospitals participating in the Child Health Accountability Initiative. Study physicians managed 397 otherwise healthy infants ages 0 to 12 months presenting to their hospital emergency departments with bronchiolitis. Mean risk aversion and discomfort with diagnostic uncertainty scores were compared across physician gender, years of experience, and formal training in emergency medicine. Additional analyses based on infants as the analytic unit determined admission rates of physicians scoring high and low on risk attitude measures. This model was controlled for severity of illness. RESULTS: Scores on measures of risk aversion and discomfort with uncertainty were similar for male and female physicians and for physicians who had completed pediatric emergency medicine fellowship training and those without such training. Risk aversion scores were significantly higher for physicians with 15 or more years of experience. Admission rates for infants with bronchiolitis were no higher among physicians scoring above the median on risk attitude measures. When adjusted for severity of illness, physicians' risk attitudes were not associated with admission rates. CONCLUSIONS: Recent growth in per-capita admissions for bronchiolitis is not accounted for by physician intolerance for diagnostic uncertainty. Physician risk attitudes should be considered in the context of hospital admissions for other pediatric conditions with unclear prognoses.
Asunto(s)
Actitud del Personal de Salud , Bronquiolitis/diagnóstico , Toma de Decisiones , Hospitalización/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Medición de Riesgo , Análisis de Varianza , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Estudios ProspectivosRESUMEN
Herbert Moran enlisted in the Royal Army Medical Corps early in World War I. His autobiography captures the impact of contemporary experience of wartime gunshot wounds, seen in vast numbers and with little understanding of the requirements of wartime surgery. Wounds of the face and brain were numerous, especially in trench fighting. In France, Germany, Britain and elsewhere, surgeons and dentists collaborated to repair mutilated faces and special centres were set up to facilitate this. The innovative New Zealand surgeon Harold Gillies developed his famous reconstructive techniques in the Queen's Hospital at Sidcup, with the help of dental surgeons, anaesthetists and medical artists. The treatment of brain wounds was controversial. Many surgeons, especially on the German side, advocated minimal primary operative surgery and delayed closure. Others advocated early exploration and immediate closure; among the first to do so was the Austro-Hungarian otologist Robert Bárány. In 1918, the pioneer American neurosurgeon Harvey Cushing published well-documented proof of the desirability of definitive operative management done as soon as possible. Few World War I surgeons developed their knowledge of plastic surgery, neurosurgery and oral surgery in post-war practice. An exception was Henry Newland, who went on to pioneer the development of these specialties in Australasia. After World War II, the French plastic surgeon Paul Tessier created the multidisciplinary subspecialty of craniomaxillofacial surgery, with the help of his neurosurgical colleague Gérard Guiot, and applied this approach to the correction of facial deformities. It has become evident that the new subspecialty requires appropriate training programs.
Asunto(s)
Traumatismos Maxilofaciales , Odontología Militar , Medicina Militar , Lesiones Encefálicas/cirugía , Historia del Siglo XX , Humanos , Traumatismos Maxilofaciales/cirugía , Cirugía Plástica , GuerraRESUMEN
This study assessed physicians' familiarity with a practice guideline for bronchiolitis, evaluated attitudes regarding guidelines, determined preference of educational materials for guideline accessibility and examined the relationship between guideline familiarity and attitudes with clinical practice behaviors. Six months following guideline implementation, surveys were distributed to eligible physicians. The response rate was 68%. Retrospective analyses of inhalation therapies across three study cohorts were also performed. Most physicians surveyed in this study were aware of and utilized a recently introduced guideline, though use of unproven inhalation therapies continued. Despite demonstrated efficiencies of care, continued educational intervention is necessary to sustain these gains.
Asunto(s)
Bronquiolitis/terapia , Adhesión a Directriz , Guías de Práctica Clínica como Asunto , Arkansas , Estudios Transversales , Educación Médica Continua , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Masculino , Pautas de la Práctica en Medicina , Terapia RespiratoriaRESUMEN
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 inter-national 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
Asunto(s)
Educación Médica/historia , Cirugía General/historia , Francia , Cirugía General/educación , Historia del Siglo XVII , Historia del Siglo XVIII , Humanos , Reino UnidoRESUMEN
BACKGROUND: Two agents are effective in preventing respiratory syncytial virus (RSV) hospitalization in premature infants: RSV immune globulin (RSV-IG) and palivizumab. RSV-IG is associated with greater parental emotional and time costs, which may account for the more limited adherence to recommended monthly treatment with this agent. OBJECTIVES: To compare the emotional distress and time costs associated with RSV-IG and palivizumab treatments and to determine the influence of these costs on treatment adherence. METHODS: We surveyed parents of 82 infants who received RSV-IG (90% of eligible) and parents of 61 infants who received palivizumab (87% of eligible) at Arkansas Children's Hospital by telephone. We measured infant distress during treatment, parental distress, parental time costs, and adherence with recommended monthly prophylaxis. RESULTS: Half of parents of RSV-IG recipients witnessed their infant in distress during infusion, over half (61%) were upset by observing the needle stick, and 22% observed infusion in the scalp. Fewer than 5% of parents of palivizumab recipients observed their infant in distress or were themselves distressed during treatment. A quarter of parents took time off from work for RSV-IG or palivizumab treatment. RSV-IG recipients completed 62% of recommended monthly treatments compared with 86% completed by palivizumab recipients. Increased parental distress and time costs largely accounted for the reduction in adherence to monthly treatment among RSV-IG recipients. CONCLUSIONS: The emotional and time costs of RSV-IG treatment far exceed those of palivizumab and predict substantial differences in treatment adherence between the 2 agents. The impact of hidden costs on treatment adherence should be included in economic evaluations of medical procedures.
Asunto(s)
Anticuerpos Monoclonales , Antivirales , Inmunoglobulinas Intravenosas , Recien Nacido Prematuro , Cooperación del Paciente , Infecciones por Virus Sincitial Respiratorio/prevención & control , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Antivirales/efectos adversos , Arkansas , Humanos , Inmunoglobulinas Intravenosas/efectos adversos , Lactante , Recién Nacido , Análisis de los Mínimos Cuadrados , Análisis Multivariante , Dolor/etiología , Palivizumab , Padres/psicología , Estrés Psicológico/etiología , Factores de TiempoRESUMEN
Camel racing is a relatively new sport in Australia. A 52 year old woman fell from her camel during a country race. Although she was wearing an approved equestrian helmet, she suffered a skull fracture and a life-threatening extradural haematoma. Her treatment highlights the key issues of management of head injuries in remote places. A paramount requirement is close collaboration between country medical practitioner, neurosurgeon and retrieval specialist.