Res Medica (E-Journal)
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Osteoporotic Vertebral Fractures and the Role of Percutaneous Vertebroplasty in Patient Care
Full text linkBackground: Osteoporosis is an age-related skeletal condition of bone, with increasing prevalence in older populations. Insufficiency of the bone is associated with increased disability and mortality. Vertebral fractures are commonly secondary to osteoporosis, however only a proportion of patients may present clinically with identifiable symptoms. Percutaneous vertebroplasty is an interventional method of managing such patients.Aim: To determine the role of percutaneous vertebroplasty in managing patients with osteoporotic vertebral fractures.Methods: Electronic databases including MEDLINE, Cochrane Library and NHS Evidence were searched for meta-analyses and randomised controlled trials, with some provision given to expert reviews due to the small pool of publications available. Search terms used included “osteoporosis and vertebral fractures”, “vertebroplasty and osteoporosis”, “percutaneous vertebroplasty in the management of osteoporosis”, “vertebral body cement augmentation”, and “balloon kyphoplasty”. Results: Vertebroplasty reduces pain in the short-term (up to 2 weeks) after surgery and has sustained effects in improving quality of life. The long-term effects are difficult to establish due to the underlying osteoporosis disease progression and comorbidities.Conclusion: Vertebroplasty is worthwhile in treating acute vertebral fractures associated with pain. However more research is needed to fully determine its effectiveness in the long term
Coronary Blood Flow and Myocardial Metabolism in Angina Pectoris
Full text linkIt is interesting to note on this centenary celebration that we still are uncertain about the nature of anginal pain; we discuss the nitrites, we carry out experiments, yielding new data, and yet we are still really not quite sure how these agents act. I think it is desirable to review with humility some f Lauder Brunton’s ideas about the actions of these drugs. At a major national meeting in America just one year ago, the observation was made that the blood pressure rises before pain occurs in attacks of spontaneous angina pectoris. Unfortunately the speaker failed to appreciate that Sir Lauder Brunton had suggested the use of amyl nitrite for this very reason, namely high blood pressure with angina. He thought that nitrites might reduce the pain of angina pectoris by lowering the pressure
Summing Up
Full text linkThis symposium has indeed been full of interest. All the speakers have given us a great deal to think about, increased depth of understanding has emerged from the transatlantic communications of Drs. Gorlin and Friesinger. They have shown where our clinical assessment, even with electrocardiographic help, can fall short of full comprehension. Until we can sharpen up our precision in assessment of these patients, a great deal of what we have been doing up to now has contained a fraction of guesswork
The Contributors
Full text linkProfessor Ronald Girdwood, Dr. Clifford Mawdsley, Dr. John Dawson, Frances Marr, John Irving and John Wild smith
Editorial
Full text linkThere are only two qualities in the world: efficiency and inefficiency — or so Shaw’s literary hyperbole would have us believe. Perhaps romanticists still wistfully yearn for the days of the Artist-doctor, purveyor of the gifts and skills of healing, days when the theory of “God’s will” could be invoked to explain away failures. Now we have the “change agents” , the technologists, the computer men: protagonists of the efficiency creed. They herald the coming of automatic systems and computer control; the apotheosis of the Machine.Most doctors welcome change that for them means less of the drudgery of medicine and for patients faster, earlier and more accurate diagnosis. All realize, perhaps, that automation and computerization can do these things. Their limited application so far (as compared to potential uses) has by and large confirmed this. What sort of information do we have, however, on the social and structural changes that widespread mechanisation will cause within the hospital service. Only a few, and on the whole inadequate, attempts to answer this question have been made in industry but they can maybe provide some clues to help avoid dangers and disadvantages
Opinion
Full text linkOrgan transplantation has evoked such mixed and even violent reaction that it would seem worthwhile to explore the ethics governing it — and to do this by examining the three major areas of contention: the act itself, the recipient and the donor.IS TRANSPLANTATION ETHICAL?News coverage of transplantation in the popular mass media has been widespread, enthusiastic and, unfortunately, too often sensational and misleading. I t has been misconceived in certain sections of the public both as a panacea and as an unethical and unjustified form of treatment. Neither assertion is accurate.Within our currently limited understanding of immunological attack on an allograft and our inability to prevent such an onslaught, the transplantation of any organ must be accepted as palliative therapy — not a final cure. It achieves palliation which equals, if it does not surpass, some forms of palliation which have been accepted for many years as the only way to deal with malignant diseases. This being established, one cannot accept as unjustifiable or unethical the palliation of symptoms and extension of life itself
The Naturopathic Approach
Full text linkThat word ‘approach’ reflects an essential feature of Naturopathy — its philosophical attitude to the problems of life. It is no mere collection of empirical techniques, although like any practical system it had its beginnings in many fields of observation and in trial and error. Its theories are co-ordinated with facts in a consistent fashion which justifies its being called a method.What this implies may be clarified by considering a person who has headache, and who consults a variety of individuals about his problem. The first might prescribe an analgesic, perhaps combined with an anti-depressant. Another could offer to sell him extracts from vegetable tissues, but essentially intended to. have the same effects as the ethical prescription. Still other advisers would propose to make the sufferer unaware of his distress, by some form of mental exercise, suggestion or counter-irritant.On principle, the Naturopath rejects all of these. All may work, but not by rectifying the causes. He has more affinity with the manipulator who, finding undue tensions or misalignments in the neck, by suitable adjustments diminishes strain and so gives relief. But Naturopathic philosophy demands that before applying even so apparently obvious a remedy one must ask the question ‘why?’. Headache and neck tension may be due to various primary causes, more often a combination of several. Without seeking to discover at least something about these, one cannot give advice or treatment likely to be of more than transient benefit
Society News
Full text linkThe two most significant recent events in the life of the Society were undoubtedly the Symposium on “Immunological Aspects of Cancer” held in the Autumn of 1970 and the visit by Dr. Issels from the Ringberg Klinik in the early Spring of 1971 .The Symposium, which was conceived, nurtured and presented by Ian Smith, then Senior President, attracted a great deal of attention in the Medical Press — especially in the British Medical Journal which covered the event in two consecutive issues of the magazine. The Symposium was held in the George Square Lecture Theatre and the main participants were, “in order of appearance”, Professor Klein, Dr. Allison, Professor Doll, Dr. Kinlen, Dr. Stuart, Dr. Burkitt, Dr. Bagshawe, Dr. Hamilton Fairley, Professor Alexander, Professor Sir Michael Woodruff, Professor Mathe, Professor Crile and, of course, as general coordinator, Ian Smith.The list is impressive and yet equally distinguished assemblies occur frequently in the many “Congress Spots” of the world. Why did the R .M.S. Symposium have such a special appeal