Experts' opinion on inositols in treating polycystic ovary syndrome and non-insulin dependent diabetes mellitus: a further help for human reproduction and beyond.

Introduction: This Experts' opinion provides an updated scientific support to gynecologists, obstetricians, endocrinologists, nutritionists, neurologists and general practitioners on the use of Inositols in the therapy of Polycystic Ovary Syndrome (PCOS) and non-insulin dependent (type 2) diabetes mellitus (NIDDM).Areas covered: This paper summarizes the physiology of Myo-Inositol (MI) and D-Chiro-Inositol (DCI), two important molecules present in human organisms, and their therapeutic role, also for treating infertility. Some deep differences between the physiological functions of MI and DCI, as well as their safety and intestinal absorption are discussed. Updates include new evidence on the efficacy exerted in PCOS by the 40:1 MI/DCI ratio, and the innovative approach based on alpha-lactalbumin to overcome the decreased therapeutic efficacy of Inositols in some patients.Expert opinion: The evidence suggests that MI, alone or with DCI in the 40:1 ratio, offers a promising treatment for PCOS and NIDDM. However, additional studies need to evaluate some still unresolved issues, such as the best MI/DCI ratio for treating NIDDM, the potential cost-effectiveness of reduced gonadotropins administration in IVF due to MI treatment, or the benefit of MI supplementation in ovulation induction with clomiphene citrate in PCOS patients.

NO-FAULT COMPENSATION FOR MEDICAL INJURIES: TRENDS AND CHALLENGES.

UNLABELLED: As an alternative to the tort or fault-based system, a no-fault compensation system has been viewed as having the potential to overcome problems inherent in the tort system by providing fair, speedy and adequate compensation for medically injured victims. Proponents of the suggested no-fault compensation system have argued that this system is more efficient in terms of time and money, as well as in making the circumstances in which compensation is paid, much clearer. However, the arguments against no-fault compensation systems are mainly on issues of funding difficulties, accountability and deterrence, particularly, once fault is taken out of the equation. Nonetheless, the no-fault compensation system has been successfully implemented in various countries but, at the same time, rejected in some others, as not being implementable. In the present trend, the no-fault system seems to fit the needs of society by offering greater access to justice for medically injured victims and providing a clearer "road map" towards obtaining suitable redress. This paper aims at providing the readers with an overview of the characteristics of the no fault compensation system and some examples of countries that have implemented it. METHODOLOGY: Qualitative Research-Content Analysis. RESULTS: Given the many problems and hurdles posed by the tort or fault-based system, it is questionable that it can efficiently play its role as a mechanism that affords fair and adequate compensation for victims of medical injuries. However, while a comprehensive no-fault compensation system offers a tempting alternative to the tort or fault-based system, to import such a change into our local scenario requires a great deal of consideration. There are major differences, mainly in terms of social standing, size of population, political ideology and financial commitment, between Malaysia and countries that have successfully implemented no-fault systems. Nevertheless, implementing a no-fault compensation system in Malaysia is not entirely impossible. A custom-made no-fault model tailored to suit our local scenario can be promising, provided that a thorough research is made, assessing the viability of a no-fault system in Malaysia, addressing the inherent problems and, consequently, designing a workable no-fault system in Malaysia.

[The possibility of medico-legal opinionating on medical error in cases of waived postmortem examination]. / Konsekwencje decyzji o zwolnieniu z sekcji zwlok w przypadkach opiniowania o bledzie lekarskim.

For several years now, with the introduction of the health care sector reform we have been observing a considerable drop in the number of postmortem examinations performed in patients who died in hospitals. The decrease amounts to as much as 50 to 70%. This is undoubtedly a consequence of financial restrictions imposed on the management of these inpatient facilities. On the other hand, Departments of Forensic Medicine established to evaluate the so-called medical errors are swamped with an increasing avalanche of complaints concerning the appropriateness of therapeutic management. This leads to a growing number of orders from penal prosecution and jurisdiction agencies with requests for assessment whether a medical error has been committed in a particular case. The result of a postmortem examination is practically the only basis for a factual evaluation of a given case. When no autopsy has been performed, the experts are virtually helpless, and in the majority of such instances, they are forced to refuse passing an expert opinion. The report presents basic principles of medico-legal opinionating in criminal cases (including proceedings pertaining to medical errors), the rules governing the medical error assessment, as well as problems encountered in evaluating the appropriate course of treatment when a post mortem examination has been waived.

Expert witness reform.

The legal system depends on the medical expert for evidence. Doctors readily complain about frivolous cases that go to trial, yet a lawyer cannot bring a frivolous claim to trial without a physician expert witness stating that the claim is not frivolous. An insurance company cannot raise premiums without medical expert witnesses servicing the increasing litigation against the insured. Physicians must look to themselves as a major contributor to rising malpractice insurance costs. For without the physician expert witness, no medical malpractice lawsuit can take place. It is the expert physician, not the attorneys or insurance companies, who defines "meritless" and "frivolous" and who ultimately controls the courts' medical malpractice caseload.

Adjuvant strategies in breast cancer: new prospectives, questions and reflections at the end of 2007 St Gallen International Expert Consensus Conference.

Breast cancer detection and staging are constantly evolving as technologies improve. Breast cancer surgery is also undergoing continuous refinement, with the objective being to achieve optimal cosmetic results. Surgery has been combined with intraoperative radiation therapy to achieve the best local-disease control with minimal side-effects. The adjuvant strategy of treatment is a 'hot' issue in this 'scenario'. Every 2 years at St Gallen, a nice and cold town in the north of Switzerland, more of 4000 breast cancer experts arrive from every part of the world, to improve their knowledge in this issue. The Consensus Conference with the discussion of 40 international panelists is the zenith of the conference. This report provides a brief presentation and reflections, immediately at the end of the conference, with the objective being to stimulate ideas regarding what should be done tomorrow.

[The position of the sociomedical expert in the Medical Services of German Statutory Sickness Insurance Bodies (MDK) as influenced by changing challenges]. / Zur Stellung des sozialmedizinischen Experten im Medizinischen Dienst der Krankenversicherung (MDK) unter dem Einfluss sich wandelnder Anforderungen.

The "Medical Services of the German Statutory Sickness Insurance Bodies (MDK)" is a non-profit organisation providing socio-medical specialist advice to the German Statutory Health and Nursing Care Insurances. Facing demographic changes as well as progress in medicine, highly qualified expertises and consultations are of increasing importance to manage the social security system and to continue to develop its structure. Sociomedical assignments of the MDK as applied health science is so far mainly related to individual aspects of insured persons (case management) but more and more to general aspects such as quality, consumer protection, efficiency, guiding concepts and organisation of the health care system. Based on its widespread experience, profound knowledge and confidence in its expertise the MDK is aware of its great sociopolitical responsibility and faces the wide range of assignments with regard to personneldevelopment and organisational innovations. Identification with principles of genuine medical practice, creating a modern job profile, and exercising creative power in accordance with the fundamental social legislation. This characterises the self-image and roleperception of medical experts of the MDK.

Malpractice issues in neurological surgery.

BACKGROUND: Malpractice litigation continues to be a serious problem in neurosurgery despite many suggestions to contain liability, including proposed federal legislation. METHODS: A current study of 275 malpractice claims has been compared with a prior study of 300 cases of liability and potential liability reported in 1985. Twenty years later, the results are surprisingly similar. Spinal surgery continues to dominate neurosurgical malpractice claims with 42% of the total, most from lumbar spine operations. As in the previous study, trauma and intracranial surgery account for the next largest groups. Of particular significance in terms of improved diagnostic methodology were spinal operations at the wrong level as well as failure to diagnose sentinel bleeds, aneurysms, arteriovenous malformation, and other cerebral lesions. RESULTS: Although many cases believed defensible were settled often because of significant neurological deficit, a number were dropped or dismissed after review, reports, or depositions, and defense verdicts were achieved in a similar number that went to trial. CONCLUSIONS: Most plaintiff claims that had merit were settled. Although hope continues for tort reform, uniform capitation of noneconomic awards, and contingency fees, it should be noted that 119 claims, more than 40%, were considered either not defensible by defendants or had merit for the plaintiff.

AMPK, the metabolic syndrome and cancer.

The fuel-sensing enzyme 5'-AMP-activated protein kinase (AMPK) has a major role in the regulation of cellular lipid and protein metabolism in response to stimuli such as exercise, changes in fuel availability and the adipocyte-derived hormones leptin and adiponectin. Recent studies indicate that abnormalities in cellular lipid metabolism are involved in the pathogenesis of the metabolic syndrome, possibly because of dysregulation of AMPK and malonyl-CoA, a closely related molecule. As we discuss in this article, several findings also point to a link between AMPK and the growth and/or survival of some cancer cells. Thus, it has been demonstrated recently that the tumor suppressor LKB1 is a kinase that has a major role in phosphorylating and activating AMPK, and that another tumor suppressor, tuberous sclerosis complex 2, is phosphorylated and activated by AMPK. In addition, other studies indicate that mammalian homolog of target of rapamycin (mTOR), which has been implicated in the pathogenesis of insulin resistance and many types of cancer, is inhibited by AMPK.

Overcoming limitations of natural anticancer drugs by combining with artificial agents.

During a billion years of evolution, living creatures have perfected cytotoxic agents to kill other organisms without killing themselves, thus providing us with antibiotics to kill bacteria without killing eukaryotic (e.g. human) cells. Some natural agents inhibit specifically most vital cellular structures and functions in cancer cells. However, nature was not creating antibiotics for cancer, and natural agents kill cancer cells precisely because they share targets with normal cells. To discriminate between particular cancer cells and normal cells, we can design or select artificial agents that are not necessarily lethal but are aimed either at cancer-specific targets or at dispensable and even unavailable (in cancer cells) targets. Using rational drug combinations, such selective agents can assist natural agents to eradicate cancer cells selectively.

Why does the rapid delivery of drugs to the brain promote addiction?

It is widely accepted that the more rapidly drugs of abuse reach the brain the greater their potential for addiction. This might be one reason why cocaine and nicotine are more addictive when they are smoked than when they are administered by other routes. Traditionally, rapidly administered drugs are thought to be more addictive because they are more euphorigenic and/or more reinforcing. However, evidence for this is not compelling. We propose an alternative (although not mutually exclusive) explanation based on the idea that the transition to addiction involves drug-induced plasticity in mesocorticolimbic systems, changes that are manifested behaviourally as psychomotor and incentive sensitization. Recent evidence suggests that rapidly administered cocaine or nicotine preferentially engage mesocorticolimbic circuits, and more readily induce psychomotor sensitization. We conclude that rapidly delivered drugs might promote addiction by promoting forms of neurobehavioural plasticity that contribute to the compulsive pursuit of drugs.

An expert experiment--medico-legal expert testimony.

For the past eight years, Radiology Associates of Albuquerque has provided physician expert testimony to plaintiff and defense attorneys. Initially, the business was confined to radiology consultation only. The division has expanded; it now includes more than 35 specialties and a national client base. This article will include a history of the division's growth and lessons learned as well as a look at the future of expert testimony in light of increasing emphasis on standards of care. Medical marketing in the present as well as in the future will also be addressed.

El cirujano ante la justicia / The surgeon in the presence of the justice

Antecedentes: El creciente aumento de las demandas por mala práctica es una preocupación de los cirujanos e interfiere en el libre ejercicio de su especialidad. Objetivo: Analizar los principales factores que influyen en este problema, los inherentes al médico y los ajenos al mismo. Proponer hechos o gestos para disminuir o frenar las demandas judiciales. Marco de referencia: Comité de Asuntos Profesionales de la Asociación Argentina de Cirugía. Diseño y población: Análisis retrospectivo de las demandas contestadas desde 1982 hasta 1997. Totalizan 209 casos con progresivo aumento. Sólo el 5,7 por ciento en el fuero penal. La patología más frecuente fueron apendicitis y oblitos, a partir de 1996 la cirugía laparoscópica con 36,7 por ciento. Conclusiones: Rescatar la relación médico-paciente, correcta redacción de la historia clínica y del parte quirúrgico, no omitir el consentimiento informado, limitar el; beneficio de litigar sin gastos y poner topes a las sumas reclamadas, impulsar y motivar a las Instituciones Científicas para unirse en defensa de una profesión sin trabas o cercamientos